Week 1: Glaucoma Flashcards
ocular HTN is defined as:
what is the goal in managing ocular HTN?
IOP > 21 mm Hg with healthy ONH and normal VF
Goal: Lower IOP by at least 20 %
For glaucoma risk calculators, what 5 factors are taken into account?
age, IOP CCT PSD Vertical C/d by contour
what do glaucoma risk calculators estimate?
estimated 5 y risk of developing glauc
goal in mild glaucoma tx based on IOP:
Mild 20-30% lower than tmax
goal in moderate glaucoma tx based on IOP:
Moderate 30-40% lower than tmax
goal in severe glaucoma tx based on IOP:
Severe 40-50% lower than tmax
Consider lowering IOP an extra 10% in these situations:
Consider lowering extra 10% if under 50yo, African America, or sibling with glaucoma
how might you classify mild glaucoma?
normal VF but glaucomatous ONH
how might you classify moderate glaucoma?
VF abnormalities in one hemifield not w/in 5 deg of fixation
Name 3 inflow altering glaucoma meds:
alpha agonists
beta blockers
carbonic anhydrase inhib
mechanism of prostaglandins:
alter structure of uveoscleral pathway to increase outflow
drug of choice/first line for glaucoma?
prostaglandins (reduce IOP by ~30%)
Travatan: starts to work in _ hours, peak at _ hours
2 hours, peak at 12 hours
Xalatan: starts to work in _ hours, peak at _ hours
3-4hrs; peaks at 8-12hrs
Lumigan: starts to work in _ hours, peak at _ hours
starts in 4 h max effect 8-12 h
Maximum therapeutic effect for prostaglandins:
Maximum therapeutic effect reached in 2 to 6 weeks,
Which 2 prostaglandins require refrigeration before opening:
Xalatan and Zioptan require refrigeration of unopened bottles, open bottles can remain at room temperature for up to 6 weeks
Side effects of prostaglandins:
- 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
what % of people are prostaglandin non-responders?
4.1% non-responders
Beta blocker mechanism:
Act on beta-adrenergic receptors in ciliary epithelium to decrease aqueous production
Beta blockers takes effect in __ mins, peaks in __ hours, wears off in __
Takes effect in 30-60 mins, peaks in 2-3 hours, wears off in 24-48h (ie requires daily dosage)
when do you give BB?
in am
selective B blocker causes _% reduction in IOP?
non-selective B blocker causes _% reduction in IOP?
Selective: 20 % decrease
Non-selective: 25 % decrease
what are specific 2 cons of taking B blockers long term?
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
what are some contraindications to B blockers?
- COPD, ANY prev or current Asthma
- Myasthenia Gravis – can worsen symptoms
- Bradycardia, pulse <55-60, unless on pacemaker
- pts already on B blocker
possible systemic side effects if beta blockers:
- Systemic hypotension
- Broncho spasm
- CNS depression :fatigues, amnesia, depression
- Lipid profile alteration
- Thyroid storm: masks signs of hyperthyroidism
- Bradycardia (unless on pacemaker)
ocular side effects of beta blockers:
- Dry eye
- corneal anesthesia
- allergic blephconjunctivitis
- uveitis
Dosing for alpha agonists? how much does it lower IOP?
TID;
Lowers IOP 20-25%
For apraclonidine, IOP drop within __ hour, peaks in _ hours, wears off in _hrs
IOP drop within 1st hour, peaks in 3 hours, wears off in 12h
For alphagan, IOP peaks in _ hours, wears off in _hrs
peaks in 2 hours, wears off in 12 hrs
ocular side effects of alpha agonists:
- Bleph
- Dry eye, mouth and nose
- Conj hyperemia
- Lid retraction
- **Allergy, follicular conjunctivitis
- Miosis
contraindications for alpha agonists:
- monoamine oxidase inhibitors (MAO inhibitors)
- Severe cardiovascular disease
- Children-cyanosis
Name 2 carbonic anhydrase inhibitors and when they peak and wear off:
Azopt peaks in 2 h wears off in 12h
Trusopt peaks in 2 h wears off in 12
side effects of carbonic anhydrase inhib or contraindications?
Side effects: Metallic taste (benign, but often bothers pts so warn them)
Contraindications:
- SULFA ALLERGIES
- Corneal endothelial compromised patients (ex Fuch’s)
carb anhydrase inhib reduce IOP by __%, dosage?
Reduces IOP 20%
TID
miotics like pilo reduce IOP by __%?
Lower 15-25%
cosopt is a combo of what drugs?
BB + CAI =Timolol + dorzolimide
combigan is a combo of what drugs?
BB + A2 ag=Timolol + Brimonidine
10% reduction in risk of progression with each __mmHg decrease in IOP
10% reduction in risk of progression with each 1mmHg decrease in IOP
Typically, adding another drop will decrease IOP another _ mmHg
Typically, adding another drop will decrease IOP another 3 mmHg
what % of people are non-responders to Beta blockers?
10-20%
ocular perfusion pressure=
diastolic pressure-IOP
IOP should be lowered an additional __% if progression detected on current glaucoma therapy
15-20%
*BUT MAKE SURE PT COMPLIANT
