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Glaucoma > Lecture 10 - Prostaglandin Analogs > Flashcards

Lecture 10 - Prostaglandin Analogs Flashcards

1
Q

True or False. Dose is not crucial when using prostaglandins, as it no disruption of he blood aqueous barrier?

A

False. Dose is crucial and it does disrupt the blood aqueous barrier

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2
Q

True or False. High dose topically will raise IOP?

A

True.

Note: Intracamerally it will also increase

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3
Q

True or False. Prostaglandins are the most effective and commonly used for lowering IOP?

A

True

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4
Q

What are Prostaglandin analogs a prodrug of?

A

Prostaglandin F2a

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5
Q

What converts PG’s into its active form when placed on the cornea?

A

Corneal enzymes

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6
Q

When PG’s are administered they activate the PGF2a receptor, but where are these receptors located?

A

CB

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7
Q

What are the three ester based PG prodrugs?

A

Latanoprost, Travoprost and unoprostone

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8
Q

Bimatoprost is described as what type of amide group?

A

prostamide

Note: An amide group will have a Nitrogen attached to the carbonyl group of its organic structure

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9
Q

What is the primary goal of a PG?

A

Increase outflow through uveoscleral pathway

Note: There is a small % increase in coventional outflow

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10
Q

True or False. PG’s reduce aqueous production.

A

False. It only works on outflow.

Note: The mechanism of action is not fully understood

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11
Q

According to the relaxation of CB muscle theory, what happens to the CB when using latanprost?

A

CB INCREASES in thickness

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12
Q

What is the proposition of Dilated spaces between ciliary muscle bundles theory?

A

PG induced stimulation of collagenase and other matrix metalloprotenases

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13
Q

What the indications of using PG’s?

A 
Primary open angle glaucoma (POAG), 
Normal tension glaucoma (NTG), 
Pigment dispersion syndrome (PDS), 
Exfoliation syndrome (XF) and
Chronic angle closure glaucoma
Caution with uveitic glaucoma and 
Less effective in pediatric glaucoma
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14
Q

What are the 4 contraindications of PG?

A
  1. Allergies to the PG
  2. Pregnancy
  3. Peds
  4. Unclear PG’s and Ocular inflammation
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15
Q

What type of macular inflammatory reaction is Latanoprost associated with?

A

Cystoid Macular Edema (CME)

Note: Largest contraindication with PG’s

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16
Q

What three type of ocular issues should PG’s not be used with?

A
  1. CME
  2. Iritis
  3. Herpes Simplex Keratitis
17
Q

When should you take a PG and why are you only taking it once a day?

A

Take in the evening and you only take it once, as two would be less effective

18
Q

What are the 5 side effects of PG’s?

A
  1. Conjunctival hyperemia
  2. Iris color change
  3. Eyelash changes
  4. Skin pigmentation
  5. Deepening of upper eye lid sulcus (DUES)
19
Q

Which PG causes conjunctival hyperemia the most?

A

Brimatoprost

20
Q

Whats a well documented side effect of PG’s?

A

Iris color change

21
Q

What cosmetic product ingredient and PG causes an increase in eyelashes

A

Bimatoprost

22
Q

True or False. Topical PG’s don’t affect retinal vasculature

A

True

23
Q

How long in advance should you stop taking PG”s, prior to cataract surgery

A

1 month

Note: You can start taking it again after 1 month

24
Q

What is the half life of PG’s in human plasma?

A

17 minutes

Note: There is no effect on blood pressure

25
Q

What perservative mixed with latanoprost will form a precipitate?

A

Thimerasol

26
Q

Which has a larger effect on IOP, Timolol or Latanoprost?

A

Latanoprost

Timolol will lower by 6.3 mmHg
Latanoprost will lower by 7.6 mmHg

Note: When put together they work even better (24% to 37% decline)

27
Q

What has better effects on African Americans, Timolol or PG’s?

A

PG’s

28
Q

True or False. Adding adrnergic agonists like brimonidine to latanoprost produces similar effect like adding dorzolamide

A

True

29
Q

What do cholinergic agonists do to trabecular outflow and what anatomical structures are impacted?

A

Increase outflow

  1. Contraction of Ciliary muscle
  2. Pulls on scleral spur
  3. Opens channels in TM

Note: Uveoscleral outflow decreases, but that doesn’t mean you stop using PG’s

30
Q

What are 3 benefits of fixed combination drugs?

A
  1. More convenient
  2. Less expensive
  3. Improved compliance
31
Q

Why is timolol not part of combination drugs?

A

It does not produce a decrease in IOP of 20%

32
Q

What new drug does not produce any heart/lung issues but lowers IOP?

A

Unoprostone RESCULA

Glaucoma (7 decks)

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