Glaucoma Flashcards
Ocular Hypertension
Elevated IOP without glaucomatous changes
Primary Open-Angle Glaucoma (POAG)
Normal anterior chamber angles
Glaucomatous changes of the optic disc
Peripheral visual field loss
Primary Angle-Closure Glaucoma (PACG)
Obstruciton of the anterior angle by the iris
Moderate to high elevations in IOP
Gonioscopy
Examination of the anterior chamber angle
Perimetry
Measure of the field of vision
Tonometry
Measures IOP
Does not test for glaucomatous changes.
Initial Target Estimate for IOP
20% of baseline
30-50% in Severe disease or Normal Tension Glaucoma
Well Tolerated Starting Pharmacotherapy Agents
Prostaglandins
Beta-Blockers
Brimonidine
When giving topical ocular solution how long must you wait to give another drug?
5 minutes
Trabeculoplasty
Laser Surgery
Trabeculoectomy
Surgery
Removal of trabecular meshwork
These two drugs are given during surgery to decrease scaring.
Mitomycin C
Antifibrotic agent
Treatment of Choice for PACG
Laser Iridotomy
Medical Therapy is used to do what in acute PACG?
Lower IOP
Reduce pain
Reverse corneal edema
Agents used to lower IOP in Acute PACG
Topical Beta-Blockers Topical Alpha-agonists Prostaglandin F2alpha analog Systemic Carbonic Anhydrase Inhibitors Hyperosmotic Agents
In Acute PACG, once IOP is under control this medication is used to break through the pupillary block.
Pilocarpine
These two drugs can induce PAOG
Docetaxel/Paclitaxel
Corticosteroids
These 3 drug classes can induce PACG
Adrenergic Agents
Anticholinergics
Sulfa-drugs
MOA of Prostaglandin Analogs
Increase uveoscleral outflow
Lower IOP 25-35%
Contraindications for prostaglandin analogs
Hypersensitivity
Rare ADR of prostaglandin analogs
Diplopia
Retinal detachment
Vitreous Hemorrhage
MOA of Beta-adrenergic antagonists
Decrease aqueous production and IOP by 20-25%
Contraindications of Beta-adrenergic antagonists
Sinus Bradycardia
Greater than first-degree AV block
Cardiogenic shock
Overt Cardiac failure
Non-selective drugs are contraindicated for bronchial asthma or severe COPD.
MOA of Alpha2-Adrenergic Agonists
Decrease production of aqueous humor
Lowering IOP by 18-2&%
Contraindications for Alpha2-Adrenergic Agonists
Hypersensitivity
Pt. on MAO inhibitors
MOA of Carbonic Anhydrase Inhibitors
Causes a decrease in sodium and water outflow from the ciliary body, but 99% of CAs must be inhibited
IOP lowering by 15-25%
Precautions of CAIs
Don’t use in renal impairment
Caution in patients with hepatic impairment
Caution in patients with sickle cell anemia.
Contraindications for CAIs
Sulfonamide allergy Hypokalemia Hyponatremia Hyperchloremic acidosis Adrenocortical insufficiency Marked renal or hepatic impairment Severe COPD Long term use in PACG
Special Instructions for CAIs
Monitor patient on the following:
Malaise or fatigue, Creatinine, serum potassium, serum carbon dioxide, baseline CBC and platelet count
MOA of Cholinergics and Cholinesterase Inhibitors
Carbachol and pilocarpine are direct cholinergic agonists that act on ACh receptors to stimulate ciliary muscle
Cholinesterase Inhibitors act indirectly bin inhibiting AChE.
Ease the restriction of outflow of aqueous humor through the trabecular meshwork.
Precautions for Cholinergics and cholinesterase inhibitors
Pregnancy and lactation
Night driving
Pts with retinal detachment, asthma, bradycardia, hypotension
Contraindications for Cholinergics and cholinesterase inhibitors
Acute iritis
Uveal inflammation
Pupillary block glaucoma
