Glaucoma Flashcards
2 ways to treat glaucoma
increase drainage (outflow) decrease aqueous humor
Open angle glaucoma
chronic
painless
decrease aq drainage
How do you treat open angle glaucoma?
drugs, reducing IOP
closed narrow angle glaucoma
angle between iris and cornea reduced
block outflow
acute
ocular pain
How do you treat closed angle glaucoma?
surgically
What type of glaucoma has IOP >30?
closed angle
Which type of glaucoma is more common?
open angle
Beta blocker role in glaucoma
decrease formation
Alpha 2 agonist role in glaucoma
decrease formation
prostaglandin role in glaucoma
increase outflow
What is a BB used for glaucoma?
timolol
What is an alpha 2 agonist used in glaucoma?
brimonidine
What is a prostaglandin used in glaucoma?
latanoprost
timolol MOA
nonselective BB
decrease IOP
unclear
Why is a nonselective BB okay for glaucoma?
B2 predominate in ciliary body, so non selective is better than B1 selective
List in order the most common used agents for glaucoma
- prostaglandin
- BB
- alpha 2 agonist
Timolol CI
asthma
cardiac insufficiency
brimonidine MOA
a2 selective
decrease aq humor production
increase outflow long term
decrease IOP
brimonidine uses
open angle glaucoma
ocular HTN
t/f brimonidine is okay for long term use
true
ADE brimonidine
dry mouth
ocular hyperemia (red eye)
foreign body sensation
local burning/stinging
Systemic effects of brimonidine
hypotension
drowsiness
fatigue
latanoprost MOA
increase outflow through uveoscleral pathway
bind FP receptors (relax ciliary muscle)
latanoprost uses
glaucoma
increase diameter of eyelashes
ADE latanoprost
well tolerated
darkening pigment of iris
Pheochromocytoma
tumor of adrenal medulla that secretes catecholamines
symptoms of pheochromocytoma
severe HTN
HA
palpitations
sweating
What are used for pheochromocytoma until surgery?
alpha receptor antagonists
Phentolamine
competitive antagonist
reversible blockade
short DOA
Phenoxybenzamine
covalent binding
irreversible blockade
long DOA
What does phentolamine do to curve with BP and log dose NE?
shift curve right
What does phenoxybenazmine do to curve with BP and log dose NE?
decrease max response
Phentolamine/phenoxybenzamine effects
attenuate vasoconstriciton (decrease MAP) increase NE release
phenoxybenzamine use
long term management (1-3 weeks)
prior to surgery for pheo-related HTN
phentolamine use
rapid reverse of dental anesthesia
short term management for pheo-related HTN
ADE of phentomlamine/phenoxybenzamie
- orthostatic hypotension
- reflex tachycardia
overdose of phentolamine/phenoxybenzamine
treat with NE (not Epi)
**NE dose not stimulate vascular B2 receptors
prevent orthostatic hypotension with phentolamine/phenoxybenzamine drugs
BB may be given, but admin alone to pheo patients
Modafinil MOA
CNS psychostimulant
unclear
How does modafinil differ from amphetamine?
- differ in structure, neurochemical profile, behavioral effects
Where does modafinil bind?
NE and DA transporters
- block reuptake
What can modafinil activate?
orexin neurons: hypocretin (promote wakefullness)
FDA use for modafinil
narcolepsy
shift work sleep disorder
sleep apnea
Off label use for modafinil
ADHD
fatigue from MS and PD
cognitive enhancement
Military use for modafinil
alternative to amphetamine for prolonged combat missions
T/F modafinil has same abuse potential as amphetamine
less
ADE for modafinil
hypersensitivity reactions (SJS) dose reduction necessary with hepatic dysfunction
What receptors do you want to block to increase outflow?
stimulate M3
What receptors do you want to block to decrease aqueous humor?
block B2
Stimulate a1
