glaucoma Flashcards
how does glaucoma develop?
obstructed drainage canal –> pushed iris against cornea –> reduces aqueous humor outflow –> increases IOP
what are the risk factors for glaucoma?
age
race (black or asian)
corneal thickness or eye injury
HTN
steroid use
nearsighted or farsighted
diabetes
sickle cell anemia
what are the symptoms of open-angle glaucoma?
asymptomatic –> progressive development of patchy blind spots in peripheral vision –> central vision difficulty
what are the test for diagnosing glaucoma?
measurement of IOP
vision loss assessment
testing for optic nerve damage
corneal thickness measurement
inspection of drainage canal
what are the drug classes that reduce aqueous humor production?
beta blockers and carbonic anhydrase inhibitors
what are the drugs classes that increase aqueous humor outflow?
prostaglandin analogs
cholinergics
rho kinase inhibitors
what is the drug class that increases aqueous humor outflow and decreases aqueous humor production?
alpha-2 agonists
what is the first line treatment regimen of open-angle glaucoma?
prostaglandin analogs
beta blockers
what is the first/second line treatment of open-angle glaucoma?
alpha-2 agonists
what is the second line treatment of open-angle glaucoma?
carbonic anhydrase inhibitors
what is the third line treatment of open-angle glaucoma?
rho kinase inhibitors
what is the last line treatment of open-angle glaucoma?
cholinergics
what drugs are prostaglandin analogs?
latanoprost (xalatan, xelpros)
bimatoprost (lumigan, latisse)
travoporst (traatan, travatan Z)
tafluprost (zioptan)
what is the warning of prostaglandin analogs?
eyelash increase in length and number
darkening of eyelids, iris, skin, and eyelashes
what are the SE of prostaglandins?
blurred vision
stinging
light sensitivity
what drugs are beta blockers?
betaxolol (betoptic S)
timolol (timoptic, istalol)
carteolol
levobunolol (betagan)
what is the dosing of prostaglandins?
1 QHS
what is the dosing of beta blockers?
1QD or BID
what are the CI of beta blockers?
sinus bradycardia
heart-related conditions (uncompensated cardiac failure, 2nd/3rd degree heart block, cardiogenic shock)
bronchospastic disease
what are the SE of beta blockers?
blurred vision
stinging
bradycardia
breathing problems
what drugs are alpha-2 agonists?
aprachlonidine (lopidine)
brimonidine (alphagan P) + timolol (combigan) + brinzolamide (simbrinza)
brimonidine (lumify)
what is the dosing of alpha-2 agonists?
1 TID
what is the warning of alpha-2 agonists?
CNS depression
what are the SE of alpha-2 agonists?
blurred vision
dry eyes
xerostomia (dry mouth)
sedation/confusion
conjunctival hyperemia
what drugs are carbonic anhydrase inhibitors?
dorzolamide (trusopt) + timolol (cosopt)
brinzolamide (azopt) + brimonidine (simbrinza)
acetazolamide (PO)
methazolamide (PO)
what is the dosing of carbonic anhydrase inhibitors?
1 TID
what is the warning of carbonic anhydrase inhibitors?
sulfonamide allergy
what are the SE of eye drops carbonic anhydrase inhibitors?
blurred vision
burning
blepharitis
taste disturbances
what are the SE of oral carbonic anhydrase inhibitors?
ataxia
confusion
photosensitivity
nausea
metabolic acidosis
what drugs are rho kinase inhibitors?
netasudil (rhopressa)
latanoprost (rocklatan)
what is the dosing of rho kinase inhibitors?
1 QPM
what are the SE of rho kinase inhibitors?
burning
corneal disease
conjunctival hemorrhage
conjunctival hyperemia
what are drugs are cholinergic?
carbachol (milostat)
pilocarpine (isopto carpine)
what is the dosing of cholinergics?
1-2 drops up to TID
QID for pilocarpine
what is the warnings of cholinergics?
caution in patients with a history of retinal detachment or corneal abrasion
what are the SE of cholinergics?
corneal clouding
pupil constriction
hypotension
bronchospasms
abdominal cramping
GI distress
what are the symptoms of closed-angle glaucoma?
severe headache
blurred vision
severe pain or halos around light
NV
redness in eye
cloudy cornea
what is the treatment of closed-angle glaucoma?
hyperosmotic agents
surgery
what are hyperosmotic agents?
IV mannitol
PO glycerin
what is the surgery option?
iridotomy
what medications that can increase IOP?
anticholinergics
topiramate
chronic steroids
decongestants
antidepressants