Week 1: Glaucoma

Question 1

ocular HTN is defined as:

what is the goal in managing ocular HTN?

Answer 1

IOP > 21 mm Hg with healthy ONH and normal VF

Goal: Lower IOP by at least 20 %

Question 2

For glaucoma risk calculators, what 5 factors are taken into account?

Answer 2

age, 
IOP
CCT
PSD
Vertical C/d by contour

Question 3

what do glaucoma risk calculators estimate?

Answer 3

estimated 5 y risk of developing glauc

Question 4

goal in mild glaucoma tx based on IOP:

Answer 4

Mild 20-30% lower than tmax

Question 5

goal in moderate glaucoma tx based on IOP:

Answer 5

Moderate 30-40% lower than tmax

Question 6

goal in severe glaucoma tx based on IOP:

Answer 6

Severe 40-50% lower than tmax

Question 7

Consider lowering IOP an extra 10% in these situations:

Answer 7

Consider lowering extra 10% if under 50yo, African America, or sibling with glaucoma

Question 8

how might you classify mild glaucoma?

Answer 8

normal VF but glaucomatous ONH

Question 9

how might you classify moderate glaucoma?

Answer 9

VF abnormalities in one hemifield not w/in 5 deg of fixation

Question 10

Name 3 inflow altering glaucoma meds:

Answer 10

alpha agonists
beta blockers
carbonic anhydrase inhib

Question 11

mechanism of prostaglandins:

Answer 11

alter structure of uveoscleral pathway to increase outflow

Question 12

drug of choice/first line for glaucoma?

Answer 12

prostaglandins (reduce IOP by ~30%)

Question 13

Travatan: starts to work in _ hours, peak at _ hours

Answer 13

2 hours, peak at 12 hours

Question 14

Xalatan: starts to work in _ hours, peak at _ hours

Answer 14

3-4hrs; peaks at 8-12hrs

Question 15

Lumigan: starts to work in _ hours, peak at _ hours

Answer 15

starts in 4 h max effect 8-12 h

Question 16

Maximum therapeutic effect for prostaglandins:

Answer 16

Maximum therapeutic effect reached in 2 to 6 weeks,

Question 17

Which 2 prostaglandins require refrigeration before opening:

Answer 17

Xalatan and Zioptan require refrigeration of unopened bottles, open bottles can remain at room temperature for up to 6 weeks

Question 18

Side effects of prostaglandins:

Answer 18

• Ocular redness 30 mins after using, clears in one hour, common reason for d/c use.
• FBS and SPK
• Hyperpigmentation of skin, irides and lashes; longer lashes;
• Anterior uveitis (rare)
• Orbital fat atrophy in longterm use

Question 19

what % of people are prostaglandin non-responders?

Answer 19

4.1% non-responders

Question 20

Beta blocker mechanism:

Answer 20

Act on beta-adrenergic receptors in ciliary epithelium to decrease aqueous production

Question 21

Beta blockers takes effect in __ mins, peaks in __ hours, wears off in __

Answer 21

Takes effect in 30-60 mins, peaks in 2-3 hours, wears off in 24-48h (ie requires daily dosage)

Question 22

when do you give BB?

Answer 22

in am

Question 23

selective B blocker causes _% reduction in IOP?

non-selective B blocker causes _% reduction in IOP?

Answer 23

Selective: 20 % decrease

Non-selective: 25 % decrease

Question 24

what are specific 2 cons of taking B blockers long term?

Answer 24

Short term escape: less effective after one wk due to receptor saturation

Long term drift: tachyphylaxis, down regulation of receptors with constant stimulation; allow for 4 wk washout and use another brand of beta in between

Question 25

what are some contraindications to B blockers?

Answer 25

- COPD, ANY prev or current Asthma - Myasthenia Gravis – can worsen symptoms - Bradycardia, pulse <55-60, unless on pacemaker - pts already on B blocker

Question 26

possible systemic side effects if beta blockers:

Answer 26

- Systemic hypotension - Broncho spasm - CNS depression :fatigues, amnesia, depression - Lipid profile alteration - Thyroid storm: masks signs of hyperthyroidism - Bradycardia (unless on pacemaker)

Question 27

ocular side effects of beta blockers:

Answer 27

- Dry eye - corneal anesthesia - allergic blephconjunctivitis - uveitis

Question 28

Dosing for alpha agonists? how much does it lower IOP?

Answer 28

TID; | Lowers IOP 20-25%

Question 29

For apraclonidine, IOP drop within __ hour, peaks in _ hours, wears off in _hrs

Answer 29

IOP drop within 1st hour, peaks in 3 hours, wears off in 12h

Question 30

For alphagan, IOP peaks in _ hours, wears off in _hrs

Answer 30

peaks in 2 hours, wears off in 12 hrs

Question 31

ocular side effects of alpha agonists:

Answer 31

- Bleph - Dry eye, mouth and nose - Conj hyperemia - Lid retraction - **Allergy, follicular conjunctivitis - Miosis

Question 32

contraindications for alpha agonists:

Answer 32

- monoamine oxidase inhibitors (MAO inhibitors) - Severe cardiovascular disease - Children-cyanosis

Question 33

Name 2 carbonic anhydrase inhibitors and when they peak and wear off:

Answer 33

Azopt peaks in 2 h wears off in 12h | Trusopt peaks in 2 h wears off in 12

Question 34

side effects of carbonic anhydrase inhib or contraindications?

Answer 34

``` Side effects: Metallic taste (benign, but often bothers pts so warn them) ``` Contraindications: - SULFA ALLERGIES - Corneal endothelial compromised patients (ex Fuch’s)

Question 35

carb anhydrase inhib reduce IOP by __%, dosage?

Answer 35

Reduces IOP 20% | TID

Question 36

miotics like pilo reduce IOP by __%?

Answer 36

Lower 15-25%

Question 37

cosopt is a combo of what drugs?

Answer 37

BB + CAI =Timolol + dorzolimide

Question 38

combigan is a combo of what drugs?

Answer 38

BB + A2 ag=Timolol + Brimonidine

Question 39

10% reduction in risk of progression with each __mmHg decrease in IOP

Answer 39

10% reduction in risk of progression with each 1mmHg decrease in IOP

Question 40

Typically, adding another drop will decrease IOP another _ mmHg

Answer 40

Typically, adding another drop will decrease IOP another 3 mmHg

Question 41

what % of people are non-responders to Beta blockers?

Answer 41

10-20%

Question 42

ocular perfusion pressure=

Answer 42

diastolic pressure-IOP

Question 43

IOP should be lowered an additional __% if progression detected on current glaucoma therapy

Answer 43

15-20% | *BUT MAKE SURE PT COMPLIANT