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Patient Sem 1 > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What are the risk factors for glaucoma?

A
  • family history of glaucoma
  • ethnicity
  • systemic hypertension
  • CVD
  • migraine
  • previous ocular disease/surgery
  • primary/secondary
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2
Q

Where is aqueous humour produced?

A

epithelial cells of the ciliary muscle

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3
Q

How is aqueous humour usually drained?

A

from the anterior chamber, through the trabecular meshwork

  • collector channel
  • episcleral vein

down a pressure gradients as the anterior chamber pressure is higher than the episcleral vein

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4
Q

What is the other way aqueous humour can be drained?

A

uveoscleral outflow, aqueous humour moves through slower

  • flows directly through the ciliary body
  • cells more tightly packed and have more resistance
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5
Q

What are the examples of prostaglandin F2a analogues?

A
  • Latanoprost
  • Tafluprost
  • Travoprost

most efficacious drugs, lower IOP up to 35%

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6
Q

What is the mechanism of action of prostaglandin analogues?

A
  • acts on FP receptors in the ciliary body, muscle and sclera
  • increase uveoscleral outflow
  • ester of the drug converted back to an acid by the enzymes in the ciliary body and corneum
  • FP receptor activates Gaq protein, activates Phospholipase C, DAG and IP3
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7
Q

What are examples of prostamide F2a analogues?

A
  • Bimatoprost

not prodrugs

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8
Q

What is the mechanism of action of the prostamide analogues?

A
  • increases uveoscleral outflow
  • remodelling the extracellular matrix
  • increased matrix metalloproteinases
  • degrades collagen and extracellular matrix
  • ciliary muscle less resistant, make them more porous and flexible
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9
Q

What are the side effects of prostamide/prostaglandin eye drops?

A
  • red eye (vasodilation) but applying at night
  • increases pigmentation
  • eyelash growth
  • sensitivity to light
  • contraindicated in pregnancy
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10
Q

What does activating B receptors usually cause?

A
  • Gs protein activated
  • Activates adenylate cyclase
  • increases cAMP:
    pigmented: Na/K/2Cl transporter
    non-pigmented: Cl efflux
  • increased ions, increased osmotic gradient
  • increased fluid production
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11
Q

How do beta blockers reduce aqueous humour?

A
  • less cAMP
  • decreased ion concentration
  • decreased volume of aqueous humour
  • better balance between the production and drainage
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12
Q

What are the advantages of a beta blocker drug?

A
  • well tolerated
  • rapid onset
  • effective in 75% of patients
  • lowers IOP by 20-30%
  • compatible with other drugs
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13
Q

What are the disadvantages of a beta blocker drug?

A
  • absorbed systemically
  • observe effects on treated and untreated eye
  • efficacy declines over time
  • BD
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14
Q

What are the side effects of beta blocker drugs?

A
  • systemic
  • cardiovascular (bradychardia)
  • constricts bronchioles
  • diabetic - masks hypoglycaemia
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15
Q

What are the advantages of a fixed dose combination?

A
  • patient compliance
  • reduced exposure to preservatives
  • avoids washout of 2nd drop
  • decreases cost of treatment
  • decreases cost to patient
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16
Q

What is the mechanism of action of carbonic anhydrase inhibitors?

A
  • catalyses reaction of Co2 and Water
  • bicarbonate ions formed and excreted
  • fluid will follow the ions
  • inhibit the enzyme to decrease the volume of aqueous humour
17
Q

What is the systemic carbonic anhydrase inhibitor?

A
  • acetazolamide
  • emergency situations
  • short term use
18
Q

What are the side effects of carbonic anhydrase inhibitor?

A
  • GI problems
  • Diuresis
  • Acid/Base balance disturbances
  • Drowsiness/Depression
  • Parasthesias
19
Q

What are the topical carbonic anhydrase inhibitors?

A
  • binzolamide
  • dorzolamide
  • decreases IOP by 20%
20
Q

How are the side effects of topical carbonic anhydrase inhibitors reduced?

A
  • better lipid solubility allows corneal absorption

- more selective to the Ca II enzyme which limits side effects IF the drug is absorbed systmeically

21
Q

What are the side effects of topical CAIs?

A
  • transient burning, stinging
  • blurred vision
  • taste disturbances, dry mouth, headache
22
Q

What is the mechanism of action of a receptor agonists?

A

alpha receptors found on the ciliary epithelial cells

  • Gi protein activated
  • inactivates adenylate cyclase
  • decreases cAMP
  • decreases ion transport
  • decreases aqueous secretion

decreases ultrafiltration
increases uveo-scleral outflow

23
Q

What are the examples of a receptor agonists?

A 
brimondine 
- selective for a2 receptors
- rapid onset, peak effect 2 hours
apraclonidine
- less selective
- shot term use - tachyphylaxis
- pre & post surgery
24
Q

What are the side effects of a receptor agonists?

A
  • allergy, stoning, burning
  • blurred vision, photophobia
  • hypotension
  • drowsiness, fatigue
  • dry mouth, taste disturbances
25
Q

What is the example of parasympathomimetics?

A

pilocarpine

26
Q

What is the MOA of parasympathomimetics?

A

binds to M3 receptors int he ciliary muscle

  • ciliary muscle contracts
  • pulls open the trabecular meshwork
  • increases the trabecular outflow
  • more drainage of the aqueous humour

QDS - effects only last 6 hours, patient compliance

Patient Sem 1 (8 decks)

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