Glaucoma

Question 1

What is intraocular pressure? (IOP)

Answer 1

Balance of between rate of formation of aqueous humor and amount of resistance to its outflow

Question 2

What is IOP considered?

Answer 2

The only modifiable risk factor of glaucoma

Question 3

What percentage of cases of primary glaucoma is open angle?

Answer 3

90-95%

Question 4

Is primary open angle glaucoma quick or slow progressing?

Answer 4

Slow

Question 5

What percentage of cases of primary glaucoma is angle closure?

Answer 5

10%

Question 6

Is angle closure glaucoma an emergency?

Answer 6

YES

Question 7

What is the MC agent used in glaucoma?

Answer 7

Beta blockers

Question 8

What to beta blockers do for glaucoma?

Answer 8

Affects on beta receptors in ciliary processes which leads to reduction of aqueous humor production

Question 9

How do you reduce systemic side effects of beta blockers?

Answer 9

Using punctal occlusion -> holding the lacrimal duct for 3-5 minutes

Question 10

What line of tx are beta blockers for glaucoma?

Answer 10

First line agent

Question 11

How effective is Betaxolol as a BB for glaucoma?

Answer 11

Doesnt lower IOP as much as other products

Question 12

What is the gold standard of tx for glaucoma?

Answer 12

Timolol solution

Question 13

Is Timolol solution selective or non-selective?

Answer 13

Non-selective

Question 14

What kind of solution is Timolol?

Answer 14

Gel-forming

Question 15

How often does a pt use Timolol?

Answer 15

Once a day

Question 16

What is the benefit of adrenergic agents?

Answer 16

They act on alpha and beta receptors

Question 17

What affect do adrenergic agents have on alpha receptors?

Answer 17

Decrease aqueous humor production

Question 18

What affect do adrenergic agents have on beta receptors?

Answer 18

Increase in outflow

Question 19

What adrenergic agents are commonly used?

Answer 19

Epinephrine

Dipivefrin

Question 20

What are some SEs of adrenergic agents?

Answer 20

Systemic:

• palpations
• tachycardia
• headache
• anxiety
• increased sweating

Question 21

What is dipivefrin?

Answer 21

A prodrug of epinephrine

Question 22

When is dipivefrin shown to be effective?

Answer 22

When in combo w/ a non-selective beta blocker

more pronounced IOP decrease

Question 23

MOA of selective alpha 2 agonists

Answer 23

Decreases aqueous humor production

Increases uveoscleral outflow

Question 24

Two selective alpha 2 agonists

Answer 24

Apraclonidine

Brimonidine

Question 25

When are select alpha 2 agonists used?

Answer 25

W/ other agents if used at all

Question 26

Issue with apraclonidine

Answer 26

Tachyphylaxis develops rapidly

Question 27

When can you use brimonidine alone?

Answer 27

With pts who are intolerant to beta blockers

Question 28

What do cholinergics do to the eye?

Answer 28

Stimulation of sphincter pupillae | and causes miosis

Question 29

What happens when cholinergics work on the eye?

Answer 29

Pulls open the meshwork and increases outflow

Question 30

What does Pilocarpine do?

Answer 30

Reduces IOP by 20-30%

Question 31

What are two cholinergic agents?

Answer 31

Pilocarpine | Carbachol

Question 32

What is a different name for Pilocarpine and how is it released?

Answer 32

Ocusert | Slow-release

Question 33

What is the MOA of cholinergic anticholinesterase agents?

Answer 33

Binds to enzyme which breaks down endogenous acetylcholine | *Cholinesterase inhibitor*

Question 34

When do you use anticholinesterases?

Answer 34

When pts are unresponsive or intolerant of other therapies

Question 35

What is the effect of carbonic anhydrase inhbitors (CAIs)

Answer 35

Inhibit carbonic anhydrase in ciliary body to decrease aqueous formation by 40-60%

Question 36

CAI agents

Answer 36

Dorzolamide and Brinzolamide | Acetazolamide

Question 37

How are dorzolamide and brinzolamide given and how large is the effect?

Answer 37

Topically | Reduced IOP and 15-26%

Question 38

How is acetazolamide given and how large is its effect?

Answer 38

Orally | Reduce IOP by 25-40%

Question 39

What is an issue with acetazolamide?

Answer 39

It has a higher incidence of SEs

Question 40

What do prostaglandin F2-alpha analogues do?

Answer 40

Increase uveoscleral outflow of aqueous humor

Question 41

How many side effects do prostaglandin F2 meds have and what are they?

Answer 41

Fewer than Timolol Iris pigmentation Eyelash thickening

Question 42

How efficacious are prostaglandin F2 meds?

Answer 42

Decrease IOP similarly to beta blockers if not MORE

Question 43

Prostaglandin F2 example and dosing

Answer 43

Latanoprost solution 0.05% | Dose q24 hours

Question 44

Tx of angle-closure glaucoma

Answer 44

Go to ER | Iridectomy = definitive tx

Question 45

What are the 3 meds of choice for glaucoma

Answer 45

Beta blockers Prostaglandin F2-alpha analogues Carbonic Anhydrase Inhibiton