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Glaucoma > Lec.11: Medical Management of Glaucoma 2 > Flashcards

Lec.11: Medical Management of Glaucoma 2 Flashcards

1
Q

where are beta-1 receptors found?

A

in the heart (stimulation causes increase heart rate, cardiac contractility and atrioventricular conduction)

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2
Q

where are beta-2 receptors found?

A

in bronchial muscle, blood vessels and uterus

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3
Q

what is the mechanism for ocular beta blockers (OBB’s)?

A

act by reduction in aqueous formation

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4
Q

(T/F) a patient on OBB can experience a decrease in aqueous formation by as much as 50%?

A

true

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5
Q

what are the indications for beta blockers?

A

lowering IOP in ocular hypertension and open angle glaucoma, secondary glaucoma and angle closure glaucoma

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6
Q

what are the contraindications for beta blockers?

A

pulmonary disease, bronchial asthma and severe COPD

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7
Q

what are the benefits for betaxolol?

A

not contraindicated for pulmonay disease, bronchial asthma or COPD

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8
Q

if a patients baseline heart rate is less than 60 bpm can you still use OBB?

A

no

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9
Q

if OBB’s are only used once daily (off label use), what time of day should they be used?

A

morning (AM)

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10
Q

according to product label, what should the treatment regimen be for OBB?

A

twice daily

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11
Q

what is the most commonly used form of timolol?

A

0.5% timolol maleate

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12
Q

what is the selectivity of timolol?

A

non selective

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13
Q

some patients experience decrease efficacy of timolol over time, why is that?

A

may be an up regulation of beta receptors in target tissue

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14
Q

what is the typical time period for a wash out period?

A

4 weeks

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15
Q

what are the benefits of gels compared to drops?

A

improve bioavailability, decreases systemic absorption, once a day dose, not preserved with BAK

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16
Q

what drug is formulated with potassium sorbate and has lower BAK concentration?

A

istalol

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17
Q

is betaxolol solution still available in the United States?

A

no. only betaxolol suspension

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18
Q

why can betaxolol be used in patients with pulmonary disease?

A

because it is a selective beta blocker

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19
Q

how do BAK issues multiply beta blocker issues?

A

decrease tear production, decreased goblet cell density and dry eye symptoms

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20
Q

which beta blocker is associated with granulomatous uveitis?

A

metipranolol

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21
Q

what is the concentration of betaxolol suspension that is most commonly prescribed?

A

0.25%

22
Q

what are the trough plasma values?

A

0.8-7.2 ng/milli liter

23
Q

what are the plasma levels when 2 drops of timolol are taken?

A

5.0-9.6 ng/milli liter

24
Q

what are the CNS adverse affects of taking timolol?

A

anxiety, depression, fatigue, lethargy, confusion, sleep, disturbance, memory loss, sexual dysfunction, decreased libido

25
Q

why would timoptic XE have less systemic absorption?

A

because it is a gel that tends to stay in the eye

26
Q

what OBB has fewer CNS adverse affects and can be safely used in patients with pulmonary disease?

A

betaxolol

27
Q

what are the metabolic adverse effects for patients on timolol?

A

12% increase in triglycerides

9% decrease in HDL

28
Q

why do diabetic patients taking beta blockers have to be extra careful?

A

beta blocker mask symptoms of hypoglycemia

29
Q

name the common adrenergic agents used by optometrist.

A

clonidine, apraclonidine, brimonidine

30
Q

what are the side effects of clonidine?

A

sedation, systemic hypotension, narrow therapeutic index

31
Q

what is the mechanism for apraclonidine?

A

decreased aqueous production, improves trabecular outflow and decreases episcleral venous pressure

32
Q

which adrenergic agents are used to prevent poster laser treatment spikes in IOP?

A

apraclonidine and brimonidine

33
Q

what drug is contraindicated for patients on monoamine oxidase inhibitors (MAO)?

A

brimonidine

34
Q

what are the adverse effects of brimonidine?

A

conjunctival follicles, ocular allergic reactions, ocular pruritus, headache, oral dryness, ocular hyperemia, blurring, fatigue/drowsiness

35
Q

what 2 drugs make up combigan? and how many times a day is it taken?

A

Brimonidine and timolol

take twice a day

36
Q

what is the usual treatment regimen for brimonidine?

A

TID

37
Q

what 2 drugs make up Simbrinza? and what is the treatment regimen for simbrinza?

A

brinzolamide and brimonidine

take TID

38
Q

which drugs approved for use in glaucoma have a indication for neuroprotection?

A

none (animal data suggest brimonidine is neuroprotective)

39
Q

what is pilocarpine indicated for?

A

angle closure glaucoma with pupillary block

40
Q

what is the mechanism for pilocarpine?

A

contraction of ciliary muscle causes unfolding of trabecular meshwork and widening of Schlemm’s Canal

41
Q

in the event of a pupillary block and angle closure at what interval should pilocarpine be administered?

A

1% or 2%, 2-3 times in 30 mins

42
Q

when will the max IOP reduction occur for a patient taking pilocarpine?

A

after 75 minutes

43
Q

what are the side effects of pilocarpine?

A

stinging/burning, risk of hyphema during surgeries, ciliary spasm, temporal or supraorbital headache and induced myopia, decrease in VF (due to miosis), constant accommodation

44
Q

what is the pharmacological antagonist for pilocarpine?

A

atropine

45
Q

what has a greater chance of formation if the pupil remains contracted and immobilized?

A

synechiae formation

46
Q

what class of drugs should patients with sulfa allergies avoid?

A

carbonic anhydrase inhibitors (CAI’s)

47
Q

how do CAI’s decrease aqueous production?

A

cause reversible reduction of bicarbonate ions in posterior chamber, which prevents movement of Na+ and water

48
Q

what are the common topical CAI’s and how many times a day should they be taken?

A

dorzolamide and brinzolamide

taken TID

49
Q

what are the contraindications for CAI’s?

A

sulfa allergies, diabetic patients susceptible to ketoacidosis, patients with hepatic insufficiency, COPD, kidney disease

50
Q

what are the more prominent side effects of CAI’s?

A

numbness, anorexia, nausea, flatulence, diarrhea and depression

Glaucoma (12 decks)

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