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PT I Exam I > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

Review technique for drop administration

A
  • Wash hands
  • Tilt patient’s head back, have them look up
  • Gently retract lower lid
  • Place drop in inferior fornix - avoid cornea
  • Avoid touching bottle to lashes or eye
  • Have patient gently close eyes for a few seconds
  • Ask patients on multiple drops to allow 5 minutes
    between drops to maximize absorption
  • Refrigeration of drops may help patient sense if drop gets in eye
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2
Q

Concerns with ophthalmic administration

A
  • Systemic Absorption via nasal mucosa
  • Avoid 1st pass metabolism
  • Increasing systemic bioavailability
  • More potential for toxicity
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3
Q

How can patients minimize systemic absorption of ophthalmic medications?

A
  • Punctal Occusuion: Pressing on the lacrimal duct near the nose where the inner part of the eye sits to block absorption into this duct
  • Keeping eyes close for a few minutes after drop administration
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4
Q

What are side effects associated with systemic absorption of ophthalmic medications?

A

Drug dependent

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5
Q

How can you improve ocular absorption?

A 
Preservative Astringent on K epithelium
Increase contact time with ocular surface 
- Spacing drops out
- Punctal Occlusion
- Gently closing eyeslids
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6
Q

Why do ophthalmic medications have preservatives other than stability/sterility?

A

Allow for increased ocular penetration

Ex: Benzalkonium chloride (BAK)

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7
Q

Four dosage forms for ophthalmic drug delivery:

A

Drops, Ointments, Periocular Injection, Intraocular Injection

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8
Q

What is the 3rd leading cause of visual loss in older people?

A

Age-Related Cataracts

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9
Q

Which type of cataract would be associated with prednisone use?

A

Posterior Subcapsular Cataracts (PSC)

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10
Q

Describe the symptoms patients with cataracts will present.

A

1) Disturbances of near or far distance
2) Progression to diminution of vision “blurry”
3) Glare

Severity + location = impairment status

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11
Q

Compare and contrast Glaucoma v cataracts visual symptoms:

A 
Glaucoma = Loss of peripheral vision
Cataracts = Scattered light = blurred vision
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12
Q

Which medication used during surgery provides anesthesia and akinesia of eye muscles?

A

Hyalurodinase

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13
Q

Why do surgeons use Healon, Viscoat or Provisc in cataracts surgery?

A

Thick gel agents injected into the eye that keep the eye formed (decreases liquid secretion)

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14
Q

Which drugs are used during cataract surgery to aid in dilation/mydriasis?

A

Tropicamide
Cyclopentolate
Phenylephrine
NSAIDs

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15
Q

Which medications are used after cataract surgery and why?

A

1) Antibiotics = prevent endophthalmitis
2) NSAIDs = reduce the risk of retinal edema
3) Steroids: Use a burst/taper to decrease inflammation

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16
Q

What is the second most common cause of permanent visual in older adults in the US? What is #1?

A 
Glaucoma
#1 = Diabetes - retinopathy
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17
Q

List the risk factors for Glaucoma development.

A 
High IOP (intraocular pressure)
African racial heritage (Oh joy!)
Advanced age
Family history of gluacoma
HTN
Diabetes
Myopia - Nearsightedness
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18
Q

How do we measure progression of glaucoma?

A

“Cup to disc ratio” increases as this disease progresses

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19
Q

Two routes for aqueous humor drainage

A

1) Trabecular Meshwork outflow

2) Uveoscleral outflow

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20
Q

Which medications can cause “Floppy-Iris” and poor dilation?

A

Alpha-blockers
MOA: Decrease iris muscle tone = flaccid iris
Ex: tamsulosin

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21
Q

Where is aqueous humor produces?

A

ciliary body

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22
Q

Which drugs can increase the outflow of aqueous humor from the trabecular meshwork(TM)?

A

Cholinergic agents that constrict the ciliary muscle

- This opens the pores in the TM

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23
Q

Which drugs act on the uveoscleral outflow pathway for aqueous humor secretion?

A

Prostaglandin analogs

α-2 AGONISTS

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24
Q

What is unique when we plot data for IOP in patients?

A

“Non-gausian curve” where more people have a higher IOP than lower IOP compared to the average

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25
Q

List the 4 types of glaucoma

A

1) Primary Open-angle glaucoma (POAG)
2) Angle-closure glaucoma
3) Juvenile/Congential Glaucoma
4) Neovascular Glaucoma (Diabetics)

26
Q

What are symptoms of angle-closure glaucoma?

A

Extreme pain, seeing halos of light, red sclera due to blood vessels coming to surface
- Will see the light reflecting unevenly with a microscope

27
Q

What four factors should be considered when treating IOP?

A

Degree of Optic Nerve Cupping
Visual Field findings
Health of the eye
Central corneal thickness

28
Q

How do glaucoma medications decrease IOP?

A

1) Decrease aqueous humor production

2) Increase aqueous humor outflow

29
Q

yellow cap

A

non-selective B-blockers

30
Q

light blue cap

A

selective B-1 blockers

31
Q

dark blue cap

A

B-blockers combo products

32
Q

green cap

A

cholinergic agonists

33
Q

purple cap

A

adrenergic agonists (mostly a-2)

34
Q

orange cap

A

carbonic anhydrase inhibitor

35
Q

teal cap

A

prostaglandins

36
Q

Why do we use Adrenergic agonists drops in glaucoma patients?

A

Decrease aqueous production and increase UVEOSCLERAL outflow

37
Q

What side effects might patients experience from using adrenergic agonist eye drops?

A

Anticholinergic effects

  • Drowsiness, Fatigue, Dry Mouth
  • Decreased BP

Tachyphylaxis (decreased efficacy despite dose increase) for Iopidine

38
Q

Which α-2 agonist drop can you use in children? Why?

Which is contraindicated in children? Why?

A

Iopidine (apraclonidine)
- Does NOT cross BBB

Alphagan-P (brimonidine) = Crosses BBB
- Kids stop breathing

39
Q

Which eye drop is contraindicated in children? Why?

A

BRIMONIDINE:

- Kids stop breathing

40
Q

Why do we use beta-blocker eye drops in glaucoma patients?

A

Reduce secretion of aqueous humor

41
Q

What side effects might patients experience from using beta-blocker eye drops?

A 
**Exacerbation of asthma/COPD **
Worsening CHF
Bradycardia
HYPOtension
Tachyphylaxis
Fatigue, decreased libido
**Blunt hypoglycemic symptoms in diabetics**
42
Q

Which eye drop can be used to decrease aqueous humor secretion and also is helpful to decrease CV activity associated with the drops?

A

Carteolol = intrinsic sympathomimetic activity

43
Q

Which beta-blocker eye drop is safe to use in asthmatics/COPD patients?

A

Betoptic-S (betaxolol) - selective B-1 blocker

44
Q

Which beta-blocker eye drops are not safe to use in asthmatics/COPD patients?

A

Non-selective Beta-blockers
Timoptic, Betimol, Istalol (timolol)
Betagan (levobunolol)
carteolol

45
Q

Why do we use cholinergic agonist eye drops in glaucoma patients?

A

Increase Trabecular Outflow by opening the pores of the TM

46
Q

List the cholinergic agonist eye drops from this lecture:

A

Pilocarpine and Carbachol = short acting

Echothiophate = Long Acting

47
Q

T/F: Pilocarpine is used to help alleviate eye crossing in children.

A

False: Long-acting echothiophate iodide is the drug used (sparingly)

48
Q

What is a major contraindication for echothiophate use?

A

Succinylcholine anethesia medication use

- Patients will no longer be able to breath by themselves if both are administered

49
Q

What are the side effects associated with cholinergic agonist eye drops?

A

Headache, Brow Pain
N/V/D
Bronchial secretions
Myopia - nearsightedness

50
Q

Why do we use carbonic anhydrase inhibitors eye drops/systemic medications in glaucoma patients?

A

Decrease aqueous humor production

51
Q

List the carbonic anhydrase inhibitor oral and topical drops medications:

A

Oral: acetazolamide, methazolamide

Topical (Drops):
Trusopt (dorzolamide)
Azopt (brinzolamide)

52
Q

What are the side effects associated with carbonic anhydrase inhibitor use in glaucoma patients?

A 
Malaise, anorexia, depression
Paresthesias, esp. around lips/fingers
Serum electrolyte abnormalities
Stinging with eye drop use
Metallic taste with carbonated drinks
Renal calculi (stones)
Blood dyscrasias
Exacerbation of Sickle cell anemia
53
Q

Paresthesia

A

an abnormal sensation, typically tingling or pricking usually due to damage/pressure on nerves

54
Q

Dyscrasia

A

an abnormal or disordered state

55
Q

Malaise

A

general feeling of discomfort, illness, or uneasiness

56
Q

Why do we use prostaglandin analog eye drops in glaucoma patients?

A

Increase Uveoscleral outflow of aqueous humor

57
Q

What are side effects associated with prostaglandin analog eye drops?

A
  • Conjunctival hyperemia
  • Iris pigmentation changes
  • Eyelash growth (Latisse)
  • Periocular skin pigmentation
  • Intraocular inflammation
58
Q

List the prostaglandin analog eye drops

A

Travatan (travoprost)
Xalatan (lantanoprost)
Lumigan (bimatoprost)

59
Q

Which eye drops will have the best patient compliance?

A

Once to Twice a day dosing:

1) Beta-blockers
2) Prostaglandins

More frequent dosing decreases compliance
(other classes are 2 to 4x per day)

60
Q

Which agents are used to prevent fibrosis with glaucoma surgery?

A

Mitomycin C

5-Fluorouracil

PT I Exam I (9 decks)

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