Glaucoma Rx

Question 1

Factors that decrease aqueous inflow

Answer 1

Alpha adrenergic stimulation

Beta receptor blocking

DA blocking

Adenylate cyclase stimulation

Question 2

Risk Factors for Primary Open-Angle Glaucoma

Answer 2

Elevated IOP

African or Hispanic descent

Fhx of glaucoma

older age

thinner central corneal thickness

Question 3

Drugs that may induce or potentiate glaucoma

Answer 3

Corticosteroids

Ophthalmic anitcholinergics

Vasodilators and Cimetidine - low

Question 4

Keys to Medical Tx

Answer 4

Effective, well-tolerated, convenient drug regimen

Close monitoring

Adherence

Question 5

Non-Pharm

Answer 5

Surgery:

Argon-laser trabeculoplasty

trabeculectomy

Question 6

Pharm Treatment

(Classes of topical agents)

Answer 6

Goal is to decrease IOP to 25% of baselin

• Beta blockers
• prostaglandin analogs
• alpha2 andrenergic agonists
• carbonic anhydrase inhbitors
• cholinergic agonists (parasympathomimetics)

Question 7

First Line Therapy

Answer 7

Beta Blockers: Timolol

• Q12-24h dosing
• Nonselective
• Dec production of aqueous humor
• AE: minimal local AE, systemic include bradycardia and HoTN, bronchospasm, masked sx of hypoglycemia, CNS sedation
• CI: asthma, bradycardia, unstable HF
• One drop of timolol = 10mg PO

Question 8

First line alternative

Answer 8

Prostaglandin - Travaprost

• Inc outflow of aqueous humor
• AE:
  
  • common: inc iris pigmentation, growth of eyelashes, itching
  • less common: inc pigmentation of skin around eye, dryness, visual disturbance, burning, eye pain
• about equal efficacy as BB at decreasing IOP