Glaucoma doc

Question 1

Define glaucoma

Answer 1

Increased or reduced intraocular pressure damaging the optic nerve; open- or closed-angle

Question 2

What 6 categories of drugs can be used to treat glaucoma? Include what the first two categories do.

Answer 2

1) Prostaglandin analogs: increase AQ humor outflow
2) Beta blockers: reduce AQ humor production
3) Cholinergics (miotics)
4) Carbonic anhydrase inhibitors
5) Adrenergic alpha-2 agonist
6) Rho kinase inhibitor

Question 3

What 5 prostaglandin analogs can be used to treat glaucoma? List the unique characteristics of each.

Answer 3

1) Bimatoprost (Lumigan): Latisse is for eyelash hypotrichosis; may also consider castor oil
2) Latanoprost (Xalatan): Cold storage; good for six weeks at room temperature
-Xelpros does not contain benzalkonium chloride(BAK)*
3) Tafluprost (Zioptan): Single-use and preservative-free
4) Travoprost (Travatan Z): Does not contain BAK

Question 4

What are the side effects of prostaglandin analogs used to treat glaucoma?

Answer 4

May cause darkening of iris and eyelashes

Question 5

What is BAK?

Answer 5

Common preservative associated with burning and irritation post medication administration

Question 6

What do beta blockers do to treat glaucoma? What are the two types used to treat this condition? Which of these two is preferred?

Answer 6

Reduce aqueous humor production:
1) Timolol (Timoptic): Consider if only needing monotherapy.
2) Betaxolol (Betoptic S): Less likely to cause pulmonary adverse effects compared to non-selective beta-blockers

Question 7

Timolol
1) What is unique about Timoptic-XE and Timolol GFS?
2) What is Cosopt?
3) How is Cosopt different from Cosopt PF?

Answer 7

1) They’re gels; administer once daily instead of twice daily
2) Timolol + dorzolamide
3) Cosopt PF is preservative free

Question 8

1) What are the side effects of using beta blockers (timolol or betaxolol) to treat glaucoma?
2) What are the contraindications (2)?

Answer 8

1) Increased light sensitivity and reduced HR / BP
2) Heart block & bronchospastic disease

Question 9

1) What Cholinergic (miotic) can be used to treat glaucoma?
2) What does it do?
3) What are its side effects?
4) When should precautions be taken?

Answer 9

1) Pilocarpine (Isopto Carpine)
2) Increase aqueous humor outflow
3) Poor night vision due to pupil constrictions, corneal clouding, GI distress
4) If history of corneal abrasion or retinal detachment

Question 10

1) What carbonic anhydrase inhibitor can be used to treat glaucoma?
2) What does it do?
3) What other carbonic anhydrase is infrequently used for glaucoma?
4) What precaution should be taken?

Answer 10

1) Dorzolamide (Trusopt)
2) Reduce aqueous humor production
3) Acetazolamide (PO)
4) Sulfonamide allergy cross reactivity

Question 11

1) What adrenergic alpha-2 agonist can be used to treat glaucoma?
2) What does it do? (2 things)
3) What are its two side effects?

Answer 11

1) Brimonidine (Alphagan P)
2) Increase aqueous humor outflow; reduce aqueous humor production
3) CNS depression and anticholinergic effects

Question 12

1) What Rho kinase inhibitor can be used to treat glaucoma?
2) What does it do?
3) How should it be stored?
4) What are its two side effects?

Answer 12

1) Netarsudil (Rhopressa)
2) Increase aqueous humor outflow
3) Cold storage; good for six weeks at room temperature
4) Conjunctival hemorrhage or hyperemia

Question 13

List the drugs that increase AQ humor outflow

Answer 13

1) Prostaglandin analogs
2) Pilocarpine (Isopto Carpine)
3) Brimonidine (Alphagan P)
4) Netarsudil (Rhopressa)