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Glaucoma Flashcards

1
Q

What is glaucoma?

A

optic neuropathy and progressive degeneration of retina ganglion cells; fluid accumulation and increased intraocular pressure

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2
Q

What is open-angle glaucoma?

A

clogging of drainage canals resulting in increased pressure

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3
Q

What is closed-angle glaucoma?

A

blockage of drainage canals causing a closed/ narrow angle between iris and cornea

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4
Q

What are risk factors for open-angle glaucoma?

A
  1. high IOP
  2. older age
  3. family hx
  4. African race
  5. Latino/Hispanic
  6. thinner central cornea
  7. myopia (near sighted)
  8. Type 2 DM
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5
Q

At what pressure is there optic nerve damage?

A

IOP >21mmHg

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6
Q

A reduction in IOP by how much will slow the progression of optic nerve damage?

A

25% reduction

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7
Q

When would a lower IOP/ more aggressive treatment be appropriate?

A
  1. severe optic nerve damage
  2. rapid progression of damage
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8
Q

When would a less aggressive treatment be appropriate?

A
  1. risk of treatment > benefits
  2. limited life expectancy
  3. can’t tolerate meds
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9
Q

Bimatoprost

A

LUMIGAN

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10
Q

Bimatoprost implant

A

DURYSTA

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11
Q

Latanoprost

A

XALATAN
XELPROS

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12
Q

Tafluprost

A

ZIOPTAN

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13
Q

Travoprost

A

TRAVATAN

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14
Q

Travoprost implant

A

iDose TR

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15
Q

Unoprostone

A

RESCULA

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16
Q

Latanoprostene bunod

A

VYZULTA

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17
Q

What is the MOA of prostaglandin analogs?

A

increased uveoscleral outflow of aqueous humor

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18
Q

What are the first-line agents for open-angle glaucoma?

A

Prostaglandin analogs “prost”

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19
Q

How much do prostaglandin analogs reduce IOP by?

A

25-30%

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20
Q

How are prostaglandin analogs generally dosed?

A

QD

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21
Q

What are SEs with prostaglandin analogs?

A
  1. increased pigmentation of the iris (irreversible)
  2. increased number, thickness, curvature, and pigmentation of eyelashes
  3. ocular pruritis/dryness/blurring
  4. eyelid erythema
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22
Q

What is the MOA of Latanoprostene bunod?

A

Nitric oxide-donating prostaglandin analog
latanoprost acid: increased aqueous humor outflow through uveoscleral pathway
Butanediol mononitrate: increase aqueous humor outflow through trabecular channel (nitric oxide)

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23
Q

What are the benefits of implant devices?

A

Bimatoprost: lasts several months
Travoprost: lasts 4-5 years

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24
Q

What beta blockers are used for glaucoma?

A
  1. betaxolol
  2. timolol
  3. levobunolol
  4. metipranolol
  5. carteolol
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25
Betaxolol
BETOPTIC S
26
Timolol
TIMOPTIC
27
Levobunolol
BETAGAN
28
Metipranolol
OPTIPRNOLOL
29
Carteolol
OCUPRESS
30
What is the MOA of beta blockers?
decrease aqueous humor production
31
Which beta blocker is superior in decreasing IOP?
Timolol
32
What is the predominant receptor in the eye?
Beta 2
33
How are beta blockers generally dosed?
BID
34
What are SEs with beta blockers?
1. exacerbation of COPD/ precipitation of bronchospasm 2. burning/stinging upon application
35
What selective alpha 2 agonists are used for glucoma?
Apraclonidine Brimonidine
36
Apraclonidine
IOPIDINE
37
Brimonidine
ALPHAGAN P
38
What is the MOA of alpha 2 agonists?
1. decreased aqueous humor production 2. increased outflow
39
Why is Brimonidine the preferred agent?
1. no ocular allergic SE 2. decreased incidence of tachyphylaxis
40
What are the SEs of alpha 2 agonists?
1. tearing 2. foreign body sensation 3. ocular inflammation 4. dry mouth 5. altered taste
41
How are alpha 2 agonists usually dosed?
TID
42
What carbonic anhydrase inhibitors are used for glaucoma?
topical: 1. Brinzolamide 2. Dorzolamide oral: 1. Acetazolamide 2. Methazolamide
43
Brinzolamide
AZOPT
44
Dorzolamide
TRUSOPT
45
Acetazolamide
DIAMOX
46
Methazolamide
NEPTAZANE
47
What is the MOA of carbonic anhydrase inhibitors?
decreased secretion of aqueous humor by inhibiting carbonic anhydrase in the ciliary body
48
What are SEs of oral carbonic anhydrase inhibitors?
1. SJS/TENS 2. malaise 3. bone marrow suppression
49
What are SEs of topical carbonic anhydrase inhibitors?
1. stinging 2. blurry vision 3. corneal edema 4. altered taste sensation
50
What Rho Kinase inhibitor is used for glaucoma?
Netarsudil (Rhopressa)
51
Netarsudil
RHOPRESSA
52
What is the MOA of rho kinase inhibitor?
1. lowers resistance to outflow through the trabecular meshwork 2. decreases production of aqueous fluid 3. decreases episcleral venous pressure
53
What role do rho kinase inhibitors have in glaucoma treatment?
not used as monotherapy unless: 1. concern with PG analog 2. intolerant/ inadequate efficacy with PG analogs 3. need or prefer alternative agent
54
What SEs do rho kinase inhibitors have?
1. conjunctival hyperemia 2. corneal verticillate 3. conjunctival hemorrhage 4. application site pain
55
What mitotic (cholinergic) agents are used for glaucoma?
1. Pilocarpine 2. Carbachol 3. Echothiophate iodide
56
Pilocarpine
ISOPTO CARPINE
57
Carbachol
MIOSTAT
58
Echithiophate iodide
PHOSPHOLINE IODIDE
59
What is the MOA of mitotics?
increased outflow of aqueous humor through trabecular meshwork
60
What are SEs with mitotic agents?
1. brow ache 2. induced myopia 3. decreased vision in low light
61
What are the administration steps for eyedrops?
1. wash hands 2. do not touch eye with tip of dropper 3. wait 5 minutes between eye drops 4. remove contact lenses before using eye drops 5. Wait 15 minutes before putting contact lenses back in
62
What can be done about shaky hands?
1. rest your hand on the face 2. use 1-2 lbs wrist weight 3. wrap paper towel around bottle
63
What is the treatment of closed angle glaucoma?
surgical intervention + medications

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