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Ada - Neuro 2 > [PHARM] DSA Glaucoma [Konorev] > Flashcards

[PHARM] DSA Glaucoma [Konorev] Flashcards

1
Q

What are the (5) Beta Blockers used in Glaucoma?

A

Betaxolol

Timolol

Metipranolol

Levobunolol

Carteolol

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2
Q

What are the Alpha 2 Adrenergic Agonists used in Glaucoma?

A

Brimonidine

Apraclonidine

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3
Q

What are the 3 Prostaglandin Analogs used in Glaucoma?

A

Bimatoprost

Latanoprost

Travoprost

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4
Q

What are 2 topical Carbonic Anhydrase Inhibitors used in Glaucoma?

A

Brinzolamide

Dorzolamide

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5
Q

What are the 2 systemic carbonic anhydrase inhibitors used in Glaucoma?

A

Acetazolamide

Methazolamide

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6
Q

What are the 2 Muscarinic Agonists used in Glaucoma?

A

Carbachol

Pilocarpine

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7
Q

What are the 2 Inhibitors of Cholinesterase used in Glaucoma?

A

Demecarium

Echothiophate

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8
Q

The Iris Circular Muscle uses ________ to ______ the pupil to cause miosis?

A

The Iris Circular Muscle uses Activation of M3 Recp** to **Constrict the pupil to cause miosis

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9
Q

The iris radial muscle uses what (?), to do what (?), to the pupil to cause Mydraisis?

A

The Iris Radial Muscle uses Alpha 1 adrenergic receptors to dilate the pupil to cause mydraisis

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10
Q

The Ciliary Muscle causes accommodation of the eye to near vision, what receptor is activated to contact this muscle?

A

M3 Receptors

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11
Q

The Ciliary Epithelium produces what?

And what increases it, and what decreases it?

A

Produces Aqueous Humor

Beta Adrenergic activation INCREASES Humor Production

Alpha 2 Adrenergic activation DECREASES Humor Production

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12
Q

Blood vessels where in the eye are under autonomic control and influence aqueous drainage?

A

Blood Vessels in the SCLERA

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13
Q

How does Carbonic Anhydrase affect aqueous humor and thus intraocular pressure?

A

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

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14
Q

Contraction of the Ciliary Muscle is caused by what?

Contraction of the Iris Circular muscle is caused by what?

Both cause what?

A

M3 Receptors

M3 Receptors

Both cause IMPROVED Outflow of Aq Humor

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15
Q

Contraction of the Iris Radial Muscle is caused by what?

What does this do for Aq Humor?

A

Contraction is by Alpha 1 receptors

It decreases outflow

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16
Q

What is thought to play an important role in the pathogenesis of glaucoma?

A

Increased IOP

17
Q

What are the 2 types of Glaucoma?

Which is Chronic/Acute?

A

Open Angle Glaucoma (95%) –> Chronic

Closed Angle Glaucoma (5%) –> Acute [EMERGENCY]

18
Q

What are some causes of Secondary Glaucoma?

A

Secondary to other diseases

Trauma

Surgery

Drug-Induced

19
Q

The risk of what is increased with increasing IOP?

A

Visual Loss

20
Q

What are the 3 types of Anatomical Predisposition of Closed Angle Glaucoma?

A

Shallow Anterior Chamber

Narrow Angle between Cornea and Iris

Tight Contact between Pupil and Lens

21
Q

Explain the following forms of Classic Primary CAG are:

With Pupillary Block

A

With Pupillary Block –> Tight Contact between Iris/lens, the flow of Humor into anterior chamber is blocked, Iris moved FORWARD and block outflow.

22
Q

Explain the following forms of Classic Primary CAG are:

W/O Pupillary Block

A

W/O Pupillary Block –> Ciliary Processes are located in a way that pushes iris forward, iris blocks outflow (during mydriasis)

23
Q

What are the first line agents of Open Angle Glaucoma?

A

Prostaglandin Analogues

Beta Blockers (Timolol)

Brimonidine

24
Q

What are some Second Line Therapies for Open Angle Glaucoma?

A

Pilocarpine

Apraclondine

Topical Carbonic Anhydrase Inhibitors

25
Q

What are the last line therapies for Open Angle Glaucoma?

A

Carbachol

Inhibitors of Cholinesterase

Oral Carbonic Anhydrase Inhibitors

26
Q

Why is Timolol favored as a Beta Blocker for Glaucoma?

A

Lacks Local Anesthetic Effects

Generic

Full ANTAGONIST

Shown to be as effective as Pilocarpine

(Reduces production of Aq Humor)

27
Q

Beta Blockers can interact with which medication?

A

Verapamil (can cause cardiac depression/heart block)

Other than this normal Beta Blocker SA

28
Q

Which Prostaglandin Analog is the most effective in lowering IOP?

A

Bimatoprost

29
Q

What are some reasons why Prostaglandin Analogs are used in Glaucoma?

A

Reduced IOP (Better than Beta Blockers)

1 Drop Daily at Bedtime

Not many systemic SA

Tolerable Local SA

30
Q

What is the MOA of Prostaglandin Analogs?

A

Reduced IOP by INCREASING uveoscleral and trabecular outflow of Aq Humor

31
Q

Why is Brimonidine the Alpha 2 Agonist first line agent for Glaucoma, over Apraclonidine?

A

Apraclonidine causes frequent allergic reactions, development of tachyphylaxis.

32
Q

What is the MOA of Brimonidine?

A

Decreases rate of Aq Humor production

33
Q

What are the adverse effects of Brimonidine?

A

Dizziness

Fatigue

Dry Mouth

Bradycardia

Reduced BP

(Local –> Allergic Rxn)

34
Q

What is the Algorithm for treating OAG?

A

Beta Blockers (start) –>

Class Alternative –>

than Prostaglandins/Brimonidine –>

Class Alternative –>

Topical Carbonic Anhydrase Inhibitors –>

Combo Therapy –>

Laser or Surgical Procedure (last resort)

35
Q

In Closed Angle Glaucoma how do we rapidly reduce IOP?

A

Oral Glycerin (prep for surgery)

IV Mannitol (prep for surgery)

Pilocarpine –> Induced Miosis

Beta Blockers/Alpha 2 Agonists/CA Inhibitors –> reduce humor production

SURGERY!

36
Q

Which Drugs induce or potentiate increased IOP?

A

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

Ada - Neuro 2 (4 decks)

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