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Therapeutics 2 Exam 5 > Ophthamology Pt II > Flashcards

Ophthamology Pt II Flashcards

1
Q

What is the second leading cause of blindness?

A

Glaucoma

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2
Q

How long does glaucoma need to be treated?

A

Life-long

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3
Q

True or False: once damage is done to the eye as a result of glaucoma it can be reversed

A

FALSE
-damage done to the eye by glaucoma cannot be reversed

*key is to recognize glaucoma early

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4
Q

How does glaucoma develop?

A

-Normally: the aqueous humor flows through the drainage canal in the eye

-In glaucoma: the drainage canal becomes blocked and fluid builds up

-The build-up of fluid causes increased pressure which damages the optic nerve (what leads messages from eye to brain) and blood vessels

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5
Q

What is the most common type of glaucoma?

A

Open-Angle

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6
Q

What are the features of open-angle glaucoma?

A

-Happens gradually over time
-Painless
-No vision changes at first (not until 30% of retinal cells are lost)

*Obstructed drainage canal but fluid can still move around eye

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7
Q

What are the features of closed-angle glaucoma?

A

-Pressure pushes iris against cornea
-Iris is very close to the lens/drainage angle of eye and COMPELTELY BLOCKS IT

-Medical Emergency
-Vision loss if not treated

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8
Q

At what age do we begin screening for glaucoma?

A

Age 40 (and over)

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9
Q

What race (s) have the highest risk of developing glaucoma?

A

African Americans: 6x more likely

Asians: 2x more likely

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10
Q

What drug class increases the risk of developing glaucoma?

A

Steroids

(in any form, for any length of time)

*especially steroid applied close to eye, greater risk of increasing intraocular pressure
*IV also has increased risk due to systemic effect

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11
Q

Which disease states increase the risk of developing glaucoma?

A

-High Blood Pressure
-Sickle Cell Anemia
-Diabetes

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12
Q

What are the symptoms of open-angle glaucoma?

A

-No symptoms in early stages
-Patchy blind spots in peripheral vision
-Difficulty seeing in central vision

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13
Q

What is tonometry?

A

A test to measure the intraocular pressure of the eye

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14
Q

What is a limitation with using tonometry to diagnose glaucoma?

A

-Half of glaucoma patients have a normal intraocular pressure
-Therefore, tonometry cannot be used by itself to diagnose glaucoma

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15
Q

What is Ophthalmoscopy?

A

Testing for optic nerve damage

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16
Q

What is Perimetry?

A

Checking for vision loss

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17
Q

What is Pachymetry?

A

Measuring corneal thickness

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18
Q

What is Gonioscopy?

A

Inspecting drainage canal

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19
Q

What are the 3 mechanisms of action of open-angle glaucoma treatment?

A

-Reduce Aqueous Humor Production
-Increase Aqueous Humor Outflow
-Both

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20
Q

How does reducing aqueous humor production help in the treatment of glaucoma?

A

Less has to drain out which decreases eye pressure

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21
Q

How does increasing aqueous humor outflow help in the treatment of glaucoma?

A

-The drainage canal is blocked and has a hard time getting fluid out
-Therefore increasing the outflow helps decrease eye pressure

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22
Q

What name ending corresponds to generic “Prostaglandin Analogs”?

A

prost

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23
Q

what is the mechanism of action of “Prostaglandin Analogs”?

A

Increase aqueous humor outflow

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24
Q

What is the dosing of “Prostaglandin Analogs”?

A

1 drop QHS
(every day at bedtime)

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25
Q

Which “Prostaglandin Analog” is indicated for eyelash hypotrichosis?

A

Bimatoprost (Latisse)

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26
Q

What ending corresponds to generic “Beta-Blockers”?

A

olol

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27
Q

What is the only selective “Beta-Blocker?”

A

Betaxolol (Betoptic S)

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28
Q

What is the common dosing for “Beta-Blockers”?

A

1 drop daily or BID

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29
Q

True or False: Non-selective “Beta-Blockers” are more effective than selective ones

A

TRUE

*selective beta-blockers are less effective even though this seems counterintuitive

30
Q

What is the mechanism of action of “Beta-Blockers”?

A

Reduce aqueous humor production

31
Q

How much do “Prostaglandin Analogs” reduce IOP?

A

30%

32
Q

How much do “Beta-Blockers” reduce IOP?

A

20-30%

(slightly lower than prostaglandin analogs)

33
Q

What are the first-line treatment options for open-angle glaucoma?

A

-Prostaglandin Analogs

-Beta-Blockers

34
Q

What is an alternative 1st/2nd line treatment for open-angle glaucoma?

A

Alpha-2 Agonists

35
Q

What is the mechanism of action of “Alpha-2 Agonists”?

A

Increase aqueous humor outflow AND Reduce aqueous humor production
(BOTH)

36
Q

Which “Alpha-2 Agonist” is only indication for redness of eye?

A

Brimonidine (Lumify)

37
Q

What is the dosing for Alpha-2 Agonists?

A

1 drop TID

38
Q

How much do “Alpha-2 Agonists” reduce IOP?

A

25%

39
Q

What is the major contraindication for “Alpha-2 Agonists”?

A

CNS Depression

40
Q

What is a major side effect of “Alpha-2 Agonists”?

A

Sedation and Confusion

41
Q

What ending corresponds to generic “Alpha-2 Agonists”?

A

idine

42
Q

What is the second line treatment option for open angle glaucoma?

A

Carbonic Anhydrase Inhibitors

43
Q

What is the mechanism of action of “Carbonic Anhydrase Inhibitors”?

A

Reduce aqueous humor production

44
Q

Which “Carbonic Anhydrase Inhibitors” are ophthalmic?

A

Dorzolamide + Timolol (Trusopt + Cosopt, Cosopt PF)

Brinzolamide + Brimonidine (Azopt + Simbrinza)

45
Q

Which “Carbonic Anhydrase Inhibitors” are oral?

A

Acetazolamide

Methazolamide

46
Q

What is the frequent dosing of Ophthalmic “Carbonic Anhydrase Inhibitors”?

A

1 drop TID

47
Q

By how much do “Carbonic Anhydrase Inhibitors” reduce IOP?

A

15-20%

48
Q

What is the dosing of the “Carbonic Anhydrase Inhibitor” Methazolamide?

A

50 to 100 mg PO 2-3 times daily

49
Q

What is an important warning associated with “Carbonic Anhydrase Inhibitors”?

A

Sulfonamide allergy

50
Q

What is the third-line treatment option for open-angle glaucoma?

A

Rho Kinase Inhibitors

51
Q

What is the mechanism of action of “Rho Kinase Inhibitors”?

A

Increase aqueous humor outflow

52
Q

What is the only “Rho Kinase Inhibitor” drug?

A

Netarsudil + Latanoprost
(Rhopressa + Rocklatan)

53
Q

What is the dosing of “Rho Kinase Inhibitors”?

A

1 drop QPM

(every night)

54
Q

By how much do “Rho Kinase Inhibitors” reduce IOP?

A

25-30%

55
Q

What 4 side effects are associated with “Rho Kinase Inhibitors”?

A

-Burning
-Corneal Disease
-Conjunctival Hemorrhage
-Conjunctival Hyperemia

56
Q

What is the last line treatment for open angle-glaucoma?

A

Cholinergics

57
Q

By how much do “Cholinergics” reduce IOP?

A

15-25%

58
Q

What are the warnings associated with “Cholinergics”?

A

Use cation in patients with:
-History of retinal detachment
-History of corneal abrasion

59
Q

What is the dosing for Carbachol (Milostat) which is a “Cholinergic”?

A

1-2 drops up to TID

60
Q

What is the dosing for Pilocarpine (Isopto Carpine) which is a “Cholinergic”?

A

1-2 drops up to QID

61
Q

How often should a patient’s response to open-angle glaucoma treatment be assessed?

A

Every 2-4 weeks

62
Q

What should always be ensured with open-angle glaucoma treatment?

A

-Compliance
-Proper administration technique

**over 1/2 of patients have compliance issues

63
Q

If a patient experiences intolerance with an open-angle glaucoma treatment, what should be done?

A

-Reduce dose/concentration

-Change formulation

-Switch to class alternative or different combination

64
Q

True or False: if a patient does not tolerate one drug in a treatment class for open-angle glaucoma, then they will not tolerate any other drugs in that treatment class

A

False

-If a patient experiences intolerance we can change to a class alternative or different combination

65
Q

How long after using eye drops should you wait to put your contacts back in?

A

15 minutes

66
Q

If you need to apply two eye drops that are the same drug how long should you wait between drops?

A

5 minutes

67
Q

If you need to apply two eye drops that are different drugs how long should you wait between drops?

A

5-10 minutes

68
Q

If you need to apply an eye ointment and an eye drop, which should you use first and how long should you wait in between application?

A

Use the eye drop first and wait 5 minutes in between application

69
Q

If you need to apply two eye ointments, how long should you wait in between application?

A

30 minutes

70
Q

What are the symptoms of closed-angle glaucoma?

A

-Severe headache
-Severe pain
-Nausea and Vomiting
-Blurred Vision
-Halos around light
-Eye redness or cloudy cornea

71
Q

What agents do we use to treat closed-angle glaucoma?

A

-Hyperosmotic Agents (mannitol and glycerin)

-Surgery

72
Q
A

Therapeutics 2 Exam 5 (9 decks)

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