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PHARMACY PRACTICE II > GLAUCOMA > Flashcards

GLAUCOMA Flashcards

1
Q

Glaucoma

A

Optic neuropathies characterized by progressive degeneration of retinal ganglion cells

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2
Q

Types of glaucoma

A

Open angle glaucoma (OAG)
Closed angle glaucoma (CAG)

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3
Q

Most common form of glaucoma

A

Primary open angle glaucoma

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4
Q

Primary OAG is rare in people under

A

50 years

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5
Q

Most visually destructive form of glaucoma

A

Closed angle glaucoma

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6
Q

Which form of glaucoma is a medical emergency

A

Closed angle glaucoma

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7
Q

Glaucomatours optic neuropathy

A

Damage and remodeling of the optic disc tissues and lamina cribosa that lead to vision loss.

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8
Q

POAG prevalence is highest in which population

A

Older Hispanic or Latino> Blacks> Whites>Asians

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9
Q

Causes of glaucoma

A

Congenital
Trauma
Type 2 DM
Pigmentary dispersion sundrome
Raised intraocular pressure
Prolonged corticosteroid use
Hereditary

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10
Q

Pigmentary dispersion syndrome

A

Pigment cells slough off from the back of the iris and float around in the aqueous humor

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11
Q

What type of glaucoma is caused by pigmentary dispersion syndrome

A

Pigmentary glaucoma

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12
Q

Distribution of glaucoma according to sex

A

Males>Females

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13
Q

Risk factors for glaucoma

A

Age
Family history
Black race
Use of systemic or topical corticosteroids
High intraocular pressure
Genetics

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14
Q

Which cells produce the aqueous humor

A

Ciliary body

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15
Q

Rate of production of aqueous humor

A

2.5mcl per minute

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16
Q

Flow of aqueous humor

A

Ciliary body secretes into the Posterior chamber
flows to Anterior chamber through the pupil
flows to the trabecular meshwork in the anterior angle

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17
Q

Pathways for drainage of the aqueous humor

A

Schlemm’s canal (from trabecular network)
Uveoscleral pathway

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18
Q

Driving force for the uveoscleral outflow pathyway

A

Pressure gradient created by movement of the ciliary muscle

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19
Q

Trabecular meshwork structure

A

Collagen and elastic tissue covered by trabecular cells that form a filter

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20
Q

Intraocular pressure is determined by

A

Balance between aqueous humor production and drainage through the trabecular meshwork and uveoscleral outflow pathway.

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21
Q

Effect of high IOP on mitochondrion

A

Mitochondrial dysfunction which leads to metabolic stress and nerve degeneration

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22
Q

Lamina cribosa

A

Mesh-like structure in a hole in the sclera where the optic disc exits the eye

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23
Q

Role of lamina cribosa

A

Maintains the pressure gradient between the inside of the eye and the surrounding tissues

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24
Q

Effect of high IOP on the lamina cribosa

A

Displaces the lamina cribosa

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25
Displacement of the lamina cribosa leads to........
Pinching of the optic nerve and blood vessels causing nerve damage
26
Normal IOP
15-16mmHG, SD of 3mmHg
27
Ocular hypertension
IOP above 21mmHg
28
Types of open angle glaucoma
Primay Secondary
29
Examples of open angle glaucoma
Juvenile glaucoma Drug-induced Low tension/normal tension Pseudo-exfoliating Pigmentary Inflammatory
30
Examples of closed angle glaucoma
Malaignant glaucoma Hyphema glaucoma Juvenile glaucoma
31
Diagnostic investigations in glaucoma
Ophthalmoscopy Tonometry Gonioscopy Fundoscopy Visual function test pectral-domain optical coherence tomograph
32
Spectral-domain optical coherence tomography
provides high-resolution, optical cross-sectional analysis of the retina, and choroid with depth-resolved segmentation
33
TONOMETRY
A test to measure the pressure inside the eye
34
GONIOSCOPY
uses a special lens and slit lamp to evaluate your eye's drainage angle (anterior chamber angle)
35
FUNDOSCOPY
Examination of the fundus of the eye using a magnifying lens and light
36
Fundus
Back surface of the eye made up of Retina Optic disc Fovea Blood vessels
37
VISUAL FUNCTION TEST
to detect changes in peripheral vision
38
Signs and symtopms of chronic open angle glaucoma
40 yrs and above Normal cornea Symptoms are nill till late then progressive visual loss IOP is usually high but may be normal
39
Signs and symtoms of acute angle closure glaucoma
Elderly Sudden visual loss Severe eye pain Very inflamed eye Watery discharge Headache Halos around light Very high IOP Hazy cornea
40
Signs and symptoms of congenital open angle glaucoma
Infants and toddlers Photophobia Watering High IOP Enlarged and hazy cornea with linear breaks
41
Target range of IOP
10-20mmHg
42
Two classes of non-pharmacological options for glaucoma
Penetrating/Incisional surgeries Non-penetrating surgeries
43
Penetrating/Incisional surgeries
Trabeculectomy Aqueous shunt Combined surgeries
44
Non-penetrating surgeries
Deep Sclerectomy Viscocanalostomy Canaloplasty Laser trabeculoplasty Laser peripheral iridoctomy
45
Types of laser trabeculoplasty
Argon and diode laser trabeculoplasty Selective laser trabeculoplasty
46
Trabeculectomy
Creating a new path in the eye for drainage
47
Deep sclerectomy
Removal of a deep scleral flap to create a scleral space for drainage
48
Drug classes used in glaucoma
Prostaglandin analogues Beta antagonists Alpha agonists Parasympathomimetics Carbonic anhydrase inhibitors Rho kinase inhibitors NMDA antagonists
49
MOA of prostaglandin analogues in glaucoma
Increase uveoscleral outflow Induction of MMP in ciliary body
50
Role of Matrix metallopeoteinases (MMP)
Breaks down extracellular matrix, reducing resistance to outflow through the uveoscleral pathway
51
Recommended first line for Primary open angle glaucoma
Prostaglandin analogues
52
XALATAN
Latanaprost
53
SAFLUTAN
Tafluprost
54
TRAVATAN
Travoprost
55
LUMIGAN
Bimatoprost
56
Prostaglandin analogues
Bimatoprost Travoprost Tafluprost Latanaprost Latanoprostene bunod ophthalmic
57
MOA of beta antagonists
Decrease aqueous humor production by ciliary body
58
Recommended first line for patients who cannot tolerate prostaglandind analogues
Beta adrenergic antagonists
59
Contraindications of beta antagonists
Bradycardia Heart block
60
BETOPTIC
Betaxolol
61
CUSIMOLOL
Timolol
62
BETAGAN
Levobunolol
63
Beta adrenergic antagonists
Nonselective: Carteolol Levobunolol Metipranolol Timolol Selective: Betaxolol
64
MOA of alpha-2 agonists
Decreases aqueous humor production Increases uveoscleral outlfow
65
ALPHAGAN
Brimonidine
66
Alpha-2 adrenoceptor agonists
Brimonidine Apraclonidine
67
Contraindications of alpha-2 agonists
Unstable cardiovascular disease
68
........................................ is used to control IOP after anterior segment laser surgery
Apraclonidine
69
Ocular adverse effects of alpha-2 agonists
Allergic or follicular conjunctivitis Contact dermatitis
70
Systemic adverse effects of alpgha-2 agonists
Dry mouth Fatigue Drowsiness Hypotension
71
MOA of parasympathomimetics
Opens inefficient drainage channels in the trabecular meshwork
72
Contraindications to parasympathomimetics
Acute iritis Anterioir uveities When pupillary constriction is undesirable
73
Parasympatho mimetics
Pilocarpine- cholinergic agonist Ecothiophate-anticholinesterase
74
Carbonic anhydrase inhibitors
Reduces bicarbonate ions production and fluid flow in the ciliary body Reduces production of aqueous humor
75
Contraindications to carbonic anhydrase inhibitors
Adrenocortical insufficiency Hypokalemia Hyponatremia Metabolic acidosis
76
AZOPT
Brinzolamide
77
TRUSOPT
Dorzolamide
78
DIAMOX
Acetazolamide
79
80
CA inhibitors
TOPICAL Brinzolamide Dorzolamide ORAL Acetazolamide Methazolamide
81
.................. and .............. is preferred for long term treatment of primary open angle glaucoma
Brinzolamide Dorzolamide
82
AZARGA
Brinzolamide Timolol
83
SIMBRINZA
Brinzolamide Brimonidine
84
COSOPT
Timolol Dorzolamide
85
Rho kinase inhibitor
Increase aqueous outflow tthrough trabecular meshwork
86
indications of rho kinase inhibitor
Open angle glaucoma Ocular hypertension
87
RHOPRESSA
Netarsudil
88
Side effects of rho-kinase inhibitors include
Hyperaemia Conjunctival Haemorrhage
88
Excitotoxicity
cells die via apoptosis because of the presence of excessive amounts of glutamate
89
NMDA antagonist
Memantine
90
NAMENDA
Memantine
91
NMDA antagonist role in glaucoma management
Protection of neurons chiefly the retinal ganglion cells axons from excitotoxicity

PHARMACY PRACTICE II (17 decks)

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