Therapeutics - Glaucoma Flashcards
glaucoma is the ___ leading cause of blindness worldwide
2nd
true or false
the treatment for glaucoma is well established
true
name some risk factors for glaucoma
old
family history
high IOP
diabetes
myopia
long term steroid use
african-american and hispanic
previous eye injury
what is normal IOP
10-21 mmHg
2 main types of glaucoma and 3 other types
2 main is open angle and angle closure
congenital
normal tension
drug-induced
what is the most common type of glaucoma
open angle
how does open angle glaucoma occur
usually occurs insidiously (slowly without noticing) and asymptomatic
people dont notice they have it until they start losing their peripheral vision
how does the anterior chamber look in open angle glaucoma
it looks normal
how does the optic disk look in open angle glaucoma
has cupping and damage
which type of glaucoma is a diagnosis of exclusion
open angle
which glaucoma is an ophthalmic emergency and immediate treatment is needed for else vision will be lost
angle closure glaucoma
aqueous humor can’t get into anterior chamber from the posterior chamber (through the pupil)
angle-closure glaucoma is most common in which patients
women
older adults
asians
ppl wit fam history
20% of glaucoma diagnoses are which kind?
angle closure glaucoma
when the pupil _______, angle-closure glaucoma is worsened
thus, what drugs are avoided?
when the pupil DILATES
avoid anticholinergics - they will dilate the pupil
true or false
angle-closure glaucoma has dramatic signs and symptoms
TRUE
ocular pain, redness, blurred vision, NV, headaches, seeing halos around lights
IOP is extremely elevated
in treating angle closure glaucoma, what meds should be given immediately?
ocular and systemic meds
pilocarpine (cholinergic) and hyperosmotic agents (fluid buildup goes into bloodstream)
what is the definitive treatment for angle closure glaucoma
surgial — iridectomy
opening made in the peripheral iris to allow aqueous humor to flow outward
main drugs that cause:
-open angle glaucoma
-angle closure glaucoma
open angle - STEROIDS (systemic, ophthalmic, or nasal/inhaled). also opthalmic anticholinergivs and vasodilators
angle closure - ANTICHOLINERGICS, ssris, and some antidepressants
true or false
even topical anticholinergics can cause drug-induced closed angle glaucoma
TRUE
name a systemic anticholinergic that can cause drug-induced closed angle glaucoma
diphenhydramine
true or false
steroids are a known cause of angle-closure glaucoma
FALSE
open angle
name the 3 goals in treating open angle glaucoma
-decrease IOP
-prevent/reduce risk of glaucoma progressing
-prevent damage to the optic disk!!
as mentioned, one of the goals of therapy in treating open angle glaucoma is to decrease IOP
how is this done and what is the typical goal?
use topical ocular hypotensive agents
goal is 25-30% decrease from baseline
first line for open angle glaucoma
topical prostaglandin analogs
topical beta blockers
2nd line for open angle glaucoma
a2 adrenergic agonists
topical carbonic anhydrous inhibitors
rho kinase inhibitors
3rd line for open angle glaucoma
cholinergic agents (mitotics)
ie - pilocarpine
name systemic agent for open angle glaucoma
carbonic anhydrase inhibitors — acetazolamide
place for topical carbonic anhydrase inhibitors in treating open angle glaucoma
2nd line
what class is brimonidine? it is ____ line for treating open angle glaucoma
a2 adrenergic agonist
2nd line
name 2 topical carbonic anhydrase inhibitors
they are ___ line for treating open angle glaucoma
dorzolamide and brinzolamide
2nd line
after initiating therapy, when should IOP be measured again and compared to the baseline?
after 2-4 weeks
if unchanged from baseline or ADR, dc and start different medication class
if IOP reduced but target not reached, continue the med and add another of different class
what is a very important consideration with eye drops
important to ensure that the patient has proper technique and adherence
true or false
adherence is a big issue with glaucoma medication
false - usually not – ppl care about keeping their sight
mechanism of prostaglandin analogs to treat glaucoma
increase aqueous humor outflow
true or false
prostaglandin analogs are 1st line in treating glaucoma
true - along with beta blockers
3 disadvantages of prostaglandin analogs
-increase iris pigmentation
-hypertrichosis of eyelashes
-intraocular inflammation (like any topical drop or ointment)
true or false
prostaglandin analogs have many systemic adverse effects
false - have few
how often are prostaglandin analogs used?
do they affect pupil size?
QHS (usually at bedtime)
do not affect pupil size - therefore, do not affect night vision
how to recognize prostaglandin analogs by looking at name
“prost”
what’s the most common prostaglandin analog for glaucoma
latanoprost
true or false
all the prostaglandin analogs are applied QHS
true
this is an advantage
mechanism of beta blockers in glaucoma
decrease the PRODUCTION of aqueous humor, reducing IOP
true or false
beta blockers are 1st line for glaucoma
true
how often are beta blocking agents applied for glaucoma
QD-BID
do beta blockers affect pupil size?
NO therefore do not affect night vision
name some disadvantages of beta blockers for glaucoma
irritation ( like all)
also can have systemic effects!! can go straight to the heart with no metabolism by liver – cause side effects like hypotension, exacerbation of asthma and COPD, bradycardia, depression impotence
systemic side effects are worse if taking an oral beta blocker as well
how to recognize beta blockers
“lol” at end
most common is timolol
how do a2 adrenergic agonists work in glaucoma
they decrease aqueous humor production and increase aqueous humor outflow
place in therapy for a2 adrenergic agonists in open angle glaucoma
2nd line
may be ADDED TO a beta blocker or prostaglandin analog
how often are a2 adrenergic agonists applied
2-3 times a day
true or false
a2 adrenergic agonists for glaucoma have few systemic adverse effects
true
2 disadvantages of a2 adrenergic agonists
more ocular irritation occurd
10-15% pts develop an intolerance to it
name 2 alpha adrenergic agonists and what used for
only one for glaucoma is brimonidine
apraclonidine is an a2 agonist but not used for glaucoma - used after surgery to decrease IOP
