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Glaucoma > Lecture 11 - Medical management of Glaucoma 2 > Flashcards

Lecture 11 - Medical management of Glaucoma 2 Flashcards

1
Q

What initial beta blocker lowered IOP but caused corneal anesthesia?

A

Propranol

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2
Q

Practolo was developed, in the wake of Propranol, even though it didn’t cause corneal anesthesia, what was a major sideffect it created?

A

Occulomucuataneous syndrome

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3
Q

What type of beta adrenoreceptor causes dilation of bronchi and blood vessels?

A

Beta 2

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4
Q

OBB’s are what type of beta drug, agonist or antagonist?

A

Antagonist

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5
Q

What is the mechanism of action of a OBB?

A

Exact mechanism not known but it will reduce aqueous formation

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6
Q

What type of stimulation of the Ciliary process interfere with?

A

Tonic stimulation

Note: This is speculative

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7
Q

What type of Glaucoma(s) are OBB’s used for?

A

OAG, Secondary glaucoma, ACG and Ocular HTN

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8
Q

What type of Betaxolol is not contraindicated for 1. Pulmonary disease

  1. Bronchial Asthma
  2. Severe COPD?
A

Selective OBB’s

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9
Q

True or False. Taking OBB’s twice a day will have a larger impact than once a day?

A

True

Note: Exception to this rule are:
Isatalol qam
Timoptic XE or GFS (gels) qd
Betagan qd

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10
Q

What is the commonly used non-selective OBB?

A

Timolol 0.5%

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11
Q

What is the maximal effect regarding Timolol instillation?

A

12 hours but IOP lowering will stick around for 24 hours

Note: Onset is 30 minutes

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12
Q

When is the best time to to instill Timolol to get the best result?

A

In the AM

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13
Q

True or False. In all pts, short term escape of timolol will occur?

A

False. Not all pts but the efficacy of Timolol will decrease over a period of time, due to constant antagonism

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14
Q

What does Long term drift mean?

A

Control of IOP is not as good as once, as it use to be. Takes about months to year to occur.

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15
Q

What is washout period?

A

IOP lowering effects may persist for 2 weeks.
Aqueous flow upto 6 weeks

Note: Clinically a 4 week wash out period is acceptable

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16
Q

What are the benefits of using gels and disadvantage of using gels?

A

Advantage: Improve bioavailability, decrease systemic absorption, and once a day drop

Disadvantage: Blurry vision in the morning, has a preservative

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17
Q

What is the major difference between Istalol vs. Timoptic XE?

A

Istalol = BAK

Timpotic XE = Benzododdecinium

18
Q

What does Betaxolol suspension have that the solution does not have?

A

resin coated beads

Note: Betaxolol is not available in the USA

19
Q

True or False. You can use a selective BB with pts who have pulmonary disease?

A

True.

Note: Betxolol can used for this process and is less effective compared to Timolol

20
Q

What are three benefits of betaxolol properties?

A
  1. May possess calcium channel blocker properties
  2. Thus may have neuroprotectic effect*
  3. Highly lipid soluble, binds well with plasma proteins
21
Q

What are three ocular sideeffects of propranolol?

A

Discomfort, Burning and stinging

22
Q

What OBB is associated with granulomarous uveitis?

A

Metipranolol

23
Q

What are 4 local sideffects regarding BAK usage?

A
  1. Decreased tear production
  2. Decreased goblet cell density
  3. Dry eye symptoms
  4. Ocular cicatrical pemphigoid.
24
Q

Which method do OBB’s enter the systemic system?

A

Nasolacrimal system

25
Q

True or False. One of the major CNS adverse effects is the decrease in libido in men.

A

True but its also true in women aswell

26
Q

What do OBB’s do to cardiovascular effects?

A

Reduce blood pressure

Bradycardia

27
Q

What receptor is blocked that causes pulmonary effects?

A

Beta 2 receptor

28
Q

True or False. OBB’s affect hypoglycemia?

A

True

29
Q

Why is clonidine not used in IOP lowering?

A

Causes sedation, systemic hypotension and narrow therapeutic index

30
Q

Apraclonidine would be a great IOP recducer but why is it not used?

A

Very hydrophillic, therefore does not penetrate eyes and BBB

Note: Use Post-laser surgery

31
Q

Why should you avoid using Brominidine post laser IOP?

A

It acts as a prophylactic???

Note: Brominidine is contraindicated with pts on MAOI’s

32
Q

What does Combigan consist of two drugs?

A

Brimonidine and Timolol

33
Q

What does neuroprotection mean?

A

Prevent destructive cellular events and enhance survivial of cells after damage

Note: No glaucoma drug is neuroprotective

34
Q

What are the 4 criteria to be considered neuroprotective in glaucoma?

A

1) the agent must have a target in the retina;
Yes they are present
2) it must be neuroprotective in animal models;
3) it must reach neuroprotective concentrations in the posterior segment after clinical dosing;
4) it must be shown to be neuroprotective in controlled clinical trials.

35
Q

Which older drug is used for ACG with pupillary block?

A

Pilocarpine - works on anterior tendons of ciliary muscles and other CB structures

and

Contraction of ciliary muscle, which causes unfolding or meshwork and widening of schlemm’s canal

36
Q

How is pilocarpine absorbed?

A

By the cornea

Note: Side effects are Stinging and Burning. You will notice intense miosis and constant accommodation as well

37
Q

What is the pharmacological antagonist for pilocarpine?

A

Atropine

38
Q

What family do CAI’s belong too?

A

Sulfonamide

Hence if someone has a sulfa allergy you don’t give CAI’s then.

39
Q

What do CAI’s actually inhibit?

A

Reduction of Bicarbonate ions in posterior chamber

40
Q

What will occur if you give CAI’s and cannot tolerate the increase in serum ammonia?

A

Hepatic insufficiency

41
Q

What drug is known to cause Hirsutism, hairy-ness in women, as a side effect?

A

CAI’s

42
Q

What are the two topical CAI’s available to us?

A

Dorzolamide and Brinzolamide

Glaucoma (7 decks)

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