Glaucoma Tx

Question 1

T/F: Glaucoma is a disease of exclusion.

Answer 1

True

Question 2

What are the targeted structures/methods of glaucoma Tx.?

Answer 2

Inhibit aq. production, Promote trabecular outflow, and promote uveoscleral outflow.

• some drugs are touted as being neuroprotective by way of improving perfusion of the optic nerve head, hence this could represent yet another targeted structure

Question 3

T/F: Glaucoma therapeutics acting via the parasympathetic nervous system stimulate ocular muscarinic receptors.

Answer 3

True

Question 4

T/F: Glaucoma therapeutics acting via the sympathetic nervous system stimulate ocular alpha-1 & 2 receptors or inhibit beta-2 receptors.

Answer 4

True

Question 5

T/F: Some glaucoma drugs act by working on nicotinic receptors in the eye for IOP reduction .

Answer 5

False.

*There are NO nicotinic receptors in the eye involved with IOP reduction.

Question 6

T/F: Sympathomimetics are not used orally for IOP reduction since they are rapidly metabolized by the first pass effect in the liver and intestine (COMT & MAO) and do not readily cross the blood-brain-barrier.

Answer 6

True

Question 7

T/F: Sympathomimetics/Alpha-2 agonists generally do not affect IOP at night since sympathetic tone is considered to be inactive (rest & digest state during sleep).

Answer 7

True.

Question 8

T/F: Prostaglandin analogs are structurally related to prostaglandins which alter ciliary body collagen.

Answer 8

True

Question 9

What is the contraindication of GLYCERIN [pO] (a hyperosmatic agent used in acute AC glaucoma)?

Answer 9

Diabetes.

*use ISOSORBIDE instead -safe for diabetes!

Question 10

T/F: one can have high IOP and not have glaucoma.

Answer 10

True.
*IOP is a risk factor however one may have ‘low’ IOP and have glaucoma but in other instances one can have ‘high’ IOP and not have glaucoma

Question 11

T/F: All patients with glaucoma benefit from IOP reduction.

Answer 11

True.

Question 12

What are the different glaucoma Txs drug classes?

Answer 12

Sympathomimetic Agents
Sympatholytic Agents
Parasympathomimetic Agents
Carbonic Anhydrase Inhibitors
Prostaglandin Analogs
Combination Agents

Question 13

Angle -closure glaucoma is characterized by what?

Answer 13

• Closed angle
• Elevated IOP and optic nerve damage with corresponding visual field defects as common markers
• Iridotrabecular apposition
• Iridotrabecular synechiae or both

Question 14

T/F: The most effective means of lowering IOP during acute AC attacks is through the use of oral hyperosmotic agents.

Answer 14

True.

GLYCERIN and ISOSORBIDE are both oral hyperosmotic drugs.

Question 15

What are the common adverse reactions of hyperosmotic drugs?

Answer 15

Dehydration, headache, vomiting, diarrhea, confusion, seizures
Hypervolemia, chest pain (CV stress) and renal stress

Question 16

What are the contraindications of hyperosmotic drugs?

Answer 16

Renal insufficiency, coronary insufficiency, pulmonary congestion, extreme dehydration, intracranial hemorrhage.

Question 17

What are the immediate treatment goals when treating acute Angle-closure glaucoma?

Answer 17

Lower IOP
Alleviate pain
Clear cornea
Prevent synechiae