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PHRM 844 Module #2 > Eye Lecture Part 2 > Flashcards

Eye Lecture Part 2 Flashcards

1
Q

Compare differences between closed-angle and open-angle glaucoma

A

open angle: “slowly clogging drain”
closed angle: “putting foot on drain”

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2
Q

Open-angle gluacoma

A

obstructed drainage canal
most common type, happens gradually over time
no pain associated with it
30% of retinal cells have to be lost before vision loss

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3
Q

Close-angle glaucoma

A

pressure pushes iris against cornea
iris close to lens or drainage angle completely blocks
can cause permanent vision loss

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4
Q

Development of glaucoma

A

drainage canal blocked –> fluid build up –> damage to blood vessels and optic nerve from the pressure buildup

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5
Q

Risk factors

A

over 40 yrs old: leading cause of blindness in those greater than 60
eye injury
high blood pressure
asian or african american
use of steroids: steroids closest to the eye increase intraocular pressure
sickle cell anemia
corneal thickness
nearsighted or farsighted
diabetes

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6
Q

Symptoms of open-angle glaucoma

A

no symptoms in early stages
patchy blind spots in peripheral vision
difficulty seeing in central vision

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7
Q

Diagnosis of open-angle glaucoma

A

getting dilated comprehensive eye exam is only way to catch glaucoma early
measuring intraocular pressure: tonometry
testing for optic nerve damage: ophthalmoscopy
checking for vision loss: perimetry
measuring corneal thickness: pachymetry
inspecting drainage canal: gonioscopy

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8
Q

Open-angle treatment

A

reduce aqueous humor production
increase aqueous humor outflow
both

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9
Q

Reduce aqueous humor production

A

beta blockers
carbonic anhydrase inhibitors

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10
Q

Increase aqueous humor outflow

A

prostaglandin analogs
cholinergics
rho kinase inhibitors

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11
Q

Both

A

alpha 2 agonists

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12
Q

1st line: prostaglandin analogs: drugs

A

bimatoprost (lumigan)
travaprost (travatan Z, travatan)
latanoprost (xalatan, xelpros)
tafluprost (zioptan)
bimatoprost (latisse) - indicated for eyelash hypotrichosis

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13
Q

1st line: prostaglandin analogs: dosing

A

1 drop QHS
reduce IOP by 30%

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14
Q

1st line: prostaglandin analogs: warnings

A

darkening of iris, eyelid, skin, and eyelashes
increase in eyelash length and number

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15
Q

1st line: prostaglandin analogs: side effects

A

blurred vision, stinging, increased pigmentation of iris/eyelashes, eyelash growth/thickening, light sensitivity, foreign body sensation

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16
Q

1st line: beta blockers: drugs

A

can mask hypoglycemia or hypothyroidism
non-selective: timolol (timoptic, timoptic-XE, isatol); carteolol; levobunolol (betagan)
selective: betaxolol (betoptic S)

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17
Q

1st line: beta blockers: dosing

A

1 drop daily or BID
reduce IOP by 20-30%

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18
Q

1st line: beta blockers: contraindications

A

sinus bradycardia
2nd or 3rd degree heart block
cardiogenic shock
uncompensated cardiac failure
bronchospastic disease

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19
Q

1st line: beta blockers: side effects

A

stinging, blurred vision, bradycardia, breathing problems, hypotension, dizziness, fatigue, impotence

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20
Q

Alternative 1st/2nd line: alpha-2 agonists

A

not more effective than single MOA meds
can also be on beta blockers or prostaglandin analogs at the same time

21
Q

Alternative 1st/2nd line: alpha-2 agonists: drugs

A

brimonidine (alphagan P) + timolol (combigan) + brinzolamide (simbrinza)
aprachlonidine (lopidine)
brimonidine (lumify) - OTC for redness of eye

22
Q

Alternative 1st/2nd line: alpha-2 agonists: dosing

A

1 drop TID
reduce IOP by 25%

23
Q

Alternative 1st/2nd line: alpha-2 agonists: contraindications & warnings

A

CNS depression

24
Q

Alternative 1st/2nd line: alpha-2 agonists: side effects

A

dry eyes, xerostomia, blurry vision, conjunctival hyperemia, sedation, confusion

25
Q

2nd line: carbonic anhydrase inhibitors

A

bottles of these meds must be capped to prevent crystallization

26
Q

2nd line: carbonic anhydrase inhibitors: drugs

A

ophthalmic: dorzolamide (trusopt) + timolol (cosopt, cosopt PF); brinzolamide (azopt) + brimonidine (simbrinza)
oral: acetazolamide; methazolamide

27
Q

2nd line: carbonic anhydrase inhibitors: dosing

A

ophthalmic: 1 drop TID
reduce IOP by 15-20%
not recommended for CrCl < 30
oral: 50-100 mg PO 2 to 3 times daily

28
Q

2nd line: carbonic anhydrase inhibitors: warnings

A

sulfonamide allergy

29
Q

2nd line: carbonic anhydrase inhibitors: side effects

A

ophthalmic: burning, blurred vision, blepharitis, taste disturbances
oral: ataxia, confusion, photosensitivity, nausea, metabolic acidosis

30
Q

3rd line: rho kinase inhibitors: drugs

A

netarsudil (rhopressa) + latanoprost (rocklatan)

31
Q

3rd line: rho kinase inhibitors: dosing

A

1 drop QPM
reduce IOP by 25-30%

32
Q

3rd line: rho kinase inhibitors: side effects

A

burning, corneal disease, conjunctival hemorrhage, conjunctival hyperemia

33
Q

Last line: cholinergics: drugs

A

carbachol (milostat)
pilocarpine (isopto carpine)

34
Q

Last line: cholinergics: dosing

A

carbachol: 1-2 drops up to TID
pilocarpine: 1-2 drops up to QID
reduce IOP by 15-25%

35
Q

Last line: cholinergics: contraindications & warnings

A

use in caution in patients with history of retinal detachment or corneal abrasion

36
Q

Last line: cholinergics: side effects

A

pupil constriction, corneal clouding, hypotension, bronchospasm, abdominal cramps

37
Q

Treatment recommendations

A

1st line: prostaglandin analog, beta blocker, alternative - brimonidine
inadequate response: no response - different 1st line option; partial response - add additional 1st or 2nd line option
inadequate response again: increase concentration/frequency; add 3rd and/or 4th line agent; consider replacing topical CAI with oral CAI
inadequate response to maximally tolerated therapy: laser or surgical procedure

38
Q

Assess response every

A

2-4 weeks
always ensure compliance, proper administration techinque

39
Q

Intolerance present

A

reduce dose/concentration
change formulation
switch to class alternative or different combination

40
Q

Close-angle glaucoma is a

A

medical emergency

41
Q

Symptoms of closed-angled glaucoma

A

severe headache
severe pain
N/V
blurred vision
halos around light
eye redness or cloudy cornea

42
Q

Treatment of closed-angle

A

hyperosmotic agents
surgery

43
Q

Hyperosmotic agents

A

mannitol (IV): 1.5-2 g/kg/dose over 30 minutes
glycerin (PO): 1-2 g/kg/dose every 5 hours as required

44
Q

Surgery

A

iridotomy: laser to creater tiny hole in iris to drain it

45
Q

Recognize which medications can increase the intraocular pressure in the eye

A

anticholinergics
chronic steroids
decongestants
topiramate
antidepressants

46
Q

Anticholinergics

A

oxybutynin
tolterodine
benztropine
scopolamine

47
Q

Decongestants

A

pseudoephedrine

48
Q

Antidepressants

A

fluoxetine
paroxetine
amitriptyline
duloxetine

PHRM 844 Module #2 (23 decks)

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