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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
Q

Betaxolol

A

BETOPTIC S

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26
Q

Timolol

27
Q

Levobunolol

28
Q

Metipranolol

A

OPTIPRNOLOL

29
Q

Carteolol

30
Q

What is the MOA of beta blockers?

A

decrease aqueous humor production

31
Q

Which beta blocker is superior in decreasing IOP?

32
Q

What is the predominant receptor in the eye?

33
Q

How are beta blockers generally dosed?

34
Q

What are SEs with beta blockers?

A
  1. exacerbation of COPD/ precipitation of bronchospasm
  2. burning/stinging upon application
35
Q

What selective alpha 2 agonists are used for glucoma?

A

Apraclonidine
Brimonidine

36
Q

Apraclonidine

37
Q

Brimonidine

A

ALPHAGAN P

38
Q

What is the MOA of alpha 2 agonists?

A
  1. decreased aqueous humor production
  2. increased outflow
39
Q

Why is Brimonidine the preferred agent?

A
  1. no ocular allergic SE
  2. decreased incidence of tachyphylaxis
40
Q

What are the SEs of alpha 2 agonists?

A
  1. tearing
  2. foreign body sensation
  3. ocular inflammation
  4. dry mouth
  5. altered taste
41
Q

How are alpha 2 agonists usually dosed?

42
Q

What carbonic anhydrase inhibitors are used for glaucoma?

A

topical:
1. Brinzolamide
2. Dorzolamide
oral:
1. Acetazolamide
2. Methazolamide

43
Q

Brinzolamide

44
Q

Dorzolamide

45
Q

Acetazolamide

46
Q

Methazolamide

47
Q

What is the MOA of carbonic anhydrase inhibitors?

A

decreased secretion of aqueous humor by inhibiting carbonic anhydrase in the ciliary body

48
Q

What are SEs of oral carbonic anhydrase inhibitors?

A
  1. SJS/TENS
  2. malaise
  3. bone marrow suppression
49
Q

What are SEs of topical carbonic anhydrase inhibitors?

A
  1. stinging
  2. blurry vision
  3. corneal edema
  4. altered taste sensation
50
Q

What Rho Kinase inhibitor is used for glaucoma?

A

Netarsudil (Rhopressa)

51
Q

Netarsudil

52
Q

What is the MOA of rho kinase inhibitor?

A
  1. lowers resistance to outflow through the trabecular meshwork
  2. decreases production of aqueous fluid
  3. decreases episcleral venous pressure
53
Q

What role do rho kinase inhibitors have in glaucoma treatment?

A

not used as monotherapy unless:
1. concern with PG analog
2. intolerant/ inadequate efficacy with PG analogs
3. need or prefer alternative agent

54
Q

What SEs do rho kinase inhibitors have?

A
  1. conjunctival hyperemia
  2. corneal verticillate
  3. conjunctival hemorrhage
  4. application site pain
55
Q

What mitotic (cholinergic) agents are used for glaucoma?

A
  1. Pilocarpine
  2. Carbachol
  3. Echothiophate iodide
56
Q

Pilocarpine

A

ISOPTO CARPINE

57
Q

Carbachol

58
Q

Echithiophate iodide

A

PHOSPHOLINE IODIDE

59
Q

What is the MOA of mitotics?

A

increased outflow of aqueous humor through trabecular meshwork

60
Q

What are SEs with mitotic agents?

A
  1. brow ache
  2. induced myopia
  3. decreased vision in low light
61
Q

What are the administration steps for eyedrops?

A
  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
Q

What can be done about shaky hands?

A
  1. rest your hand on the face
  2. use 1-2 lbs wrist weight
  3. wrap paper towel around bottle
63
Q

What is the treatment of closed angle glaucoma?

A

surgical intervention + medications

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