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Spring 15 - Pharm Unit II > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Features of Glaucoma

A
  • changes in optic nerve head
  • loss of visual sensitivity and field
  • increased IOP
  • incidence increases with age, black > white
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2
Q

Pathophysiology of Glaucoma

A
  • increased IOP
  • retinal ischemia
  • reduced or dysregulated blood flow
  • extracellular matrix changes
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3
Q

What can increase inflow of aqueous humor?

A

beta receptor stimulation

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4
Q

What can decrease aqueous humor inflow?

A
  • alpha 1 and 2 adrenergic stimulation
  • beta receptor blocking
  • DA blocking
  • adenylate cyclase stimulation
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5
Q

Classification Categories of Glaucoma

A
  • primary: open angle, angle closure
  • secondary: open angle, angle closure
  • congenital
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6
Q

Risk Factors for Primary Open Angle Glaucoma

A
  • elevated IOP
  • African or Hispanic descent
  • family hx of glaucoma
  • older age
  • thinner central corneal thickness
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7
Q

Possible Risk Factors for Primary Open Angle Glaucoma

A
  • systemic HTN
  • DM
  • myopia
  • low diastolic perfusion pressures
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8
Q

List some drugs that may induce or potentiate glaucoma.

A
  • corticosteroids: ophthalmic (high risk), systemic, inhaled/nasal
  • ophthalmic anticholinergics
  • vasodilators
  • cimetidine
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9
Q

POAG Diagnosis (what 3 things)

A
  • disc changes
  • visual field loss
  • increased IOP
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10
Q

When is pharmacologic tx of glaucoma considered effective?

A

when it stops progression of visual field loss

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11
Q

Glaucoma Treatment Goals

A
  • target IOP based on patient baseline IOP and existing visual field loss
  • initial target at least 25% below baseline
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12
Q

What are the 5 classes of drugs used in tx of glaucoma?

A
  • beta blockers
  • prostaglandin analogs
  • alpha2 adrenergic agonists
  • carbonic anhydrase inhibitors
  • cholinergic agonists
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13
Q

Beta Blockers MOA

A

decrease production of aqueous humor

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14
Q

Beta Blockers AEs

A
  • local: stinging on application, dry eyes, corneal anesthesia, blepharitis, blurred vision
  • systemic: decreased HR and BP, bronchospasm, masked sx of hypoglycemia, CNS sedation
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15
Q

Beta Blockers CIs

A
  • asthma
  • 2/3rd degree heart block
  • bradycardia
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16
Q

One drop of timolol in each eye is equivalent to what PO dose?

A

10 mg PO timolol

17
Q

Prostaglandin Analogs MOA

A

increase outflow of aqueous humor

18
Q

Prostaglandin Analogs AEs

A
  • common: increased iris pigmentation, growth of eyelashes, itching
  • less common: dryness, visual disturbance, burning, eye pain, increased pigmentation of skin around eye
19
Q

Alpha2 Adrenergic Agonists MOA

A

decrease production of aqueous humor

20
Q

Alpha2 Adrenergic Agonists AEs

A
  • local: blepharoconjunctivitis

- systemic: HA, dry mouth, fatigue

21
Q

How are Alpha2 Adrenergic Agonists usually used for glaucoma?

A

as adjunct in combination with other agents

22
Q

Carbonic Anhydrase Inhibitors MOA

A

decrease production of aqueous humor

23
Q

Carbonic Anhydrase Inhibitors AEs

A

may cause burning, stinging, itching, dry eyes, bitter/unusual taste

24
Q

Carbonic Anhydrase Inhibitors CIs

A

sulfa allergy

25
Q

Oral Carbonic Anhydrase Inhibitors AEs

A

not well tolerated due to:

  • malaise, fatigue
  • anorexia, wt loss
  • depression, decreased libido
  • increased UA, blood dyscrasias
26
Q

Beta Blocker/CAI Combo MOA

A

-decrease production of aqueous humor

27
Q

Beta Blocker/CAI Combo AEs

A
  • most common: ocular burning or stinging, bitter/unusual taste
  • less common: blurred vision, superficial punctate, keratitis
28
Q

Cholinergics MOA

A

increased outflow of aqueous humor

29
Q

Cholinergics AEs

A
  • local: decreased night vision, frontal HA, browache, periorbital pain, eyelid twitching
  • systemic: diaphoresis, N/V/D, urinary frequency, bradycardia
30
Q

Which drugs are considered first line in glaucoma tx?

A
  • beta blockers first choice

- prostaglandin analogs are first line alternative to BBs

31
Q

Patient Education for Glaucoma

A
  • chronic/continuous meds even when IOP has decreased
  • demonstration of proper eye drop technique
  • verbal and written instructions
  • reduce systemic AEs with don’t open eyes (DOT) technique
32
Q

Adherence in Glaucoma Pts

A
  • poor; 25-60% non-adherent

- missed doses or incorrect use of eyedrops

33
Q

Monitoring in Glaucoma Pts

A
  • IOP
  • ophthalmic exam
  • visual fields
  • local and systemic AEs
34
Q

Angle Closure Glaucoma

A
  • <5% of primary glaucoma

- treatment emergency to avoid vision loss

Spring 15 - Pharm Unit II (9 decks)

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