Glaucoma therapeutics part Flashcards
mechanism of Rho Kinase (ROCK) inhibitors to treat glaucoma
increase the outflow of aqueous humor
place in therapy for ROCK inhibitors in open angle glaucoma
not really clear bc it’s new— but can be considered 2nd line
they’re EXPENSIVE
Name some disadvantages of rho kinase (ROCK) inhibitors
there’s a lot of local pain, irritation, and redness of eyelids — 20% of pts stop using it bc of the side effects
also, doesnt work well in pts who have very high IOP at baseline (26 or more)
name rho kinase inhibitor and how often is it applied
QHS
netarsudil
how do topical carbonic anhydrase inhibitors work to treat glaucoma
decrease aqueous humor production
place in therapy for topical carbonic anhydrase inhibitors for open angle glaucoma
can be considered 3rd line
often used in adjunct with first line agents
disadvantages of topical carbonic anhydrase inhibitors
stinging, lid reactions, photophobia
name 2 topical carbonic anhydrase inhibitors and how often they’re applied
dorzolamide and brinzolamide
when used on their own, Q8H
if used with other 1st line agents, may be Q12
how do systemic carbonic anhydrase inhibitors work to treat glaucoma
decrease aqueous humor production
pts with ___ allergy should not use systemic carbonic anhydrase inhibitors
sulfa
some side effects systemic carbonic anhydrase inhibitors
systemic acidosis
malaise
hyperuricemia
renal calicli
myopia
(LOT OF SE)
name 2 systemic carbonic anhydrase inhibitors that can be used for glaucoma
acetazolamide (oral and parenteral)
methazolamide
another name for cholinergics used in eye
miotics
place in therapy for cholinergics for open angle glaucoma
like 3rd line
relatively inexpensive with few systemic side effects
how do cholinergics work in open angle glaucoma
constrict the pupil (miosis)
decrease resistance to aqueous humor outflow
name some disadvantages of cholinergics
they cause miosis (pupil constriction) which negatively affects night vision - driving in dark not advised
can cause blurred vision and retinal tears, also applied frequently at 3-4 times a day
name a cholinergic used in open angle glaucoma and how often applied
pilocarpine
BID-QID
true or false
if one eye is affected by glaucoma, the other must be as well
false - not necessarily
name 4 combination products for glaucoma (open angle)
INCLUDE HOW OFTNE USED
dorzolamide + timolol BID
brinzolamide + timolol BID
brinzolamide + brimonidine TID
netarsudil + latanoprost QHS
no prostaglandin analog and b blocker!
explain laser therapy for open angle glaucoma
this is typically done before what is ued?
usually recommended for miotic agents or oral carbonic anhydrase inhibitors
may decrease or eliminate need for meds. lowers IOP by reducing resistance to aqueous humor outflow
name 3 surgical procedures that can be done for open angle glaucoma
-can create a new channel to drain the fluid
-can insert tubal
-can remove the epithelium ciliary body to permanently reduce the aqueous humor
what is a risk of the surgical procedure in which a new channel is created to drain the aqueous humor
growth of scar tissue
to prevent this, use antifibrotic medications like fluorouracil or mitomycin
where are eye drops applied and why
to the nasolacrimal occlusion
has improved bioavailability and reduced systemic absorption
allows less frequent dosing and lower concentrations
pt education on applying drops
apply to NLO and place index finger over inner corner for 1-3 mins
this improves the drug response and reduces side effects, allows for less frequent dosing and lower conc
if someone is using 2 eye drops, how long to wait between them
5-10 mins
patient education for eye OINTMENTS
pull eyelid down to form a pouch
apply the ointment to this pouch inside of the eyelid
close the eye and roll it around to distribute the ointment all over the eye
DOES NOT NEED TO BE DONE FOR DROPS
