Glaucoma and Contraception

Question 1

only modifiable risk factor for glaucoma

Answer 1

intraocular P

Question 2

primary open-angle glaucoma

Answer 2

90-95% of all primary glaucoma

slowly progressive

Question 3

primary angle-closure glaucoma

Answer 3

10% of all primary glaucoma
emergency room!
tdxw tih iridectomy

Question 4

most common agents for glaucoma

Answer 4

BB!
acts on B2 ref’s in the ciliary processes which leads to red of aqueous humor prod
systemic SE dec by using punctual occlusion

Question 5

punctual occlusion

Answer 5

holding lacrimal duct for 3-5 min

Question 6

BB’s for glaucoma

Answer 6

doesn’t lower IOP as much as other pdts
first line
timolol solution is gold standard!!

Question 7

adrenergic agnets for glaucoma

Answer 7

alpha rec’s: dec aqueous humor prod
beta rec’s: inc in outflow
epinephrine and Dipivefrin SE: palpitation, tachycardia, HA, anxiety, sweating

Question 8

Dipivefrin

Answer 8

prodrug of epinephrine

shown to be effective in combo with nonselective BB (more pronounced IOP dec)

Question 9

cholinergics- direct acting miotics

Answer 9

simulation of sphincter pupillae
causes miosis
pulls open the meshwork
inc outflow 
includes

Question 10

ocusert

Answer 10

cholinergic

slows release delivery system

Question 11

anticholinesterase agents

Answer 11

binds to enzyme which breaks down endogenous acetylcholine (cholinesterase inhibitor)
used only in pt’s unresponsive or intolerant of other therapies

Question 12

Carbonic anhydrase inhibitors

Answer 12

1/3 of med of choice for glaucoma

BB, prostaglandin F2 alpha analogues and them

Question 13

Prostaglandin F2-alpha analogues

Answer 13

inc uveoscleral outflow of aqueous humor

fewer systemic SE than Timolol

Question 14

highest fail rate for non-hormonal contraception

Answer 14

cervical cap and spermicide

Question 15

least failure for non-hormonal contraception

Answer 15

copper IUD and sterilization

Question 16

primary MOA for hormonal contraceptives

Answer 16

inhibition of ovulation

Question 17

hormonal components

Answer 17

estrogens (synthetic) - ethinyl estradiol

progestins (synthetic progesterone analogs) - levonorgestrel

Question 18

common OCPs

Answer 18

mono phase, biphasic, triphasic, quadriphasic pdts and progestin only (mini pill)

Question 19

non contraceptive benefits of hormonal control

Answer 19

inc Hgb (some OCPs contain Fe)
red risk of fetal neural tube defects (some OCPs contain folate)
dec vasomotor symptoms in perimenopause
inc bone mineral density in perimenopause

Question 20

VTE and OCPs

Answer 20

greatest RF’s: obesity, smokers, HTN, DM, recent post-op and previous DVT (use progestin only in these pt’s)
least risk with levonorgestrel

Question 21

CA and CV Effects with OCPs

Answer 21

mostly associated with unopposed estrogen
lower ethinyl estradiol inc risk of failure/preg
MI/stroke risk
ethinyl estradiol not recommended in smokers >35, women with HTN and migraines

Question 22

less serious SE of OCPs

Answer 22

most can be minimized or avoided by adjusting the EE and/or progestin content

Question 23

LARC’s

Answer 23

subnormal implant or intrauterine device (non hormonal is copper, or hormonal)

Question 24

copper IUD

Answer 24

10 yr duration of use
most effective form of contraception (more effective than emergency pills!!)
may be inserted up to 10 days post intercourse
SE: inc menstrual bleeding

Question 25

hormonal IUDs

Answer 25

3-5 yr duration use

tend to have dec menstrual bleeding

Question 26

IUD drawbacks

Answer 26

can be unsuccessful in up to 18%
risk of uterine perforation
risk of expulsion: immediately post placenta delivery, 10 min - 48 hrs post placenta delivery or 4-8 weeks post party (risk dec’s with each)