Glaucoma therapeutics Flashcards
- Elevated IOP
- Thinning of retinal nerve fibre and macular ganglion layer
- optic disk cupping and peripheral vision loss
What is this called?
Glaucoma
What are the 3 types of glaucoma?
- open angle
- angle closure
- secondary/acquired
This blockage in the trabecular meshwork results in the eye’s inability to drain the aqueous humor, leading to increased intraocular pressure
open angle glaucoma
T or F: the iris blocks the flow of aqueous humor in open angle glaucoma
False: the drainage system is blocked. The iris is not blocking it
5 risk factors for glaucoma
Demographics: Older age, Female, African, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
Family history
Medical history: Diabetes, High blood pressure, Chronic corticosteroids
Prior eye injury or surgery
Increased IOP
Ages + screening of open-angle glaucoma
< 40, every 10 years
40-49 every 3 years
50-59 every 2 years
60+ annually
Closure of the angle between the iris and cornea, obstructing the outflow of aqueous humour
angle-closure glaucoma
What kind of glaucoma is it when the trabecular meshwork is blocked by the iris and the aqueous humour cant drain properly
closed-angle glaucoma
Symptoms of acute attacks in closed-angle glaucoma and what can happen if untreated?
pain, blurry vision, halos around lights,
headache, N/V
can become blind in 24 hours
Risk factors for closed-angle glaucoma
Demographics: Older age , Female, East Asian ancestry •
Family history •
Other ocular factors
- Congenital defects
• Trauma, surgery, insult/infection
• Corticosteroid use
secondary or acquired glaucoma
2 goals of therapy
Preserve visual function by slowing or halting the progression of
disease: Lower IOP and Preserve structure & function of the optic nerve
Maintain or enhance health-related quality of life
What is the pressure that is likely to stop further damage to the optic nerve
(don’t give a number)
target IOP
Treatment for angle-closure glaucoma?
Referral! Pt needs surgery asap
What is the function of prostaglandin analogue?
a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production
d) Increased aqueous humor outflow
b) increase aqueous humor outflow
What is the function of beta blockers?
a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production
c) Decreased aqueous humor production
What is the function of Alpha 2 agonists?
a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production
d) Increased aqueous humor outflow
a) decrease production and increase outflow
What is the function of cholinergic?
a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production
b) Increased aqueous humor outflow
What is the function of carbonic anhydrase?
a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production
c) decrease aqueous humor production
List the order of medications in most efficacy
bimatoprost, pilocarpine, timolol, brinzolamide, dorzolamide, latanoprost. brimondine, surgery
latanoprost bimatoprost timolol dorzolamide brinzolamide brimonidine pilocarpine surgery
Which prostaglandin analogue may increase trabecular flow?
bimatoprost
Increase uveoscleral outflow which med?
prostaglandins (latanoprost)
The side effects of prostaglandin analogue?
iris colour change
eyelash changes
hyperemia
migraine-like headache
flu like symptoms
Contraindications in prostaglandin analogues
pregnancy
macular edema
history of herpetic keratitis
active uveitis
The function of Beta-Adrenergic Antagonists in glaucoma
Inhibit formation of aqueous humor
Betaxolol
Timolol
which one is selective
which one is non-selective
betaxolol is selective
timolol is selective
Side effects of Beta-Adrenergic Antagonists
Allergic conjunctivitis --> know this one for sure Bradycardia Bronchospasm Hypotension May mask symptoms of hypoglycemia
contraindications to beta-blockers
- Asthma, severe COPD
- Sinus bradycardia
- 2nd or 3rd-degree heart block
- Heart Failure
- Hypotension
- Myasthenia gravis
caution in pregnancy but can be used in lactation
Function of alpha 2 adrenergic agonists?
decrease AH production
increase uveoscleral outflow
Side effects of Alpha 2 adrenergic agonists?
allergic conjunctivitis bitter taste dry mouth and nose hypotension headache fatigue
contraindications of alpha 2 adrenergic agonists
With MAOIs
use with caution in pregnancy
The function of carbonic anhydrase inhibitor
inhibit bicarbonate ion to form in aqueous humor
Side effects of Carbonic Anhydrase Inhibitors
Allergic/ dermatitis/conjunctivitis
•Burning
•Corneal edema
•Metallic/sour taste
Contraindications of carbonic anhydrase inhibitors
Kidney stones •Aplastic anemia •Sickle cell anemia •Thrombocytopenia ?Sulfa allergy
Function of Parasympathomimetics (Cholinergics)
Directly stimulate muscarinic receptors to contract the ciliary muscle
and increase trabecular outflow
Side Effects of Parasympathomimetics (Cholinergics)
intestinal cramps
blurred vision
bronchospasm
retinal detachment
Contraindications Parasympathomimetics (Cholinergics)
neovascular, uveitc, or malignant glaucoma
use in caution with pregnancy
3 methods to intensify therapy for glaucoma
- combine topical medications
- Laser therapy
- surgery
how long to wait before putting in eye contacts after drops
Need to wait at least 15 minutes after drops before contacts lens insertion
List 2 preservative free eye drops
travoprost
brimonidine
Efficacy points to monitor for – IOP/visual field/optic nerve head • early: at least every \_\_\_\_ months • moderate: at least every \_\_\_ months • severe: at least every \_\_\_ months
- early: at least every 12 months
- moderate: at least every 6 months
- severe: at least every 4 months
Medications to avoid with open-angle glaucoma
Corticosteroids (all formulations)
Medications to avoid in closed-angle glaucoma
Antidepressants Anticholinergic medications such as 1st gen antihistamines, some antipsychotics Antispasmodics Adrenergic agents such as decongestants
Sulfonamides –> allergic reaction
