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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
Q

Displacement of the lamina cribosa leads to……..

A

Pinching of the optic nerve and blood vessels causing nerve damage

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26
Q

Normal IOP

A

15-16mmHG, SD of 3mmHg

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27
Q

Ocular hypertension

A

IOP above 21mmHg

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28
Q

Types of open angle glaucoma

A

Primay
Secondary

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29
Q

Examples of open angle glaucoma

A

Juvenile glaucoma
Drug-induced
Low tension/normal tension
Pseudo-exfoliating
Pigmentary
Inflammatory

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30
Q

Examples of closed angle glaucoma

A

Malaignant glaucoma
Hyphema glaucoma
Juvenile glaucoma

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31
Q

Diagnostic investigations in glaucoma

A

Ophthalmoscopy
Tonometry
Gonioscopy
Fundoscopy
Visual function test
pectral-domain optical coherence tomograph

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32
Q

Spectral-domain optical coherence tomography

A

provides high-resolution, optical cross-sectional analysis of the retina, and choroid with depth-resolved segmentation

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33
Q

TONOMETRY

A

A test to measure the pressure inside the eye

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34
Q

GONIOSCOPY

A

uses a special lens and slit lamp to evaluate your eye’s drainage angle (anterior chamber angle)

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35
Q

FUNDOSCOPY

A

Examination of the fundus of the eye using a magnifying lens and light

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36
Q

Fundus

A

Back surface of the eye made up of
Retina
Optic disc
Fovea
Blood vessels

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37
Q

VISUAL FUNCTION TEST

A

to detect changes in peripheral vision

38
Q

Signs and symtopms of chronic open angle glaucoma

A

40 yrs and above
Normal cornea
Symptoms are nill till late then progressive visual loss
IOP is usually high but may be normal

39
Q

Signs and symtoms of acute angle closure glaucoma

A

Elderly
Sudden visual loss
Severe eye pain
Very inflamed eye
Watery discharge
Headache
Halos around light
Very high IOP
Hazy cornea

40
Q

Signs and symptoms of congenital open angle glaucoma

A

Infants and toddlers
Photophobia
Watering
High IOP
Enlarged and hazy cornea with linear breaks

41
Q

Target range of IOP

A

10-20mmHg

42
Q

Two classes of non-pharmacological options for glaucoma

A

Penetrating/Incisional surgeries
Non-penetrating surgeries

43
Q

Penetrating/Incisional surgeries

A

Trabeculectomy
Aqueous shunt
Combined surgeries

44
Q

Non-penetrating surgeries

A

Deep Sclerectomy
Viscocanalostomy
Canaloplasty
Laser trabeculoplasty
Laser peripheral iridoctomy

45
Q

Types of laser trabeculoplasty

A

Argon and diode laser trabeculoplasty
Selective laser trabeculoplasty

46
Q

Trabeculectomy

A

Creating a new path in the eye for drainage

47
Q

Deep sclerectomy

A

Removal of a deep scleral flap to create a scleral space for drainage

48
Q

Drug classes used in glaucoma

A

Prostaglandin analogues
Beta antagonists
Alpha agonists
Parasympathomimetics
Carbonic anhydrase inhibitors
Rho kinase inhibitors
NMDA antagonists

49
Q

MOA of prostaglandin analogues in glaucoma

A

Increase uveoscleral outflow
Induction of MMP in ciliary body

50
Q

Role of Matrix metallopeoteinases (MMP)

A

Breaks down extracellular matrix, reducing resistance to outflow through the uveoscleral pathway

51
Q

Recommended first line for Primary open angle glaucoma

A

Prostaglandin analogues

52
Q

XALATAN

A

Latanaprost

53
Q

SAFLUTAN

A

Tafluprost

54
Q

TRAVATAN

A

Travoprost

55
Q

LUMIGAN

A

Bimatoprost

56
Q

Prostaglandin analogues

A

Bimatoprost
Travoprost
Tafluprost
Latanaprost
Latanoprostene bunod ophthalmic

57
Q

MOA of beta antagonists

A

Decrease aqueous humor production by ciliary body

58
Q

Recommended first line for patients who cannot tolerate prostaglandind analogues

A

Beta adrenergic antagonists

59
Q

Contraindications of beta antagonists

A

Bradycardia
Heart block

60
Q

BETOPTIC

A

Betaxolol

61
Q

CUSIMOLOL

A

Timolol

62
Q

BETAGAN

A

Levobunolol

63
Q

Beta adrenergic antagonists

A

Nonselective:
Carteolol
Levobunolol
Metipranolol
Timolol

Selective:
Betaxolol

64
Q

MOA of alpha-2 agonists

A

Decreases aqueous humor production
Increases uveoscleral outlfow

65
Q

ALPHAGAN

A

Brimonidine

66
Q

Alpha-2 adrenoceptor agonists

A

Brimonidine
Apraclonidine

67
Q

Contraindications of alpha-2 agonists

A

Unstable cardiovascular disease

68
Q

…………………………………. is used to control IOP after anterior segment laser surgery

A

Apraclonidine

69
Q

Ocular adverse effects of alpha-2 agonists

A

Allergic or follicular conjunctivitis
Contact dermatitis

70
Q

Systemic adverse effects of alpgha-2 agonists

A

Dry mouth
Fatigue
Drowsiness
Hypotension

71
Q

MOA of parasympathomimetics

A

Opens inefficient drainage channels in the trabecular meshwork

72
Q

Contraindications to parasympathomimetics

A

Acute iritis
Anterioir uveities
When pupillary constriction is undesirable

73
Q

Parasympatho mimetics

A

Pilocarpine- cholinergic agonist
Ecothiophate-anticholinesterase

74
Q

Carbonic anhydrase inhibitors

A

Reduces bicarbonate ions production and fluid flow in the ciliary body
Reduces production of aqueous humor

75
Q

Contraindications to carbonic anhydrase inhibitors

A

Adrenocortical insufficiency
Hypokalemia
Hyponatremia
Metabolic acidosis

76
Q

AZOPT

A

Brinzolamide

77
Q

TRUSOPT

A

Dorzolamide

78
Q

DIAMOX

A

Acetazolamide

79
Q
A
80
Q

CA inhibitors

A

TOPICAL
Brinzolamide
Dorzolamide

ORAL
Acetazolamide
Methazolamide

81
Q

……………… and ………….. is preferred for long term treatment of primary open angle glaucoma

A

Brinzolamide
Dorzolamide

82
Q

AZARGA

A

Brinzolamide
Timolol

83
Q

SIMBRINZA

A

Brinzolamide
Brimonidine

84
Q

COSOPT

A

Timolol
Dorzolamide

85
Q

Rho kinase inhibitor

A

Increase aqueous outflow tthrough trabecular meshwork

86
Q

indications of rho kinase inhibitor

A

Open angle glaucoma
Ocular hypertension

87
Q

RHOPRESSA

A

Netarsudil

88
Q

Side effects of rho-kinase inhibitors include

A

Hyperaemia
Conjunctival Haemorrhage

88
Q

Excitotoxicity

A

cells die via apoptosis because of the presence of excessive amounts of glutamate

89
Q

NMDA antagonist

A

Memantine

90
Q

NAMENDA

A

Memantine

91
Q

NMDA antagonist role in glaucoma management

A

Protection of neurons chiefly the retinal ganglion cells axons from excitotoxicity

PHARMACY PRACTICE II (17 decks)

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