Glaucoma + Management (3/27/14) Gillepsie Flashcards
glaucoma risk factors
-high IOP
-positive FH
-Hispanic/AA
-Myopia = near sighted
-hypertension
-uveitis
-opthalmic trauma
STEROIDS!!!!
what do you give first if patient has closed-angle glaucoma?
IV Acetazolamide
What drugs decrease humor production?
- B receptor antagonists (-lol)
- Carbonic Anhydrase Inhibitors (-zolamide)
What drugs increase humor outflow?
- miotic agents (pilocarpine, physiostigmine)
- PGF2a = prost’s
- epinephrine-related agents (-ephrine/efrin)
Pilocarpine
cholinergic agonist
miotic agent
increases humoral outflow
Physiostigmine
ACh-E inhibitor
miotic agent
increases humoral outflow
toxicity of miotic agents
ciliary muscle spasm
CI of miotic agents
- young patients intolerant of visual blurring
- patients w/ increased risk of retinal detachment
CI of B-receptor antagonists
ASTHMA
COPD w/ bronchospasm
arrythmias: bradycardia, heart block
latanoprost
PGF-2a prodrug
increases humoral absorption
FRONT LINE THERAPy
toxicity of epinephrine-related agents
systemic absorption –> systemic effects
dipivefrin
epi pro-drug
epinephrine-related agent
epinephrine
epinephrine-related agent
acetazolamide
carbonic anhydrase inhibitor
methazolamide
carbonic anhydrase inhibitor
toxicity/CI of CA inhibitors
- malaise/fatigue
- depression
- parasthesias
- KIDNEY STONES
aproclondine (iopidine)
a2 selective agent
epinephrine-related agent
reducing IOP by 30% does what?
decreases disease progression from 35-15% even in patients w/ normal IOP
what the the order of treatment?
1 ) “prost” (alternative = b-blocker)
2/3 ) CA inhibitors, epinephrine-related agonists, and miotic agents
combo ) add topical agents
systemic ) add Carbonic Anhydrase inhibitors
