Test therapeutics

Question 1

What Are Glaucomas?

Answer 1

Glaucomas are ocular disorders characterized by
changes in the optic nerve head (optic disk) and by loss
of visual sensitivity and field.

Question 2

Types of Glaucomas?

Answer 2

There are two major types of glaucoma: open-angle

glaucoma, which accounts for most cases, and closedangle glaucoma.

Question 3

Causes of open angle glaucoma

Answer 3

Increased intraocular pressure
or increased
susceptibility of the optic nerve to ischemia, reduced
or dysregulated blood flow, excitotoxicity, autoimmune
reactions, and other abnormal physiologic processes.

Question 4

What determines IOP

Answer 4

The balance between the inflow and outflow of

aqueous humor determines IOP.

Question 5

How is inflow increased/ decreased?

Answer 5

Inflow is increased by β-adrenergic agents and
decreased by α2 and β-adrenergic blockers;
dopamine blockers; carbonic anhydrase inhibitors
(CAIs); and adenylate cyclase stimulators.
A2BCD

Question 6

What increases Outflow?

Answer 6

Outflow is increased by cholinergic agents, which
contract the ciliary muscle and open the
trabecular meshwork, and by prostaglandin
analogs and β- and α2-adrenergic agonists, which
affect uveoscleral outflow.

Question 7

What causes secondary open - angled glaucoma?

Answer 7

exfoliation syndrome, pigmentary glaucoma, systemic
diseases, trauma, surgery, lens changes, ocular inflammatory
diseases, and drugs.

Question 8

Whats secondary glaucoma?

Answer 8

Secondary glaucoma can be classified as pretrabecular
(normal meshwork is covered and prevents outflow of
aqueous humor), trabecular (meshwork is altered or material
accumulates in the intertrabecular spaces), or posttrabecular
(episcleral venous blood pressure is increased).

Question 9

When does close-angled glaucoma occur?

Answer 9

Closed-angle glaucoma occurs when there is a physical
blockage of the trabecular meshwork, resulting in increased
IOP.

Question 10

Open - angled glaucoma present symptoms?

Answer 10

slowly progressive and is
usually asymptomatic until the onset of
substantial visual field loss. Central visual acuity is
maintained, even in late stages.

Question 11

Closed- angled glaucoma symptoms?

Answer 11

experience intermittent prodromal symptoms
(e.g., blurred or hazy vision with halos around
lights and occasionally, headache).

Acute episodes produce symptoms associated
with a cloudy, edematous cornea; ocular pain;
nausea, vomiting, and abdominal pain; and
diaphoresis.

Question 12

Diagnosis of open-angled glaucoma?

Answer 12

confirmed by the presence of characteristic optic
disk changes and visual field loss, with or without
increased IOP.

Question 13

Whats Normal tension glaucoma?

Answer 13

Normal tension glaucoma refers to disk changes,

visual field loss, and IOP of less than 21 mm Hg.

Question 14

Whats ocular hypertension glaucoma?

Answer 14

Ocular hypertension refers to IOP of more than
21 mm Hg without disk changes or visual field
loss.

Question 15

Diagnosis of close- angled glaucoma?

Answer 15

For closed-angle glaucoma, the presence of a
narrow angle is usually visualized by
gonioscopy.
IOP is generally markedly elevated (e.g., 40 to
90 mm Hg)

Question 16

Whats the goal of drug therapy?

Answer 16

The goal of drug therapy in patients with
glaucoma is to preserve visual function by
reducing the IOP to a level at which no further
optic nerve damage occurs.

Question 17

Who qualifies for treatment?

Answer 17

Treatment is indicated for ocular hypertension if the patient
has a significant risk factor such as IOP greater than 25 mmHg, vertical cup-disk ratio (CDR) greater than 0.5, or
central corneal thickness less than 555 micrometers.
n initial treatment and is
initiated in a stepwise manner, starting with a single well tolerated topical agent.

Question 18

What’s the treatment of choice?

Answer 18

β-blockers (e.g., timolol)- cheap

Question 19

Newer agents

Answer 19

Prostaglandin analogs (e.g., latanoprost, bimatoprost and travoprost) have the advantage of strong potency, unique mechanism suitable for combination therapy, good safety profile, and once-a-day dosing

Question 20

Briminodine adv.

Answer 20

Brimonidine has the theoretical advantage of
neuroprotection
Topical CAI used

Question 21

What are the third in line therapies

Answer 21

Pilocarpine and dipivefrin, a prodrug of epinephrine drug of epinephrine, are used as thirdline therapies because of adverse
events or reduced efficacy as compared with newer
agents.

Question 22

Last resort options:

Answer 22

Carbachol, topical cholinesterase inhibitors, and oral

CAIs (e.g., acetazolamide)

Question 23

Drugs used in chronic open-angled glaucoma that increase aqueous outflow

Answer 23

Topical prostaglandins, prostamides, miotics

Question 24

Drugs used in chronic open-angled glaucoma that decrease aqueous outflow

Answer 24

Topical B-blocking agents, carbonic anhydrase inhibitors, oral carbonic hydrase inhibitors
Adrenergic -increases/ decreases

Question 25

Treatment of closed- angled glaucoma?

Answer 25

Iridectomy, which produces a hole in the iris that

permits aqueous flow to move directly from the posterior to the anterior chamber.

Question 26

Whats the drug therapy for an acute attack of close-angled glaucoma?

Answer 26

Drug therapy of an acute attack typically consists of an osmotic agent and secretory inhibitor (e.g., β-blocker, α2 agonist, latanoprost, or CAI), with or
without pilocarpine.

Question 27

Why are osmotic agents used?

Answer 27

Osmotic agents are used because they rapidly decrease IOP. Examples include
glycerin, 1 to 2 g/kg orally, and mannitol, 1 to 2 g/kg IV.

Question 28

Why isn’t pilocarpine used as initial therapy?

Answer 28

It’s controversial; Once IOP is controlled, pilocarpine should be given every 6hours until iridectomy is performed.

Question 29

Why is epinephrine used in caution?

Answer 29

Topical corticosteroids can be used to reduce ocular inflammation and
synechiae. Epinephrine should be used with caution because it can precipitate acute closed-angle glaucoma, especially when used with a β-
blocker.