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Intro to Principles of Drug Action > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Define: Glaucoma

A

damage of the eye’s optic nerve, usually associated with increased intraocular pressure = vision loss and blindness

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2
Q

What are the risk factors for glaucoma?

A

-age = >40 years old
-family history
-angle closure glaucoma= women

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3
Q

How can glaucoma be diagnosed?

A

-exam of the optic nerve
-exam of the visual field
-intraocular pressure (>21 mmHg)

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4
Q

What is the iris smooth muscle responsible for?

A

pupil size
-sympathetic= mydriasis (dilation)
-parasympathetic= miosis (constriction)

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5
Q

What is the ciliary body responsible for?

A

vision focus/lens shape
-sympathetic= relaxed (less convex), far vision
-parasympathetic= contracted (more convex), near vision

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6
Q

Describe: Aqueous Humor

A

produced in the ciliary epithelium and flows around the iris through the trabecular meshwork and out the canal of Schlemm into the bloodstream, responsible for intraocular pressure

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7
Q

Describe: Open Angle Glaucoma

A

most common type, drainage angle is open, but the fluid passes too slowly through the meshwork

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8
Q

Describe: Closed Angle Glaucoma

A

obstruction of outflow of aqueous humor, medical emergency!

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9
Q

What is the treatment goal of glaucoma?

A

to decrease pressure inside the eye either by increasing outflow of aqueous humor or decreasing production of aqueous humor

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10
Q

What adrenergic receptors are found in the eye?

A

alpha1= contraction of the dilator muscle that results in pupil dilation, beta= increased secretion of fluid, alpha2= decreased secretion of fluid

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11
Q

What cholinergic receptors are found in the eye?

A

M3= causes contraction of the ciliary muscle which allows increased outflow of aqueous humor AND causes contraction of sphincter muscle that results in pupil constriction

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12
Q

What classes of drugs would increase the outflow of aqueous humor?

A

mAChR agonists, AChE inhibitors

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13
Q

What classes of drugs would decrease secretion of aqueous humor?

A

beta blockers, alpha2 agonists, nonselective agonists

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14
Q

What beta blockers are used to treat glaucoma?

A

-timolol (non-selective)
-betaxolol (beta1 selective)

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15
Q

MOA: Adrenergic drugs for treatment of Glaucoma

A

reduce aqueous humor production

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16
Q

What alpha2 agonists are used to treat glaucoma?

A

-apraclonidine
-brimonidine

17
Q

What non-selective adrenergic agonists are used to treat glaucoma?

A

-epinephrine
-dipivefrin (prodrug -> epinephrine)

18
Q

MOA: Cholinergic drugs for the treatment of Glaucoma

A

increase outflow of aqueous humor by contracting the ciliary muscle which widens the trabecular mesh to allow outflow through the canal of Schlemm

19
Q

What mAchR agonists are used to treat glaucoma?

A

-pilocarpine
-carbachol

20
Q

What AChE inhibitors are used to treat glaucoma?

A

-physostigmine
-echothiophate

21
Q

Side effects: Cholinergic drugs

A

the are cholinomimetics that may induce visual problems, eyelid muscle twitching when used locally. occasionally, systemic parasympathetic effects occur, such as: diarrhea and urinary incontinence

22
Q

MOA: Prostaglandins analogs for the treatment of glaucoma

A

stimulates prostaglandin F receptor, which enhances outflow of aqueous humor through the uveoscleral tract

23
Q

What prostaglandin analogs are used to treat glaucoma?

A

-latanoprost
-travoprost
-bimatoprost

24
Q

MOA: Nitric Oxide

A

promotes outflow of aqueous humor via trabecular meshwork through canal of Schlemm

25
Q

MOA: Carbonic Anhydrase inhibitors

A

diminishes the production of aqueous humor

26
Q

MOA: Netarsudil (Rhopressa)

A

main mechanism= reduces cell contraction and stiffness in the trabecular meshwork to increase outflow through the canal of Schlemm, minor mechanism= inhibitor of the norepinephrine transporter which decreases aqueous humor production

27
Q

What is the treatment of closed-angle glaucoma?

A

-initially a combination of a direct muscarinic agonist and a cholinesterase inhibitor
-IV mannitol to rapidly reduce intraocular pressure
-once pressure is controlled, patient is prepared for a corrective surgery (iridectomy or iridotomy)

Intro to Principles of Drug Action (11 decks)

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