glaucoma

Question 1

how does glaucoma develop?

Answer 1

obstructed drainage canal –> pushed iris against cornea –> reduces aqueous humor outflow –> increases IOP

Question 2

what are the risk factors for glaucoma?

Answer 2

age
race (black or asian)
corneal thickness or eye injury
HTN
steroid use
nearsighted or farsighted
diabetes
sickle cell anemia

Question 3

what are the symptoms of open-angle glaucoma?

Answer 3

asymptomatic –> progressive development of patchy blind spots in peripheral vision –> central vision difficulty

Question 4

what are the test for diagnosing glaucoma?

Answer 4

measurement of IOP
vision loss assessment
testing for optic nerve damage
corneal thickness measurement
inspection of drainage canal

Question 5

what are the drug classes that reduce aqueous humor production?

Answer 5

beta blockers and carbonic anhydrase inhibitors

Question 6

what are the drugs classes that increase aqueous humor outflow?

Answer 6

prostaglandin analogs
cholinergics
rho kinase inhibitors

Question 7

what is the drug class that increases aqueous humor outflow and decreases aqueous humor production?

Answer 7

alpha-2 agonists

Question 8

what is the first line treatment regimen of open-angle glaucoma?

Answer 8

prostaglandin analogs
beta blockers

Question 9

what is the first/second line treatment of open-angle glaucoma?

Answer 9

alpha-2 agonists

Question 10

what is the second line treatment of open-angle glaucoma?

Answer 10

carbonic anhydrase inhibitors

Question 11

what is the third line treatment of open-angle glaucoma?

Answer 11

rho kinase inhibitors

Question 12

what is the last line treatment of open-angle glaucoma?

Answer 12

cholinergics

Question 13

what drugs are prostaglandin analogs?

Answer 13

latanoprost (xalatan, xelpros)
bimatoprost (lumigan, latisse)
travoporst (traatan, travatan Z)
tafluprost (zioptan)

Question 14

what is the warning of prostaglandin analogs?

Answer 14

eyelash increase in length and number
darkening of eyelids, iris, skin, and eyelashes

Question 15

what are the SE of prostaglandins?

Answer 15

blurred vision
stinging
light sensitivity

Question 16

what drugs are beta blockers?

Answer 16

betaxolol (betoptic S)
timolol (timoptic, istalol)
carteolol
levobunolol (betagan)

Question 17

what is the dosing of prostaglandins?

Answer 17

1 QHS

Question 18

what is the dosing of beta blockers?

Answer 18

1QD or BID

Question 19

what are the CI of beta blockers?

Answer 19

sinus bradycardia
heart-related conditions (uncompensated cardiac failure, 2nd/3rd degree heart block, cardiogenic shock)
bronchospastic disease

Question 20

what are the SE of beta blockers?

Answer 20

blurred vision
stinging
bradycardia
breathing problems

Question 21

what drugs are alpha-2 agonists?

Answer 21

aprachlonidine (lopidine)
brimonidine (alphagan P) + timolol (combigan) + brinzolamide (simbrinza)
brimonidine (lumify)

Question 22

what is the dosing of alpha-2 agonists?

Answer 22

1 TID

Question 23

what is the warning of alpha-2 agonists?

Answer 23

CNS depression

Question 24

what are the SE of alpha-2 agonists?

Answer 24

blurred vision
dry eyes
xerostomia (dry mouth)
sedation/confusion
conjunctival hyperemia

Question 25

what drugs are carbonic anhydrase inhibitors?

Answer 25

dorzolamide (trusopt) + timolol (cosopt) brinzolamide (azopt) + brimonidine (simbrinza) acetazolamide (PO) methazolamide (PO)

Question 26

what is the dosing of carbonic anhydrase inhibitors?

Answer 26

1 TID

Question 27

what is the warning of carbonic anhydrase inhibitors?

Answer 27

sulfonamide allergy

Question 28

what are the SE of eye drops carbonic anhydrase inhibitors?

Answer 28

blurred vision burning blepharitis taste disturbances

Question 29

what are the SE of oral carbonic anhydrase inhibitors?

Answer 29

ataxia confusion photosensitivity nausea metabolic acidosis

Question 30

what drugs are rho kinase inhibitors?

Answer 30

netasudil (rhopressa) latanoprost (rocklatan)

Question 31

what is the dosing of rho kinase inhibitors?

Answer 31

1 QPM

Question 32

what are the SE of rho kinase inhibitors?

Answer 32

burning corneal disease conjunctival hemorrhage conjunctival hyperemia

Question 33

what are drugs are cholinergic?

Answer 33

carbachol (milostat) pilocarpine (isopto carpine)

Question 34

what is the dosing of cholinergics?

Answer 34

1-2 drops up to TID QID for pilocarpine

Question 35

what is the warnings of cholinergics?

Answer 35

caution in patients with a history of retinal detachment or corneal abrasion

Question 36

what are the SE of cholinergics?

Answer 36

corneal clouding pupil constriction hypotension bronchospasms abdominal cramping GI distress

Question 37

what are the symptoms of closed-angle glaucoma?

Answer 37

severe headache blurred vision severe pain or halos around light NV redness in eye cloudy cornea

Question 38

what is the treatment of closed-angle glaucoma?

Answer 38

hyperosmotic agents surgery

Question 39

what are hyperosmotic agents?

Answer 39

IV mannitol PO glycerin

Question 40

what is the surgery option?

Answer 40

iridotomy

Question 41

what medications that can increase IOP?

Answer 41

anticholinergics topiramate chronic steroids decongestants antidepressants