Tx of Glaucoma

Question 1

open angle glaucoma

Answer 1

• gradual loss of peripheral vision
• usually in both eyes
• tunnel vision in advanced stage

Question 2

acute angle closure glaucoma

Answer 2

• eye pain, sudden onset (usually in low light)

- N/V, blurred vision, halos around lights, red eyes

Question 3

risk factors for developing glaucoma

Answer 3

• IOP: generally increased in glaucoma pts but can happen w/ normal IOP
• age: older = more likely
• ethnicity: most common in blacks
• genetics: higher risk if family member has it
• drugs: corticosteroid eye drops

Question 4

what classes of drugs can be used for glaucoma?

Answer 4

• beta blockers (timolol, betaxolol)
• carbonic anhydrase inhibitors (CAIs)
• alpha-2 agonists
• cholinergic agents
• prostaglandin analogs
• non-selective adrenergic agents

Question 5

cholinergic agents: mechanism of action, how they work for the types of glaucoma

Answer 5

• stimulate contraction of sphincter and ciliary mm. = mitosis = decreased IOP
• in open angle: ciliary mm. contract = increased flow through intertrabecular spaces
• close angle: contraction of sphincter mm. increases angle of sclera and iris
• direct = pilocarpine, carbachol
• indirect = physostigmine, echothiophate

Question 6

cholinergic agents: mechanism of action

Answer 6

• stimulate contraction of sphincter and ciliary mm. = mitosis = decreased IOP
• in open angle: ciliary mm. contract = increased flow through intertrabecular spaces
• close angle: contraction of sphincter mm. increases angle of sclera and iris

Question 7

acute angle closure glaucoma

Answer 7

• eye pain, sudden onset (usually in low light)

- N/V, blurred vision, halos around lights, red eyes

Question 8

risk factors for developing glaucoma

Answer 8

• IOP: generally increased in glaucoma pts but can happen w/ normal IOP
• age: older = more likely
• ethnicity: most common in blacks
• genetics: higher risk if family member has it
• drugs: corticosteroid eye drops

Question 9

what classes of drugs can be used for glaucoma?

Answer 9

• beta blockers (timolol, betaxolol)
• carbonic anhydrase inhibitors (CAIs)
• alpha-2 agonists
• cholinergic agents
• prostaglandin analogs
• non-selective adrenergic agents

Question 10

cholinergic agents: mechanism of action

Answer 10

• stimulate contraction of sphincter and ciliary mm. = mitosis = decreased IOP
• in open angle: ciliary mm. contract = increased flow through intertrabecular spaces
• close angle: contraction of sphincter mm. increases angle of sclera and iris

Question 11

pilocarpine: when it’s used and s/e

Answer 11

• direct acting cholinergic agent
• used in emergencies
• works on open and close angle
• s/e = HTN, tachycardia

Question 12

s/e of cholinergic agents

Answer 12

• pilocarpine has it’s own card
• carbachol = autonomic disturbances if in systemic circulation
• physostigmine = crosses BBB - can cause seizures and abnormal defecation
• ecothiophate = night blindness and frontal headache

Question 13

beta blockers

Answer 13

• betaxolol, carteolol, timolol
• MOA: interact w/ ciliary epithelium = decrease production of aqueous
• betaxolol = BETA-1 SELECTIVE; timolol and carteolol = non selective
• used for open angle, ocular HTN
• use betaxolol in asthmatics

Question 14

s/e of beta blockers

Answer 14

• timolol = bradycardia, confusion, blurred vision, dry eye, hallucination, BRONCHOSPASM
• carteolol = insomnia, BRONCHOSPASM
• betaxolol = AV block, MI!!; use in asthmatics b/c only one that DOESN’T cause bronchospasm

Question 15

prostaglandin analogs

Answer 15

• lantanoprost, bimatoprost, travoprost
• MOA: act on suspensory ligament; increase drainage of aqueous
• used for open angle and intraocular HTN

Question 16

s/e of prostaglandin analogs

Answer 16

• darkens color of iris (browning)
• macular retinal edema
• conjunctival hyperemia (w/ bimatoprost and travoprost)

Question 17

carbonic anhydrase inhibitors (CAIs)

Answer 17

• acetazolamide, brinzolamide, dorzolamide
• MOA: decrease aqueous production secondary to decrease in bicarb b/c inhibiting carbonic anhydrase II
• no effect on pupil or vision
• used for open angle and ocular HTN

Question 18

s/e of CAIs

Answer 18

• metabolic acidosis, urolithiasis (kidney stones)
• acetazolamide = agranulocytosis, aplastic anemia, thrombocytopenia
• dorzolamide = immune hypersensitivity rxns, burning in eye, visual discomfort

Question 19

alpha-2 selective agonists

Answer 19

• apraclonidine, brimonidine
• MOA: decrease production and increase outflow of aqueous = decreased IOP
• apraclonidine given pre and post surgery to decrease ocular pressure
• brimonidine used in open angle and for ocular HTN

Question 20

s/e of alpha-2 selective agonists

Answer 20

• irregular HR, fatigue, dry mouth, red/itchy/swollen eyes
• apraclonidine: depression, dizziness, chest pain
• brimonidine = xerostomia, somnolence, syncope

Question 21

non-selective adrenergic agonists

Answer 21

• dipivefrin, epinephrine
• MOA: decrease aqueous production and decrease blood flow to ciliary bodies (epi)
• dipivefrin = pro-drug; gets hydrolyzed to epi in the eye
• used for open angle

Question 22

s/e of non-selective adrenergic agonists

Answer 22

• dipivefrin = burning in eyes, follicular conjunctiva

- epi = mydriasis, stinging; NOT for close angle