Glaucoma

Question 1

Features of Glaucoma

Answer 1

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

Question 2

Pathophysiology of Glaucoma

Answer 2

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

Question 3

What can increase inflow of aqueous humor?

Answer 3

beta receptor stimulation

Question 4

What can decrease aqueous humor inflow?

Answer 4

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

Question 5

Classification Categories of Glaucoma

Answer 5

• primary: open angle, angle closure
• secondary: open angle, angle closure
• congenital

Question 6

Risk Factors for Primary Open Angle Glaucoma

Answer 6

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

Question 7

Possible Risk Factors for Primary Open Angle Glaucoma

Answer 7

• systemic HTN
• DM
• myopia
• low diastolic perfusion pressures

Question 8

List some drugs that may induce or potentiate glaucoma.

Answer 8

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

Question 9

POAG Diagnosis (what 3 things)

Answer 9

• disc changes
• visual field loss
• increased IOP

Question 10

When is pharmacologic tx of glaucoma considered effective?

Answer 10

when it stops progression of visual field loss

Question 11

Glaucoma Treatment Goals

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Beta Blockers MOA

Answer 13

decrease production of aqueous humor

Question 14

Beta Blockers AEs

Answer 14

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

Question 15

Beta Blockers CIs

Answer 15

• asthma
• 2/3rd degree heart block
• bradycardia

Question 16

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

Answer 16

10 mg PO timolol

Question 17

Prostaglandin Analogs MOA

Answer 17

increase outflow of aqueous humor

Question 18

Prostaglandin Analogs AEs

Answer 18

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

Question 19

Alpha2 Adrenergic Agonists MOA

Answer 19

decrease production of aqueous humor

Question 20

Alpha2 Adrenergic Agonists AEs

Answer 20

• local: blepharoconjunctivitis

- systemic: HA, dry mouth, fatigue

Question 21

How are Alpha2 Adrenergic Agonists usually used for glaucoma?

Answer 21

as adjunct in combination with other agents

Question 22

Carbonic Anhydrase Inhibitors MOA

Answer 22

decrease production of aqueous humor

Question 23

Carbonic Anhydrase Inhibitors AEs

Answer 23

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

Question 24

Carbonic Anhydrase Inhibitors CIs

Answer 24

sulfa allergy

Question 25

Oral Carbonic Anhydrase Inhibitors AEs

Answer 25

not well tolerated due to: - malaise, fatigue - anorexia, wt loss - depression, decreased libido - increased UA, blood dyscrasias

Question 26

Beta Blocker/CAI Combo MOA

Answer 26

-decrease production of aqueous humor

Question 27

Beta Blocker/CAI Combo AEs

Answer 27

- most common: ocular burning or stinging, bitter/unusual taste - less common: blurred vision, superficial punctate, keratitis

Question 28

Cholinergics MOA

Answer 28

increased outflow of aqueous humor

Question 29

Cholinergics AEs

Answer 29

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

Question 30

Which drugs are considered first line in glaucoma tx?

Answer 30

- beta blockers first choice | - prostaglandin analogs are first line alternative to BBs

Question 31

Patient Education for Glaucoma

Answer 31

- 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

Question 32

Adherence in Glaucoma Pts

Answer 32

- poor; 25-60% non-adherent | - missed doses or incorrect use of eyedrops

Question 33

Monitoring in Glaucoma Pts

Answer 33

- IOP - ophthalmic exam - visual fields - local and systemic AEs

Question 34

Angle Closure Glaucoma

Answer 34

- <5% of primary glaucoma | - treatment emergency to avoid vision loss