Eye Lecture 2 Flashcards
Development of Glaucoma
1) flow of ___ through drainage canal
2) drainage ___ blocked leading to fluid buildup
3) damage to blood vessels and ____ ____
1) aqueous humor
2) canal
3) optic nerve
Open Angle - obstructed ____
drainage canal
Closed Angle - pressure pushes ___ against ___
iris, cornea
Risk Factors
- Over ___ years old
- eye injury
- high blood pressure
- asian or african american
- use of ___
- ___ anemia
- ___ thickness
- near or farsighted
- diabetes
- 40
- steroids
- sickle cell
- corneal
Symptoms of Open Angle Glaucoma
- no symptoms in early stages
- patchy blind spots in ___ vision
- difficulty seeing ___ vision
- peripheral
- central
Diagnosis
What is used to measure intraocular pressure?
tonometry
Diagnosis
What is used to test for optic nerve damage?
ophthalmoscopy
Diagnosis
What is used to check for vision loss?
perimetry
Diagnosis
What is used to measure corneal thickness?
pachymetry
Diagnosis
What is used to inspect the drainage canal?
gonioscopy
Open Angle Treatment
to reduce aqueous humor production (2)
- beta blockers
- carbonic anhydrase inhibitors
Open Angle Treatment
to increase aqueous humor outflow (3)
- prostaglandin analogs
- cholinergics
- rho kinase inhibitors
Open Angle Treatment
Both to reduce aqueous humor production and increase aqueous humor outflow (1)
- alpha 2 agonists
Open Angle Treatment - 1st Line
Prostaglandin analogs
- MOA: increase ___ outflow
- examples: bimatoprost ___ , travoprost ___ , latanaprost ___ , tafluprost ___ , bimatoprost ___ (indicated for longer eyelashes)
- dosing: 1 gtt ___
- reduces IOP by ___ %
- aqueous humor
- Lumigan, Travatan Z, Xalatan or Xelpros, Zioptan, Latisse
- QHS
- 30%
Open Angle Treatment - 1st Line
Prostaglandin analogs
Warnings:
- ___ of iris, eyelid, skin, and eyelashes
- increase in eyelash ___ and ___
Side Effects:
- blurred vision
- stinging
- increased pigmentation of iris/eyelashes
- eyelash growth/thickening
- light sensitivity
- ___ ___ sensation
- darkening
- length, number
- foreign body
Open Angle Treatment - 1st Line
Beta Blockers
- MOA: reduce ___ production
Non-selective drugs:
- timolol ( ___ ) , carteolol, and levobunolol (___ )
Selective:
- betaxolol ( ___ )
Dosing: 1 gtt ___ or ___
reduce IOP by ___ - ___ %
- aq humor
- Timoptic, Betagan
- Betoptic
- daily, BID
- 20-30%
Open Angle Treatment - 1st Line
Beta Blocker
Contraindications
- sinus ___
- 2nd or 3rd degree __ block
- cardiogenic ___
- uncompensated ___ failure
- ___ disease
SE
- stinging
- blurred vision
- ___cardia
- ___ problems
- ___tension
- dizziness
- fatigue
- impotence
- bradycardia
- heart
- shock
- cardiac
- broncospastic
- bradycardia
- breathing
- hypotension
Open Angle Treatment - alternative 1st/2nd line
alpha-2 agonists
MOA: increase ___ outflow and reduce ___ production
- examples: ___ (Alphagan P), + timolol ( ___ ), + brinzolamide ( ___ )
- aprachlonidine ( ___ )
- ___ (Lumify) - indicated for OTC ___ of the eye
- reduce IOP by ___ %
aq humor, aq humor
- brimonidine, Combigan, Simbrinza
- Iopidine
- brimonidine, redness
- 25%
Open Angle Treatment - alternative 1st/2nd line
alpha-2 agonist
Contraindications/warnings:
- ___ depression
SE:
- ___eyes
- xerostomia
- blurry vision
- conjunctival hyperemia
- sedation
- confusion
- ___tension
CNS
- dry
- hypertension
Open Angle Treatment - 2nd line
Carbonic Anhydrase Inhibitors
MOA: reduce ___ production
Ophthalmic drugs
- dorzolamide ( ___ ), + timolol ( ___ , ___ )
- brinzolamide ( ___ ), + brimonidine ( ___ )
- dosing: 1 gtt ___
Oral Drugs
- ___ and ____
- dosing: ___ - ___ mg PO ___ or ___ x daily
Reduce IOP by ___ - ___ %
- Trusopt, Cosopt/Cosopt PF
- Azopt, Simbrinza
- TID
- Acetazolamide, methazolamide
- 50-100, 2-3x
- 15-20%
Open Angle Treatment - 2nd line
Carbonic Anhydrase Inhibitors
Warnings: ___ allergy
Ophthalmic SE
- burning
- blurred vision
- blepharitis
- ___ disturbances
Oral SE
- ataxia
- confusion
- photosensitivity
- nausea
- metabolic acidosis
Sulfonamide
- taste
Open Angle Treatment - 3rd line
Rho Kinase Inhibitors
- MOA: increase ___ outflow
- drugs: ___ (Rhopressa), + latanoprost ( ___ )
- dosing: 1 gtt ___
- SE: burning, corneal disease, conjunctival hemorrhage and hyperemia
- reduce IOP by ___ - ___ %
aq humor
- Netarsudil, Rocklatan
- QPM
- 25-30%
Open Angle Treatment - last line
Cholinergics
MOA: increase ___ outflow
- Drugs: carbachol ( ___ )
- Dosing: 1-2 gtts up to ___
- Drugs: pilocarpine ( ___ ___ )
- Dosing: 1-2 gtts up to ___
Contraindications/Warnings:
- use in caution in patients with history of ___ detachment or ___ abrasion
- SE: pupil constriction, corneal clouding, ___tension, brochospasm, abdominal cramps
Reduce IOP by ___ - ___ %
aq humor
- Milostat
- TID
- Isopto Carpine
- QID
- retinal, corneal
- hypotension
- 15-25%
Open Angle 1st Line (2)
Alternative: ___
1) prostaglandin analogs
2) beta-blockes
- brimonidine
Open Angle Treatment
assess response every ___ - ___ weeks
if there is an inadequate response…
- no response = try a different ___ option
- partial response = add addition ___ or ___ line option (CAI)
- increase ___ / ___
- add ___ or ___ line agent
- consider replacing topical ___ with oral ___
inadequate response to maximaly tolerated therapy = ___
if intolerance…
- ___ dose/concentration
- change formulation
- switch to alternative ___ or different combo
- 2-4
- 1st line
- 1st, 2nd
- frequency/concentration
- 3rd, 4th
- CAI, CAI
- surgery (laser)
- reduce
- class
administration and time
- wait __ min to reinsert contacts
for 2 drops…
same medication = wait ___ min between drops
diff medication = wait ___ - ___ min between drops
15
5
5-10
Closed Angle Glaucoma
medical ___
symptoms
- severe ___ and ___
- blurred vision
- ___ around light
- N/V
- eye ___ or ___ cornea
EMERGENCY
- HA, pain
- halo
- redness, cloudy
Closed Angle Treatment
hyperosmotic agents
- ___ (IV): ___ - ___ g/kg/dose over ___ min
- ___ ( PO): ___ - ___ g/kg/dose q ___ hr as required
Surgery ( ___ )
- mannitol, 1.5-2, 30
- glycerin, 1-2, 5
- iridotomy
Medications that can increase IOP
- anticholinergics (4)
- chronic ___
- decongestants: ___
- topiramate
- antidepressants (4)
- oxybutynin, tolterodine, benztropine, scopolamine
- pseudoephedrine
- fluoxetine, paroxetine, amitriptyline, duloxetine
Prostaglandin Analogs
Lumigen
Travatan
Xalatan or Xelpros
Zioptan
Latisse
bimatoprost
travoprost
latanaprost
tafluprost
bimatoprost
Beta-Blockers
Non Selective:
- Timoptic
- Betagan
- (generic, no brand)
Selective:
- Betoptic
Non-selective drugs:
- timolol
- levobunolol
- cartelol
Selective:
- betaxolol
alpha-2 agonist
- Alphagan P
- Combigan
- Simbrinza
- Iopidine
- Lumify
- brimonidine
- brimonidine + timolol
- brimonidine + brinzolamide
- aprachlonidine
- brimonidine
cabonic anhydrase inhibitors
Ophthalamic
- Trusopt
- Cosopt/Cosopt PF
- Azopt
- Simbrinza
Oral
___ and ___ (generic)
- dorzolamide
- dorzolamide + timolol
- brinzolamide
- brinzolamide + brimonidine
acetazolamide, methazolamide
Rho Kinase Inhibitors
Rhopressa
Rocklantan
- netarsudil
- netarsudil + latanoprost
cholinergics
Milostat
Isopto Carpine
- carbachol
- pilocarpine
