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HEENT > Glaucoma therapeutics > Flashcards

Glaucoma therapeutics Flashcards

1
Q
  1. Elevated IOP
  2. Thinning of retinal nerve fibre and macular ganglion layer
  3. optic disk cupping and peripheral vision loss

What is this called?

A

Glaucoma

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2
Q

What are the 3 types of glaucoma?

A
  1. open angle
  2. angle closure
  3. secondary/acquired
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3
Q

This blockage in the trabecular meshwork results in the eye’s inability to drain the aqueous humor, leading to increased intraocular pressure

A

open angle glaucoma

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4
Q

T or F: the iris blocks the flow of aqueous humor in open angle glaucoma

A

False: the drainage system is blocked. The iris is not blocking it

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5
Q

5 risk factors for glaucoma

A

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

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6
Q

Ages + screening of open-angle glaucoma

A

< 40, every 10 years
40-49 every 3 years
50-59 every 2 years
60+ annually

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7
Q

Closure of the angle between the iris and cornea, obstructing the outflow of aqueous humour

A

angle-closure glaucoma

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8
Q

What kind of glaucoma is it when the trabecular meshwork is blocked by the iris and the aqueous humour cant drain properly

A

closed-angle glaucoma

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9
Q

Symptoms of acute attacks in closed-angle glaucoma and what can happen if untreated?

A

pain, blurry vision, halos around lights,
headache, N/V

can become blind in 24 hours

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10
Q

Risk factors for closed-angle glaucoma

A

Demographics: Older age , Female, East Asian ancestry •
Family history •
Other ocular factors

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11
Q
  • Congenital defects
    • Trauma, surgery, insult/infection
    • Corticosteroid use
A

secondary or acquired glaucoma

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12
Q

2 goals of therapy

A

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

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13
Q

What is the pressure that is likely to stop further damage to the optic nerve
(don’t give a number)

A

target IOP

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14
Q

Treatment for angle-closure glaucoma?

A

Referral! Pt needs surgery asap

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15
Q

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

A

b) increase aqueous humor outflow

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16
Q

What is the function of beta blockers?

a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production

A

c) Decreased aqueous humor production

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17
Q

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

a) decrease production and increase outflow

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18
Q

What is the function of cholinergic?

a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production

A

b) Increased aqueous humor outflow

19
Q

What is the function of carbonic anhydrase?

a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production

A

c) decrease aqueous humor production

20
Q

List the order of medications in most efficacy

bimatoprost, pilocarpine, timolol, brinzolamide, dorzolamide, latanoprost. brimondine, surgery

A 
latanoprost
bimatoprost
timolol
dorzolamide
brinzolamide 
brimonidine 
pilocarpine 
surgery
21
Q

Which prostaglandin analogue may increase trabecular flow?

A

bimatoprost

22
Q

Increase uveoscleral outflow which med?

A

prostaglandins (latanoprost)

23
Q

The side effects of prostaglandin analogue?

A

iris colour change
eyelash changes

hyperemia
migraine-like headache
flu like symptoms

24
Q

Contraindications in prostaglandin analogues

A

pregnancy
macular edema
history of herpetic keratitis
active uveitis

25
Q

The function of Beta-Adrenergic Antagonists in glaucoma

A

Inhibit formation of aqueous humor

26
Q

Betaxolol
Timolol
which one is selective
which one is non-selective

A

betaxolol is selective

timolol is selective

27
Q

Side effects of Beta-Adrenergic Antagonists

A 
Allergic conjunctivitis --> know this one for sure 
Bradycardia 
Bronchospasm
Hypotension
May mask symptoms of hypoglycemia
28
Q

contraindications to beta-blockers

A
  • 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

29
Q

Function of alpha 2 adrenergic agonists?

A

decrease AH production

increase uveoscleral outflow

30
Q

Side effects of Alpha 2 adrenergic agonists?

A 
allergic conjunctivitis 
bitter taste
dry mouth and nose 
hypotension
headache 
fatigue
31
Q

contraindications of alpha 2 adrenergic agonists

A

With MAOIs

use with caution in pregnancy

32
Q

The function of carbonic anhydrase inhibitor

A

inhibit bicarbonate ion to form in aqueous humor

33
Q

Side effects of Carbonic Anhydrase Inhibitors

A

Allergic/ dermatitis/conjunctivitis
•Burning
•Corneal edema
•Metallic/sour taste

34
Q

Contraindications of carbonic anhydrase inhibitors

A 
Kidney stones
•Aplastic anemia
•Sickle cell anemia
•Thrombocytopenia
?Sulfa allergy
35
Q

Function of Parasympathomimetics (Cholinergics)

A

Directly stimulate muscarinic receptors to contract the ciliary muscle
and increase trabecular outflow

36
Q

Side Effects of Parasympathomimetics (Cholinergics)

A

intestinal cramps
blurred vision
bronchospasm
retinal detachment

37
Q

Contraindications Parasympathomimetics (Cholinergics)

A

neovascular, uveitc, or malignant glaucoma

use in caution with pregnancy

38
Q

3 methods to intensify therapy for glaucoma

A
  1. combine topical medications
  2. Laser therapy
  3. surgery
39
Q

how long to wait before putting in eye contacts after drops

A

Need to wait at least 15 minutes after drops before contacts lens insertion

40
Q

List 2 preservative free eye drops

A

travoprost

brimonidine

41
Q 
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
A
  • early: at least every 12 months
  • moderate: at least every 6 months
  • severe: at least every 4 months
42
Q

Medications to avoid with open-angle glaucoma

A

Corticosteroids (all formulations)

43
Q

Medications to avoid in closed-angle glaucoma

A 
Antidepressants
Anticholinergic medications such as 1st gen
antihistamines, some antipsychotics
Antispasmodics
Adrenergic agents such as decongestants

Sulfonamides –> allergic reaction

HEENT (14 decks)

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