Medical Management Of Glaucoma Flashcards
Methods for managing glaucoma
- reduce IOP
- reduce inflow
- increase outflow
What treatment options are avaliable excluding ocular medication
- topical hypotensives
- YAG laser
- trabeculectomy
- deep sclerectomy
- oral azetazolamide
What are the 6 classes of topical drugs available
- prostaglandin
- beta blocker
- carbonic anhydrase
- alpha 2 agonist
- miotic
- ROCK inhibitor
Examples of prostaglandin analogues and mechanism
Increased uveoscleral outflow by ciliary muscle relaxation
- latanaprost (xalatan)
- travoprost (travastan)
- bimatoprost (lumigan)
- talfuprost
Mechanism of action PG
- pro inflammatory molecules
- act at F2 inhibitors In ciliary muscle
- increase aqueous outflow by indicating ciliary muscle relaxation
- initial effect after 2 hours
- peak effect after 8 hours
Prostaglandin contraindications
- uveitis
- CMO
- pseudophakic
- HSK
Prostaglandin side effects
- conjunctival hyperaemia
- mild punctate keratopathy
- foreign body sensation
- ocular irritation
- increased iris pigmentation
- lengthening of eyelashes
- CMO
- reactivate HSK
- exacerbate uveitis
Carbonic anhydrase inhibitor examples
- Dorzolamide
- brinzolamide
Carbonic anhydrase inhibitor mechanism
- reduce aqueous production by inhibiting enzyme carbonic anhydrase
CAI side effects
- blurred vision
- eye irritation
- eye pain
- FB sensation
Beta blockers example
- timolol
Beta blocker mechanism of action
- decreases aqueous production by reducing ultra filtration
- ultra filtration is a process by which aqueous is produced
- 20/30% reduction
Beta blocker ocular side effects
- Corneal hypaethesia
- punctate keratopathy
- dry eye syndromes
- burning/stinging
BB systemic side effects
- anxiety
- hallucinations
- skin disorders
- depression
- GI disturbance
- bradycardia
- systemic hypotension
- heart failure
Beta blocker contraindications
- arrhythmias
- cardiac failure
- COPD
- asthma
- calcium channel blockers
Alpha 2 agonist examples
- apraclonidine
- brimonidine
A2A mechanism of action
- reduction in aqueous production and increased uveoscleral outflow
- acts on alpha 2 receptors which inhibit enzymes involved in production of aqueous
- 20-25% reduction
Ocular and systemic side effects of A2A
- conjunctival hyperaemia
- follicular conjunctivitis
- dry mouth
- blood pressure reduction
- fatigue
A2A contraindications
- px on mono amine oxidase inhibitors
- px on tricyclic antidepressants
- severe cardiac disease
Cholinergic agent (miotic) examples
- pilocarpine
CA mechanism of action
- increase trabecular outflow via ciliary muscle contraction
- plus minor decrease in aqueous inflow
- 20% reduction in IOP
Pilocarpine side effects
- ciliary muscle spasms,
- brow ache
- accommodative myopia
- miosis with constricted VF
- higher risk of retinal detachment
- keratopathy
- acute or chronic angle closure
- bradycardia
ROCK inhibitor mechanism
- Rho Kinase inhibitor
- this is a protein involved in regulation of cell shape and size by acting on the cytoskeleton
- increases aqueous outflow by reducing outflow resistance
- reducing cell stiffness in schlemms canal
Rock inhibitor side effects
- conjunctival hyperaemia
- conjunctival haemorrhages
