[PHARM] DSA Glaucoma [Konorev] Flashcards by A. Ozumba

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

Betaxolol

Timolol

Metipranolol

Levobunolol

Carteolol

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What are the Alpha 2 Adrenergic Agonists used in Glaucoma?

Brimonidine

Apraclonidine

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What are the 3 Prostaglandin Analogs used in Glaucoma?

Bimatoprost

Latanoprost

Travoprost

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What are 2 topical Carbonic Anhydrase Inhibitors used in Glaucoma?

Brinzolamide

Dorzolamide

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

Acetazolamide

Methazolamide

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What are the 2 Muscarinic Agonists used in Glaucoma?

Carbachol

Pilocarpine

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What are the 2 Inhibitors of Cholinesterase used in Glaucoma?

Demecarium

Echothiophate

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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

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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

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

M3 Receptors

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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

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

Blood Vessels in the SCLERA

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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

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Contraction of the Ciliary Muscle is caused by what?

Contraction of the Iris Circular muscle is caused by what?

Both cause what?

M3 Receptors

Both cause IMPROVED Outflow of Aq Humor

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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

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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