Glaucoma

Question 1

Etiology

Answer 1

Primary
-Intolerance of retinal tissue to intraocular pressure

Secondary
-GC
-Mass effect
-Hemorrhage
-Abnormal vessel growth

Question 2

RF

Answer 2

-Elevated IOP
-Older age
-African, Hispanic
-Family hx

*T2D, myopia, thin cornea, migraine

Question 3

Efficacy

Answer 3

-Prostaglandins are most effective, then BB
-Other agents still reasonable to use

Question 4

Prostaglandins AE
-End in prost

Answer 4

-Muscle/joint pain
-Flu like sx
-Iris darkening
-Hyperemia (red)
-Eyelash thickening

HM PIE

Question 5

BB AE

Answer 5

-Respiratory, CV, psychiatric

CI: asthma, COPD, heart block, CHF, bradycardia (CH ABC)

DDI: CCB (additive effect with anti-htn)

Question 6

Alpha Agonist, Brimonidine AE

Answer 6

-Low BP
-Sedation
-Fatigue
-Depression
-Dry mouth
-Itch, red, itis, edema

DID BRIM SELFI

Question 7

CAIs (dorzolamide, brinzolamide) AE

Answer 7

-SJS, sulfa allergy
-Kidney stones
-Acidosis
-Blood dycrasias (low RBC/PLT/WBC)
-Bitter taste
-Burning (dorz)

zola has SKABBBS

Question 8

Pilocarpine AE

Answer 8

-Bronchospasm
-NVD, cramping
-Urinary frequency
-Sweating
-Mitosis, myopia

PIE MM BUNS

*cholinergic

Question 9

Local AE: any agent

Answer 9

-Eye discomfort (dry, burn, sting, tear)
-Allergic/inf: anything ending in ITIS
-HA (C/CAI/AA)
-Blurred vision

Question 10

Monitoring Parameters

Answer 10

-IOP, eye exam, sx
-AEs
-Technique, adherence

Question 11

Follow-Up Action

Answer 11

IOP above target
-Increase dose
-Add agent
-Switch agents

Progressive disease
-Lower target IOP

AEs
-Switch agents

Question 12

Follow-Up Frequency

Answer 12

PD Q1-2 months

IOP+ Q3-6 months

Stable Q6-12 months

Question 13

Pt Ed: admin

Answer 13

1. Naso-lacrimal occlusion
2. Separate by 5+ min if using multiple drops
3. Remove contact lenses before admin, wait 15 min before reinserting
4. Hygiene (wash hands, keep dropper clean)

Question 14

Acute Crisis Tx

Answer 14

1. Acetazolamide 500 mg IV/PO STAT
2. Mannitol 0.5-1.5 g/kg IV STAT

Topical tx
-some/all, 1 drop each, stat

IOP 30-40+

Question 15

Combination Tx

Answer 15

Brim + Timolol = Combigan

Dora + Timolol = Cosopt

Simpler admin, no waiting, longer dosing interval, fewer copays