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Intro to D&D Final > Therapeutics - Glaucoma > Flashcards

Therapeutics - Glaucoma Flashcards

1
Q

glaucoma is the ___ leading cause of blindness worldwide

A

2nd

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2
Q

true or false

the treatment for glaucoma is well established

A

true

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3
Q

name some risk factors for glaucoma

A

old
family history
high IOP
diabetes
myopia
long term steroid use
african-american and hispanic
previous eye injury

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4
Q

what is normal IOP

A

10-21 mmHg

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5
Q

2 main types of glaucoma and 3 other types

A

2 main is open angle and angle closure

congenital
normal tension
drug-induced

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6
Q

what is the most common type of glaucoma

A

open angle

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7
Q

how does open angle glaucoma occur

A

usually occurs insidiously (slowly without noticing) and asymptomatic

people dont notice they have it until they start losing their peripheral vision

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8
Q

how does the anterior chamber look in open angle glaucoma

A

it looks normal

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9
Q

how does the optic disk look in open angle glaucoma

A

has cupping and damage

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10
Q

which type of glaucoma is a diagnosis of exclusion

A

open angle

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11
Q

which glaucoma is an ophthalmic emergency and immediate treatment is needed for else vision will be lost

A

angle closure glaucoma

aqueous humor can’t get into anterior chamber from the posterior chamber (through the pupil)

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12
Q

angle-closure glaucoma is most common in which patients

A

women
older adults
asians
ppl wit fam history

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13
Q

20% of glaucoma diagnoses are which kind?

A

angle closure glaucoma

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14
Q

when the pupil _______, angle-closure glaucoma is worsened

thus, what drugs are avoided?

A

when the pupil DILATES

avoid anticholinergics - they will dilate the pupil

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15
Q

true or false

angle-closure glaucoma has dramatic signs and symptoms

A

TRUE

ocular pain, redness, blurred vision, NV, headaches, seeing halos around lights

IOP is extremely elevated

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16
Q

in treating angle closure glaucoma, what meds should be given immediately?

A

ocular and systemic meds

pilocarpine (cholinergic) and hyperosmotic agents (fluid buildup goes into bloodstream)

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17
Q

what is the definitive treatment for angle closure glaucoma

A

surgial — iridectomy

opening made in the peripheral iris to allow aqueous humor to flow outward

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18
Q

main drugs that cause:

-open angle glaucoma
-angle closure glaucoma

A

open angle - STEROIDS (systemic, ophthalmic, or nasal/inhaled). also opthalmic anticholinergivs and vasodilators

angle closure - ANTICHOLINERGICS, ssris, and some antidepressants

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19
Q

true or false

even topical anticholinergics can cause drug-induced closed angle glaucoma

A

TRUE

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20
Q

name a systemic anticholinergic that can cause drug-induced closed angle glaucoma

A

diphenhydramine

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21
Q

true or false

steroids are a known cause of angle-closure glaucoma

A

FALSE

open angle

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22
Q

name the 3 goals in treating open angle glaucoma

A

-decrease IOP

-prevent/reduce risk of glaucoma progressing

-prevent damage to the optic disk!!

23
Q

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?

A

use topical ocular hypotensive agents

goal is 25-30% decrease from baseline

24
Q

first line for open angle glaucoma

A

topical prostaglandin analogs

topical beta blockers

25
Q

2nd line for open angle glaucoma

A

a2 adrenergic agonists
topical carbonic anhydrous inhibitors
rho kinase inhibitors

26
Q

3rd line for open angle glaucoma

A

cholinergic agents (mitotics)

ie - pilocarpine

27
Q

name systemic agent for open angle glaucoma

A

carbonic anhydrase inhibitors — acetazolamide

28
Q

place for topical carbonic anhydrase inhibitors in treating open angle glaucoma

A

2nd line

29
Q

what class is brimonidine? it is ____ line for treating open angle glaucoma

A

a2 adrenergic agonist

2nd line

30
Q

name 2 topical carbonic anhydrase inhibitors

they are ___ line for treating open angle glaucoma

A

dorzolamide and brinzolamide

2nd line

31
Q

after initiating therapy, when should IOP be measured again and compared to the baseline?

A

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

32
Q

what is a very important consideration with eye drops

A

important to ensure that the patient has proper technique and adherence

33
Q

true or false

adherence is a big issue with glaucoma medication

A

false - usually not – ppl care about keeping their sight

34
Q

mechanism of prostaglandin analogs to treat glaucoma

A

increase aqueous humor outflow

35
Q

true or false

prostaglandin analogs are 1st line in treating glaucoma

A

true - along with beta blockers

36
Q

3 disadvantages of prostaglandin analogs

A

-increase iris pigmentation
-hypertrichosis of eyelashes
-intraocular inflammation (like any topical drop or ointment)

37
Q

true or false

prostaglandin analogs have many systemic adverse effects

A

false - have few

38
Q

how often are prostaglandin analogs used?
do they affect pupil size?

A

QHS (usually at bedtime)

do not affect pupil size - therefore, do not affect night vision

39
Q

how to recognize prostaglandin analogs by looking at name

A

“prost”

40
Q

what’s the most common prostaglandin analog for glaucoma

A

latanoprost

41
Q

true or false

all the prostaglandin analogs are applied QHS

A

true

this is an advantage

42
Q

mechanism of beta blockers in glaucoma

A

decrease the PRODUCTION of aqueous humor, reducing IOP

43
Q

true or false

beta blockers are 1st line for glaucoma

A

true

44
Q

how often are beta blocking agents applied for glaucoma

A

QD-BID

45
Q

do beta blockers affect pupil size?

A

NO therefore do not affect night vision

46
Q

name some disadvantages of beta blockers for glaucoma

A

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

47
Q

how to recognize beta blockers

A

“lol” at end

most common is timolol

48
Q

how do a2 adrenergic agonists work in glaucoma

A

they decrease aqueous humor production and increase aqueous humor outflow

49
Q

place in therapy for a2 adrenergic agonists in open angle glaucoma

A

2nd line

may be ADDED TO a beta blocker or prostaglandin analog

50
Q

how often are a2 adrenergic agonists applied

A

2-3 times a day

51
Q

true or false

a2 adrenergic agonists for glaucoma have few systemic adverse effects

A

true

52
Q

2 disadvantages of a2 adrenergic agonists

A

more ocular irritation occurd
10-15% pts develop an intolerance to it

53
Q

name 2 alpha adrenergic agonists and what used for

A

only one for glaucoma is brimonidine

apraclonidine is an a2 agonist but not used for glaucoma - used after surgery to decrease IOP

54
Q
A

Intro to D&D Final (22 decks)

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