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PEBC > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

_____________ is the term used to describe a group of ocular diseases in which optic neuropathy leads to peripheral vision loss

A

Glaucoma, cupping of the optic nerve occurs

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2
Q

The nerve damage in glaucoma is a result of elevated ?

A

IOP within the eye (> 22 mmHg)

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3
Q

Elevated ___, also known as ocular hypertension, is the most important and only modifiable risk factor for glaucoma

A

IOP

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4
Q

3 Glaucoma subtypes?
1.
2.
3.

A

POAG

SOAG

ACG - angle closure glaucoma

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5
Q

Risk factors for the development of glaucoma

POAG
1.
2.
3.

SOAG
1
2.
3.

ACG
1.
2.
3.

A

POAG
1.Advance Age
2. IOP
3. Black/Hispanic
fam hx, vascular dx

SOAG
1. Trauma
2. Surgery
3. steroid use (inhaled, nasal, systemic)

ACG
1. inuit, asian, caucasian
2. female
3. advance age

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6
Q

Ocular hypertension is defined as IOP > ___ mmHG but normal visual fields and normal optic discs

A

21 mmHG

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7
Q

What is the most common type of glaucoma

A

Primary open angle glaucoma

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8
Q

Primary open angle glaucoma develops slowly and is a result of

A

poor drainage of aqueous humor

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9
Q

Secondary open angle glaucoma is caused by underlying conditions and leads to blockage of the?

A

trabecular meshwork and canal of schlemm

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10
Q

Angle closure glaucoma is considered a ?

A

Medical emergency
- develops suddenly with rapid increase in IOP causing sudden blurred vision, severe pain, halos

Acute attack may terminate without treatment but if IOP remains high it will cause irreversible optic nerve damage

Fluid cannot drain out

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11
Q

Some drug induced causes of glaucoma include:

A
  1. corticosteroids **
  2. anticholinergic agents
  3. topiramate
  4. oral contraceptives use of longer than 3-5 years may be associated with higher prevalence of POAG
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12
Q

Lifestyle modifications have not been shown to alter the outcome of the disease. _______________can lower IOP modestly in some patients with glaucoma

A

aerobic exercise

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13
Q

______ or ________ procedures are treatment options if drug therapy is unsuccessful or not tolerated by the patient

A

laser or surgical

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14
Q

Laser trabeculoplasty indicated for what type of glaucoma?

A

Open angle glaucoma

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15
Q

1st line agents for glaucoma?

A

Prostaglandin analogues

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16
Q

Latanoprost, travoprost and latanoprostene are

A

prostaglandin analogues, dosed once daily HS

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17
Q

All prostaglandin analogues work by increasing outflow of aqueous humour through the _________ pathway

A

uveoscleral pathway

(Latanoprost and travoprost increase outflow by both uveo and trabecular pathways)

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18
Q

This prostaglandin analogue must be stored in the fridge until dispensed (6 weeks at room temp)

A

Latanoprost

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19
Q

Adverse effects associated with prostaglandin analogues
1.
2.

A
  1. increase eyelash length
  2. iris pigmentation

burn, itch, foreign body sensation

20
Q

This prostaglandin analogue does not use benzalkonium as a preservative, instead it uses ionic buffer

A

Travoprost

21
Q

Timolol, Betaxolol, Levobunolol, belong to beta-blockers, which reduce IOP by ?

A

inhibiting formation of aqueous humor

22
Q

This topical beta blocker is B1 specific and is associated with less systemic side effects:

A

Betaxololl

23
Q

Topical betablockers are contraindicated in
1.
2.

A

Pulmonary and cardiac disease

asthma, cold, Bradycardia, heart block, overt HF

24
Q

Systemic side effects of topical beta blockers include?
1.
2.
3.

A
  1. bronchospasms
  2. exacerbation of CHF
  3. dyspnea, Bradycardia, syncope
25
Q

This topical beta blocker is available as a gel-forming solution and can be dosed once daily instead of BID

A

Timolol

26
Q

Brinzolamde and Dorzolamide are examples of ?

A

Carbonic anhydrase inhibitors

2nd line or adjunct

27
Q

Carbonic anhydrase inhibitors reduce IOP by ?

A

inhibiting enzyme carbonic anhydrase, which is involved in the production of aqueous humour thereby reducing aqueous humour formation

28
Q

Class of topical therapy for glaucoma associated with bitter, sour or unusual taste?

A

Carbonic anhydrase inhibitors

29
Q

Brimonidine and apraclonidine belong to what class of medications?

A

Alpha2 adrenergic agonists

30
Q

Apraclonidine was thefirst alpha2-specific agonist introduced, but local allergic reactions limit its use to the management of acute _____ _______

A

IOP spikes

31
Q

_______ has higher alpha-2 selectivity and is used for both open and closed angle glaucoma

A

Brimonidine

32
Q

Alpha2 Adrenergic agonists work to decrease IOP by
1.
2.

A

Suppress formation of aqueous humor

increase uvescleral outflow

33
Q

Alpha2 adrenergic agonists are contraindicated:
1.
2.

A

with MAOi

Children <6

34
Q

Systemic side effects with alpha2 adrenergic agonists:
1.
2.
3.

A

Dry mouth/nose
fatigue
drowsiness/dizzy
Headache,
dec HR/BP

35
Q

The only drug okay in pregnancy for glaucoma ?

A

Brimonidine P1/P2

36
Q

The topical cholinergic agonists (e.g., pilocarpine) directly stimulate muscarinic receptors to contract the ciliary muscle and increase ___________ outflow

A

trabecular

37
Q

Cholinergic agonists (pilocarpine) are dosed ____ and associated with many side effects such as
1.
2.
3.

A

QID

1.Brow ache
2. reduced vision
3. myopia (reduced night vision)

can cause closed angle glaucoma

38
Q

Oral carbonic anhydrase inhibitors such as acetazolamide and methazolamide are contraindicated in
1.
2,

A

renal and hepatic dysfunction

Reserved for medical emergencies only

39
Q

______________ chloride, the most common preservative in eye drops

A

Benzalkonium - Prolonged exposure to this preservative can result in superficial damage to the ocular surface​

40
Q

Brimonidine is available with a non–benzalkonium chloride preservative called _____

A

Purite

41
Q

Suspension eye drops should be what before use?

A

Shaken well

42
Q

How long to wait between administration of different eye drops?

A

~5 minutes

43
Q

How long to wait between administration of the SAME eye drop?

A

~1 minute

44
Q

Discard eye drop bottle after how many days after opening ?

A

28 days

45
Q

Patients who use soft contact lenses should wait at least __ minutes after each dose before reinserting lenses

A

15

46
Q

Max effect of therapy with prostaglandin analogues occurs in ?

A

4-6 weeks of use

47
Q

Unexplained eye pain, vision loss, abnormal photophobia, eye irritation or redness from eye drops that becomes bothersome, changes in comorbid conditions all mean you should ?

A

REFER!!!

PEBC (35 decks)

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