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PHM 604- Dermatology and Glaucoma > Glaucoma- POAG > Flashcards

Glaucoma- POAG Flashcards

1
Q

Normal range for IOP

A

13-21 mmHg

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2
Q

NT glaucoma classification

A

Normal IOP with glaucomatous changes

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3
Q

Glaucoma classification

A

Elevated IOP with glaucomatous changes

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4
Q

Ocular HTN classification

A

Elevated IOP with no glaucomatous changes

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5
Q

Risk factors for POAG

A 
Age (>60, >40 for Black patients)
Elevated IOP (>21)
Ethnicity (Blacks and Hispanics)
Increased cup-to-disk ratio
Family history
Central corneal thickness (thinner is at an increased risk)
Ocular perfusion pressure (lower is at an increased risk)
T2DM
Myopia (near-sightedness)
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6
Q

Who to treat for glaucoma

A

All patients with elevated IOP AND confirmed disc changes/field defects

All patients with ocular HTN AND at least 2 risk factors

All patients with NT glaucoma AND documented progression of visual field loss

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7
Q

Glaucoma treatment goals

A

PRESERVE THE NERVE

Lower IOP ≥25% below pretreatment IOP

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8
Q

Surgery for glaucoma

A

Mainstay of treatment (more effective at lowering IOP) but more expensive and invasive

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9
Q

QOL differences with glaucoma surgery

A

Increased risk of cataract formation, loss of visual acuity and local eye Sx infrequent but higher in surgical patients

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10
Q

How to choose a glaucoma med

A

Choose a drug and regiment that have minimal impact on QOL and vision

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11
Q

Prostaglandin analog drugs

A

Bimatoprost, latanoprost, latanoprostene bunod

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12
Q

How much do prostaglandin analogs lower IOP?

A

25-33%

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13
Q

Bimatoprost pearls

A

Best efficacy, but worst side effects in generic 0.03% formulation. Lumigan is 0.1% and has a better side effect profile but still brand name regardless

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14
Q

Latanoprost pearl

A

Most popular generic

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15
Q

PA ADEs

A

Red eyes, hypertrichosis (eyelash growth), systemic infection, headache, eye color changes (iris)

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16
Q

PA CIs

A

macular edema, iritis, uveitis, keratitis

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17
Q

Beta-blocker drugs

A

Betaxolol, cartelol, levobunolol, metiprandolol, timolol

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18
Q

How much do beta-blockers lower IOP?

19
Q

Betaxolol pearls

A

Selective, use in patients with COPD (as an example)

20
Q

Cartelol pearl

A

Moderate intrinsic sympathomimetic activity

21
Q

Beta-blocker ADEs

A

Local irritation, cardiac, pulmonary, and CNS side effects, tachyphylaxis

22
Q

Beta-blocker CIs

A

Absolute: sinus bradycardia, heart block, HF
Relative: pulmonary disease

23
Q

Alpha-2 adrenergic agonist drug

A

Brimonidine

24
Q

Brimonidine pearls

A

Not recommended as a single agent (usually combined with timolol)

25
Q

When does brimonidine become a first-line option?

A

When PAs and beta-blockers are CI’ed

26
Q

Brimonidine IOP lowering

27
Q

Brimonidine ADEs

A

conjunctival hyperemia, irritation, allergic reactions, drowsiness, xerostomia (dry mouth), tachyphylaxis

28
Q

Brimonidine precaution

A

CV diseases

29
Q

Carbonic anhydrase inhibitor drugs

A

Acetazolamide, brinzolamide, dorzolamide, methazolamide

30
Q

Acetazolamide and metazolamide are available in what formulation?

31
Q

Brinzolamide is also available in combination with what other drug?

A

Brimonidine

32
Q

Dorzolamide is also available in combination with what other drug?

33
Q

Carbonic anhydrase inhibitor ADEs

A

Favorable side effect profile overall, can be good for patients who don’t like the side effects of other meds

34
Q

When can you use the dorzolamide/timolol combo?

A

If bimatoprost isn’t tolerated

35
Q

Carbonic anhydrase inhibitors decrease IOP by how much?

A

15-20% for topical formulations

20-30% for PO formulations

36
Q

Rho kinase inhibitor drugs

A

Netarsudil (Rhopressa), Rocklatan (netarsudil and latanoprost)

37
Q

Rho kinase inhibitor IOP lowering

A

~20% if IOP <27

38
Q

Rho kinase inhibitors ADEs

A

Hyperemia, conjunctival hemorrhage

39
Q

When are rho kinase inhibitors used?

A

Used as a last-line option and as an add-on drug

40
Q

Overall treatment options for POAG (what should you take into account when picking a med for a patient?)

A

Fewest drugs at the lowest concentrations
Stress convenience and adherence
Counsel on nasolacrimal occlusion
Not at goal? Switch if adherence or tolerance issues, poor efficacy, add a drug if one is helping but not at goal yet

41
Q

First-line treatment options for POAG

A

PAs and beta-blockers

42
Q

Second-line treatment options for POAG

A

Dorzolamide+timolol
Brimonidine (but becomes 1st line if patient has CIs)
Brinzolamide, dorzolamide alone, PO carbonic anhydrase inhibitors (acetazolamide and methazolamide)
Netarsudil/Rhopressa

43
Q

Progression risk factors

A

Increasing IOP, older age, disc hemorrhage, larger cup-to-disk ratio, thinner central cornea, lower ocular perfusion pressure, poor adherence to meds, progression in the other eye

PHM 604- Dermatology and Glaucoma (9 decks)

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