Glaucoma Medications - Final, not Exam 2

Question 1

increased IOP without damage to optic nerve

Answer 1

Ocular hypertension

Question 2

progressive optic neropathy with distinctive atrophy of the optic nerve head with cytotoxic retinal ganglion cell death, in association or not to elevated intraocular pressure

Answer 2

Glaucoma

Question 3

Risk factors: high IOP, family hx, ethnicity, advanced age, myopia, DM, CVD

Answer 3

risk factors for Glaucoma

Question 4

2 mechanisms for treating ocular hypertension

Answer 4

decrease aqueous production, increase outflow

Question 5

IOP at what point requires multiple pharmacological agents?

Answer 5

30 mmHg

Question 6

3 categories that act on the ciliary epithelium

Answer 6

Beta blockers, alpha 2 agonists, CAI

Question 7

2 categories that affect uveoscleral outflow

Answer 7

prostaglandins and alpha 2 agonists

Question 8

1 category affecting trabecular meshwork

Answer 8

direct acting cholinergics

Question 9

Only category with dual action ( ciliary epithelium and uveoscleral outflow)

Answer 9

alpha 2 agonists

Question 10

Adrenergic antagonists or sympatholytic, B2 adrenergic antagonist that block excitatory response of alpha 2 receptors responsible of aqueous humor formation

Answer 10

Beta blockers- timolol, lovobunolol, metipranolol, carteolol, betaxolol

Question 11

B2 blocker - better iop control than pilo and eminephrine, well tolerated in CLS pts, works for 3 weeks, wash out period for 1-2 months

Answer 11

Timolol

Question 12

Beta blocker for glaucoma with more side effects in some patients

Answer 12

Levobunolol

Question 13

BEta blocker with no significant effect in pulmonary function for glaucoma

Answer 13

Betaxolol

Question 14

beta blocker for glaucoma that increases HDL, less effective than levo and hydrosoluble

Answer 14

Carteolol

Question 15

category of non bacteriostatic sulfonamides that inhbit an enzyme to reduce rate of aq humour production, found mainly in RBC, inhibits formation of bicarbonate,

Answer 15

CAI’s

Question 16

CAI reduces iop by 3 to 5 mmHg - not good for IOP above 30, better for mid 20 range, TID mono, BID combo, SE bitter taste, CI in cls, caution in sulfa allergies, safe in children older than 3

Answer 16

Dorzolamide

Question 17

CAI 1% suspension, reduce iop 4 to 5, known to cause headaches, careful with migraines

Answer 17

Brinzolamide

Question 18

CAI for OAG, secondary glaucoma and pre op tx for CAG, safe in children, comes in tablets, capsules and IV, CI sulfa allergies, short term- 250 acute- 500 mg, SE paresthesia, transient MYOPIA from lens retaining water

Answer 18

Acetazolamide

Question 19

CAI with less frequent administration than Acetazolamide, 2 or 3 times per day

Answer 19

Methazolamide

Question 20

Cholinergic direct acting- increase outflow- not widely used due to SE’s, 1 drop QID, contracts longitudinal muscle, not in patients younger than 40 years old due to fighting between accommodation and drug action causing pain

Answer 20

Pilocarpine

Question 21

cholinergic direct acting- increase outflow- 1.5 and 3%, 1 drop 3 or 4 times per day, pre and post op IOP decrease, not for long term use

Answer 21

Carbechol

Question 22

cholinergic antagonist to decrease aq outflow, cholinesterase inhbitor, irreversible, needs to be reconstituted, has many side effects like twitching, uveitis, myopia, retinal detachment, antidote is Atropine

Answer 22

Echothiopate

Question 23

First line treatment in glaucoma, increase outflow, safe, one dose per day, safe with other meds, prostanoid receptors relax ciliary muscles and dilate ciliary vessels to enhance outflow, CI in immunocompromised or inflammatory conditions

Answer 23

Prostaglandins

Question 24

Second line treatment in glaucoma

Answer 24

Betablockers

Question 25

first prostaglandin for glaucoma, decrease IOP by 6 to 8 mmHg reduction - 25%, works at same rate 24 hrs per day, not like beta blockers that are more active waking hours, BAK preservative can cause irritation, must be refrigerated SE: darkening iris, conj. hyperemia, hypertrichosis, uveitis, CI in uveitis, risk CME (careful with cataract sx), recurrent herpes keratitis

Answer 25

Latanaprost

Question 26

prostaglandin, IOP reduction of 6.8 to 8.3, SE hypermia

Answer 26

Travaprost

Question 27

prostaglanid ethanolamide-prostamine, no activation of FP receptors , 3rd choice of prostaglandans, SE hyperpigmentation, conj hyperemia

Answer 27

Bimatoprost

Question 28

analog prostaglandin with IOP reduction of only 3 to 4, flu like syndrome, used 2 times a day (once per day is a benefit of prostaglandins)

Answer 28

Unosprone Isopropyl

Question 29

Prostaglandin in single vials, preservative free, reduces IOP 6 to 8 mmHg, SE less hyperemia, same as other prostaglandins as far as SE

Answer 29

Tafluprost

Question 30

Direct adrenergic agonist- alpha2 receptor stimulation to produce inhibitory response that decreases aqueous humor production. (2)

Answer 30

Apraclonidine and Brimonidine

Question 31

Direct adrenergic agonist on A2, IOP control after surgery, 30% develop allergic reactions

Answer 31

Apraclonidine

Question 32

Direct adrenergic agonist on A2, 30x more affinity to receptors than apraclonidine and neuroprotective actions, IOP reduction of 4-6 mmhg, 2% with BAC (allergic rxn) or 0.1% w purite. 2x/day is enough

Answer 32

Brimonidine Tartrate - Alphagan

Question 33

Combos used for High IOP above 30

Answer 33

Timolol (beta) and Dorzolamide (CAI)
Brimonidine (A2) and Timolol (Beta) - NPE
Timolol (beta)and Brinzolamide (CAI)
Timolol (beta) and Travaprost (prost)

Question 34

Hyperosmotic agents used for emergency high IOP like acute angle closure glaucoma, last resort, decrease osmotic pressure

Answer 34

Mannitol, Urea, Glycerol

Question 35

guidelines for reducing non compliance

Answer 35

use less often, AM over PM, hx of missed appointments or poor understanding of condition are non compliant, Elderly - memory, cognition, hearing