Glaucoma Flashcards
Review technique for drop administration
- 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
Concerns with ophthalmic administration
- Systemic Absorption via nasal mucosa
- Avoid 1st pass metabolism
- Increasing systemic bioavailability
- More potential for toxicity
How can patients minimize systemic absorption of ophthalmic medications?
- 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
What are side effects associated with systemic absorption of ophthalmic medications?
Drug dependent
How can you improve ocular absorption?
Preservative Astringent on K epithelium Increase contact time with ocular surface - Spacing drops out - Punctal Occlusion - Gently closing eyeslids
Why do ophthalmic medications have preservatives other than stability/sterility?
Allow for increased ocular penetration
Ex: Benzalkonium chloride (BAK)
Four dosage forms for ophthalmic drug delivery:
Drops, Ointments, Periocular Injection, Intraocular Injection
What is the 3rd leading cause of visual loss in older people?
Age-Related Cataracts
Which type of cataract would be associated with prednisone use?
Posterior Subcapsular Cataracts (PSC)
Describe the symptoms patients with cataracts will present.
1) Disturbances of near or far distance
2) Progression to diminution of vision “blurry”
3) Glare
Severity + location = impairment status
Compare and contrast Glaucoma v cataracts visual symptoms:
Glaucoma = Loss of peripheral vision Cataracts = Scattered light = blurred vision
Which medication used during surgery provides anesthesia and akinesia of eye muscles?
Hyalurodinase
Why do surgeons use Healon, Viscoat or Provisc in cataracts surgery?
Thick gel agents injected into the eye that keep the eye formed (decreases liquid secretion)
Which drugs are used during cataract surgery to aid in dilation/mydriasis?
Tropicamide
Cyclopentolate
Phenylephrine
NSAIDs
Which medications are used after cataract surgery and why?
1) Antibiotics = prevent endophthalmitis
2) NSAIDs = reduce the risk of retinal edema
3) Steroids: Use a burst/taper to decrease inflammation
What is the second most common cause of permanent visual in older adults in the US? What is #1?
Glaucoma #1 = Diabetes - retinopathy
List the risk factors for Glaucoma development.
High IOP (intraocular pressure) African racial heritage (Oh joy!) Advanced age Family history of gluacoma HTN Diabetes Myopia - Nearsightedness
How do we measure progression of glaucoma?
“Cup to disc ratio” increases as this disease progresses
Two routes for aqueous humor drainage
1) Trabecular Meshwork outflow
2) Uveoscleral outflow
Which medications can cause “Floppy-Iris” and poor dilation?
Alpha-blockers
MOA: Decrease iris muscle tone = flaccid iris
Ex: tamsulosin
Where is aqueous humor produces?
ciliary body
Which drugs can increase the outflow of aqueous humor from the trabecular meshwork(TM)?
Cholinergic agents that constrict the ciliary muscle
- This opens the pores in the TM
Which drugs act on the uveoscleral outflow pathway for aqueous humor secretion?
Prostaglandin analogs
α-2 AGONISTS
What is unique when we plot data for IOP in patients?
“Non-gausian curve” where more people have a higher IOP than lower IOP compared to the average
