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PODA > Glaucoma And Dry Eye Disease > Flashcards

Glaucoma And Dry Eye Disease Flashcards

1
Q

TorF: glaucoma can potentially induce reversible damage to the retina if untreated, or inadequately treated

A

FALSE. It can potentially induce irreversible damage to the retina if untreated, or inadequately treated

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2
Q

Conventional Pathway:

A

exit/outflow through the trabecular meshwork (TM) ⇨

Schlemm’s Canal

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3
Q

Unconventional Pathway:

A

Most common is the uveoscleral pathway: outflow through base of ciliary
muscle ⇨ uvea ⇨ sclera

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4
Q

In a healthy person normal IOP is

A

~15 mm Hg

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5
Q

IOP ranges from

A

Range 11 – 21 mm Hg

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6
Q

Most common pathology of glaucoma is:

A

increased resistance to outflow

e.g., dysfunction of the trabecular meshwork

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7
Q

Acute Angle-Closure Glaucoma:

A

Primary and secondary

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8
Q

Primary AAG:

A

closure of a pre-existing narrow anterior chamber angle

Associated shallow anterior chamber (linked with far sightedness, small eye, enlargement of lens with age, inheritance)

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9
Q

Closure of angle is precipitated by

A

Pupillary dilation

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10
Q

Secondary AAG

A

May occur in anterior uveitis

With dislocation of lens

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11
Q

TorF: secondary AAG does not require a pre-existing narrow angle

A

True

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12
Q

Chronic glaucoma is characterized by ___________ of the optic disk with loss of vision

A

gradual progressive excavation (cupping)

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13
Q

In chronic Open-angle glaucoma (primary or secondary), IOP is _________ due to __________ drainage of AH through the trabecular
meshwork

A

In chronic Open-angle glaucoma (primary or secondary), IOP is
ELEVATED due to REDUCED drainage of AH through the trabecular
meshwork

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14
Q

TorF: Primary (chronic) open-angle glaucoma is usually bilateral

A

True

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15
Q

Secondary open-angle glaucoma may result from ocular disease

such as

A

pigment dispersion, uveitis, trauma or corticosteroid therapy

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16
Q

this appears as a red donut:

A

Retinal nerve fibers converge at the optic disc which forms the optic nerve

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17
Q

On dilated eye exam, this appears as the white center of the donut

A

The center of the optic disc, optic cup, which is devoid of nerve fibers

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18
Q

The _______ collapses under elevated IOP, pinching blood vessels and nerve fibers

A

Lamina cribosa

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19
Q

A major pharmacological strategy employed in treating glaucoma is focused on lowering IOP via:

A

Decreasing AH production from the ciliary processes

Increasing AH outflow from conventional or uveoscleral pathways or remodeling of the trabecular meshwork cytoskeleton)

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20
Q

What is the MOA of prostaglandin analogs?

A

Binds to prostaglandin FP receptors to cause an increase in AH outflow ‘ from the uveoscleral pathway via:

Relaxation of ciliary smooth muscles

Cytoskeletal alteration leading to change in shape of cells

Remodeling of extracellular matrix of the uveoscleral pathway by
increasing matrix metalloproteinases

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21
Q

Ocular side effects of latanoprost:

A

blurred vision

conjunctival hyperemia

foreign body sensation

itching

Increase ocular pigmentation (e.g., iris, eyelid and eyelashes)

photophobia

22
Q

Latanoprost is used for the treatment of:

A

open-angle glaucoma and

ocular HTN

23
Q

LATANOPROSTENE BUNOD

A

A nitric oxide (NO)-donating prostaglandin F2α analog

24
Q

What is the MOA of lantanoprostene bunod ?

A

Dual mechanism of action:

*Increasing AH outflow from uveoscleral pathway

  • Increasing AH outflow from trabecular meshwork pathway
    mediated by NO (lantanoprost does not have this MOA)
25
Q

What is the MOA of BETA-ADRENOCEPTOR BLOCKERS

A

Lower production of AH from the ciliary epithelial cells of the ciliary processes leading to decreased inflow into the posterior chamber.

26
Q

Ocular side effects of timolol include:

A

irritation, photophobia, eyelid

erythema, epiphora (Excessive watering of the eye)

27
Q

Systemic side effects of timolol are:

A

Systemic side effects include bradycardia, arrhythmias,

hypotension, bronchospasm and heart failure

28
Q

TorF: Timolol is used for the treatment of open-angle glaucoma

A

True

29
Q

TorF: BETAXOLOL is a cardioselective B1 blocker

A

True

30
Q

BETAXOLOL can be used for:

A

open-angle glaucoma

and

ocular hypertension

31
Q

MOA of a2 agonist:

A
  • Leads to an INCREASE in both intracellular and aqueous humor CAMP levels and INCREASE in AH outflow facility
  • Leads to VASOCONSTRICTION and REDUCED AH production
32
Q

Brimonidine is used:

A

Used in the treatment of open-angle glaucoma and ocular

hypertension

33
Q

PARASYMPATHOMIMETICS Acts by increasing AH outflow via two mechanisms:

A

*Activation of muscarinic receptors in scleral spur and the ciliary
muscle to cause contraction leading to an increase in aqueous
humor outflow

*Activation of muscarinic receptors in the iris to cause
contraction (miosis) which can relief the narrowing of the
anterior chamber angle

34
Q

___________ is a cholinesterase inhibitor which acts by increasing
the concentration of acetylcholine at muscarinic receptor sites

A

Ecothiophate

35
Q

PILOCARPINE is used in the tx of:

A

open-angle glaucoma

36
Q

ECOTHIOPHATE is used in the tx of

A

reduction of elevated intraocular presssure

37
Q

CARBONIC ANHYDRASE INHIBITORS MOA:

A
  • Acts by inhibiting carbonic anhydrase isoenzymes present in the ciliary processes leading to a REDUCTION of bicarbonate and AH SECRETION.

AND

  • A decrease in AH secretion will cause a decrease in AH
    inflow into the posterior chamber.
38
Q

ACETAZOLAMIDE is used in the tx of:

A

adjunct in open-angle glaucoma

39
Q

Inhibition of rho kinase reduces intraocular pressure via:

A
  • lowering of outflow resistance in the trabecular meshwork leading to enhanced outflow of AH from the eye
  • Decreasing AH production
  • Decreasing episcleral venous pressure
40
Q

NETARSURDIL is used in the tx of:

A

open-angle glaucoma and ocular hypertension

41
Q

What is the function of the tears?

A

 Makes cornea a smooth optical surface by covering minor surface
epithelial irregularities

 Moisten and protect corneal and conjunctival epithelium

 Inhibit the growth of microorganisms by mechanical flushing and antimicrobial action

 Provide nutrition for the cornea

 Maintain ocular tissues; support wound healing

42
Q

The outermost lipid layer:

A

Seal the tear film and prevent evaporation of aqueous layer

43
Q

The middle aqueous layer:

A

Produced by lacrimal glands and accessory glands

Contains water-soluble substances: electrolytes; proteins; immunoglobulins; nutrients

Lubricate eye, prevent infection, flush particles from eye, nourish cornea

44
Q

Dry Eye Disease Definition:

A

Dry eye is a multifactorial disease of the ocular surface characterized by:

*a loss of homeostasis of the tear film, and accompanied
by ocular symptoms, in which tear film instability and
hyperosmolarity, ocular surface inflammation and damage,and neurosensory abnormalities play etiological roles.

45
Q

What is the most common cause of evaporative dry eye?

A

Meibomian Gland Dysfunction

46
Q

Artificial tear substitutes are _______ or __________ solutions composed of electrolytes, surfactants, preservatives, and some viscosity-increasing agent that prolongs the residence time in the cul-de-sac and precorneal tear film.

A

hypotonic or isotonic

47
Q

MOA of ANTI-INFLAMMATORY IMMUNOMODULATORS

A

A calcineurin inhibitor that exerts immunomodulatory action by blocking T cell infiltration, activation and subsequent release of inflammatory cytokines and chemokines (IL-1β, TNF-α, IL-6, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1)

 Cyclosporine A also inhibits p38 and JNK activation that leads to IL-2 production. Reduced IL-2 levels further blocks the function of effector T cells

48
Q

PHARMACOLOGICAL ACTIONS of CYCLOSPORINE A

A

Increases tear production in patients with dry eye
disease that are refractory to conservative treatments
such as ocular lubricants

Protects human conjunctival epithelial cells via its
antiapoptotic actions

Improves conjunctival goblet cell density and corneal
surfact integrity via its immunomodulatory actions

49
Q

CYCLOSPORINE A is used in the tx of:

A

*Ocular side effects include instillation site pain,
conjunctival hyperemia, blepharitis, eye irritation

*Systemic side effects include urinary tract infection,
headache

*Used to increase tear production in adults with
keratoconjunctivitis sicca (dry eye)
50
Q

Lifitegrast _____ T cell migration, activation and release of proinflammatory cytokines

A

Inhibit

51
Q

LIFITEGRAST is used for the tx of:

A

Used for the treatment of signs and symptoms of dry eye disease

52
Q

This drug is a corticosteroid that reduces the inflammatory processes associated with dry eye disease

A

LOTEPREDNOL

PODA (5 decks)

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