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9. Glaucoma > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Which of the following does not describe Glaucoma?

a. it is a group of diseases
b. it is the narrowing of the visual field
c. it is usually secondary to retinal ganglion cell death
d. it is a disease of inclusion
e. leading cause of blindness in African Amer. and Hispanics

A

d is false. Glaucoma is a disease of EXCLUSION, not inclusion!

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2
Q

Which is not a correct target for glaucoma therapy?

a. decrease aqueous production
b. increase trabecular outflow
c. decrease uveoscleral outflow

A

c. is incorrect! should be INCREASE uveoscleral outflow.

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3
Q

Which is true?

a. Nicotinic Receptors are postganglionic in the Somatic NS and terminal in the Autonomic NS
b. Muscarinic Receptors are postganglionic in cholinergic systems.
c. NorEpi is the NT in Sympathetic Cholinergic System
d. Muscarinic Receptors are terminal in cholinergic systems.

A

d. is true!
all the others are false!
-Nicotinic Receptors are postganglionic in the AUTONOMIC system and terminal in the SOMATIC system.
-Muscarinic Receptors are TERMINAL in the cholinergic systems.
-NorEpi is the NT in Sympathetic ADRENERGIC system.
(and ACh is the NT in all the other systems)

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4
Q

Which is not true for ocular pharmacokinetics?

a. tear film –> cornea –> aqueous humor –> iris –> systemic circ.
b. tear film –> cornea –> iris –> aqueous humor –> systemic circ.
c. tear film –> conjunctiva –> systemic circ.
d. tear film –> conjunctiva/sclera –> ciliary body –> systemic circ.
e. tear film –> nasolacrimal duct –> systemic circ.

A

b. is not true!

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5
Q

T/F: the only 2 that can go directly to systemic circ. from the tear film are conjunctiva and nasolacrimal duct.

A

true!

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6
Q

+b2 = bronchoDILATION, vasoDILATION, glucogenoLYSIS, INCREASE insulin release, & INCREASE aqueous production.

A

true. memorize this!

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7
Q

+a2 = INHIBITION of signal propagation, vasoDILATION, DECREASE insulin release & DECREASE aqueous production.

A

true. memorize this!

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8
Q
  • b2 = DECREASE aqueous production

note: there is no -a2.

A

true!

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9
Q 
\+b1 = INCREASE contractility and conduction.
\+a1 = vasoCONSTRICTION, mydriasis (dilate), and INCREASE uveoscleral outflow.
A

true!

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10
Q

epinephrine and dipivephrine are:

a. selective sympathomimetics
b. nonselective sympathomimetics

A

nonselective sympathomimetics

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11
Q

Receptors for nonselective sympathomimetics are:

a. +b1,+b2, +a1, +a2
b. +a2 and +a1 only.

A

a. +b1,2 +a1,2

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12
Q

apraclonidine and brimonidine (“onidine” suffix) are:

a. selective sympathomimetics
b. nonselective sympathomimetics

A

selective

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13
Q

which is more effective?

a. brimonidine
b. apraclonidine

A

brimonidine, because it effectively decreases aq. production and increases uveoscleral outflow. While apraclonidine only MILDLY decreases aq. production. Also, apraclonidine is not good for long term use, due to risk of tachyphylaxis.

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14
Q

Which are NOT used orally for IOP reduction because they are rapidly metabolized by the 1st pass effect in the liver/intestine?

a. epinephrine and dipivephrine
b. apraclonidine and brimonidine

A

epinephrine and dipivephrine (nonselective sympathomimetics)

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15
Q

T/F: dipivephrine is a lipophilic pro-drug, meaning it penetrates the corneal epithelium; while epinephrine is a major ocular surface irritant.

A

True!

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16
Q

If your patient is taking MAOI’s, which glaucoma treatment should NOT be used due to contraindications??

a. CA Inhibitors
b. Hyperosmotic agents
c. Sympathomimetic agents
d. Sympatholytic agents
e. Parasympathomimetic agents

A

sympathomimetic agents (epinephrine, dipivephrine, apraclonidine, and brimonidine)

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17
Q

T/F: brimonidine has less likelihood of causing tachyphylaxis compared to apraclondine. and it does not cause conjunctival blanching. therefore brimonidine is the better drug.

A

true!

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18
Q

metipranolol, timolol, betaxolol, carteolol, levobunolol are what kind of glaucoma treatment?

a. Sympatholytic beta blockers
b. Sympathomimetics
c. Parasympathomimetics
d. CA inhibitors

A

sympatholytic beta blockers (all have “olol” suffix)

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19
Q

which beta blocker targets only the b1 receptor?

a. metipranolol
b. timolol
c. betaxolol
d. levobunolol
e. carteolol

A

betaxolol

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20
Q

which beta blocker is known to have significant anesthetic effects?

a. metipranolol
b. timolol
c. betaxolol
d. levobunolol
e. carteolol

A

metipranolol

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21
Q

which beta blocker is NOT good for asthma, but is OK for diabetes, and is a nitric oxide agonist?

a. metipranolol
b. timolol
c. betaxolol
d. levobunolol
e. carteolol

A

carteolol

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22
Q

which beta blocker is cardio-selective, and is known as the safest beta blocker for asthmatic patients?

a. metipranolol
b. timolol
c. betaxolol
d. levobunolol
e. carteolol

A

betaxolol

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23
Q

T/F: all the beta blockers used for OAG have extensive first pass metabolism

A

true

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24
Q

T/F: apraclonidine, a selective sympathomimetic, selects a2 receptor more over a1 compared to brimonidine.

A

False!

brimonidine is the one that selects a2&raquo_space;> a1

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25
Q

which is NOT an adverse effect of beta blockers?

a. depression
b. sedation
c. tachycardia
d. alopecia
e. corneal anesthesia

A

c. tachycardia is NOT an adverse effect. bradycardia is!

note: alopecia = hair loss

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26
Q

which of the following are contraindications for beta blocker usage?

a. asthma
b. COPD
c. CHF
d. bradycardia
e. all of the above!

A

e. all of the above!

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27
Q

If patient has hyperthyroidism or diabetes, you must take precaution when giving them beta blockers because of what reason?

A

masked symptoms from beta blockers.

28
Q

which is the BEST parasympathomimetic to treat OAG?

a. pilocarpine
b. carbachol
c. phystigmine
d. echothiophate
e. all are equally good.

A

pilocarpine is the BEST parasympathomimetic!!

29
Q

Physostigmine (a parasympathomimetic) is indirect,

a. reversible and short/intermediate acting.
b. reversible and long acting
c. irreversible and short/intermediate acting.
d. irreversible and long acting

A

indirect, REVERSIBLE, and short/intermediate acting.

30
Q

Which parasympathomimetic is indirect, irreversible, and long acting?

a. carbachol
b. pilocarpine
c. physostigmine
d. echothiophate

A

d. echothiophate

31
Q

Which parasympathomimetic has a receptor that is not M=N, but rather M>N ?

a. carbachol
b. pilocarpine
c. physostigmine
d. echothiophate

A

b. pilocarpine!

32
Q

Which type of glaucoma treatment is also used as chemical war weapons?

a. sympathomimetics
b. parasympathomimetics
c. beta blockers
d. CA inhibitors
e. hyperosmotic agents

A

parasympathomimetics!! (pilocarpine, carbachol, physostigmine, and echothiophate)

33
Q

All of the following are sympathomimetic drugs used to treat glaucoma (OAG or increased IOP), except:

a. brimonidine
b. epinephrine
c. apraclonidine
d. physostigmine
e. none of the above

A

physostigmine is NOT a sympathomimetic, it is a parasympathomimetic!!!

34
Q

sympatholytic agents are also called ___________.

a. hyperosmotic agents
b. sympathomimetic agents
c. beta blockers
d. none of the above

A

beta blockers (all 5 have “olol” suffix)

35
Q

brimonidine is an example of a __________.

a. sympathomimetic
b. sympatholytic (beta blocker)
c. parasympathomimetic

A

a. sympathomimetic (selective)

36
Q

T/F: pilocarpine, the #1 parasympathomimetic drug, is good for treating OAG and also ACG.

A

true

37
Q

If a patient suffers from asthma, COPD, bradycardia, and CHF, you must NOT prescribe him which drug?

a. sympathomimetic
b. sympatholytic (beta blocker)
c. parasympathomimetic
d. CA inhibitor

A

do NOT give beta blockers

38
Q

for successful therapy using pilocarpine, IOP must be BELOW _____ mmHg.

a. 10
b. 50
c. 100
d. 500

A

below 50 mmHg

39
Q

adverse reactions of browache and perfuse perspiration are characteristic of what glaucoma drug?

a. pilocarpine
b. carbachol
c. brimonidine
d. epinephrine

A

browache and perfuse sweating are ADVERSE RXNS of pilocarpine

40
Q

If your patient is < 40 years old, which drug should he not use due to ciliary spasm?

a. pilocarpine
b. carbachol
c. brimonidine
d. epinephrine

A

do not use pilocarpine.

41
Q

acetazolamide is an example of what drug?

a. sympathomimetic
b. sympatholytic (beta blocker)
c. parasympathomimetic
d. CA inhibitor
e. prostaglandin analog

A

CA inhibitor (good for treating OAF, acute ACG and post-op IOP).

42
Q

All of the following are descriptive of CARBONIC ANHYDRASE INHIBITORS (CAI’s), except:

a. Reversible
b. Non-competitive
c. Indirect
d. Inhibitory effect on ciliary body anhydrase enzyme
e. Decrease in bicarbonate ion generation.

A

Indirect is false. CAI’s are direct!!!

43
Q

which 3 CA Inhibitors are ORAL formulations?

a. acetazolamide
b. brinzolamide
c. methazolamide
d. dichlorphenamide
e. dorzolamide

A

Note: All the Carbonic Anhydrase Inhibitors have “amide” suffix.

Oral: acetazolamide, methazolamide, and dichlorphenamide (AMD)

44
Q

Arrange the 3 ORAL CA Inhibitors from short to long acting:

a. acetazolamide, methazolamide, dichlorphenamide
b. acetazolamide dichlorphenamide, methazolamide

A

Short – Intermediate – Long:

acetazolamide, dichlorphenamide, methazolamide (ADM)

45
Q

Note that all the CA inhibitor drugs are all sulfa drugs, and they will not help NVG (neovascular glaucoma) at the closed angle stage.

A

True

46
Q

From the 3 oral CA inhibitors, which one is considered the BEST drug for treating ACG?

a. acetazolamide
b. dichlorphenamide
c. methazolamide.

A

acetazolamide, BEST for ACG.

47
Q

From the 3 oral CA inhibitors, which is least ionic and considered the BEST ocular penetrating agent?

a. acetazolamide
b. dichlorphenamide
c. methazolamide.

A

methazolamide

48
Q

From the 3 oral CA inhibitors, which has limited patient tolerability?

a. acetazolamide
b. dichlorphenamide
c. methazolamide.

A

dichlorphenamide.

49
Q

If you patient has OAG but is allergic to sulfonamides, which drug must you NOT give him?

a. sympathomimetics
b. parasympathomimetics
c. carbonic anhydrase inhibitors
d. prostaglandin analogs
e. hyperosmotic agents

A

don’t give CAI’s! because CAI’s are all sulfa drugs.

50
Q

adverse reactions of transient myopia, symptom complex, irregular taste, metabolic acidosis, hypokalemia, hypotension, and paresthesias are of what glaucoma drug?

a. sympathomimetics
b. parasympathomimetics
c. carbonic anhydrase inhibitors
d. prostaglandin analogs
e. hyperosmotic agents

A

CAI’s (recall it is linked to metabolic acidosis, symptom complex, and paresthesias (tingling in extremities.)

51
Q

What is the #1 drug (first line) for glaucoma therapy??????

a. sympathomimetics
b. parasympathomimetics
c. carbonic anhydrase inhibitors
d. prostaglandin analogs
e. hyperosmotic agents

A

prostaglandin analogs (Topical PGF2a analogs!!!!!!!!)

52
Q

which is NOT a true, classic prostaglandin (PG) and is instead a Prostamide.

a. latanoprost
b. travoprost
c. bimatoprost
d. tafluprost

A

Bimatoprost (note that all four PGF2a analogs have “prost” suffix!!)

53
Q

What is the main reason why prostaglandin analogs are considered the FIRST LINE drug of choice to treat OAG?

A

once a day bedtime dosing!!

54
Q

which of the four prostaglandin analogs is PF (preservative free)?

a. latanoprost
b. travoprost
c. bimatoprost
d. tafluprost

A

tafluprost is the only PGF2a that is PF!!!

needs to be refrigerated

55
Q

Which glaucoma drug alters ciliary body COLLAGEN, increasing uveoscleral outflow?

a. sympatholytics (beta blockers)
b. parasympathomimetics
c. carbonic anhydrase inhibitors
d. prostaglandin analogs (PGF2a)
e. hyperosmotic agents

A

prostaglandin analogs!!

56
Q

If patient has uveitis, iritis, or a prior case of Herpes Simplex Keratitis (HSK), you should NOT give which glaucoma drug?

a. sympathomimetics
b. parasympathomimetics
c. carbonic anhydrase inhibitors
d. prostaglandin analogs (PGF2a)
e. sympatholytics (Beta blockers)

A

do NOT give prostaglandin analogs if patient has uveitis, iritis or HSK.

57
Q

Hypertrichosis, blurred vision, and influenza syndrome (including. headache) are all adverse reactions of which type of glaucoma drug?

a. sympathomimetics
b. parasympathomimetics
c. carbonic anhydrase inhibitors
d. prostaglandin analogs (PGF2a)
e. hyperosmotic agents

A

adverse rxns of prostaglandin analogs

58
Q

which glaucoma drug can be administered via IV to increase serum osmolarity relative to ocular structures, causing transfer of fluid from eye to circulation to quickly drop IOP in ACG attacks below 50 mmHg.

a. prostaglandin analogs (PGF2a)
b. hyperosmotic agents
c. carbonic anhydrase inhibitors
d. sympatholytics (beta blockers)

A

hyperosmotic agents!!!!!

59
Q

mannitol and urea, glycerin, and isosorbide are all examples of what type of glaucoma treatment?

a. prostaglandin analogs (PGF2a)
b. hyperosmotic agents
c. sympatholytics (beta blockers)
d. carbonic anhydrase inhibitors

A

hyperosmotic agents

60
Q

which hyperosmotic agent can NOT be used for diabetics?

a. mannitol and urea
b. isosorbide
c. glycerin

A

glycerin can NOT be used on diabetic patients.

61
Q

which hyperosmotic agent is SAFE for diabetics, but is no longer available?

a. mannitol and urea
b. isosorbide
c. glycerin

A

isosorbide is no longer available.

62
Q

Which “combination therapy” is PF (preservative free)?

a. timolol + dorzolamide
b. timolol + brimonidine
c. brinzolamide + brimonidine.

A

timolol + dorzolamide (Cosopt PF Solution)

63
Q

All of the following are true “combination therapies”, except:

a. timolol + dorzolamide
b. timolol + brimonidine
c. timolol + dichlorphenamide

A

c. timolol + dichlorphenamide is NOT a combination therapy!!

64
Q

which drugs lower aqueous production (x3)?

a. a-adrenergics
b. beta blockers
c. miotics
d. prostaglandins
e. CAI’s

A

a-adrenergics, beta blockers, and CAI’s (ABC)

65
Q

which drugs increase trabecular outflow (x2)?

a. a-adrenergics
b. beta blockers
c. miotics
d. prostaglandins
e. CAI’s

A

a-adrenergics, miotics.

66
Q

which drugs increase uveoscleral outflow (x2)?

a. a-adrenergics
b. beta blockers
c. miotics
d. prostaglandins
e. CAI’s

A

a-adrenergics, prostaglandins.

67
Q

Future glaucoma therapies include drugs that reduce IOP (via decrease aqueous production, increase uveoscleral outflow, and increase TM outflow), neuroprotectors such as antioxidants, and vasoactive agents such .

A

True!

9. Glaucoma (1 decks)

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