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PHRM 844 > Eye Lecture 2 > Flashcards

Eye Lecture 2 Flashcards

1
Q

Development of Glaucoma

1) flow of ___ through drainage canal
2) drainage ___ blocked leading to fluid buildup
3) damage to blood vessels and ____ ____

A

1) aqueous humor
2) canal
3) optic nerve

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2
Q

Open Angle - obstructed ____

A

drainage canal

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3
Q

Closed Angle - pressure pushes ___ against ___

A

iris, cornea

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4
Q

Risk Factors

  • Over ___ years old
  • eye injury
  • high blood pressure
  • asian or african american
  • use of ___
  • ___ anemia
  • ___ thickness
  • near or farsighted
  • diabetes
A
  • 40
  • steroids
  • sickle cell
  • corneal
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5
Q

Symptoms of Open Angle Glaucoma

  • no symptoms in early stages
  • patchy blind spots in ___ vision
  • difficulty seeing ___ vision
A
  • peripheral
  • central
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6
Q

Diagnosis

What is used to measure intraocular pressure?

A

tonometry

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7
Q

Diagnosis

What is used to test for optic nerve damage?

A

ophthalmoscopy

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8
Q

Diagnosis

What is used to check for vision loss?

A

perimetry

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9
Q

Diagnosis

What is used to measure corneal thickness?

A

pachymetry

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10
Q

Diagnosis

What is used to inspect the drainage canal?

A

gonioscopy

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11
Q

Open Angle Treatment

to reduce aqueous humor production (2)

A
  • beta blockers
  • carbonic anhydrase inhibitors
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12
Q

Open Angle Treatment

to increase aqueous humor outflow (3)

A
  • prostaglandin analogs
  • cholinergics
  • rho kinase inhibitors
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13
Q

Open Angle Treatment

Both to reduce aqueous humor production and increase aqueous humor outflow (1)

A
  • alpha 2 agonists
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14
Q

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 ___ %

A
  • aqueous humor
  • Lumigan, Travatan Z, Xalatan or Xelpros, Zioptan, Latisse
  • QHS
  • 30%
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15
Q

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

A
  • darkening
  • length, number
  • foreign body
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16
Q

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 ___ - ___ %

A
  • aq humor
  • Timoptic, Betagan
  • Betoptic
  • daily, BID
  • 20-30%
17
Q

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

A
  • bradycardia
  • heart
  • shock
  • cardiac
  • broncospastic
  • bradycardia
  • breathing
  • hypotension
18
Q

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 ___ %

A

aq humor, aq humor
- brimonidine, Combigan, Simbrinza
- Iopidine
- brimonidine, redness
- 25%

19
Q

Open Angle Treatment - alternative 1st/2nd line

alpha-2 agonist
Contraindications/warnings:
- ___ depression

SE:
- ___eyes
- xerostomia
- blurry vision
- conjunctival hyperemia
- sedation
- confusion
- ___tension

A

CNS
- dry
- hypertension

20
Q

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 ___ - ___ %

A
  • Trusopt, Cosopt/Cosopt PF
  • Azopt, Simbrinza
  • TID
  • Acetazolamide, methazolamide
  • 50-100, 2-3x
  • 15-20%
21
Q

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

A

Sulfonamide
- taste

22
Q

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 ___ - ___ %

A

aq humor
- Netarsudil, Rocklatan
- QPM
- 25-30%

23
Q

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 ___ - ___ %

A

aq humor
- Milostat
- TID
- Isopto Carpine
- QID
- retinal, corneal
- hypotension
- 15-25%

24
Q

Open Angle 1st Line (2)
Alternative: ___

A

1) prostaglandin analogs
2) beta-blockes

  • brimonidine
25
Q

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

A
  • 2-4
  • 1st line
  • 1st, 2nd
  • frequency/concentration
  • 3rd, 4th
  • CAI, CAI
  • surgery (laser)
  • reduce
  • class
26
Q

administration and time

  • wait __ min to reinsert contacts

for 2 drops…
same medication = wait ___ min between drops
diff medication = wait ___ - ___ min between drops

A

15
5
5-10

27
Q

Closed Angle Glaucoma

medical ___

symptoms
- severe ___ and ___
- blurred vision
- ___ around light
- N/V
- eye ___ or ___ cornea

A

EMERGENCY
- HA, pain
- halo
- redness, cloudy

28
Q

Closed Angle Treatment

hyperosmotic agents
- ___ (IV): ___ - ___ g/kg/dose over ___ min
- ___ ( PO): ___ - ___ g/kg/dose q ___ hr as required

Surgery ( ___ )

A
  • mannitol, 1.5-2, 30
  • glycerin, 1-2, 5
  • iridotomy
29
Q

Medications that can increase IOP
- anticholinergics (4)
- chronic ___
- decongestants: ___
- topiramate
- antidepressants (4)

A
  • oxybutynin, tolterodine, benztropine, scopolamine
  • pseudoephedrine
  • fluoxetine, paroxetine, amitriptyline, duloxetine
30
Q

Prostaglandin Analogs

Lumigen
Travatan
Xalatan or Xelpros
Zioptan
Latisse

A

bimatoprost
travoprost
latanaprost
tafluprost
bimatoprost

31
Q

Beta-Blockers

Non Selective:
- Timoptic
- Betagan
- (generic, no brand)

Selective:
- Betoptic

A

Non-selective drugs:
- timolol
- levobunolol
- cartelol
Selective:
- betaxolol

32
Q

alpha-2 agonist

  • Alphagan P
  • Combigan
  • Simbrinza
  • Iopidine
  • Lumify
A
  • brimonidine
  • brimonidine + timolol
  • brimonidine + brinzolamide
  • aprachlonidine
  • brimonidine
33
Q

cabonic anhydrase inhibitors

Ophthalamic
- Trusopt
- Cosopt/Cosopt PF
- Azopt
- Simbrinza

Oral
___ and ___ (generic)

A
  • dorzolamide
  • dorzolamide + timolol
  • brinzolamide
  • brinzolamide + brimonidine

acetazolamide, methazolamide

34
Q

Rho Kinase Inhibitors

Rhopressa
Rocklantan

A
  • netarsudil
  • netarsudil + latanoprost
35
Q

cholinergics

Milostat
Isopto Carpine

A
  • carbachol
  • pilocarpine

PHRM 844 (52 decks)

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