Glaucoma Treatment

Question 1

True or false: glaucoma is usually associated with increased aqueous production.

Answer 1

False; it is usually associated with decreased aqueous outflow.

Question 2

Which classes of glaucoma drugs are used to decrease aqueous production?

Answer 2

Adrenergic antagonists (beta blockers, and carbonic anhydrase inhibitors.

Question 3

Timolol, betaxolol, levobunolol, metipranolol, and carteolol are all beta blockers that can be used to treat glaucoma. Which of these is the gold standard, and is used in many combination glaucoma meds?

Answer 3

Timolol

Question 4

Timolol, betaxolol, levobunolol, metipranolol, and carteolol are all beta blockers that can be used to treat glaucoma. Which of these is the beta1 selective?

Answer 4

Betaxolol

Question 5

Which beta blocker has the most sting/burn?

Answer 5

Betoptic (betaxolol)

Question 6

Which beta blocker has the longest half life?

Answer 6

Levobunolol

Question 7

Which beta blocker crosses the BBB less and so causes less depression?

Answer 7

Carteolol

Question 8

Which beta blocker has the least sting/burn?

Answer 8

Carteolol

Question 9

Beta blockers decrease IOP by what amount? What is their typical dosage?

Answer 9

IOP decrease 22-33%

Dosage is bid usually, though qd may be enough.

Question 10

Topical CAIs for glaucoma decrease IOP by about how much? What is their typical dosage?

Answer 10

IOP decrease 15-20%; dosage is bid-tid

Question 11

When would you consider using a systemic CAI for glaucoma?

Answer 11

In an emergency situation (IOP over 40mmHg)

Question 12

Which classes of glaucoma drugs are used to increase aqueous outflow?

Answer 12

Adrenergic agonists, cholinergic agonists, prostaglandins, docosanoid, and hyperosmotics.

Question 13

Dipivefrin, apraclonidine, and brimonidine are adrenergic agonists for glaucoma treatment. Which of these meds features a slight IOP elevation prior to the IOP decrease?

Answer 13

Dipivefrin

Question 14

Dipivefrin, apraclonidine, and brimonidine are adrenergic agonists for glaucoma treatment. Which of these meds is typically used for post laser surgery?

Answer 14

Apraclonidine

Question 15

Dipivefrin, apraclonidine, and brimonidine are adrenergic agonists for glaucoma treatment. Which of these meds has a safe systemic profile?

Answer 15

Brimonidine

Question 16

Combigan and simbrinza are both combination glaucoma medications. Which meds are in each of these?

Answer 16

Combigan: brimonidine + timolol

Simbrinza: brinzolamide + brimonidine

Question 17

Latanoprost, travaprost,bimatoprost, and tafluprost are all prostaglandins for glaucoma treatment. Which of these is usually the first choice?

Answer 17

Latanoprost.

Question 18

Latanoprost, travaprost,bimatoprost, and tafluprost are all prostaglandins for glaucoma treatment. Which of these may be the most effective single drop? Hint: this medication is also known as Latisse.

Answer 18

Bimatoprost

Question 19

Latanoprost, travaprost,bimatoprost, and tafluprost are all prostaglandins for glaucoma treatment. Which of these is preservative free?

Answer 19

Tafluprost

Question 20

Uniprostone possibly works through TM outflow. How does this compare with the other glaucoma meds that affect aqueous outflow?

Answer 20

The others work by increasing uveoscleral outflow.

Question 21

What are some of the hyperosmotics used for emergency situations?

Answer 21

Glycerol, isosorbide, mannitol, urea.