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Ocular Pharm > Ocular Pharm: L6: Drugs for Treating Glaucoma > Flashcards

Ocular Pharm: L6: Drugs for Treating Glaucoma Flashcards

1
Q

Types of Glaucoma

  1. Primary Open Angle Glaucoma (POAG)
    a. What 3 other types of Glaucoma are treated just like POAG?
  2. Pre-Glaucoma (Glaucoma Suspect)?
  3. Steroid Response Glaucoma?
  4. Angle Closure Glaucoma?
  5. Ocular Hypertension
    a. % risk of developing Glaucoma after 5 yrs?
    b. When do we treat it?
A
  1. a. Secondary Glaucoma, Steroid Response Glaucoma, Normal Tension Glaucoma (NTG)
  2. Workup and treat if confirmed
  3. stop or switch steroid; Treat like POAG; AVOID PROSTAGLANDINS or MIOTICS if RECENT OCULAR INFLAMMATORY DISEASE!
  4. Surgical Tx, and may be Acutely Treated w/IOP Lowering Drugs
  5. a. 9.5%
    b. If it’s a HIGH RISK!
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2
Q

When to Treat Ocular Hypertension

  1. Low Risk
    a. Treat?
    b. IOP?
    c. C/D?
  2. Moderate Risk
    a. Treat?
    b. IOP?
    c. C/D?
    d. Corneal thickness?
    e. FHx of what?
    f. What kind of astigmatism?
  3. High Risk
    a. Treat?
    b. What is seen in the Retina?
    c. IOP?
    d. IOP w/what cornea?
    e. Vertical C/D?
A
  1. a. Monitor every 2 yrs
    b. 22-23 mmHg w/Avg or Greater Corneal Thickness

c. 0.4
d. Avg
e. POAG
f. HIGH MYOPIA

  1. a. TREAT!
    b. NFL Defects, and Parapapillary Changes

c. > or equal to 30 mmHg
d. > or equal to 26 mmHg w/THIN CORNEA
e. Vertical C/D > or equal to 0.4 w/Thin Cornea

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3
Q

Managing Glaucoma

  1. Get Good BASELINE VALUES for what 5 THINGS?
  2. Lower IOP: Currently Antiglaucoma Eye Drops can lower IOP by what %?
  3. Monitor IOP every (how long)?
    a. When should you be MORE AGGRESSIVE with THERAPY?

b. Consider surgery when?
4. What 2 things should be checked EVERY YEAR?
5. Repeat Gonioscopy when?

A
  1. a. IOP
    b. Pachymetry
    c. Gonioscopy
    d. ONH Parameters
    e. VF
  2. about 30%
  3. 3 MONTHS
    a. when IOP goal is not being reached or maintained

b. when drugs aren’t working to lower IOP or in a Noncompliant pt.
4. ONH and VF
5. Every 2 YEARS

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4
Q

Drugs Used to Manage Glaucoma

  1. First line (2)?
    a. Which is DOC?
  2. 2nd Line (2)?
A
  1. Prostaglandins and Beta-Blockers
    a. Prostaglandins
  2. Alpha-2 Agonists and Carbonic Anhydrase Inhibitors
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5
Q

Prostaglandins

  1. What do they do?
  2. Best efficacy: what % reduction?
    a. Most convenient dosing: What is it?
    b. Are they safe?
  3. What can they do to the Iris and Eyelashes?
  4. What might pts complain about on initial instillation?
    a. May be due to what?
  5. How long might it take to get the FULL EFFECT?
A
  1. Increase UVEOSCLERAL OUTFLOW
  2. 30%
    a. 1 gtt, qhs
    b. Yes. They’re the SAFEST
  3. Change color of both, and increase growth of eyelashes
  4. Ocular Irritation
    a. to the Preservative: BAK
  5. May take over 1 Month
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6
Q

Commonly-Used Prostaglandins
(BLT-T -PROST)

  1. Brimatoprost:
    a. Preservative? If so, what?
    b. Technically it’s a what?
    c. May also increase OUTFLOW thru what?
  2. Latanoprost (Oldest and cheapest..cash pt)
    a. Preserved? If so, what?
    b. Is there a Generic version available?
  3. Travaprost (Newest, most expensive: Insurance Pt)
    a. Preserved? If so, What?
  4. Tafluprost
    a. Preserved? If so, what?
A
  1. a. Yes; BAK
    b. Prostamide
    c. thru TM
  2. a. Yes; BAK
    b. Yes
  3. a. Yes. SOFZIA
  4. a. No
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7
Q

VF Loss

  1. Glaucomatous VF Defects
    a. Need a MINIMUM of what?
  2. HF VF is a Static/Dynamic VF?
  3. What about FDT and SWAP?
A
  1. a. Min. of a Cluster of at least or more of 3 Points that are CONTIGUOUS and not on the Edge of pre faster, but to confirm diagnosis, need to do a HF VF.
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8
Q

Adrenergic Receptors

  1. Alpha 2
    a. Found where?
    b. When stimulated, what happens?
  2. Beta 2
    a. Where are they found?
    b. When stimulated, what do they do?
A
  1. a. In Ciliary epithelium
    b. When stimulated, DECREASES AQ. Secretion and INCREASES UVEOSCLERAL OUTFLOW!
  2. a. Ciliary epithelium and Bronchi
    b. Increase Aq. Production and causes Bronchodilation
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9
Q

Beta Blockers

  1. What do they do?
  2. Decrease in IOP: What do we expect (%)?
    a. Response decreases over time in what % of Pts?
    b. Additional (what %) reduction when added to Prostaglandin?
    c. And additional what % reduction when added to Alpha 2 Antagonist or CAI?
  3. Sympathetic effects?
    a. What can be avoided by using a BETA-1 SELECTIVE BLOCKER?
    b. Other side effects can be reduced by using what?
  4. Regimen?
    a. Why this?
A
  1. Decrease Aq. Production
  2. 25% decrease in IOP
    a. 10%
    b. 20%
    c. 15%
  3. Tons
    a. Bronchospasm

b. a Partial Agonist
3. BID, once in Morning and once after dinner
a. So any hypotensive effects will be noticed!
* some formulas can be used QD

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10
Q

Commonly Used Beta Blockers! (C-BLT) (-olol)

  1. Carteolol
    a. What type of Sympathomimetic Activity? (full or partial agonist?)
    b. More selective for what?
  2. Betaxolol
    a. Selective for what BETA? Why is this good?
    b. However, what about IOP?
    c. What else does it block? This may do what to the Circulation of the DISC and may PROTECT WHAT?
    d. Can it be used in kids?
  3. Levobunolol
    a. Regimen?
    b. May be protective of what?
  4. Timolol
    a. Also available in what?
A
  1. Intrinsic. (Partial Agonist)
    b. for the EYE, less Bradycardia
  2. a. BETA-1 Selective; Decreased Side effects
    b. You get a smaller decrease in IOP
    c. Ca2+ Channels. May INCREASE; and May PROTECT VF!
    d. Not yet. Betopic S: In trials for Pediatric use.
  3. a. BID or QD
    b. Neuroprotective (Less Nocturnal Hypotension)
  4. a. in QD Form.
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11
Q

Alpha-2 Agonists (AB -nidine)

  1. What do they do?
  2. Aproclonidine
    a. What can happen?
    b. Used for what?
  3. Bromonidine
    a. IOP Decrease similar to what other type of Antiglaucomatic drugs? (Less than which one, but GREATER than what)?

b. Effective ADDITIVE to that of what drug?

c. Can CAUSE DELAYED what?
i. up to how long before it occurs?

A
  1. Decrease Aq. Production AND increase Uveoscleral Outflow.
  2. a. Tachyphylaxis (acute sudden decrease in action of the drug after being administered)
    b. ACUTE IOP LOWERING (e.g. After Dilation)
  3. a. Beta Blockers! (Less than TIMOLOL, but GREATER than BETAXOLOL)
    b. of Beta Blockers
    c. delayed Allergic Conjunctivitis
    i. may not be seen until a YEAR later.
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12
Q

Carbonic Anhydrase Inhibitors
(DB -MIDE)

  1. What do they do?
  2. Chemically Related to what other type of drugs?
    a. So someone who is allergic to WHAT should NOT take these?
  3. Dorzolamide
    a. Dosing?
    b. Similar Efficacy to what Beta Blocker?
    c. Can cause what?
    d. Can Precipitate Decompensation in Pts w/Corneal what?
  4. Brinzolamide
    a. Similar effects to what drug?
    b. However, there is less what?
A
  1. Inhibit Aq. Secretion
  2. Suphonamides
    a. someone allergic to Sulfa Drugs
  3. a. TID
    b. BETAXOLOL
    c. Allergic Blepharitis!
    d. w/Corneal Endothelial Dysfunction
  4. a. to Dorzolamide
    b. Less Stinging and Allergy
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13
Q

Prostones

  1. Unoprostone Isopropyl
    a. How old. Is it being used?
  2. What does it do?
  3. Lowers IOP by what, in a Patient w/iOP of what? (not as good as Timolol)
  4. It’s Effective in what?
  5. Produces CONSTANT what?
    a. What does not, but what does?
  6. Dosing?
A
  1. a. Older drug. Being re-introduced
  2. Activates ION Channels to PROMOTE FLUID FLOW and Protect Cells
  3. by 3-4 mm Hg in pt w/IOP of 23 mmHg
  4. In Combinations!
  5. Constant lowering over the ENTIRE DIURNAL PERIOD
    a. Bromonidine doesn’t do this. TRAVOPROST does.
  6. 1 Drop in Affected eye(s) BID
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14
Q

Drug Combinations

  1. Advantage?
  2. COSOPT: What 2 drugs?
    a. Color cap?
  3. Combigan: What 2 Drugs?
    a. What color Cap?
  4. Xalcom: What 2 drugs?
    a. What color Cap?
  5. Simbrinza: What 2 drugs?
    a. What color cap?
A
  1. Less drops to administer (2 Medications per drop)
  2. TIMOLOL and Dorzolamide
    a. Blue or Yellow
  3. TIMOLOL and ALPHAGAN
    a. Blue Cap
  4. TIMOLOL and Latanoprost
    a. Yellow cap
  5. Bromonidine and Brinzolamide
    a. Light Green Cap
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15
Q

Other Drugs

  1. Topical Miotics
    a. What 2?
    b. What do they do?
    c. Similar Efficacy to what Antiglaucomatic Drugs?
    d. Problem (SIDE EFFECTS)?
    e. Dosing?
  2. Oral CAIs: DAM
    a. Long or Short-term Tx of ACUTE GLAUCOMA?

b. Problem (Side effects)?

  1. Systemic Osmotic Agents:
    a. 2 that are ORAL?
    b. 1 that’s an IV?
    c. Lower IOP by doing what?
    d. For what type of GLAUCOMA?
A
  1. a. Pilocarpine and Carbachol
    b. INCREASE OUTFLOW thru TM
    c. to BETA BLOCKERS
    d. Miosis, Brow ache, myopic Shift
    e. QID vs BID w/Beta Blocker
  2. Dichlorphenamide, ACETAZOLAMIDE (also IV) and METHAZOLAMIDE
    a. SHORT TERM
    b. Parasthesia, Malaise complex, GI Complex; Rarely Blood dyscrasias and SJS
  3. a. GLYCEROL and Isosorbide
    b. MANNITOL
    c. Drawing water out of the Vitreous
    d. ACUTE ANGLE CLOSURE Glaucoma
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16
Q

Herbal Treatments

  1. Marijuana
    a. % Decrease in IOP?
    b. Regimen?
  2. Ginkgo Biloba
    a. Some evidence for improvements in VF in what Glaucoma type patient?
    b. Does IOP get lowered?
  3. Bilberry
    a. Lowering of IOP comparable to what Drug?
    b. Faster or slower onset than said drug?
    c. What kind of effect occurs with this said drug?
    d. What appears to be the Main Proponent?
A
  1. a. 20%
    b. 1 joint q3h, or equivalent oral dose of THC
  2. a. in NTG
    b. NO
  3. a. to LATANOPROST
    b. Slower onset
    c. Additive effect
    d. who…Steigerwalt (the dude who did the study…)
17
Q

Treatments in Development

  1. Drug Delivery thru what device?
    a. Can deliver drugs for how long?
    b. What 2 things produce Sustained Release?
  2. Trabodenoson
    a. What does it INHIBIT? This may DECREASE STIFFNESS of what?

b. Also Inhibits what? This may reduce activity of what?
c. Overall, it’s as effective as what drug class?
d. May be more effective than what drugs in patient’s with what?

A
  1. CL
    a. for up to 1 month
    b. Polymer Films and Embedded Nanodiamonds
  2. a. RHO KINASE (ROCK inhibitor); May decrease “Stiffness” of TM
    b. NE Transport Inhibition; reduces ADRENERGIC Activity
    c. as Prostaglandins
    d. than Prostaglandins in Pts w/LOWER Baseline IOPs!
18
Q

Considerations for Treatment

  1. Once you start, it’s hard to do what?
  2. Treat NTG ONLY if there’s what?
  3. Consider Ability of Pt to do what?
A
  1. STOP
  2. a Progression (For NTG in elderly pt, check history to r/o burnt out glaucoma)
  3. to Comply w/Treatment
    (Financial, Ability to administer drops, Motivation)
19
Q

General Guidelines for Tx

  1. Treat which pts more aggressively?
  2. Consider other Medications…
  3. Keep accurate records of what?
  4. Start medication with what trial?
  5. If IOP lowering is not sufficient, what do you do?
    a. If still not sufficient, what do you do?
  6. Carefully and regularly check for effectiveness of what?
A
  1. Younger pts (higher risk of developing vision loss over time); Black Patients (4x’s more likely their glaucoma will progress)
  2. a. Systemic use of Beta-blockers will make Topical Beta Blocker Ineffective
    b. Use Selective Beta-blockers w/Asthmatics!
  3. of Baseline and Tx IOP readings
  4. UNIOCULAR Trial
  5. Stop it and try another drug.
    a. Once you’ve gone thru the WHOLE set and still haven’t gotten an IOP drop to where you want, then start using TWO MEDS
  6. of meds and progression of glaucoma.

Ocular Pharm (13 decks)

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