Glaucoma Flashcards
1
Q
Compare differences between open-angle and closed-angle glaucoma
A
- Glaucoma: drainage canal blocked, causing fluid to build up; the excesssive pressure damages optic nerve, leading to loss of eyesight
- Open-angle: damage to filter in eye’s drainage canal
- Closed-angle: rapid blockage of eye’s drainage canal, medical emergency
2
Q
Medications that can increase intraocular pressure (IOP) in the eye
A
- Anticholinergics (oxybutynin, tolterodine, benztropine, scopolamine)
- Chronic steroids
- Decongestants (pseudoephedrine)
- Topiramate
- Antidepressants (fluoxetine, paroxetine, amitriptyline, duloxetine)
3
Q
Step-wise treatment
A
- Prostaglandin analog, beta-blocker; alternative: brimonidine
- No respone -> diff 1st line option; partial response -> add additional 1st or 2nd line option (CAI)
- Inadequate response -> Incr conc/freq OR add 3rd/4th line agent OR replace topical CAI with oral CAI
- Inadequate response to max tolerated therapy -> laser/surgical procedure
4
Q
Follow-up guidelines
A
- assess response q2-4 weeks
- ensure compliance and proper admin technique
- if intolerance -> change formulation OR switch to diff class OR reduce dose
5
Q
Admin & Timing
A
- take out contact lens
- if 2 drops: (same med) wait 5 mins between drops, (diff meds) wait 5-10 mins between drops
- can reinsert contacts after 15 mins
6
Q
Open-angle
A
symptoms: no symptoms early stages, patchy blind spots in peripheral vision, difficulty seeing in central vision
7
Q
Closed-angle
A
symptoms: severe headache, pain, N/V, halos around light, blurred vision, eye redness or cloudy cornea
8
Q
Risk factors for glaucoma
A
> 40 yrs, asian or AA, corneal thickness, eye injury, use of steroids, high BP, sickle cell anemia, diabetes
9
Q
Open-angle treatment
A
- Reduce aqueous humor production: beta-blockers, carbonic anhydrase inhibitors
- Increase aqueous humor outflow: prostaglandin analogs, cholinergics, rho kinase inhibitors
- Both: alpha 2 agonists
10
Q
Closed-angle treatment
A
- Hyperosmotic agents: mannitol (IV), glycerin (PO)
- Surgery: iridotomy (tiny hole drilled in iris to drain fluid)
11
Q
Prostaglandin Analogs
A
- MOA: incr aqueous humor outflow
- Reduces IOP by 30%
- Dosing: 1 gtt QHS
- Warnings: Incr eyelash length/number, darkening of iris/eyelid/skin/eyelashes
- Side effects: Blurred vision, stinging, light sensitivity, foreign body sensation
- Drugs: bimatoprost, travoprost, latanoprost, tafluprost, bimatoprost (for eyelash hypotrichosis)
12
Q
Beta-blockers
A
- MOA: reduce aqueous humor production
- Reduces IOP by 20-30%
- Dosing: 1 gtt daily or BID
- Contraindications: sinus bradycardia, 2nd/3rd degree heart block, cardiogenic shock, uncompensated cardiac failure, bronchospastic disease
- Side effects: stinging, blurred vision, bradycardia, hypotension, breathing problems, dizziness, fatigue, impotence
- Drugs: (Non-selective) timolol, carteolol, levobunolol; (Selective) betaxolol
13
Q
Alpha-2 Agonists
A
- MOA: incr aqueous humor outflow AND reduce aqueous humor production
- Reduces IOP by 25%
- Dosing: 1 gtt tid
- Contraindications/Warnings: CNS depression
- Side effects: dry eyes, xerostomia, blurry vision, conjunctival hyperemia, sedation, confusion, hypertension
- Drugs: brimonidine/timolol/brinzolamide, aprachlonidine, brimonidine
14
Q
Carbonic Anhydrase Inhibitors (CAI)
A
- MOA: reduce aqueous humor production
- Reduces IOP by 15-20%
- Dosing: (Ophthalmic) 1 gtt tid; (Oral) 50-100mg PO 2-3x daily
- Warnings: sulfonamide allergy, CrCl < 30
- Side effects: (ophthalmic) burning, blurred vision, blepharitis, taste disturbances; (oral) ataxia, confusion, photosensitivity, nausea, metabolic acidoses
- Bottles need to be capped b/c can lead to crystallization if not
- Drugs: (Ophthalmic) dorzolamide/timolol, brinzolamide/brimonidine; (Oral) acetazolamide, methazolamide
15
Q
Rho Kinase Inhibitors
A
- MOA: increase aqueous humor outflow
- Reduces IOP by 25-30%
- Dosing: 1 gtt qpm
- Side Effects: burning, corneal disease, conjunctival hemorrhage, conjunctival hyperemia
- Drugs: netarsudil/latanoprast
