Glaucoma Flashcards
_____________ is the term used to describe a group of ocular diseases in which optic neuropathy leads to peripheral vision loss
Glaucoma, cupping of the optic nerve occurs
The nerve damage in glaucoma is a result of elevated ?
IOP within the eye (> 22 mmHg)
Elevated ___, also known as ocular hypertension, is the most important and only modifiable risk factor for glaucoma
IOP
3 Glaucoma subtypes?
1.
2.
3.
POAG
SOAG
ACG - angle closure glaucoma
Risk factors for the development of glaucoma
POAG
1.
2.
3.
SOAG
1
2.
3.
ACG
1.
2.
3.
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
Ocular hypertension is defined as IOP > ___ mmHG but normal visual fields and normal optic discs
21 mmHG
What is the most common type of glaucoma
Primary open angle glaucoma
Primary open angle glaucoma develops slowly and is a result of
poor drainage of aqueous humor
Secondary open angle glaucoma is caused by underlying conditions and leads to blockage of the?
trabecular meshwork and canal of schlemm
Angle closure glaucoma is considered 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
Some drug induced causes of glaucoma include:
- corticosteroids **
- anticholinergic agents
- topiramate
- oral contraceptives use of longer than 3-5 years may be associated with higher prevalence of POAG
Lifestyle modifications have not been shown to alter the outcome of the disease. _______________can lower IOP modestly in some patients with glaucoma
aerobic exercise
______ or ________ procedures are treatment options if drug therapy is unsuccessful or not tolerated by the patient
laser or surgical
Laser trabeculoplasty indicated for what type of glaucoma?
Open angle glaucoma
1st line agents for glaucoma?
Prostaglandin analogues
Latanoprost, travoprost and latanoprostene are
prostaglandin analogues, dosed once daily HS
All prostaglandin analogues work by increasing outflow of aqueous humour through the _________ pathway
uveoscleral pathway
(Latanoprost and travoprost increase outflow by both uveo and trabecular pathways)
This prostaglandin analogue must be stored in the fridge until dispensed (6 weeks at room temp)
Latanoprost
Adverse effects associated with prostaglandin analogues
1.
2.
- increase eyelash length
- iris pigmentation
burn, itch, foreign body sensation
This prostaglandin analogue does not use benzalkonium as a preservative, instead it uses ionic buffer
Travoprost
Timolol, Betaxolol, Levobunolol, belong to beta-blockers, which reduce IOP by ?
inhibiting formation of aqueous humor
This topical beta blocker is B1 specific and is associated with less systemic side effects:
Betaxololl
Topical betablockers are contraindicated in
1.
2.
Pulmonary and cardiac disease
asthma, cold, Bradycardia, heart block, overt HF
Systemic side effects of topical beta blockers include?
1.
2.
3.
- bronchospasms
- exacerbation of CHF
- dyspnea, Bradycardia, syncope
This topical beta blocker is available as a gel-forming solution and can be dosed once daily instead of BID
Timolol
Brinzolamde and Dorzolamide are examples of ?
Carbonic anhydrase inhibitors
2nd line or adjunct
Carbonic anhydrase inhibitors reduce IOP by ?
inhibiting enzyme carbonic anhydrase, which is involved in the production of aqueous humour thereby reducing aqueous humour formation
Class of topical therapy for glaucoma associated with bitter, sour or unusual taste?
Carbonic anhydrase inhibitors
Brimonidine and apraclonidine belong to what class of medications?
Alpha2 adrenergic agonists
Apraclonidine was thefirst alpha2-specific agonist introduced, but local allergic reactions limit its use to the management of acute _____ _______
IOP spikes
_______ has higher alpha-2 selectivity and is used for both open and closed angle glaucoma
Brimonidine
Alpha2 Adrenergic agonists work to decrease IOP by
1.
2.
Suppress formation of aqueous humor
increase uvescleral outflow
Alpha2 adrenergic agonists are contraindicated:
1.
2.
with MAOi
Children <6
Systemic side effects with alpha2 adrenergic agonists:
1.
2.
3.
Dry mouth/nose
fatigue
drowsiness/dizzy
Headache,
dec HR/BP
The only drug okay in pregnancy for glaucoma ?
Brimonidine P1/P2
The topical cholinergic agonists (e.g., pilocarpine) directly stimulate muscarinic receptors to contract the ciliary muscle and increase ___________ outflow
trabecular
Cholinergic agonists (pilocarpine) are dosed ____ and associated with many side effects such as
1.
2.
3.
QID
1.Brow ache
2. reduced vision
3. myopia (reduced night vision)
can cause closed angle glaucoma
Oral carbonic anhydrase inhibitors such as acetazolamide and methazolamide are contraindicated in
1.
2,
renal and hepatic dysfunction
Reserved for medical emergencies only
______________ chloride, the most common preservative in eye drops
Benzalkonium - Prolonged exposure to this preservative can result in superficial damage to the ocular surface
Brimonidine is available with a non–benzalkonium chloride preservative called _____
Purite
Suspension eye drops should be what before use?
Shaken well
How long to wait between administration of different eye drops?
~5 minutes
How long to wait between administration of the SAME eye drop?
~1 minute
Discard eye drop bottle after how many days after opening ?
28 days
Patients who use soft contact lenses should wait at least __ minutes after each dose before reinserting lenses
15
Max effect of therapy with prostaglandin analogues occurs in ?
4-6 weeks of use
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 ?
REFER!!!
