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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
Which "Prostaglandin Analog" is indicated for eyelash hypotrichosis?
Bimatoprost (Latisse)
26
What ending corresponds to generic "Beta-Blockers"?
olol
27
What is the only selective "Beta-Blocker?"
Betaxolol (Betoptic S)
28
What is the common dosing for "Beta-Blockers"?
1 drop daily or BID
29
True or False: Non-selective "Beta-Blockers" are more effective than selective ones
TRUE *selective beta-blockers are less effective even though this seems counterintuitive
30
What is the mechanism of action of "Beta-Blockers"?
Reduce aqueous humor production
31
How much do "Prostaglandin Analogs" reduce IOP?
30%
32
How much do "Beta-Blockers" reduce IOP?
20-30% (slightly lower than prostaglandin analogs)
33
What are the first-line treatment options for open-angle glaucoma?
-Prostaglandin Analogs -Beta-Blockers
34
What is an alternative 1st/2nd line treatment for open-angle glaucoma?
Alpha-2 Agonists
35
What is the mechanism of action of "Alpha-2 Agonists"?
Increase aqueous humor outflow AND Reduce aqueous humor production (BOTH)
36
Which "Alpha-2 Agonist" is only indication for redness of eye?
Brimonidine (Lumify)
37
What is the dosing for Alpha-2 Agonists?
1 drop TID
38
How much do "Alpha-2 Agonists" reduce IOP?
25%
39
What is the major contraindication for "Alpha-2 Agonists"?
CNS Depression
40
What is a major side effect of "Alpha-2 Agonists"?
Sedation and Confusion
41
What ending corresponds to generic "Alpha-2 Agonists"?
idine
42
What is the second line treatment option for open angle glaucoma?
Carbonic Anhydrase Inhibitors
43
What is the mechanism of action of "Carbonic Anhydrase Inhibitors"?
Reduce aqueous humor production
44
Which "Carbonic Anhydrase Inhibitors" are ophthalmic?
Dorzolamide + Timolol (Trusopt + Cosopt, Cosopt PF) Brinzolamide + Brimonidine (Azopt + Simbrinza)
45
Which "Carbonic Anhydrase Inhibitors" are oral?
Acetazolamide Methazolamide
46
What is the frequent dosing of Ophthalmic "Carbonic Anhydrase Inhibitors"?
1 drop TID
47
By how much do "Carbonic Anhydrase Inhibitors" reduce IOP?
15-20%
48
What is the dosing of the "Carbonic Anhydrase Inhibitor" Methazolamide?
50 to 100 mg PO 2-3 times daily
49
What is an important warning associated with "Carbonic Anhydrase Inhibitors"?
Sulfonamide allergy
50
What is the third-line treatment option for open-angle glaucoma?
Rho Kinase Inhibitors
51
What is the mechanism of action of "Rho Kinase Inhibitors"?
Increase aqueous humor outflow
52
What is the only "Rho Kinase Inhibitor" drug?
Netarsudil + Latanoprost (Rhopressa + Rocklatan)
53
What is the dosing of "Rho Kinase Inhibitors"?
1 drop QPM (every night)
54
By how much do "Rho Kinase Inhibitors" reduce IOP?
25-30%
55
What 4 side effects are associated with "Rho Kinase Inhibitors"?
-Burning -Corneal Disease -Conjunctival Hemorrhage -Conjunctival Hyperemia
56
What is the last line treatment for open angle-glaucoma?
Cholinergics
57
By how much do "Cholinergics" reduce IOP?
15-25%
58
What are the warnings associated with "Cholinergics"?
Use cation in patients with: -History of retinal detachment -History of corneal abrasion
59
What is the dosing for Carbachol (Milostat) which is a "Cholinergic"?
1-2 drops up to TID
60
What is the dosing for Pilocarpine (Isopto Carpine) which is a "Cholinergic"?
1-2 drops up to QID
61
How often should a patient's response to open-angle glaucoma treatment be assessed?
Every 2-4 weeks
62
What should always be ensured with open-angle glaucoma treatment?
-Compliance -Proper administration technique **over 1/2 of patients have compliance issues
63
If a patient experiences intolerance with an open-angle glaucoma treatment, what should be done?
-Reduce dose/concentration -Change formulation -Switch to class alternative or different combination
64
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
False -If a patient experiences intolerance we can change to a class alternative or different combination
65
How long after using eye drops should you wait to put your contacts back in?
15 minutes
66
If you need to apply two eye drops that are the same drug how long should you wait between drops?
5 minutes
67
If you need to apply two eye drops that are different drugs how long should you wait between drops?
5-10 minutes
68
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?
Use the eye drop first and wait 5 minutes in between application
69
If you need to apply two eye ointments, how long should you wait in between application?
30 minutes
70
What are the symptoms of closed-angle glaucoma?
-Severe headache -Severe pain -Nausea and Vomiting -Blurred Vision -Halos around light -Eye redness or cloudy cornea
71
What agents do we use to treat closed-angle glaucoma?
-Hyperosmotic Agents (mannitol and glycerin) -Surgery
72

Therapeutics 2 Exam 5 (9 decks)

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