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PY6020 > Glaucoma & its Management > Flashcards

Glaucoma & its Management Flashcards

1
Q

What is glaucoma?

A

It is raised ocular pressure in the eye due to increased aqueous humour, causing optic nerve damage & loss of visual field

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2
Q

What is the threshold pressure level for someone to be diagnosed with glaucoma?

A

> 12mm/Hg

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3
Q

What is the function of aqueous humour in the eye?

A

It provides nutrients to the cornea/lens of the eye, and maintain pressure

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4
Q

What happens when production/drainage of aqueous humour in the eye is compromised?

A

Pressure in the eye increases & can destroy delicate parts of the eye.

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5
Q

What is the main mechanism of action for drugs used in glaucoma?

A

They either increase aqueous humour drainage, or stop its production.

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6
Q

What must occur to allow the drainage of aqueous humour?

A

The angle between the iris & the cornea must always be open to allow drainage.

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7
Q

What are the 3 types of glaucoma?

A
  1. Congenital & development glaucoma
  2. Primary adult glaucoma - either primary open angle glaucoma (POAG), or primary angle closure glaucoma (PACG)
  3. Secondary glaucoma
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8
Q

Which type of primary glaucoma is likely to cause blindness?

A

POAG - primary open angle glaucoma.

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9
Q

What are the risk factors for glaucoma?

A
  1. > 40 years old
  2. Family history
  3. Diabetes
  4. Myopia - short/near sighted
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10
Q

What are the symptoms of POAG?

A
  1. Asymptomatic in most cases
  2. Vision field loss
  3. No pain/discomfort
  4. Acute POAG: redness, blurred vision, pain, nausea/vomiting, cloudiness of eye
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11
Q

What are the clinical signs for identifying POAG?

A
  1. IOP raised >12mm/Hg
  2. Delicate parts of the eye lost (>50%)
  3. Visual field impairment - starting with peripheral, then central vision
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12
Q

Why is acetazolamide not given for glaucoma, even though it can reduce IOP?

A
  1. It needs a high dose to be effective
  2. Can lead to systemic effects
  3. Its administration can be difficult
  4. Poor adherence can arise from it
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13
Q

How can we prevent the need for multiple eye drops to be instilled?

A

The medicine can be in contact lenses, which can act as a reservoir for the drug and prevent multiple eye drops being needed.

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14
Q

What are punctal plugs?

A

They are devices inserted in the eyelid which delays the drainage of the drug and acts as a sustained release reservoir for the drug

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15
Q

Why are preservatives used in eye drops?

A
  1. They maintain stability of the drug

2. They prevent bacterial growth from the water in the eye drops

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16
Q

What side effect can preservatives in eye drops cause?

A

They can be irritants, and compromise the integrity of tears & the corneal surface

17
Q

What are the 5 glaucoma drugs that can be used?

A
  1. B-blockers - reduces production of aq. humour & lowers IOP
  2. Prostaglandin analogues - 1st line treatment, used OD to control IOP for 24h
  3. Sympathomimetic drugs - A adrenergic agonists
  4. Carbonic anhydrase inhibitors
  5. Miotics
18
Q

What are some examples of B-blockers used in glaucoma?

A
  1. Betaxolol
  2. Timolol
  3. Carteolol
  4. Levonbunolol
19
Q

Why aren’t B-blockers favoured in glaucoma?

A

Because they induce many side effects, especially in the CV system.
Must avoid using in patients with bradycardia, uncontrolled asthma/HF, COPD

20
Q

Why are gel B-blockers preferred than eye drops?

A

Because gels are more viscous, which can stick to the ocular surface longer & reduce the drugs use from BD to OD

  • E.G. Timolol combinations
21
Q

What are some examples of prostaglandin analogues in glaucoma?

A
  1. Latanoprost
  2. Tafluprost
  3. Travoprost
  4. Bimatoprost
22
Q

Why aren’t gel prostaglandin analogues for glaucoma needed?

A

Because PG analogues are used OD which cover 24h, so no gel is needed.

23
Q

What are some side effects of PG analogues in glaucoma?

A
  1. Changes in eye colour
  2. Increased hair growth around eyes
  3. Dry eyes
  4. Rash
  5. Photophobia
24
Q

What can PG analogues also be used for, besides glaucoma treatment?

A

They can also be used cosmetically to darken, thicken and lengthen eyelashes.

25
Q

What 2 carbonic anhydrase inhibitor eye drops are used in the UK?

A
  1. Brinzolamide

2. Dorzolamide

26
Q

What specific side effect can carbonic anhydrase inhibitors cause?

A

They can reduce blood sugar levels, since they are based on sulphonamides.

27
Q

What are some examples of sympathomimetics?

A
  1. Brimonidine

2. Apraclonidine

28
Q

What 2 side effects can sympathomimetics cause?

A
  1. CVD

2. Cerebral/coronary insufficiency

29
Q

What are some common therapeutic problems in glaucoma?

A
  1. Lack of adherence
  2. Contraindications
  3. Intolerance to the drug
  4. Hypersensitivity

PY6020 (22 decks)

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