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Therapeutics II > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What damages to the eye can lead to glaucoma?

A

-Drainage canal blocked leading to fluid build-up (increased pressure)
-Damage to blood vessels and optic nerve (optic nerve damage cannot be reversed)

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2
Q

What is open-angle glaucoma?

A

-Obstructed drainage canal
-No vision changes
-Painless
-Do not lose sight until 30% cell death

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3
Q

What is closed-angle glaucoma?

A

-Pressure pushes iris against cornea
-Painful
-Vision loss

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4
Q

Risk factors for glaucoma

A

-Over 40 years old
-Asian or African American
-Corneal thickness
-Eye injury
-Use of steroids
-Nearsighted or farsighted
-High blood pressure
-Sickle cell anemia
-Diabetes

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5
Q

Symptoms of open-angle glaucoma

A

-No symptoms in early stage
-Patchy blind spots in peripheral vision
-Difficulty seeing in central vision

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6
Q

How do you diagnose glaucoma?

A

-Measuring intraocular pressure (Tonometry)
-Testing for optic nerve damage (Ophthalmoscopy)
-Checking for vision loss (Perimetry)
-Measuring corneal thickness (Pachymetry)
-Inspecting drainage canal (Gonioscopy)

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7
Q

How do you treat open-angle glaucoma?

A

-Reduce aqueous humor production
-Increase aqueous humor outflow

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8
Q

What medications can you use to reduce aqueous humor production?

A

-Beta blockers
-Carbonic anhydrase inhibitors
-Alpha 2 agonists

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9
Q

What medications can you use to increase aqueous humor outflow?

A

-Prostaglandin analogs
-Cholinergics
-Rho Kinase inhibitors
-Alpha 2 agonists

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10
Q

First line treatment of open-angle glaucoma

A

-Prostaglandin analogs
-Beta-blockers
-Alpha 2 agonists (first/second line)

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11
Q

What are the prostaglandin analogs?

A

-Bimatoprost
-Travoprost
-Latanoprost
-Tafluprost

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12
Q

What are the brand names for bimatoprost?

A

-Lumigan
-Latisse (indicated for eyelash hypotrichosis)

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13
Q

What are the brand names for travoprost?

A

-Travatan Z
-Travatan

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14
Q

What are the brand names for latanoprost?

A

-Xalatan
-Xelpros

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15
Q

What is the brand name for tafluprost?

A

-Zioptan

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16
Q

How are prostaglandin analogs dosed?

A

1 drop every night at bedtime

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17
Q

How much do prostaglandin analogs decrease intraocular pressure?

A

Reduce 30%

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18
Q

Warnings associated with prostaglandin analogs

A

-Darkening of iris, eyelid, skin, and eyelashes
-Increase in eyelash length and number

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19
Q

Side effects associated with prostaglandin analogs

A

-Blurred vision
-Stinging
-Increased pigmentation of iris/eyelashes
-Eyelash growth/thickening
-Light sensitivity
-Foreign body sensation

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20
Q

What are the beta-blockers?

A

-Timolol
-Carteolol
-Levobunolol
-Betaxolol (selective)

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21
Q

What are the brand names for timolol?

A

-Timoptic
-Timoptic-XE
-Istalol

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22
Q

What is the brand name for levobunolol?

A

-Betagan

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23
Q

What is the brand name for betaxolol?

A

-Betoptic S

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24
Q

How do you dose beta blockers?

A

1 drop daily or BID

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25
Q

How much do beta blockers reduce intraocular pressure?

A

20-30%

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26
Q

What are beta blockers contraindicated with?

A

-Sinus bradycardia
-Second or third degree heart block
-Cardiogenic shock
-Uncompensated heart failure
-Bronchospastic disease

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27
Q

Side effects associated with beta blockers

A

-Stinging
-Blurred vision
-Bradycardia
-Breathing problems
-Hypotension
-Dizziness
-Fatigue
-Impotence

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28
Q

What are the alpha 2 agonists?

A

-Brimonidine
-Aprachlonidine

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29
Q

What are the possible alpha 2 agonist combination products?

A

-Combigan (brimonidine+timolol)
-Simbrinza (brimonidine+brinzolamide)

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30
Q

What are the brand names for brimonidine?

A

-Alphagan P
-Lumify (OTC for redness of eye)

31
Q

What is the brand name for aprachlonidine?

A

Lopidine

32
Q

How are alpha 2 agonists dosed?

A

1 drop TID (TID dosing is why it is not always first line)

33
Q

How much do alpha 2 agonists reduce intraocular pressure?

A

25%

34
Q

Contraindications of alpha 2 agonists

A

CNS depression

35
Q

Side effects of alpha 2 agonists

A

-Dry eyes
-Xerostomia
-Blurry vision
-Conjunctival hyperemia
-Sedation
-Confusion
-Hypertension

36
Q

What are the carbonic anhydrase inhibitors?

A

Ophthalmic:
-Dorzolamide
-Brinzolamide

Oral:
-Acetazolamide
-Methazolamide

37
Q

What are the possible carbonic anhydrase inhibitor combination products?

A

-Cosopt (dorzolamide+timolol)
-Simbrinza (brinzolamide+brimonidine)

38
Q

How do you dose ophthalmic carbonic anhydrase inhibitors?

A

1 drop TID

39
Q

How do you dose oral carbonic anhydrase inhibitors?

A

50 to 100 mg PO 2 to 3 times daily

40
Q

How much does carbonic anhydrase inhibitors reduce intraocular pressure?

A

15-20%

41
Q

Warning associated with carbonic anhydrase inhibitors

A

-Sulfonamide allergy
-Can crystallize if the bottle is not capped
-Use with caution if CrCl is less than 30

42
Q

Side effects associated with ophthalmic carbonic anhydrase inhibitors

A

-Burning
-Blurred vision
-Blepharitis
-Taste disturbances

43
Q

Side effects associated with oral carbonic anhydrase inhibitors

A

-Ataxia
-Confusion
-Photosensitivity
-Nausea
-Metabolic acidosis

44
Q

Second line treatment of open-angle glaucoma

A

-Alpha 2 agonists (first or second)
-Carbonic anhydrase inhibitors

45
Q

Third line treatment of open-angle glaucoma

A

-Rho Kinase inhibitors

46
Q

What are the rho kinase inhibitors?

A

-Netarsudil

47
Q

What are the possible rho kinase inhibitor combination products?

A

-Rocklatan (Netarsudil+latanoprost)

48
Q

What is the brand name for dorzolamide?

A

Trusopt

49
Q

What is the brand name for brinzolamide?

A

Azopt

50
Q

What is the brand name for netarsudil?

A

Rhopressa

51
Q

How do you dose rho kinase inhibitors?

A

1 drop every day in the evening

52
Q

How much do rho kinase inhibitors reduce intraocular pressure?

A

25-30%

53
Q

Side effects associated with rho kinase inhibitors

A

-Burning
-Corneal disease
-Conjunctival hemorrhage
-Conjunctival hyperemia

54
Q

Last line treatment of open-angle glaucoma

A

Cholinergics

55
Q

What are the cholinergics?

A

-Carbachol
-Pilocarpine

56
Q

Brand name for carbachol

A

Milostat

57
Q

Brand name for pilocarpine

A

Isopto Carpine

58
Q

How do you dose carbachol?

A

1-2 drops up to TID

59
Q

How do you dose pilocarpine?

A

1-2 drops up to QID

60
Q

How much do cholinergics reduce intraocular pressure?

A

15-25%

61
Q

Contraindications and warnings associated with cholinergics

A

Use with caution in patients with history of retinal detachment or corneal abrasion

62
Q

Side effects associated with cholinergics

A

-Pupil constriction
-Corneal clouding
-Hypotension
-Bronchospasm
-Abdominal cramps

63
Q

How often should patients with open-angle glaucoma be assessed?

A

Assess response every 2-4 weeks

64
Q

What should always be ensured in patients with open-angle glaucoma?

A

-Compliance
-Proper administration technique

65
Q

What to do for patients intolerant to their open-angle glaucoma treatment

A

-Reduce dose/concentration
-Change formulation
-Switch class alternative or different combination

66
Q

How long should you wait before administering the second drop of the same medication?

A

5 minutes

67
Q

How long should you wait before administering the second drop of a different medication?

A

5-10 minutes between drops

68
Q

Symptoms of closed-angle glaucoma

A

-Severe headache
-Severe pain
-Nausea or vomiting
-Blurred vision
-Halos around light
-Eye redness or cloudy cornea

69
Q

How do you treat closed-angle glaucoma?

A

-Hyperosmotic agents
-Surgery (Iridotomy)

70
Q

Examples of hyperosmotic agents

A

-Mannitol (IV)
-Glycerin (PO)

71
Q

How do you dose mannitol?

A

1.5-2 g/kg/dose over 30 minutes

72
Q

How do you dose glycerin?

A

1-2 g/kg/dose every 5 hours as required

73
Q

What medications can increase intraocular pressure?

A

-Anticholinergics (Oxybutynin, tolterodine, benztropine, scopolamine)
-Chronic steroids
-Decongestants (pseudoephedrine)
-Topiramate
-Antidepressants (fluoxetine, paroxetine, amitriptyline, duloxetine)

Therapeutics II (33 decks)

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