[PHARM] DSA Glaucoma [Konorev] Flashcards
What are the (5) Beta Blockers used in Glaucoma?
Betaxolol
Timolol
Metipranolol
Levobunolol
Carteolol
What are the Alpha 2 Adrenergic Agonists used in Glaucoma?
Brimonidine
Apraclonidine
What are the 3 Prostaglandin Analogs used in Glaucoma?
Bimatoprost
Latanoprost
Travoprost
What are 2 topical Carbonic Anhydrase Inhibitors used in Glaucoma?
Brinzolamide
Dorzolamide
What are the 2 systemic carbonic anhydrase inhibitors used in Glaucoma?
Acetazolamide
Methazolamide
What are the 2 Muscarinic Agonists used in Glaucoma?
Carbachol
Pilocarpine
What are the 2 Inhibitors of Cholinesterase used in Glaucoma?
Demecarium
Echothiophate
The Iris Circular Muscle uses ________ to ______ the pupil to cause miosis?
The Iris Circular Muscle uses Activation of M3 Recp** to **Constrict the pupil to cause miosis
The iris radial muscle uses what (?), to do what (?), to the pupil to cause Mydraisis?
The Iris Radial Muscle uses Alpha 1 adrenergic receptors to dilate the pupil to cause mydraisis
The Ciliary Muscle causes accommodation of the eye to near vision, what receptor is activated to contact this muscle?
M3 Receptors
The Ciliary Epithelium produces what?
And what increases it, and what decreases it?
Produces Aqueous Humor
Beta Adrenergic activation INCREASES Humor Production
Alpha 2 Adrenergic activation DECREASES Humor Production
Blood vessels where in the eye are under autonomic control and influence aqueous drainage?
Blood Vessels in the SCLERA
How does Carbonic Anhydrase affect aqueous humor and thus intraocular pressure?
Carbonic Anhydrase transports Na and Bicarb from ciliary body to Aq Humor –> Increase in osmotic pressure of Aq Humor –> enhances transport of water to humor –> increases volume
Contraction of the Ciliary Muscle is caused by what?
Contraction of the Iris Circular muscle is caused by what?
Both cause what?
M3 Receptors
M3 Receptors
Both cause IMPROVED Outflow of Aq Humor
Contraction of the Iris Radial Muscle is caused by what?
What does this do for Aq Humor?
Contraction is by Alpha 1 receptors
It decreases outflow
What is thought to play an important role in the pathogenesis of glaucoma?
Increased IOP
What are the 2 types of Glaucoma?
Which is Chronic/Acute?
Open Angle Glaucoma (95%) –> Chronic
Closed Angle Glaucoma (5%) –> Acute [EMERGENCY]
What are some causes of Secondary Glaucoma?
Secondary to other diseases
Trauma
Surgery
Drug-Induced
The risk of what is increased with increasing IOP?
Visual Loss
What are the 3 types of Anatomical Predisposition of Closed Angle Glaucoma?
Shallow Anterior Chamber
Narrow Angle between Cornea and Iris
Tight Contact between Pupil and Lens
Explain the following forms of Classic Primary CAG are:
With Pupillary Block
With Pupillary Block –> Tight Contact between Iris/lens, the flow of Humor into anterior chamber is blocked, Iris moved FORWARD and block outflow.
Explain the following forms of Classic Primary CAG are:
W/O Pupillary Block
W/O Pupillary Block –> Ciliary Processes are located in a way that pushes iris forward, iris blocks outflow (during mydriasis)
What are the first line agents of Open Angle Glaucoma?
Prostaglandin Analogues
Beta Blockers (Timolol)
Brimonidine
What are some Second Line Therapies for Open Angle Glaucoma?
Pilocarpine
Apraclondine
Topical Carbonic Anhydrase Inhibitors
What are the last line therapies for Open Angle Glaucoma?
Carbachol
Inhibitors of Cholinesterase
Oral Carbonic Anhydrase Inhibitors
Why is Timolol favored as a Beta Blocker for Glaucoma?
Lacks Local Anesthetic Effects
Generic
Full ANTAGONIST
Shown to be as effective as Pilocarpine
(Reduces production of Aq Humor)
Beta Blockers can interact with which medication?
Verapamil (can cause cardiac depression/heart block)
Other than this normal Beta Blocker SA
Which Prostaglandin Analog is the most effective in lowering IOP?
Bimatoprost
What are some reasons why Prostaglandin Analogs are used in Glaucoma?
Reduced IOP (Better than Beta Blockers)
1 Drop Daily at Bedtime
Not many systemic SA
Tolerable Local SA
What is the MOA of Prostaglandin Analogs?
Reduced IOP by INCREASING uveoscleral and trabecular outflow of Aq Humor
Why is Brimonidine the Alpha 2 Agonist first line agent for Glaucoma, over Apraclonidine?
Apraclonidine causes frequent allergic reactions, development of tachyphylaxis.
What is the MOA of Brimonidine?
Decreases rate of Aq Humor production
What are the adverse effects of Brimonidine?
Dizziness
Fatigue
Dry Mouth
Bradycardia
Reduced BP
(Local –> Allergic Rxn)
What is the Algorithm for treating OAG?
Beta Blockers (start) –>
Class Alternative –>
than Prostaglandins/Brimonidine –>
Class Alternative –>
Topical Carbonic Anhydrase Inhibitors –>
Combo Therapy –>
Laser or Surgical Procedure (last resort)
In Closed Angle Glaucoma how do we rapidly reduce IOP?
Oral Glycerin (prep for surgery)
IV Mannitol (prep for surgery)
Pilocarpine –> Induced Miosis
Beta Blockers/Alpha 2 Agonists/CA Inhibitors –> reduce humor production
SURGERY!
Which Drugs induce or potentiate increased IOP?
OAG –> Glucocorticoids (all forms), Topical Antimuscarinic Drugs
CAG –> any drug that causes Mydriasis (Antimuscarinics, alpha 1 adrenomimetic activity (topical),
Use systemic or inhaled drugs with caution
