Glaucoma Flashcards
Primary Open Angle Glaucoma (POAG)
- what kind of sx’s? until ?
- What happens when it gets severe?
- Asymptomatic … vision loss is severe
- Progressive, peripheral –> central
-Isolated scotomas or altered color vision
-irreversible
POAG : Objective
1. Each eye is evaluated ___
2. What kind of 3 exams?
- independently
- Visual field testing (automated perimetry), fundus exam, anterior chamber angle (gonioscopy) –> distinguishes open from closed angle glaucoma
Etiology : Intolerance of retinal tissue to ? this results in ?
Glaucoma can be secondary to other causes such as ? (4)
- intraocular pressure
- retinal damage and vision loss - -glucocorticoid use
-mass effect
-hemorrhage
-neovascularization (abnormal vessel growth)
Risk factors POAG (4)
- Elevated intraocular pressure (IOP)
- Older age
- African or Hispanic race
- Family history
Normal range for IOP?
8-21 mmhg
When do you treat:
- yes if ?
- Depends if?
- Goals of therapy? (2)
- Any vision loss or damage to optic disk
- Elevated IOP alone! consider pt risk factors, drugs pros and cons
- Prevent loss of vision and reduce IOP by 20-30% and up to 50%
Systemic AE’s
1. Prostaglandins? (2) (QHS)
- Beta blockers (BID)
-3 main categories?
-CI’s (5)
-Precaution in ? (4)
-DDI’s? - Alpha Agonists - Brimonidine (TID)
-2 main categories?
(5) actual ae’s
- Muscle and joint pain, flu like sx’s which are rare
- respiratory, cardiovascular, psychiatric
-CI : asthma, COPD, HEart block, CHF, bradycardia
-Cardiac arrhythmias, DM, depression, thyroid disease
-Additive effects
w/antihypertensives especially CCB’s and beta blockers
- cardiovasc + psychiatric
-decr BP, sedation, fatigue, depression, dry mouth
Systemic AE’s :
1) CAI’s (TID)
-Allergic ? (2)
-Electrolytes / Heme? (3)
2) Cholinergic Agents (TID)
-Respiratory (1)?
-GI? (4)
-Other? (2)
- SJS, sulfa allergy
-kidney stones, acidosis, blood dyscrasias (Decr RBC’s , PLT’s, WBC’s) - Bronchospasm
- nausea, vomiting, diarrhea, cramping
-Urinary frequency, sweating
- Bronchospasm
Local AE’s for Any Agent
1) Eye discomfort such as ? Mostly ___
2) Allergic rxns and inflamm such as ? (4)
3) Headaches w/mostly (3) ?
4) B___
- Dryness, burning, stinging, tearing, corneal anesthesia, hyperemia –> prostaglandins
- Conjunctivitis, blepharitis, keratitis, uveitis
- cholinergics, CAI’s, alpha agonists
- blurred vision
Loca AE’s for Specific Agents
- Prostaglandins (2) (I, H, E –> Caution in ?)
- Alpha agonists? (A)
- CAI’s ? (B)
- Cholinergics? (V)
- Iris darkening –> permanent, especially in light or multi - colored eyes
-Hyperemia (redness) , eyelash thickening –> caution in macular edema, keratitis, HSV reactivation - Allergic like rxn –> itch, hyperemia, conjunctivitis, edema
- Bitter taste, burning –> burning with Dorzolamide > Brinzolamide
- Vision changes –> Miosis (night blindness), myopia (nearsightedness)
Frequency and Cost : See Chart
See chart
Benefits of Combo Products?
Name 4
- simpler admin
- no 5-10 minute wait between drops
- may allow longer dosing interval
- fewer copays
Combo products :
- What is combigan ?
- What is Cosopt ?
- Brimonidine + Timolol
- Dorzolamide + timolol
Prostaglandins :
- Latanoprost : need to store in ? Cost?
- travoprost?
-Highest incidence of ?
-May be more effective in ?
-Formulation is free of ? - Bimatoprost
-Available as __ for glaucoma and __ for eyelashes - Tafluprost
-__ free, ___ product ; less __
-___ risk ! - Unoprostone
-Dosing ?
-Whats not available?
- fridge until open. least expensive
- hyperemia
-black pt’s
-benzalkonium chloride (BAK) preservative - Lumigan, latisse
- Preservative free, single use, irritating
-infection - BID , may be less effective than other PG’s
-no generic avail!!
Beta Blockers
- Timolol
-Which has qdaily dosing and fewer systemic AE’s?
-which is preservative free? - Betaxolol : the only ____ therefore should have less ___ but may also be less effective
- Carteolol
- the only ___, should have fewer ___ but similar efficacy to __ - Levobunolol
-May be used ___ or __, similar efficacy to ____ - Metipranolol
-rarely used due to ?
- Timoptic XE Gel
-Timoptic OcuDose - B1 specific antag , systemic ae’s
- partial agonist, systemic ae’s, timolol
- daily or BID, timolol
- Frequent uveitis, stinging , burning
Follow up Action :
- If IOP above target what should u do?
- If progressive disease?
- AE”s or intolerance?
Follow up Frequency
1. Progressive disease
2. IOP above goal ?
3. Stable
- Incr dose, add agent, switch agents
- Lower target IOP
- Switch agents
- q 1 -2 months
- q 3-6 months
- q 6-12 months
Admin Technique
- Naso lacrimal Occlusion
-enhances ___
-Reduces ___
-May allow ___ - If you have to use multiple drops at the same time, separate by how long?
- this avoids?
- -efficacy
- systemic AE’s
-lower dosing freq - > = 5 mins
- Dilution and washout
Contact Lenses
1) Remove when ?
2) How long to wait before reinserting ?
3) Especially for drops with ?
Hygiene
- before admin do this
- avoid direct eye contact with ___
- keep dropper __
- prior to admin
- 15 mins
- Benzalkonium-chloride (BAK) , preservative absorbed by soft lenses
- wash hands
- dropper
- clean
CAp Color codes
- Turquoise
- Blue and Yellow
- Purple
- Orange
- Green
- Pink
- Prostaglandins
- Beta blockers
- Alpha agonists
- CAI’s
- Cholinergics
- NSAIDS and steroids
Primary Angle CLOSURE GLAUCOMA (PACG)
- Acute crisis
what are the LOCAL sx’s? (5)
Systemic sx’s? (4)
rapidly progressive to ? - Chronic disease is similar to ?
- pain, redness, swelling, vision loss / halos
- nausea, vomiting, sweating, headache
- permanent vision loss
- open angle glaucoma
PACG Objective
1. Acute crisis –> Closed angle, ____, ____
-IOP may exceed ?
- Chronic disease
-Closed angle, otherwise similar to ?
- ocular edema, mydriasis
- 30-40 mmHg - POAG
Etiology : drugs that may precipitate acute attacks
- Anticholinergics such as ? (3 classes)
- Sympathomimetics such as ?
- OTC antihistamines, some antipsychotics + antidepressants
- OTC decongestants, some drugs of abuse
PACG : RISK FACTORS ? (4)
- fam history
- older age
- female sex
- asian or inuit race
Acute Crisis TX : Topical Therapy
- use some or all topical agent classes.. how many drops?
- Cholinergics can lose effectiveness at very high ___
- Prostaglandins NOT INDICATED due to ?
- 1 drop each , STAT
- IOP
- Slow onset
Acute Crisis TX : Systemic Therapy
- Acetazolamide
-Dose?
-Best __ and most __ - Mannitol
-Dose?
-More __ and less practical, but very __ - Surgical Therapy ? (Whats the procedure called)
- Short term topical Medications w/ surg therapy
-Osmotics PRN for?
-Mydriatics PRN for?
-Corticosteroids for ?
Chronic Tx :
1) L___
2) Further therapy if needed, same agents in __
- 500 mg IV/PO stat
-tolerated, practical - 0.5-1.5 g/kg IV STAT
-AE’s , powerful - Laser iridotomy ASAP
- Pre-op corneal cloudiness
-peri-op prevention of synechiae
-post op inflammation - laser iridotomy
-open angle tx
