Opthamology:Glaucoma Flashcards
What are risk factors for glaucoma
increased IOP, central corneal thickness (thinner), optic nerve damage, age, race, gender, family history
What drugs are most likely to cause open-angle glaucoma
Opthalmci corticosteriods, systemic/nasal/inhaled corticosteroids, opthalmic anticholinergics
Which glaucoma is considered a medical emergency, what side effects are seen
Angle closure (IOP greater than 40 and sudden), nausea/vomiting, orbital pain, halos
What are high risk meds that can cause angle closure glaucoma
Topical anticholinergics and sympathomimetics, systemic anticholinergics, anti-depressants, antihistamines
What is the pathophysiology of closed angle gluacoma
Iris bends inward to hit the cornea to cause a physical blockage that doesn’t leave the posterior chamber
What is the determining factor to diagnose glaucoma
If cup-disc ratio is GREATER than 0.5 (sign of optic nerve damage)
T/F: Patients who are starting to get glaucoma will have tunnel vision (no periphery/only central)
True
What is the goal change in IOP for treating glaucoma, what value is related to reduction in visual field defects
30% decrease from baseline, less than 18 mmHg
What are the targets of glaucoma treatment
Inflow (ciliary body), Trabecular outflow (conventional passage 85%), Uveoscleral outlfow (unconventional passage 15%)
What are the beta- blockers used in glaucoma, what is the MOA
timolol, betaxolol, carteolol, leveunolol, metipranolol/ Reduce the aqueous humor production of the ciliary body
What is the only beta-blocker that is selective, selective for what, when would it be preferred
Betaxolol Beta-1 selective, pulmonary disorder
How often are the beta-blockers dosed, what is the exception
1 gtt BID,
istalol timoptic XE (1 gtt every day)
T/F: Timolol has the best efficacy
False: All the beta-blockers are equally efficacious
What are the AE of beta blockers for glaucoma
blurred vision, stinging, dry eyes, corneal anesthesia, eyelid inflammation
What patients should have caution when taking beta blockers
Pulmonary disorders, cardiovascular diseases, diabetes, concurrent use of oral beta-blockers
What are the prostaglandin analogs, prostamide analog
Latanoprost, latanoprostene bunod, travaprost, tafluprost/ Bimatoprost
What is the MOA prostaglandin/prostamide analog
INCREASE UVEOSCLERAL OUTFLOW of the aqueous humor and to a lesser extent tradecular outflow
What is special about latanoprostene bunod
Releases nitric oxide which can relax the trabecular meshwork increasing drainage of aqueous humor
How are the prostaglandin and prostamide analogs dosed, stored
1 gtt qhs, In refrigerator until opened (latanoprost, latanoprostene bunod, taflupost) then stable for 6 weeks at room temperature
Which prostaglandin and prostamide analogs have benzalkonium chloride
Latanoprost, latanoprostene bunod and bimatoprost
Which prostaglandin analog is preservative free, contains sofzia
Tafluprost, travoprost
What are the three unique side effects of prostaglandin and prostamide analogs
Altered iris pigmentation (permenant), hypertrichosis (increasing eyelashes/temporary), hyperpigmentation around lids (reversible)
What are the alpha-2 adrenergic agonists, which increases uveoscleral outflow, dosing
Birmonidine and apraclonidine, brimonidine, 1 gtt BID to TID
What are the adverse effects related to alpha-2 adrenergic agonists
Allergic type reaction: lid edema, eye discomfort, foreign body-sensation, itching, hyperemia (DISCONTINUE IMMEDIATELY)
When should alpha-2 adrenergic agonists be used with caution
Cardiovascular disease, cerebrovascular disease, antihypertensives, MAO-Is, TCAs
What is the MOA of carbonic anhydrase inhibitors (CAIs),
Block active secretion of the sodium and bicarbonate ions from the ciliary body to the aqueous humor
What are the topical (eye drop) CAIs, oral
Brinzolamide and dorzolamide/ acetazolamide and methazolamide
How are the CAIs dosed topically, oral
1 gtt BID to TID, 1 tab BID to QID
T/F: Brinzolamide is associated with stinging while dorzolamide is associated with blurry vision
False: Brinzolamide is associated with blurry vision while dorzolamide is associated with stinging
T/F: Topical and oral solutions of CAIs should not be taken at the same time
True
What is the adverse effect seen whether using oral or topical CAIs, others
Metallic taste, NVD, less eating, renal stones, metabolic acidosis, malaise fatigue
What patients cannot take CAIs, what patients should be cautioned
Patient’s with gout/ sulfa allergies, pulmonary disorders, hepatic and/or renal disease, history of renal calculi
What are the parasympathetic agents, dosing, changes to dosing
Carbachol and pilocarpine, 1 gtt BID to TID, higher concentrations used for darker pigmented eyes
What is the Rho Kinase inhibitor, dose
Netarsudil, 1 gtt daily in evening
How should treatment be monitored
Start with one medication, follow up in 2-4 weeks, once target IOP reached then follow up every 3-6 months
What is ocular hypertension
Elevated IOP greater than 22 mmHg but no disk changes or visual field loss
