Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PharmD > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is glaucoma?

A

Optic neuropathy that leads to peripheral vision loss
- thinning of the retinal nerve fibre
Neuropathy caused by increased IOP that presses down on optic nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two types of glaucoma?

A

Open-angle
Angle-closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two classifications referring to?

A

Whether the anterior chamber angle (space where the iris means cornea) is opened or narrowed/closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between open-angle or angle-closure glaucoma?

A

Open-angle= space between the iris and cornea is still opened, fluid draining slowly but still draining. Progressive glaucoma symptoms
Angle-closure= space between iris and cornea is completely closed. Sudden increase in intraocular pressure. May lead to emergency acute attack of glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Are glaucoma patients usually asymptomatic?

A

Yes. Symptoms don’t appear unless patient has reached advanced stages in this chronic disease or if it’s an acute attack emergency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What symptoms would warrant urgent referral?

A

Eye pain, blurred vision, halos around lights, headache, nausea, vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the only modifiable and most important risk factor for glaucoma?

A

Elevated IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What’s another name for elevated IOP?

A

Ocular hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

We are focused on medications that lower IOP, but what other procedures are able to reduce IOP?

A

Laser or surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are ocular symptoms of glaucoma?

A
  • loss of peripheral vision
  • scotoma
  • halos around lights
  • decreased visual acuity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some systemic symptoms associated with glaucoma?

A

Abdominal pain, nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What medications could cause or worsen glaucoma?

A
  1. Corticosteroids (all routes)
  2. Drugs with antimuscarinic activity (rare)
    - antidepressants, antihistamines, decongestants, antispasmodics
  3. Anticonvulsants
    - topiramate associated with angle-closure
  4. Oral contraceptive >3 years associated with open angle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is screening for elevated IOP helpful for diagnosis of glaucoma?

A

Lacks adequate sensitivity and specificity
(up to 50% of glaucoma patients have IOP in normal range)
(about 90% of people with elevated IOP do not have glaucoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is normal range of IOP?

A

<21 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is positive family history a risk factor for glaucoma?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are risk factors for open-angle glaucoma?

A
  • Elevated IOP
  • Advanced age
  • Myopia
  • Vascular disease such as migraine, hypertension or nocturnal hypotension
  • Type 2 diabetes
  • Blunt or penetrating trauma
  • Previous intraocular surgery
  • Previous intraocular inflammation
  • Corticosteroid use
  • Black, Hispanic or Mexican descent
  • Family history of glaucoma
  • Sleep apnea
  • Obesity
  • Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are risk factors for angle-closure glaucoma?

A
  • Female
  • Advanced age
  • Hyperopia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The goal of therapy is to use medications to lower IOP. IF patient with glaucoma has IOP in normal range, do we still use medications?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some non-pharm choices for glaucoma?

A

Lifestyle modifications did not alter outcome.
Aerobic exercise can lower IOP modestly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When does laser or surgical procedures come into play?

A

If drug therapy is unsuccessful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment for acute attack of angle-closure glaucoma?

A

Laser or surgical iridectomy.
If iridectomy cannot be performed, aggressive medical treatment is required until it can be performed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are two pathways that aqueous humour could drain from?

A

Trabecular meshwork and uveoscleral pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the topical classes to treat open-angle glaucoma?

A
  1. Prostaglandin Analogues
  2. Beta-blockers
  3. Alpha2-adrenergic agonists
  4. Carbonic anhydrase inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which drug class is often first-line?

A

Prostaglandin analogues
- slightly more efficacious than beta blockers
- preserve visual field and delay progression
- very few systemic adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What drugs are within the prostaglandin analogue drug class?

A

Latanoprost
Travoprost
Latanoprostene bunod
Bimatoprost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does each of the prostaglandin analogue help treat open-angle glaucoma?
Latanoprost
Travoprost
Latanoprostene bunod
Bimatoprost

A

Latanoprost and travoprost= lower IOP by increasing outflow of aqueous humor through uveoscleral pathway
Latanoprostene bunod and bimatoprost= increase outflow in both uveoscleral and trabecular meshwork

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are adverse effects of prostaglandin analogues?

A

Ocular
- darkening of brown colour iris
- lengthening of eye-lashes
- mild conjunctival hyperemia

28
Q

Is there a preference between prostaglandin analogues?

A

No

29
Q

At what time of the day is prostaglandin analogues usually used?

A

Before bedtime/evening

30
Q

How long does it take for onset of action of prostaglandin analogues

A

4 hours

31
Q

What happens if we do more than one dose of prostaglandin analogues in one day?

A

Reduces the effectiveness of the drops

32
Q

What are the storage instructions for latanoprost?

A

In fridge until opened.
Once opened, can be kept at room temp for 6 weeks.

33
Q

What agents are part of the beta blocker drug classes?

A

Betaxolol
Timolol

34
Q

How do beta blockers help with glaucoma?

A

Decrease IOP by inhibiting the formation of aqueous humor
Provided visual field protection

35
Q

Which patient population should we try to avoid beta blockers in?

A

Patients with:
- asthma
- COPD (CI if severe)
- CI if AV block
- bradycardic (CI if severe)

36
Q

How do we pick between timolol and betaxolol?

A

Timolol= non-selective
betaxolol= relatively selective for beta 1 receptor blockade
-> more preferred for those with mild obstructive pulmonary disease

37
Q

What drugs are in the alpha2-adrenergic agonist class?

A

Apraclonidine
Brimonidine

38
Q

How does alpha-2 adrenergic agonists help glaucoma?

A

Suppresses the formation of aqueous humor
Increase uveoscleral outflow

39
Q

How do we pick between apraclonidine and brimonidine?

A

Apraclonidine has limited use due to local allergic reactions
Brimonidine has higher specificity for alpha 2 receptor. Less severe conjunctival hyperemia (red eye)

40
Q

What are the two different brimonidine formulations?

A

Brimonidine 0.15% (preserved with urite)
-> slightly lower rate of ocular allergy
Brimonidine 0.2% (preserved with benzalkonium)

41
Q

What’s the brand names of the two brimonidine?

A

Alphagan= brimonidine 0.2% preserved with benzalkonium
Alphagan P= brimonidine 0.15% preserved with urite

42
Q

What are the drugs in the carbonic anhydrase inhibitor class?

A

-dorzolamide
- brinzolamide

43
Q

How does carbonic anhydrase inhibitors help glaucoma?

A

Inhibits an enzyme that is involved in the formation of aqueous humor

44
Q

How do we pick between dorzolamide and brinzolamide

A

Brinzolamide is more comfortable to instill. Seem to be as efficacious

45
Q

When does carbonic anhydrase inhibitors come into play?

A

Either as adjunctive therapy
OR
Primary treatment if patient has cardiopulmonary contraindication to beta-blockers

46
Q

What drug is in the cholinergic agonist drug class?

A

Pilocarpine

47
Q

How does cholinergic agonists help with glaucoma?

A

Directly stimulate muscarinic receptors to contract ciliary muscles and increase trabecular outflow

48
Q

What limits the use of cholinergic agonists?

A

Poorly tolerated in children and young adults
Ocular side effects like:
- miosis (reduced night vision)
- accommodative spasm (myopia)
- brow ache
- retinal detachment (rare)

49
Q

What are the benefit of combo products?

A
  • more convenient and improves adherence for patients who need more than one agent
  • reduce exposure to preservative
  • prevent drug washout
50
Q

What are the 6 fixed-combo products in Canada?

A
  1. Brimonidine/timolol
  2. Brinzolamide/timolol
  3. Dorzolamide/timolol
  4. Latanoprost/timolol
  5. Travoprost/timolol
  6. Brimonidine/brinzolamide
51
Q

What’s the most common preservative in eye drops?

A

Benzalkoniuim chloride

52
Q

Does benzalkonium chloride enhance drug penetration into cornea?

A

Yes, but there is no evidence that they are superior to preservative-free formulations.

53
Q

Are preservative-free eyedrops safer than those with preservatives?

A

No, they can still cause some toxic effects

54
Q

What are concerns with prolonged exposure to this preservative?

A

Superficial damage to ocular surface and cause symptoms like irritation, dryness, itchiness, and burning

55
Q

What are some management methods for this preservative concern?

A
  1. Travoprost available with ionic buffer preservative (Travatan Z)
  2. Brimonidine availabe with purite preservative (Alphagan P)
  3. Some eye drops are available in preservative-free single-dose units
56
Q

When are oral carbonic anhydrase inhibitors used?

A

Reserved for emergencies due to significant adverse effects (GI or CNS difficulties, paresthesia, metabolic acidosis or renal lithiasis)

57
Q

What are the two agents that are oral carbonic anhydrase inhibitors?

A

Acetazolamide
Methazolamide

58
Q

What is a reaction we have to watch out for with oral carbonic anhydrase inhibitors?

A

Sulfa allergy. Not contraindication but should be monitored with caution especially in those with serious reactions (anaphylaxis, Steven-Johnson syndrome)

59
Q

Is there evidence to support cannabis in glaucoma treatment?

A

No

60
Q

Topical glaucoma medications are ______ concentrated to allow adequate intraocular __________.

A

highly
penetration

61
Q

How can systemic absorption of these agents be reduced?

A

Digital occlusion of the nasolacrimal drainage system for several minutes
OR
Close eyelids for 3-5 minutes

62
Q

How long should patients separate the administration of different eye drops? Why?

A

5 minutes
To avoid washout of previously administered medication

63
Q

Can patients use contact lenses if using glaucoma eye drops?

A

Yes. Soft contact lenses.
Wait at least 15 minutes after each dose before reinserting lenses

64
Q

Glaucoma patients should use non-prescription ___________ products with caution.

A

Antihistamine
Rarely causes a problem with open angle glaucoma.
In the rare instance, it can precipitate angle closure glaucoma.

65
Q

Which patient population needs to be more cautious about this rare incident with antihistamines and glaucoma?

A

Elderly females who have significant hyperopic
Positive family history of angle closure glaucoma (with no therapeutic or prophylactic iridectomy)

66
Q

What major drug interaction should we keep in mind with glaucoma eye drops?

A

Alpha2 adrenergic agonists with MAO inhibitors

67
Q

What glaucoma eyedrop is first-line and safe for all three trimesters of pregnancy?

A

Brimonidine

PharmD (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions