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PATHO/PHARM II > Part Four: Chronic DX - Glaucoma > Flashcards

Part Four: Chronic DX - Glaucoma Flashcards

Exam 4 (Final)

1
Q

Overview of the Eye:

What does the external eye consist of?

A

sclera

conjunctiva

cornea

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2
Q

Overview of the Eye:

What does the middle portion of the eye consist of?

A

The middle portion of the eye includes the

iris,

pupil,

lens,

ciliary body

choroid layer

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3
Q

Overview of the Eye:

What does the posterior portion of the eye consist of?

A

The posterior portion of the eye contains the

vitreous humor

retina

optic nerve

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4
Q

Normal conditions:

What produces the aqueous humor and where is it secreted?

A

Aqueous humor is produced by the ciliary body & secreted into posterior chamber

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5
Q

Normal conditions:

Aqueous humor is produced by the ciliary body & secreted into posterior chamber

What does this play a role in maintaining?

A

~ role in maintaining IOP < 20mmHg

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6
Q

Normal conditions:

Aqueous humor is produced by the ciliary body & secreted into posterior chamber

From there, where does it go? Where does it exit?

A

From there, it circulates around iris –> anterior chamber –> exits thru trabecular meshwork (drain) & canal of Schlemm

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7
Q

Normal conditions:

Aqueous humor is produced by the ciliary body & secreted into posterior chamber

If outflow is impeded from anterior chamber, what will happen?

A

If outflow impeded from anterior chamber, back-pressure will develop & IOP will rise

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8
Q

Patho of Glaucoma: Glaucoma ~ group of DX

What happens to fluid in the front of the eye? What does this lead to?

A

Fluid builds up in front part of eye from impaired drainage (clogged drain)

Pressure inside eye rises

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9
Q

Patho of Glaucoma: Glaucoma ~ group of DX

Fluid builds up in front part of eye from impaired drainage (clogged drain)

Pressure inside eye rises- What does this lead to?

A

↓ peripheral vision

Damage to optic nerve damage

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10
Q

Patho of Glaucoma: Glaucoma ~ group of DX

Common forms (2 types): What are they?

A

Primary open-angle POAG, more common

Acute angle-closure (narrow-angle)

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11
Q

Patho of Glaucoma

Secondary glaucoma: What is it caused by?

A

Caused by underlying condition or drugs that increase eye pressure

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12
Q

Patho of Glaucoma

Secondary glaucoma: What meds are used for this?

A

Meds ~ corticosteroids

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13
Q

Patho of Glaucoma

Secondary glaucoma:

Systemic DX includes what?

A

~ arteriosclerosis, DM, Htn

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14
Q

Patho of Glaucoma

Ocular HTN: What is this?

A

↑ IOP, ⍉ optic nerve damage

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15
Q

Patho of Glaucoma

Ocular HTN: How high can pressure be?

A

IOP may be > 30mmHg but there’s no injury to optic nerve

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16
Q

Patho of Glaucoma

Ocular HTN: Is this glaucoma?

A

Not glaucoma

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17
Q

There are two major types of glaucoma

What are they?

A

Primary Open Angle Glaucoma (POAG)

Acute-angle ~ displaced iris, blocks trabecular network

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18
Q

There are two major types of glaucoma

Impeded outflow from anterior chamber ~ ↑ IOP

What kind of glaucoma is this?

A

Primary Open Angle Glaucoma (POAG)

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19
Q

There are two major types of glaucoma

What is the most common type of glaucoma?

A

Primary Open Angle Glaucoma (POAG)

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20
Q

There are two major types of glaucoma

POAG ~ clogged drain (most common): Why does this occur?

A

Resistance to drainage

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21
Q

There are two major types of glaucoma

Primary Open Angle Glaucoma (POAG): What happens to eye pressure, what does this lead to?

A

Eye pressure ↑ progressive damage to optic nerve

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22
Q

There are two major types of glaucoma

Eye pressure ↑ progressive damage to optic nerve

Risk Factors

A

↑ IOP (but can develop with normal IOP)

African or South American ancestry

FHX

Advanced age

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23
Q

There are two major types of glaucoma

Eye pressure ↑ progressive damage to optic nerve

What will it EVENTUALLY lead to?

A

Eventual vision impairment

Painless, insidious occurs over yrs

Vision loss

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24
Q

There are two major types of glaucoma

Eye pressure ↑ progressive damage to optic nerve

Vision loss: How does it occur? When does it occur?

A

Peripheral –> central visual field

Sx absent until extensive optic nerve damage

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25
Q

There are two major types of glaucoma

Eye pressure ↑ progressive damage to optic nerve

Vision loss:

What must be done for this?

A

Regular screening

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26
Q

There are two major types of glaucoma

Acute-angle ~ displaced iris, blocks trabecular network

How is it precipitated?

A

Precipitated by displaced iris –> covers trabecular meshwork

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27
Q

There are two major types of glaucoma

Acute-angle ~ displaced iris, blocks trabecular network

What is blocked?

A

Drainage angle completely blocked

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28
Q

There are two major types of glaucoma

Acute-angle ~ displaced iris, blocks trabecular network

What is prevented from occuring?

A

Exit of aqueous humor from ant chamber prevented

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29
Q

There are two major types of glaucoma

Acute-angle ~ displaced iris, blocks trabecular network

What happens to IOP?

A

IOP increases rapidly to dangerous levels

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30
Q

There are two major types of glaucoma

Acute-angle ~ displaced iris, blocks trabecular network

How does this disease develop?

A

Develops suddenly, extremely painful

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31
Q

There are two major types of glaucoma

Acute-angle ~ displaced iris, blocks trabecular network

What is this disease considered? What does it lead to?

A

Medical emergency - ⍉ TX ~ irreversible blindness in 1-2d

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32
Q

There are two major types of glaucoma

Acute-angle ~ displaced iris, blocks trabecular network

What is treatment?

A

Tx with drops & corrective surgery

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33
Q

There are two major types of glaucoma

Acute-angle ~ displaced iris, blocks trabecular network

What are causes of this?

A

Trauma

Sudden/prolonged pupil dilation

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34
Q

Comparative Anatomy:

Open Angle Glaucoma: What does it look like?

A

The angle between the iris and cornea is open, permitting unimpeded outflow of aqueous humor through the canal of Schlemm and trabecular meshwork.

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35
Q

Comparative Anatomy:

Acute Angle Glaucoma: What does it look like?

A

The angle between the iris and cornea is constricted in angle-closure glaucoma, thereby blocking outflow of aqueous humor through the canal of Schlemm and trabecular meshwork.

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36
Q

Pharmacotherapy (topical):

What is it?

A

Beta-adrenergic blocking agents

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37
Q

Pharmacotherapy (topical):

Beta-adrenergic blocking agents

Agents (first-line): Include what 2 groups?

A

NON-selective:

Beta1 Selective:

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38
Q

Pharmacotherapy (topical):

Beta-adrenergic blocking agents

Agents (first-line): NON-selective- what is an example?

A

NON-selective: timolol

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39
Q

Pharmacotherapy (topical):

Beta-adrenergic blocking agents

Agents (first-line):

Beta1 Selective: What is an example? What is this kind preferred for?

A

Beta1 Selective: betaxolol (preferred in asthma, COPD – why???)

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40
Q

Pharmacotherapy (topical)

Beta-adrenergic blocking agents: What are they used for?

A

Used for initial & maintenance tx in open-angle,

ocular htn,

& emergency tx of acute

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41
Q

Pharmacotherapy (topical)

Beta-adrenergic blocking agents: MOA

A

↓ aqueous humor production

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42
Q

Pharmacotherapy (topical)

Beta-adrenergic blocking agents: MOA

By decreasing aqueous humor production, what it the beta blocker doing?

A

By decreasing aqueous humor production, beta-blockers help lower eye pressure.

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43
Q

Pharmacotherapy (topical)

Beta-adrenergic blocking agents: MOA

Where do effects occur?

A

Local effects

44
Q

Pharmacotherapy (topical)

Beta-adrenergic blocking agents:

Local effects include what?

A

Transient ocular stinging, conjunctivitis, blurred vision, photophobia, dry eyes

45
Q

Pharmacotherapy (topical)

Beta-adrenergic blocking agents:

Systemic ADEs possible and what should be monitored?

A

Bradycardia,

AV block

Bronchospasm

CI: AVB, SB, cardiogenic shock

Monitor pulse

46
Q

Pharmacotherapy:

What is a another group of drugs?

A

Prostaglandin analogs

47
Q

Pharmacotherapy:

Prostaglandin analogs: Latanoprost

How effective is it compared to beta blockers?

A

Effective as BBs, less SEs

48
Q

Pharmacotherapy:

Prostaglandin analogs: What is the first line drug?

A

Latanoprost

49
Q

Pharmacotherapy

Latanoprost: MOA

What does it do to reduce IOP?

A

Increases the outflow of aqueous humor through the uveoscleral pathway –> indirectly reduces IOP

50
Q

Pharmacotherapy
Prostaglandin analogs–> Latanoprost

What is uveosceral pathway?

A

uvea (includes the iris, ciliary body, and choroid)

and the sclera (the white outer layer of the eye).

51
Q

Pharmacotherapy
Prostaglandin analogs–> Latanoprost

Increases the outflow of aqueous humor through the uveoscleral pathway –> indirectly reduces IOP

What is this pathways an alternative for?

A

This pathway is an alternative route for aqueous humor drainage that does not involve the trabecular meshwork.

52
Q

Pharmacotherapy
Prostaglandin analogs–> Latanoprost

When is this medication administered?

A

Given in the evening

53
Q

Pharmacotherapy
Prostaglandin analogs–> Latanoprost

What is a common side effect? Who is it most noticeable in? What happens is medication is stopped?

A

Harmless brown pigmentation of iris

Most noticeable in light eyes

Stops when d/c’d but does not usually regress

54
Q

Pharmacotherapy
Prostaglandin analogs–> Latanoprost

What is a side effect that MAY happen? Who is it most noticeable in? What happens is medication is stopped?

A

May increase eyelid pigmentation

May increase length, thickness, pigmentation of eyelashes

55
Q

Pharmacotherapy
Prostaglandin analogs–> Latanoprost

What are serious side effects of this drug? (not eye lid or eye color stuff)

A

Blurred vision, burning stinging

56
Q

Alpha2-adrenergic agonists

What is the prototype?

A

Brimonidine (Alphagan P)

57
Q

Alpha2-adrenergic agonists

Brimonidine (Alphagan P): MOA?

A

↓ aqueous humor production & ↑ outflow

58
Q

Alpha2-adrenergic agonists

Brimonidine (Alphagan P): MOA

How does it ↓ aqueous humor production & ↑ outflow?

A

stimulates alpha receptors found on the blood vessels that supply the ciliary body, causing them to constrict, so it reduces the amount of watery fluid that filters out of the blood vessels to form aqueous humour

59
Q

Alpha2-adrenergic agonists

Brimonidine (Alphagan P):

What is the dosage?

A

1 drop three times a day

60
Q

Alpha2-adrenergic agonists

Brimonidine (Alphagan P):

ADEs

A

Ophthalmic irritation, dry mouth, engorgement of ocular BVs, local burning, stinging, blurry vision

Can cross BBB & cause drowsiness, fatigue, hypotension, dry mouth

61
Q

Alpha2-adrenergic agonists

Brimonidine (Alphagan P):

ADEs :Can cross BBB & cause drowsiness, fatigue, hypotension, dry mouth

Why does this happen?

A

Remember activation of alpha2 receptors in brain decreases sympathetic outflow to BVs & lowers BP

62
Q

Alpha2-adrenergic agonists

Alpha2 Agonist/BB combo: What is it composed of?

A

Brimonidine/timolol

63
Q

Cholinergics (parasympathetic/muscarinic agonist):

What is the prototype?

A

Pilocarpine

64
Q

Cholinergics (parasympathetic/muscarinic agonist):

Pilocarpine: MOA?

A

Miosis due to iris sphincter contraction

Contraction of ciliary muscle

65
Q

Cholinergics (parasympathetic/muscarinic agonist):

Pilocarpine: Contraction of ciliary muscle- What does this do to focus?

A

Focuses the lens for near vision

66
Q

Cholinergics (parasympathetic/muscarinic agonist):

Pilocarpine: Contracting ciliary muscle promotes widening of the spaces within trabecular meshwork, directly reducing IOP

What does this do to aqueous humor outflow?

A

↑ aqueous humor outflow

66
Q

Cholinergics (parasympathetic/muscarinic agonist):

Pilocarpine: Contraction of ciliary muscle- What does this promote and lead to?

A

Contracting ciliary muscle promotes widening of the spaces within trabecular meshwork, directly reducing IOP

67
Q

Cholinergics (parasympathetic/muscarinic agonist):

Pilocarpine: Contracting ciliary muscle promotes widening of the spaces within trabecular meshwork, directly reducing IOP

What is this good to treat?

A

Good for acute angle

68
Q

Cholinergics (parasympathetic/muscarinic agonist):

Pilocarpine: Contracting ciliary muscle promotes widening of the spaces within trabecular meshwork, directly reducing IOP

Good for acute angle: Why?

A

Pulls iris away from trabecular network removing impediment to outflow

69
Q

Cholinergics (parasympathetic/muscarinic agonist):

Pilocarpine:

What are ADEs?

A

Miosis, blurred vision, decreased visual acuity (alters shape of lens), systemic rare

70
Q

Cholinergics (parasympathetic/muscarinic agonist):

Pilocarpine:

What are rare ADEs?

A

Rare – sustained contraction of ciliary muscle causes retinal detachment

71
Q

Carbonic anhydrase inhibitors : How effective? How is this used?

A

(less effective, adjunct)

72
Q

Carbonic anhydrase inhibitors :

What is the prototype?

A

Dorzolamide (trusopt)

73
Q

Carbonic anhydrase inhibitors :

Dorzolamide (trusopt): MOA

A

Reduce IOP

↓ aqueous humor production

74
Q

Carbonic anhydrase inhibitors :

What is the ADRs?

A

Ocular stinging, bitter taste, conjunctivitis

75
Q

Carbonic anhydrase inhibitors :

What is Dorzolamide used in combination with?

What would this do?

A

Greater reduction of IOP

76
Q

Management of POAG

What is the goal? Is there a cure? How long should you use medicine? What does it do?

A

Goal: ↓ IOP

⍉ cure, chronic use req.

↓ slow, or stop DX progression

77
Q

Management of POAG

Drug actions include?

A

Facilitate aqueous humor outflow

↓ aqueous humor production

78
Q

Management of POAG

Treatment model: What is preferred? Why?

A

Ophthalmic route preferred

Systemic ADEs uncommon

79
Q

Management of POAG

Different MOAs: What may be more effective for some people?

A

Combo TX may be more effective > mono-TX

80
Q

Management of POAG

1st line agents include?

A

Beta-adrenergic blocking agents

Alpha2-adrenergic agonists

Prostaglandin analogs

81
Q

Management of POAG

2nd line options include?

A

Cholinergics/cholinesterase inhibitors

Carbonic anhydrase inhibitors

82
Q

Management of POAG

Procedures last line?

A

Laser SX
Filtering SX
Drainage implants

82
Q

Management of Acute-Angle Glaucoma

Drug therapy

A

Control acute attack

Cholinergics ~ muscarinic agonists

Carbonic anhydrase inhibitors

Beta-adrenergic blockers

83
Q

Management of Acute-Angle Glaucoma

Drug therapy: What are beta blockers for?

A

Emergency management

⍉ maintenance

84
Q

Management of Acute-Angle Glaucoma

Corrective SX:

A

Iridectomy or laser iridotomy

Alters iris to permit unimpeded outflow of aqueous humor

85
Q

Intraocular Exam

Mydriatics/cycloplegics

Mydriasis: What does it do?

A

Mydriasis – blocks muscarinic receptors that promotes iris sphincter contraction

86
Q

Intraocular Exam

Mydriatics/cycloplegics

Cycloplegia: What does it do?

A

Cycloplegia – blocks muscarinic receptors that promote contraction of ciliary muscle

87
Q

Intraocular Exam

Anticholinergics/Muscarinic antagonists:

What kind of drugs are included?

A

Atropine,

Cyclopentolate,

Homatropine,

Scopolamine,

Tropicamide

88
Q

Intraocular Exam

Anticholinergics/Muscarinic antagonists:

What do these drugs do?

A

Dilation of pupil for direct visualization of eye structures

89
Q

Intraocular Exam

Anticholinergics/Muscarinic antagonists:

Dilation of pupil for direct visualization of eye structures- How does it do this?

A

Paralyze iris sphincter to prevent reflexive pupil constriction in response to light from scope

90
Q

Intraocular Exam

Anticholinergics/Muscarinic antagonists:

What are ADEs?

A

ADEs: Photophobia (prevents pupil from constricting to light), blurry vision from paralysis of ciliary muscle prevents focusing for near vision, precipitation of angle-closure by relaxing iris sphincter

91
Q

Intraocular Exam

Adrenergic Agonists: What is the prototype?

A

(phenylephrine)

92
Q

Intraocular Exam

Adrenergic Agonists (phenylephrine): What does it do?

A

Also dilate pupils by activating alpha1-adrenergic receptors on the radial (dilator) muscle of iris

93
Q

Intraocular Exam

Adrenergic Agonists (phenylephrine): What can it be combined with?

A

Can be combined with anticholinergic

94
Q

Intraocular Exam

Adrenergic Agonists (phenylephrine): What can it be used for?

A

Used as aid in intraocular surgery, eye exam

95
Q

Intraocular Exam

Adrenergic Agonists (phenylephrine): What can it increase?

A

Increases degree of mydriasis

96
Q

Intraocular Exam

Adrenergic Agonists (phenylephrine): What are ADEs?

A

ADEs: AC glaucoma, CV responses

97
Q

Inserting Eye Drops/Ointment:

What should be done first? What may need to be done?

A

Wash hands before touching bottle and checking drug label

If needed, wipe eye with moistened gauze to remove exudate

98
Q

Inserting Eye Drops/Ointment:

How to insert the drops?

A

Pull lower eyelid down and instill 1 to 2 drops in lower conjunctival sac without touching tip of dropper to eye

99
Q

Inserting Eye Drops/Ointment:

After inserting the drops, what should be done?

A

After releasing lid, instruct to keep eye closed for about 1 minute, and slowly rotate eyes to distribute drug

100
Q

Inserting Eye Drops/Ointment:

How to promote local effectiveness and decrease systemic absorption of drug?

A

Gently press inner canthus for 2 to 3 minutes to promote local effectiveness and decreases systemic absorption of the drug

101
Q

Inserting Eye Drops/Ointment:

If instilling more than 1 drug, what should be done?

A

If instilling more than 1 drug, wait 5-10 min between each dose

102
Q

When administering ophthalmic ointment

A

Hold the applicator tube close to the eye while squeezing about an ½ inch ribbon of ointment into the inferior cul-de-sac starting from the inner canthus to the outer eye

Instruct patient to close eyes for about 1 minute

103
Q

When administering ophthalmic ointment

If administering ophthalmic drops and ointment at the same time, what should be done?

A

Note: If administering ophthalmic drops and ointment at the same time, administer drops first and then ointment to the eye

PATHO/PHARM II (27 decks)

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