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Pharmacotherapy > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is glaucoma

A

Eye disease characterized by intraocular hypertension or increased pressure within the eye

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2
Q

At what intraocular pressure can a glaucoma be confirmed

A

> 22 mmHg

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3
Q

Why can glaucoma cause blindness or vision loss

A

Increased pressure in the eye can lead to damage of the optic nerve

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4
Q

Clear front of the eye that transmits and focuses light onto the eye

A

Cornea

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5
Q

Colored part of the eyes with muscles to constrict or relax the eye to regulate the size of the pupil

A

Iris

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6
Q

Size determines or regulates how much light enters the eye

A

Pupil

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7
Q

Transparent flexible tissue that help focus light and images on the retina

A

Lens

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8
Q

Senses light and create electrical impulse and sends them to the optic nerve

A

Retina

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9
Q

The chamber between the cornea and iris

A

Anterior chamber

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10
Q

Chamber between Iris and lens

A

Posterior chamber

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11
Q

Btw the Lens and retina carrying Virteous humor

A

Virteous Chamber

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12
Q

What chambers carry the aqueous humor

A

Anterior and posterior chamber

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13
Q

Clean water fluid produced by the ciliary body and brings nutrient to the eyes and maintains intraocular pressure

A

Aqueous humor

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14
Q

What is the roadway travel of aqueous humor

A

Starts from the posterior chamber to the anterior chamber through the pupil, across the iris and trabecular meshwork into the collecting duct (canal of schlemms) to the episcleral vein

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15
Q

What happens when aqueous humor enters the episcleral vein

A

It is absorbed into the bloodstream

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16
Q

What causes the intraocular pressure that leads to glaucoma

A

Interruption in flow of aqueous humor as a result of a blockage

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17
Q

Once blindness or damage to the optic nerve occurs is there treatment

A

No

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18
Q

What is the goal of glaucoma therapy

A

Prevent further damage to the optic nerve

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19
Q

What are the risk factors of glaucoma

A

Older adults

Family history of glaucoma

African Americans

Systemic or topical corticosteroid use

Patients with high intraocular pressure

Diabetes

Myopia

Genetic mutations

Thinner central corneal thickness

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20
Q

What is primary open angle glaucoma

A

Blockade in the trabecular meshwork causing increased resistance to aqueous humor drainage through the trabecular meshwork

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21
Q

What is primary closed angle glaucoma

A

Increase in the lens size that it presses against the cornea leading to obstruction of drainage pathways by the Iris

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22
Q

What are the diagnostic test

A

Visual field testing

Ocular tonometry

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23
Q

Open angle glaucoma symptoms

A

Asymptomatic until substantial vision loss occurs

Reduce IOP by 20-30% to reduce risk of optic nerve damage

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24
Q

True/False: in open angle glaucoma Intra ocular pressure can be normal or elevated ( > 21 mmHg)

A

True

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25
Q

In open angle glaucoma what is considered mild IOP

A

Optic disk abnormalities with normal visual field

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26
Q

In open angle glaucoma what is considered moderate IOP

A

Optic disk changes with visual field abnormalities in one hemifield

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27
Q

In open angle glaucoma what is considered severe IOP

A

Optic disk changes with visual field abnormalities in both hemifield

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28
Q

Open angle glaucoma signs

A

Disk changes and visual field loss

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29
Q

Closed angle glaucoma symptoms

A

Asymptomatic

Prodromal symptoms

Acute episodes

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30
Q

Prodromal symptoms of closed angle glaucoma

A

Blurred vision

Halos around light

Occasional headache

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31
Q

Acute episodes of closed open Glaucoma

A

Cloudy

Edematous corneas

Ocular pain

Discomfort

Nausea and vomiting

Abdominal pain

Diaphoresis

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32
Q

What are the signs of closed angle glaucoma

A

Acute

Hyperemia Conjuctiva

Cloudy cornea

Shallow anterior Chamber

Occasional edematous and hyperemic optic disk

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33
Q

True/False: Closed angle glaucoma IOP is generally markedly elevated (40-90mmHg)

A

True

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34
Q

Which drugs induce open angle Glaucoma

A

Corticosteroids

Ophthalmic anticholinergics

Succinylcholine

Vasodilator

Cimetidine

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35
Q

Drugs that induce closed angle glaucoma

A

Anticholinergics

BZ

Topiramate

Antihistamine

Tetracycline

Pratropium

Phenothiazine

SSRIs

Venlafaxine

Sympathomimetics

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36
Q

How are ways in which IOP is decreased

A

Decrease aqueous humor production

Increase aqueous humor outflow

Both ways

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37
Q

Drugs to decrease aqueous humor production

A

Beta-blockers

Carbonic hydrase inhibitors

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38
Q

Drugs to increase aqueous humor outflow

A

Prostaglandin analogs

Cholinergic analogs

Rho kinase inhibitors

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39
Q

Drugs of both ways

A

Alpha 2 adrenergic agonist

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40
Q

Beta blockers cap color

A

Yellow

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41
Q

Beta blocker MOA

A

Decrease production of aqueous humor by the ciliary body

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43
Q

Non-selective beta blockers

A

Timolol

Levobunolol

Metipranolol

Carteolol

44
Q

Selective beta blocker

45
Q

Reduce IOP by 20-30%

A

Beta blockers

46
Q

Frequency of beta blocker administration

47
Q

Systemic ADR of beta blockers

A

Decreased heart rate

Decreased blood pressure

Bronchospasm

48
Q

Local adp of beta blockers

A

Ocular irritation and dry eyes

49
Q

Carbonic anhydrase inhibitors cap color

50
Q

Topical CAI

A

Dorzolamide

Brinzolamide

51
Q

CAI MOA

A

Inhibit aqueous humor production by blocking active secretion of sodium and bicarbonate ions from the ciliary body

52
Q

Systemic CAI is typically reserved for?

A

Acute treatment

53
Q

Reduce CAI by 15-26%

54
Q

CAI Frequency of Dosing

A

BID or TID

55
Q

CAI local ADR

A

Burning or stinging

Dry eyes

Ocular discomfort

Transient blurred vision

Tearing

56
Q

CAI Systemic ADR

A

Malaise

Fatigue

Nausea

Weight loss

Altered taste

Renal stones

57
Q

What color are prostaglandin analog color

58
Q

Drugs of prostaglandin analogs

A

Bimatoprost

Lantanoprost

Tafluprost

Travoprost

Lantanoprostene bound

59
Q

Prostaglandin analog MOA

A

Increases uveoscleral outflow and trabecular outflow of aqueous humor

Produces collagen changes in the matrix of the cilliary body and trabecular meshwork

60
Q

Lantoprostene bunod

A

Latanoprost prodrug metabolized to nitric oxide donating moiety

61
Q

Reduce IOP by 25-35%

A

Prostaglandin Analogs

62
Q

Frequency of prostaglandin analog dosing

A

Once daily

One drop at night

63
Q

Local ADR of prostaglandin analogs

A

Lengthening and darkening of eyelashes

Brown discoloration of eyes (irreversible)

Macular edema

64
Q

Systemic ADR of prostaglandin analogs

A

Minimal but may occasionally cause headache

65
Q

Cholinergic agent cap color

66
Q

Drugs of cholinengic cholinergic agents

A

Pilocarpine

Carbachol

67
Q

Cholinergic agent MOA

A

Physical pulling of trabecular meshwork open thereby increasing outflow

68
Q

IOP reduction by 20-30%

A

Cholinerigic agents

69
Q

Cholinergic dosing frequency agents

A

TID or QID

70
Q

Local ADR of cholinergic agents

A

Mitosis: decreasing vision and night vision IM patients with central cataracts

Ocular discomforts

71
Q

Systemic ADR of cholinergic agents

A

Frontal headache

Brow ache

Eyelid twitching

72
Q

Rho kinase inhibitor

A

Netarsudil

73
Q

Netarsudil MOA

A

Increases trabecular meshwork outflow

74
Q

Decrease IOP by 15-22%

A

Netarsudil

75
Q

Frequency of Netarsudil dosing

A

Once daily

76
Q

Local ADR of Netarsudil

A

Conjunctival hyperemia and hemorrhage

Corneal verticillate

77
Q

Systemic ADR of Netarsudil

78
Q

How can we increase outflow and decrease production

A

Alpha 2 adrenergic agonist

79
Q

Drugs of alpha 2 adrenergic

A

Bromonidine

Apraclonidine

80
Q

Reduce IOP by 18-27%

A

Alpha 2 adrenergic agonist

81
Q

Frequency of Dosing of alpha 2 adrenergic agonist

A

BID or TID

82
Q

Local ADR of alpha 2 agonist

A

Allergic reactions

Dry eyes

Ocular discomfort

83
Q

Systemic ADR of alpha 2 agonist

A

Dizziness

Fatigue

Dry mouth

Reduction in blood pressure and pulse (postural hypotension)

84
Q

Who should alpha 2 be dosed cautiously

A

Patient with insufficient coronary and cerebral function

Hepatic and renal dysfunction

85
Q

Timolol combination drop

A

Dorzolamide

Brimonidine

Prostaglandins

86
Q

Brimonidine combo.

A

Brinzolamide

87
Q

Netarsudil combo

A

Lantanoprost

88
Q

First line therapy

A

Prostaglandin analogue

Beta blocker

89
Q

Alternate first line

A

Brominidine

90
Q

If there is contraindication to first line therapies what should be used

A

Topical CAI

91
Q

How long till patient is reassessed

92
Q

If patient is intolerant fo therapies what should be done

A

Reduce dose/concentration first

Or

Change formulation

Or

Switch to Class alternative or alternative combination

93
Q

If inadequate response what should be done

A

Ensure compliance

Instruct on nasolacrimal occlusion

Increase concentration or dose frequency

Switch to alternative first line therapies

94
Q

If partial response with first line agents what should be done

A

Add second or third first line agent or topical CAI

95
Q

If there is inadequate response to first line and second line what should be done

A

Consider adding direct-acting cholinergic agent as fourth line and consider replacing with cholinestrase inhibitor

Consider adding oral CAI over topical CAI

Multiple topical therapies plus oral carbonic anhydrase inhibitor

96
Q

When all pharmanologic therapy have failed that is left to do

A

Surgery or laser procedure

97
Q

Surgery for open angle glaucoma

A

Trabeculoplasty

98
Q

Surgery for closed angle glaucoma

99
Q

What is acute angle closure crisis (AACC)

A

Medical emergency: sudden closure of angle between the iris and trabecular meshwork lending to rapid increase of IOP

100
Q

Symptoms of AACC

A

Rapid onset of blurred vision

Red eye

Pain

Headache

Nausea and vomiting

101
Q

Goals of therapy for AACC

A

Rapidly Reduce IOP

Avoid surgical or laser iridectomy

102
Q

AAC treatment options

A

One or more anti-glaucoma agent:

Miotics-pilocarpine

Secretory inhibitors: beta blockers, alpha I agonist, topical/systemic CAI
or
Prostaglandins

Give osmotic agents like oral glycerin 1-2 g/kg or IV mannitol 1-2 g/kg

Quickly withdraw water from the eyes using osmotic gradient between the blood and eye

103
Q

When all pharmacologic therapies for AACC fail what should be done.

A

Peripheral iridectomy

104
Q

What should patients know prior to Administration

A

Do not administer more than one drop per dose

When 2 or more drugs administered, meds should be separated by at least 5 minutes (10 minutes
preferred)

Remove contacts prior to administration

105
Q

Systemic CAI

A

Acetazolamide

Dichlorphenamide

Methazolamide

Pharmacotherapy (12 decks)

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