Glaucoma therapeutics part

Question 1

mechanism of Rho Kinase (ROCK) inhibitors to treat glaucoma

Answer 1

increase the outflow of aqueous humor

Question 2

place in therapy for ROCK inhibitors in open angle glaucoma

Answer 2

not really clear bc it’s new— but can be considered 2nd line

they’re EXPENSIVE

Question 3

Name some disadvantages of rho kinase (ROCK) inhibitors

Answer 3

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)

Question 4

name rho kinase inhibitor and how often is it applied

Answer 4

QHS

netarsudil

Question 5

how do topical carbonic anhydrase inhibitors work to treat glaucoma

Answer 5

decrease aqueous humor production

Question 6

place in therapy for topical carbonic anhydrase inhibitors for open angle glaucoma

Answer 6

can be considered 3rd line

often used in adjunct with first line agents

Question 7

disadvantages of topical carbonic anhydrase inhibitors

Answer 7

stinging, lid reactions, photophobia

Question 8

name 2 topical carbonic anhydrase inhibitors and how often they’re applied

Answer 8

dorzolamide and brinzolamide

when used on their own, Q8H

if used with other 1st line agents, may be Q12

Question 9

how do systemic carbonic anhydrase inhibitors work to treat glaucoma

Answer 9

decrease aqueous humor production

Question 10

pts with ___ allergy should not use systemic carbonic anhydrase inhibitors

Answer 10

sulfa

Question 11

some side effects systemic carbonic anhydrase inhibitors

Answer 11

systemic acidosis
malaise
hyperuricemia
renal calicli
myopia

(LOT OF SE)

Question 12

name 2 systemic carbonic anhydrase inhibitors that can be used for glaucoma

Answer 12

acetazolamide (oral and parenteral)

methazolamide

Question 13

another name for cholinergics used in eye

Answer 13

miotics

Question 14

place in therapy for cholinergics for open angle glaucoma

Answer 14

like 3rd line

relatively inexpensive with few systemic side effects

Question 15

how do cholinergics work in open angle glaucoma

Answer 15

constrict the pupil (miosis)

decrease resistance to aqueous humor outflow

Question 16

name some disadvantages of cholinergics

Answer 16

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

Question 17

name a cholinergic used in open angle glaucoma and how often applied

Answer 17

pilocarpine

BID-QID

Question 18

true or false
if one eye is affected by glaucoma, the other must be as well

Answer 18

false - not necessarily

Question 19

name 4 combination products for glaucoma (open angle)

INCLUDE HOW OFTNE USED

Answer 19

dorzolamide + timolol BID

brinzolamide + timolol BID

brinzolamide + brimonidine TID

netarsudil + latanoprost QHS

no prostaglandin analog and b blocker!

Question 20

explain laser therapy for open angle glaucoma

this is typically done before what is ued?

Answer 20

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

Question 21

name 3 surgical procedures that can be done for open angle glaucoma

Answer 21

-can create a new channel to drain the fluid

-can insert tubal

-can remove the epithelium ciliary body to permanently reduce the aqueous humor

Question 22

what is a risk of the surgical procedure in which a new channel is created to drain the aqueous humor

Answer 22

growth of scar tissue

to prevent this, use antifibrotic medications like fluorouracil or mitomycin

Question 23

where are eye drops applied and why

Answer 23

to the nasolacrimal occlusion

has improved bioavailability and reduced systemic absorption
allows less frequent dosing and lower concentrations

Question 24

pt education on applying drops

Answer 24

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

Question 25

if someone is using 2 eye drops, how long to wait between them

Answer 25

5-10 mins

Question 26

patient education for eye OINTMENTS

Answer 26

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