Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Derm/Ophth > Glaucoma > Flashcards

Glaucoma Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

aqueous humor (AH) purpose

A 
maintain proper IOP, prevent corneal collapse and optic nerve damage
transparent medium for optical system
nutrient delivery
waste removal
immune response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

AH pathway

A

produced in ciliary body
secreted into posterior chamber
pressure from production pushes AH into anterior chamber
AH is drained and returned to circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

AH outflow %s

A

90% is from trabecular outflow

10% from uveoscleral outflow through the face of the ciliary body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

only modoficable RF for glaucoma

A

inc IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

IOP

normal, high

A

normal is 13-21

>21 is elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

normal IOP and (+) glaucomatous changes

A

Normotensive glaucoma (N-T)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

normal IOP and (-) glaucomatous changes

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

elevated IOP and (+) glauc changes

A

Glaucoma

Primary open angle (POAG) or closed angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

elevated IOP and (-) glauc changes

A

ocular hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

POAG risk factors (9)

A

elevated IOP (16 to 21mmHg is a 16x inc risk)
age (>60, >40 for black patients)
inc cup-to-disc ratio (0.3 +)
central corneal thickness (the thinner the worse it is)
ocular perfusion pressure (SBP or DBP - IOP –> lower = more risk)
T2DM
myopia (20/50) (near-sighted)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

who should be treated

A
  1. all pts with elevated IOP and confirmed disc changes/field defects (POAG)
  2. OH AND 2+ RFs such as ethnicity, FHx, thin central cornea, large cup-to-disc ratio, IOP >25
  3. NTG with documented progressoin of visual field loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

goals of glaucoma tx

A
  1. Preserve the nerve!

2. lower IOP, target is a >/= 25% decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

medical vs surgical tx

A

CIGTS study: surgery more effective at lowering IOP and better for severe cases; QOL differences w few surgical complications but possible cataract formation and loss of visual acuity

medical therapy can be as good as surgical!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

tx options for POAG

A 
prostaglandin analogs
BBs
alpha-antags
carbonic anhydrase-i (CA-i)
Rho kinase inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

PG analogs
drugs
effectiveness

preferred in ....
   - efficacy
   - burning/stinging/hyperemia
   - generic avail
use?
A

bimatoprost
latanoprost
latanoprostene bunod
all reduce IOP 25-35% (only one to do this adequately)

efficacy: Bimato = latano B
AE: Latano = Latano B
generic: Bimato 0.3%, Latano, Travo

1st line in all patients except ocular infections or chronic uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bimatoprost is generic at ____ concentrations BUT _____

A

high

increased AE :/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PG analogs AE

CI

A

conjunctival hyperemia, hypertrichosis, periocular/iris pigmentation changes
CI in existing ocular inflammation (keratitis, iritis, uveitis, macular edema)

18
Q

BBs
MOA
drugs
preferred in convenience, systemic AE risk, generic availability?

A

dec AH production, minimal effects on uveoscleral outflow

betaxolol, carteolol, levobunolol, metipranolol, timolol

convenience: LVB, TIM qd sol, gel
side effect risk: BTX», CAR (for pts w/ BB CI)
generic avail: BTX sol, TIM, CAR, LVB, MTP

19
Q

BBs AE

CI

A

local irritation (switch product/form)
systemic: cardiac, pulmonary, CNS
tachyphylaxis (20-25%)

CI: sinus bradycardia, heart block, HF (absolute), pulmonary disease (relative)

20
Q

a-agonists
MOA
drug

A

Brimonidine
reduces AH production by ciliary body
reduces IOP 20-25% and proposed neuroprotective effect

21
Q

Brimonidine AE and precautions

A

AE: local irritation, conjunctival hyperemia, irritation, allergic rxns
systemic: drowsiness, xerostomia, tachyphylaxis
precaution in CV diseases

22
Q

Brimonidine-Timolol combo vs Latano

A

Iop reductions no different
diurnal control similar
latanoprost is far cheaper rn anyway

23
Q

carbonic anhydrase-i
MOA
drugs
use

A 
dec AH prod by dec bicarbonate ion secretoin
reduce IOP 15-20%
favorable AE profile
acetazolamide (po)
dorzolamide
brinzolamide
methazolamide (po)
used as add on since dec in IOP not at 25%
dorzolamide/timolol available (DTFC)
24
Q

if a pt is on Bimatoprost and is having AE, want to swtich to a non PG analog… which drug should they switch to

A

DTFC

25
Q

Rhok-i
MOA
drugs
AE

A

improves trobecular outflow by decreasing actin myosin contractions
~20% dec in IOP IF IOP is <27mmHg
Netarsudil (Rhopressa)

AE: high rate… , hyperemia, conjunctival hemorrhage

26
Q

POAG 1st line options

A

PG analogs, alternative is BBs

27
Q

POAG 2nd line options

A

dorzolamide (DTFC)
Brimonidine (alt 1st line too)
Brinzolamide, dorzolamide alone or po CA-is
netarsudil

28
Q

EMGT study RF for progression

A
  1. high baseline IOP
  2. older age
  3. disc hemorrhage
  4. larger cup-to-disc ratio
  5. thinner central cornea
  6. low ocular perfusion pressure
  7. poor medication adherence
  8. progression in fellow eye
29
Q

Ocular HTN

who to tx?

A

O HTN with RF

30
Q

N-T glaucoma
description
tx?

A

wnl IOP + glocamotous changes
tx helps w sx even if its wnl
tx if NTG + documented progressoin of visual field loss

31
Q

PACG
stands for?
patho?

A

primary angle closure glaucoma

patho:
1. pupillary block (lens contracts iris at pupillary margin
2. plateau iris (less common)

32
Q

PACG attacks

when to go to hospital?

A

subacute attacks are self-limiting

normal/high IOP with infrequent acute angle closure crisis (AACC) GO to hopsital

33
Q

AACC
definition
RF?

A

acute angle closure crisis
wild IOP fluctuations (up to 80mmHg)
rapid vision damage
halo around light, edematous cornea, pain, HA, N/V, rapid mydriasis
RF: shallow anterior chamber depth, FHx, hyperopia, age

34
Q

AACC goal

A

medically break the attack quickly to preserve vision and prep eye for laser peripheral iridotomy (LPI)

35
Q

AACC treatment IOP

A

CA-i (500mg acetazolamide IR IV or po)
topical BB
topical alpha-ag

36
Q

AACC treatment angle

AE

A

topical pilocarpine
induces miosis
AE: spasm, HA, brow ache, lid twitch

37
Q

AACC treatment inflammation

A

ophthalmic steroid

38
Q

AACC hyperosmotic

A

reduce vitreous volume
give if antisecretories and pilocarpine have no effect on IOP after 1 hour
PO glycerin or isosorbide 1-2g/kg
Iv mannitol 1.5-2g/kg

39
Q

AACC

how to tell when crisis is improving?

A

IOP low, angle open, pupil miotic, check IOP q15-30 min, check angle when IOP drops to wnl

40
Q

AACC at 1 hour after meds, IOP still high. tx?

A

hyperosmotic PRN high IOP
repeat doses of BB, a-ag, pilocarpine
may add ophthalmic steroid

Derm/Ophth (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions