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Eye Disorder-glucoma Flashcards

1
Q

Aqueous humour

A

Secreted by cells of the epithelium then into POSTERIOR CHAMBER (behind iris)

Then drains from ANTERIOR chamber to blood stream

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2
Q

Intraocular pressure IOP

A

Determined by the vol of aqueous humour in ANTERIOR chamber of eye

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3
Q

Glaucoma (raised IOP)

A

^IOP caused by blockage of circulation / drainage of AH

Result: damage /impaired blood sup to optic nerve -> which is slowly destroyed (irreversible)

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4
Q

Types of glaucoma

A

Chronic (primary) open angle glaucoma

Acute angle closure glaucoma (need surgery)

Congenital glaucoma

Secondary glaucoma

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5
Q

Treat primary/open angle glucoma

A

Prostaglandin analogue (1st line)

Beta-blocking analogue (2nd line)

Alpha 2 agonist (3rd line)

Carbonic anhydrase inhibitor

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6
Q

Prostaglandins drugs

*ends with oprost

A

Latanoprost

Bimatoprost

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7
Q

Prostaglandin MOA

*glucoma asymptotic- adherence / compliance to drug is major problem

A

Reduce IOP by increasing uveoscleral outflow

Outflow ⬆️~ pressure ⬇️

Possibly due to
• activation of molecular transduction cascade
• ^ in biosynthesis of certain metallo-proteinases
• reduction of extracellular matrix within uveoscleral pathway

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8
Q

Prostaglandin AE

Applies to >1% pts

A

Irreversible increase in iris pigmentation

Darkening , lengthening , thickening of eyelashes

Eye irritation, blurred vision

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9
Q

Beta receptors

A

B1 - heart
B2 - smooth muscle of bronchioles, aterioles, visceral organs
B3 - adipose tissue

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10
Q

Adrenergic receptors

A

Alpha 1,2

Beta 1,2,3

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11
Q

Cholinergic receptors

A

Nicotinic

Muscarinic

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12
Q 
B blocker (b receptor antagonist) 
MOA
A

Block B2 : reduce aqueous humour formation

⬇️production =⬇️ pressure

May also act on b2 on ciliary arteries and induce vasoC - further ⬇️ ptoduction

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13
Q

B blocker AE

A

Systemic related ..

But and prevent by use appropriately
• close eye and pressure on tear duct for 3min after instillation
• systemic absorption reduce by up to 70%
• drug stay in eye rather than system

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14
Q

B blocker drugs

*end with : olol

A

Timolol

Betaxolol

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15
Q

Timolo

A

Non selective blocker
B1-heart B2-bronchioles

Not used in pts with cardio /airway disease

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16
Q

Betaxolol

A

Selective B1 (cardio) yet still works in eye

Dose related - efficiency
Use with caution in pts with airway disease
But contraindicate in cadio

17
Q

Alpha 2 adrenergic agonist MOA

A

⬆️uveoscleral outflow = ⬇️ IOP

⬇️production = ⬇️IOP

18
Q

A2 agonist AE

A

Palpitation : irregular and rapid heart beat

Hypertension

Tremors

19
Q

A2 agonist drugs

* end with onidine

A

Apraclonidine

Brimonidine

20
Q

Carbonic anhydrase inhibitor

* end with - zolamide

A

Aceta-zolamide (old - oral)

Brin-zolamide (new - topical)

Dor-zolamide (new- topical)

21
Q

Carbonic anhydrase CA

A

Family of enzymes
Extremely rapid enzyme activity
Reversible

22
Q

CA inhibitor

A

Reduces HCO3- synthesis

⬇️AH production = ⬇️ IOP

23
Q

CA inhibitor (acetazolamide) in kidney

A

Inhib CA in lumen and proximal tubule of kidney

Reduction in H+ions for NA+ _ H+ exchanges
•hinders Na+ reabsorption and diuresis occurs
•NaHCO3 excretion ^

May result in mild / moderate metabolic acidosis

24
Q 
Cholinergic receptors (mus)
M3
A

M3 : glandular / smooth muscle
(Stimulatory)
• gland secretion or muscle contraction

25
Q

Iris and ANS

Two set of muscles with diff activation

A

Sphincter pupillae

Dilator pupillae

26
Q

Sphincter pupillae

A

Circular group muscle
⬇️pupil size on contraction

M3 receptor of ParaSymNS stimulated

In bright light ( protective ) regulate how much light entering eye

27
Q

Dilator pupillae

A

Radial group ⬆️ size of pupil

A1 of adrenergic of sympNS stimulated

When in dark (allow to see)

28
Q

Pilocarpine

Not in use

A

Act on parasymp (cholinergic) M3
• constrict pupil
Increase outflow through trabecular meshwork

29
Q

Acute ( angle closure) glaucoma

need laser iriditomy : laser create a hole on rim of iris, allow aqueous humour to flow

Drugs

A
  • topical pilocarprine plus topical b blocker
  • iv acetazolamide
  • diuretics
30
Q

Drugs for eye examinstion

anticholinergic - able to dilate eyes, as block m3 receptor activity on the sphincter pupillae

A

Atropine (Too long action duration)

Tropicamide (6hrs)

Cyclopentolate (24hrs)

31
Q

Drugs for eye examination

Sympathomimics- mimic a1 receptor mediated actions , dilate eyes

A

Phenylephrine

Naphazolin

Tetrahydrozoline

32
Q

Topical sympathomimetics also cause :
Vasoconstriction and decrease congestion of conjunctival blood vessel
⬇️redness

A

OTC meds

Especially
Naphzaoline and tetrahydrozoline

33
Q

Sympathmimetics AE

A

Usually non
But concerns with elderly and children; also cardio pts

Could cause tachycardia and elevated BP

34
Q

Ocular congestion drugs

Same as sympathomimetics

A

Phenylephrine
Naphazoline
Tetrahydrozoline

35
Q

Dry eye syndrome drugs

A

Artifical tears

  • carmellose
  • hypromellose

Pho2 (7 decks)

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