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Glaucoma > Glaucoma > Flashcards

Glaucoma Flashcards

1
Q

What is the intraocular pressure maintained at?

A

10 - 20 mmHg

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2
Q

When does intraocular pressure increase and by how much?

A

over the age of 40

1 mmHg every decade

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3
Q

When is intraocular pressure at a max and min?

A

max - 8-11 am

min midnight to 2pm

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4
Q

What is aqueous humour indirectly related to?

A

blood pressure and blood flow in the ciliary body

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5
Q

What is the adrenergic receptor for the iris radial muscle?

A

alpha 1

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6
Q

What is the adrenergic receptor subtype for the ciliary epithelium?

A

alpha 2 and beta 2

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7
Q

Adrenergic receptor for ciliary muscle?

A

beta 2

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8
Q

Adrenergic receptor for lacrimal gland?

A

alpha 2

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9
Q

5 types of glaucoma?

A
  1. chronic open-angle glaucoma (COAG)
  2. normal tension glaucoma
  3. ocular hypertension (OHT)
  4. primary angle-closure glaucoma
  5. secondary glaucoma
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10
Q

What happens in COAG?

A

obstruction of aqueous outflow
through trabecular network
both eyes

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11
Q

Normal tension glaucoma?

A

IOP not seen on 1st screening

signs of damage

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12
Q

ocular hypertension?

A

elevated IOP in absence of visual field loss

or optic nerve damage

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13
Q

What is glaucoma caused by?

A

poor drainage of aqueous humour

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14
Q

What is IOP increased to in glaucoma?

A

> 21 mmHg

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15
Q

What happens to the fundus in glaucoma?

A

optic disk ‘cupping’

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16
Q

What type of drugs are ocular prostanoids?

A

ester compounds

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17
Q

What do ocular prostanoids do?

A

decrease IOP by increasing the uveoscleral outflow

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18
Q

Which prostanoid used when patient allergic to the preservatives?

A

tafluprost

it has no preservatives

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19
Q

What happens to lasanoprost in the body?

A

converted to its active free acid on entering the eye

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20
Q

How does travosprost work?

A

ester prodrug converted to its active form by corneal hydrolytic enzymes as it’s absorbed from the eye

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21
Q

How does bimatoprost work?

A

lowers IOP

sustained for 4 years

22
Q

What other type of drugs are used?

A

beta adrenoceptor antagonists

23
Q

What do beta blockers do?

A

block ciliary beta receptors
prevent the cyclic AMP induced rise in aqueous solution
reduce aqueous humour formation rather then increase outflow

24
Q

Which beta blocker is cardioselective?

A

betaxolol

careful with heart problems

25
Q

What side effects doe beta blockers have?

A

bradycardia
orthostatic hypotension and syncope in elderly
avoid in patients with normal tension glaucoma
bronchospasm

26
Q

What treatment is first line?

A

prostaglandin analogues

27
Q

What is mydriasis?

A

dilation of the pupil

28
Q

2 sympathomimetic agents

A

apraclonidine

brimonidine

29
Q

What type of drug is apraclonidine?

A

alpha 2 selective agonist

30
Q

What does apraclonidine do in high concentrations?

A

activates alpha 1 receptors

decreases ciliary blood flow

31
Q

What part of the eye does apraclonidine work on?

A

ciliary body

decreases aqueous humour

32
Q

Is apraclonidine used on its own?

A

no, adjunctive therapy

33
Q

When is apraclonidine used?

A

0.5% solutions used for short term therapy adjunctive treatment
patients on max tolerated therapy to delay laser treatment or surgery

34
Q

How does brimonidine work?

A

alpha 2 selective

results in miosis (pupil constriction)

35
Q

Is brimonidine used on its own?

A

yes or with beta blockers and PGA

36
Q

What does brimonidine do?

A

decreases aqueous humour production

increases uveoscleral flow

37
Q

When is brimonidine contraindicated?

A

in patients taking MAOIs or TCAs (antidepressants)

caution in severe CAD

38
Q

Miotic drug

A

pilocarpine

39
Q

How does pilocarpine work?

A

increases outflow of aqueous humour

opens channels of trabecular meshwork

40
Q

What is pilocarpines duration of action?

A

short, 4 times daily

onset of action 19 mins

41
Q

What types of glaucoma is pilocarpine used in?

A

COAG

secondary glaucoma

42
Q

Where do carbonic anhydrase inhibitors work?

A

in ciliary epithelium

43
Q

How do carbonic anhydrase inhibitors work?

A
  • inhibit CA-II
  • slows formation of bicarbonate ion and its secretion into posterior chamber
  • decreases Na transport into posterior chamber
  • lowers IOP
44
Q

3 types of carbonic anhydrase inhibitors

A

acetazolamide
dorzolamide
brinzolamide

45
Q

2 types of hyperosmotic agents

A

glycerol

mannitol

46
Q

When are hyperosmotic agents used?

A

PACG emergency

47
Q

How are glycerol and mannitol administered?

A

glycerol - oral

mannitol - IV

48
Q

How do hyperosmotic agents work?

A

move water out of vitreous humour
reduce IOP
deepen the anterior chamber

49
Q

Symptoms of PACG

A 
severe pain
nausea
redness
blurred vision
blindness within 2 days if not treated
50
Q

Permanent cure of PACG

A

laser surgery

51
Q

Iredectomy

A

hole in iris
increases flow of aqueous humour
laser surgery

52
Q

What laser is used?

A

YAG - Yttrium aluminum garnet

Glaucoma (2 decks)

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