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Humber Cardio FINAL > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Primary Open Angle Glaucoma (POAG)

  1. what kind of sx’s? until ?
  2. What happens when it gets severe?
A
  1. Asymptomatic … vision loss is severe
  2. Progressive, peripheral –> central
    -Isolated scotomas or altered color vision
    -irreversible
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2
Q

POAG : Objective
1. Each eye is evaluated ___
2. What kind of 3 exams?

A
  1. independently
  2. Visual field testing (automated perimetry), fundus exam, anterior chamber angle (gonioscopy) –> distinguishes open from closed angle glaucoma
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3
Q

Etiology : Intolerance of retinal tissue to ? this results in ?

Glaucoma can be secondary to other causes such as ? (4)

A
  1. intraocular pressure
    - retinal damage and vision loss
  2. -glucocorticoid use
    -mass effect
    -hemorrhage
    -neovascularization (abnormal vessel growth)
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4
Q

Risk factors POAG (4)

A
  1. Elevated intraocular pressure (IOP)
  2. Older age
  3. African or Hispanic race
  4. Family history
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5
Q

Normal range for IOP?

A

8-21 mmhg

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6
Q

When do you treat:

  1. yes if ?
  2. Depends if?
  3. Goals of therapy? (2)
A
  1. Any vision loss or damage to optic disk
  2. Elevated IOP alone! consider pt risk factors, drugs pros and cons
  3. Prevent loss of vision and reduce IOP by 20-30% and up to 50%
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7
Q

Systemic AE’s
1. Prostaglandins? (2) (QHS)

  1. Beta blockers (BID)
    -3 main categories?
    -CI’s (5)
    -Precaution in ? (4)
    -DDI’s?
  2. Alpha Agonists - Brimonidine (TID)
    -2 main categories?
    (5) actual ae’s
A
  1. Muscle and joint pain, flu like sx’s which are rare
  2. 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

  1. cardiovasc + psychiatric
    -decr BP, sedation, fatigue, depression, dry mouth
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8
Q

Systemic AE’s :
1) CAI’s (TID)
-Allergic ? (2)
-Electrolytes / Heme? (3)

2) Cholinergic Agents (TID)
-Respiratory (1)?
-GI? (4)
-Other? (2)

A
  1. SJS, sulfa allergy
    -kidney stones, acidosis, blood dyscrasias (Decr RBC’s , PLT’s, WBC’s)
    • Bronchospasm
      - nausea, vomiting, diarrhea, cramping
      -Urinary frequency, sweating
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9
Q

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___

A
  1. Dryness, burning, stinging, tearing, corneal anesthesia, hyperemia –> prostaglandins
  2. Conjunctivitis, blepharitis, keratitis, uveitis
  3. cholinergics, CAI’s, alpha agonists
  4. blurred vision
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10
Q

Loca AE’s for Specific Agents

  1. Prostaglandins (2) (I, H, E –> Caution in ?)
  2. Alpha agonists? (A)
  3. CAI’s ? (B)
  4. Cholinergics? (V)
A
  1. Iris darkening –> permanent, especially in light or multi - colored eyes
    -Hyperemia (redness) , eyelash thickening –> caution in macular edema, keratitis, HSV reactivation
  2. Allergic like rxn –> itch, hyperemia, conjunctivitis, edema
  3. Bitter taste, burning –> burning with Dorzolamide > Brinzolamide
  4. Vision changes –> Miosis (night blindness), myopia (nearsightedness)
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11
Q

Frequency and Cost : See Chart

A

See chart

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12
Q

Benefits of Combo Products?

Name 4

A
  1. simpler admin
  2. no 5-10 minute wait between drops
  3. may allow longer dosing interval
  4. fewer copays
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13
Q

Combo products :

  1. What is combigan ?
  2. What is Cosopt ?
A
  1. Brimonidine + Timolol
  2. Dorzolamide + timolol
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14
Q

Prostaglandins :

  1. Latanoprost : need to store in ? Cost?
  2. travoprost?
    -Highest incidence of ?
    -May be more effective in ?
    -Formulation is free of ?
  3. Bimatoprost
    -Available as __ for glaucoma and __ for eyelashes
  4. Tafluprost
    -__ free, ___ product ; less __
    -___ risk !
  5. Unoprostone
    -Dosing ?
    -Whats not available?
A
  1. fridge until open. least expensive
  2. hyperemia
    -black pt’s
    -benzalkonium chloride (BAK) preservative
  3. Lumigan, latisse
  4. Preservative free, single use, irritating
    -infection
  5. BID , may be less effective than other PG’s
    -no generic avail!!
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15
Q

Beta Blockers

  1. Timolol
    -Which has qdaily dosing and fewer systemic AE’s?
    -which is preservative free?
  2. Betaxolol : the only ____ therefore should have less ___ but may also be less effective
  3. Carteolol
    - the only ___, should have fewer ___ but similar efficacy to __
  4. Levobunolol
    -May be used ___ or __, similar efficacy to ____
  5. Metipranolol
    -rarely used due to ?
A
  1. Timoptic XE Gel
    -Timoptic OcuDose
  2. B1 specific antag , systemic ae’s
  3. partial agonist, systemic ae’s, timolol
  4. daily or BID, timolol
  5. Frequent uveitis, stinging , burning
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16
Q

Follow up Action :

  1. If IOP above target what should u do?
  2. If progressive disease?
  3. AE”s or intolerance?

Follow up Frequency
1. Progressive disease
2. IOP above goal ?
3. Stable

A
  1. Incr dose, add agent, switch agents
  2. Lower target IOP
  3. Switch agents
  4. q 1 -2 months
  5. q 3-6 months
  6. q 6-12 months
17
Q

Admin Technique

  1. Naso lacrimal Occlusion
    -enhances ___
    -Reduces ___
    -May allow ___
  2. If you have to use multiple drops at the same time, separate by how long?
  3. this avoids?
A
  1. -efficacy
    - systemic AE’s
    -lower dosing freq
  2. > = 5 mins
  3. Dilution and washout
18
Q

Contact Lenses
1) Remove when ?
2) How long to wait before reinserting ?
3) Especially for drops with ?

Hygiene

  1. before admin do this
  2. avoid direct eye contact with ___
  3. keep dropper __
A
  1. prior to admin
  2. 15 mins
  3. Benzalkonium-chloride (BAK) , preservative absorbed by soft lenses
  4. wash hands
  5. dropper
  6. clean
19
Q

CAp Color codes

  1. Turquoise
  2. Blue and Yellow
  3. Purple
  4. Orange
  5. Green
  6. Pink
A
  1. Prostaglandins
  2. Beta blockers
  3. Alpha agonists
  4. CAI’s
  5. Cholinergics
  6. NSAIDS and steroids
20
Q

Primary Angle CLOSURE GLAUCOMA (PACG)

  1. Acute crisis
    what are the LOCAL sx’s? (5)
    Systemic sx’s? (4)
    rapidly progressive to ?
  2. Chronic disease is similar to ?
A
  1. pain, redness, swelling, vision loss / halos
  • nausea, vomiting, sweating, headache
  • permanent vision loss
  1. open angle glaucoma
21
Q

PACG Objective
1. Acute crisis –> Closed angle, ____, ____
-IOP may exceed ?

  1. Chronic disease
    -Closed angle, otherwise similar to ?
A
  1. ocular edema, mydriasis
    - 30-40 mmHg
  2. POAG
22
Q

Etiology : drugs that may precipitate acute attacks

  1. Anticholinergics such as ? (3 classes)
  2. Sympathomimetics such as ?
A
  1. OTC antihistamines, some antipsychotics + antidepressants
  2. OTC decongestants, some drugs of abuse
23
Q

PACG : RISK FACTORS ? (4)

A
  1. fam history
  2. older age
  3. female sex
  4. asian or inuit race
24
Q

Acute Crisis TX : Topical Therapy

  1. use some or all topical agent classes.. how many drops?
  2. Cholinergics can lose effectiveness at very high ___
  3. Prostaglandins NOT INDICATED due to ?
A
  1. 1 drop each , STAT
  2. IOP
  3. Slow onset
25
Q

Acute Crisis TX : Systemic Therapy

  1. Acetazolamide
    -Dose?
    -Best __ and most __
  2. Mannitol
    -Dose?
    -More __ and less practical, but very __
  3. Surgical Therapy ? (Whats the procedure called)
  4. 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 __

A
  1. 500 mg IV/PO stat
    -tolerated, practical
  2. 0.5-1.5 g/kg IV STAT
    -AE’s , powerful
  3. Laser iridotomy ASAP
  4. Pre-op corneal cloudiness
    -peri-op prevention of synechiae
    -post op inflammation
  5. laser iridotomy
    -open angle tx

Humber Cardio FINAL (13 decks)

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