Ocular Pharmacology of Glaucoma

Question 1

What is glaucoma?

Answer 1

-a disease associated with increased intraocular pressure that results in direct and vascular damage to the optic nerve.

Question 2

Agueous humor is made in _____

Answer 2

ciliary body

Question 3

aqueous movement?

Answer 3

From the posterior chamber to the pupil, into the anterior chamber, into the trabecular meshwork, into the canal of schlemm, and then into the episcleral veins (some will move in a “uveo-scleral outflow” or “non-conventional pathway”

Question 4

Pupil constriction is referred to as _____. Pupil dilation is referred to as _____. Drug that cause both?

Answer 4

• miosis caused by M3 agonist or alpha 1 antagonists

- mydriasis caused by alpha 1 agonist or M3 antagonist

Question 5

What drugs are used to dilate the eyes? class?

Answer 5

• short acting atropine like drugs (tropicamide, cyclopentolate)
• short acting adrenergics drugs to enhance effect (phenylephrine)

Question 6

What causes acute glaucoma? What are the clinical presentations?

Answer 6

• impedint of aqueous flow resulting in pressure building behind the iris, pushing it forward, closing the angle, and rapidly increasing intraocular pressure (very good picture in the notes)
• pupil fixed in mid-position, cloudy view of the iris from corneal edema, high intraoclar pressure, no view of normal angle structures, very red eye, pain!

Question 7

How do you treat angle closure glaucoma?

Answer 7

• constrict the pupil (pilocarpin)
• reduce production of aqueous (b-blocker and carbonic anhydrase inhibitor), peripheral laser iridotomy (prevents pupillary block from forward movement of the iris)

Question 8

What happens in open angle glaucoma? What is exam and intraocular pressure findings?

Answer 8

• trabecular meshwork becomes resistant to flow w/ age (increase in production of glycosaminoglycans)
• exam of angle reveals normal appearing trabecular meshwork
• intraocular pressure is 20-50 w/o pain or redness

Question 9

What is the treatment for open angle and their effects?

Answer 9

• b-blocker (reduce aqeuous production)
• prostaglandins (increase uveal-scleral outflow
• alpha 2 agonist (reduce produc and increase uveo-scleral outflow)
• Ca inhibitors (reduce production)

Question 10

What are the following drugs and function: timolol, latanoprost, brimonidine acetazolamide, dorzolamide?

Answer 10

• timolol: B-blocker (reduces aqueous humor production)
• latanoprost: prostaglandin (increases uveal-scleral outflow)
• brimonidine: alpha 2 agonist (reduce production and increase uveo scleral outflow)
• acetazolamide and dorzolamide: carbonic anhydrase inhibitors