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Ocular Pharm > Final: Glaucoma (Prostaglandin Analogs) > Flashcards

Final: Glaucoma (Prostaglandin Analogs) Flashcards

1
Q

What are usually the first mediations for glaucoma that you will try?

A

Prostaglandin Analogs

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2
Q

What are the 5 prostaglandin analogs we can prescribe for glaucoma treatment?

A

Xalatan (latanaprost)
Travatan Z (travoprost)
Lumigan (bimatoprost)
Zioptan(tafluprost)
Vyzulta (latanoprostene bunod)

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3
Q

What is the mechanism of action for prostaglandin analogs?

A

Increase uveoscleral outflow.

Prostaglandins are prodrugs that are hydrolyzed in the cornea and turn into free acids. The acids bind to FP receptors and increases MMPs which degrade collagen in the uveoscleral pathway which makes the uveoscleral pathway more porous allowing aqueous to flow out.

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4
Q

What 2 ways can you decrease IOP?

A

Increase aqueous outflow
Decrease Production

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5
Q

What 5 classes of drugs increase aqueous outflow?

A

1)Cholinergic agonists (pilocarpine)
2)Prostaglandin Analogs
3)Prostone
4)ROCK inhibitors
5)Sympathomimetics (a2 agonists)

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6
Q

What 3 classes of drugs decrease aqueous production?

A

1) Sympathomimetics (a2 agonists)
2) Sympatholytics (beta blockers)
3) Carbonic anhydrase inhibitors (CAIs)

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7
Q

What prostaglandin analog has the most stable IOP control over 24 hours?

A

Xalatan (latanoprost)

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8
Q

What are the Ester-based PGAs (prostaglandin analogs)? What are the Amide-Based? What is the difference?

A

Ester-Based: Travatan, Xalatan, Zioptan
Amide-Based: Lumigan

Ester-based are quickly broken down to its active form so requires less concentration of drug. You need higher concentration of drug for Amide based (Lumigan).

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9
Q

What was the 1st prostaglandin analog? What percent reduction in IOP would you expect when using this medication? What is the typical dose? When does IOP reduction start? When is its max effect?

A

Xalatan (latanoprost 0.05%)
Drops IOP by 30%
1 drop once a day at night!!! (this helps compliance ,take at best time for patient)
Reductions starts 4-6 hours and max effect at 12 hours

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10
Q

When storing Xalatan, what do you want to avoid?

A

Avoid storing in direct sun and heat

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11
Q

What is the preservative-free prostaglandin analog that you could use if someone has ocular surface disease or on multiple glaucoma meds? What percent reduction in IOP would you expect when using this medication? What is the typical dose? When does IOP reduction start? When is its max effect?

A

Zioptan (Tafluprost)
Drops IOP by 25-30%
1 drop once a day at night.
IOP reduction starts 4-6 hours and max effect at 12 hours.

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12
Q

What are 2 cons for Zioptan?

A

It is more expensive
You have to refrigerate since it is preservative free.

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13
Q

What prostaglandin analog contains the preservative Sofzia and is supposed to be more gentle on the ocular surface?

A

Travatan Z (travoprost)

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14
Q

What prostaglandin analog has shown to maintain IOP reduction for over 48 hours with only 1 drop? How may this be helpful?

A

Travatan Z (Travoprost)
If patients complain of running out of drops before the end of the month, they can start taking them every other day to make them last longer.

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15
Q

What prostaglandin analog supposedly works the quickest?

A

Travatan Z.
Takes 2 hours to start working instead of the 4-6 hours for the other PGAs

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16
Q

What is the preservative-free prostaglandin analog that you could use if someone has ocular surface disease or on multiple glaucoma meds? What percent reduction in IOP would you expect when using this medication? What is the typical dose? When does IOP reduction start? When is its max effect?

A

Zioptan (Tafluprost)
Drops IOP by 25-30%
1 drop once a day at night.
IOP reduction starts 4-6 hours and max effect at 12 hours.

17
Q

What is the amide-based prostaglandin analog drop? What percent reduction in IOP does it have? How do you dose it? When does IOP reduction start? When is its max effect?

A

Lumigan (Bimatoprost)
30% reduction in IOP
1 drop every night
IOP reduction starts in 4 hours, max effect in 8-12 hours.

18
Q

What PGA is the only PGA that has a generic version that is the same as the name brand?

A

Xalatan (latanoprost)

19
Q

What is the newer PGA that has a duel mechanism of action by using nitric oxide to make trabelucal meshwork more porous and increase uveoscleral outflow?

A

Vyzulta (Latanoprostene bunod)

20
Q

What is the mechanism of action of the prostaglandin analog Vyzulta?

A

Increase TM outflow by donating nitric oxide and also increases uveoscleral outflow from prostaglandin pathway.

21
Q

What PGA has causes the most eye redness? Why?

A

Vyzulta
Since it has nitric oxide, the nitric oxide acts as a vasodilator which increases the size and redness of blood vessels.

22
Q

What is the dosing regimen for Vyzulta? How much IOP reduction?

A

1 drop every night
Reduces IOP about the same as others, 30%, maybe 35%.

23
Q

What are the 7 side effects of all prostaglandin analogs?

A

1) Conj redness/hyperemia
2) Burning (lumigan worse)
3) Increase skin pigmentation (in hazel or multicolored eyes)
4) Eyelash growth
5) Intraocular inflammation (uveitis, reactivation of HSV?)
6) Macular Edema
7) Prostaglandin-associated Periorbitopathy

24
Q

What is the most common side effect of prostaglandin analogs?

A

Eye Redness, must tell the patient.

25
Q

What is Prostaglandin-associated Periorbitopathy?

A

Atrophy of orbital fat due to prostaglandin use.

26
Q

What is Latisse used for? What medication is found in it?

A

Bimatoprost 0.03% (same as lumigan)
used for eyelash growth

27
Q

What are 6 contraindications of prescribing Prostaglandin analogs (PGA)?

A

1) History of: HSV, CME, Iritis
2) Pseudophakia with: AC IOL, PC IOL with YAG capsulotomy
3) Aphakic patients
4) Contact lens wearer due to BAK
5) Hypersensitivity to BAK
6) Pregnant women

28
Q

True or False:
There are typically no systemic side effects with prostaglandin analogs?

A

True

29
Q

How much IOP reduction do prostaglandin analogs give?

A

approximately 30%

Ocular Pharm (8 decks)

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