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Pharm > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is intraocular pressure? (IOP)

A

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

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2
Q

What is IOP considered?

A

The only modifiable risk factor of glaucoma

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3
Q

What percentage of cases of primary glaucoma is open angle?

A

90-95%

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4
Q

Is primary open angle glaucoma quick or slow progressing?

A

Slow

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5
Q

What percentage of cases of primary glaucoma is angle closure?

A

10%

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6
Q

Is angle closure glaucoma an emergency?

A

YES

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7
Q

What is the MC agent used in glaucoma?

A

Beta blockers

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8
Q

What to beta blockers do for glaucoma?

A

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

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9
Q

How do you reduce systemic side effects of beta blockers?

A

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

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10
Q

What line of tx are beta blockers for glaucoma?

A

First line agent

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11
Q

How effective is Betaxolol as a BB for glaucoma?

A

Doesnt lower IOP as much as other products

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12
Q

What is the gold standard of tx for glaucoma?

A

Timolol solution

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13
Q

Is Timolol solution selective or non-selective?

A

Non-selective

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14
Q

What kind of solution is Timolol?

A

Gel-forming

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15
Q

How often does a pt use Timolol?

A

Once a day

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16
Q

What is the benefit of adrenergic agents?

A

They act on alpha and beta receptors

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17
Q

What affect do adrenergic agents have on alpha receptors?

A

Decrease aqueous humor production

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18
Q

What affect do adrenergic agents have on beta receptors?

A

Increase in outflow

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19
Q

What adrenergic agents are commonly used?

A

Epinephrine

Dipivefrin

20
Q

What are some SEs of adrenergic agents?

A

Systemic:

  • palpations
  • tachycardia
  • headache
  • anxiety
  • increased sweating
21
Q

What is dipivefrin?

A

A prodrug of epinephrine

22
Q

When is dipivefrin shown to be effective?

A

When in combo w/ a non-selective beta blocker

more pronounced IOP decrease

23
Q

MOA of selective alpha 2 agonists

A

Decreases aqueous humor production

Increases uveoscleral outflow

24
Q

Two selective alpha 2 agonists

A

Apraclonidine

Brimonidine

25
Q

When are select alpha 2 agonists used?

A

W/ other agents if used at all

26
Q

Issue with apraclonidine

A

Tachyphylaxis develops rapidly

27
Q

When can you use brimonidine alone?

A

With pts who are intolerant to beta blockers

28
Q

What do cholinergics do to the eye?

A

Stimulation of sphincter pupillae

and causes miosis

29
Q

What happens when cholinergics work on the eye?

A

Pulls open the meshwork and increases outflow

30
Q

What does Pilocarpine do?

A

Reduces IOP by 20-30%

31
Q

What are two cholinergic agents?

A

Pilocarpine

Carbachol

32
Q

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

A

Ocusert

Slow-release

33
Q

What is the MOA of cholinergic anticholinesterase agents?

A

Binds to enzyme which breaks down endogenous acetylcholine

Cholinesterase inhibitor

34
Q

When do you use anticholinesterases?

A

When pts are unresponsive or intolerant of other therapies

35
Q

What is the effect of carbonic anhydrase inhbitors (CAIs)

A

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

36
Q

CAI agents

A

Dorzolamide and Brinzolamide

Acetazolamide

37
Q

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

A

Topically

Reduced IOP and 15-26%

38
Q

How is acetazolamide given and how large is its effect?

A

Orally

Reduce IOP by 25-40%

39
Q

What is an issue with acetazolamide?

A

It has a higher incidence of SEs

40
Q

What do prostaglandin F2-alpha analogues do?

A

Increase uveoscleral outflow of aqueous humor

41
Q

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

A

Fewer than Timolol
Iris pigmentation
Eyelash thickening

42
Q

How efficacious are prostaglandin F2 meds?

A

Decrease IOP similarly to beta blockers if not MORE

43
Q

Prostaglandin F2 example and dosing

A

Latanoprost solution 0.05%

Dose q24 hours

44
Q

Tx of angle-closure glaucoma

A

Go to ER

Iridectomy = definitive tx

45
Q

What are the 3 meds of choice for glaucoma

A

Beta blockers
Prostaglandin F2-alpha analogues
Carbonic Anhydrase Inhibiton

Pharm (32 decks)

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