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Other Topics EXAM 1
Other Topics EXAM 1 - Carlson
74
Pharmacology
Graduate
03/16/2012

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Cards

Term
open angled glaucoma
Definition
optic neuropathy

OPTIC NERVE DAMAGE!

loss of retinal ganglion cell axons

visual field loss

blindness

can present at a wide range of IOP

rate of progression is variable
Term
closed angle glaucoma
Definition
mechanical blockade of the angle by the iris

trabecular meshwork is blocked

AH leaves anterior chamber through trabecular meshwork -> Canal of Schlemm -> aqueous veing

inadequate drainage of AH

optic nerve damage

elevated IOP

IOP > 40 -> optic nerve damage

IOP > 60 -> permanent visual field loss in hours or days
Term
understand how aqueous humor (AH)is formed and its role in glaucoma
Definition
INFLOW:

the AH is produced by the ciliary body via filtration and secretion

ciliary body epithelium secretes solutes Na and HCO3 into the posterior chamber creating an osmotic gradient

H2O moves into the posterior chamber -> aqueous humor

AH inflow into posterior chamber -> pressure

AH pushed between iris and lens -> pupil -> anterior chamber

OUTFLOW:

AH leaves anterior chamber through trabecular meshwork -> Canal of Schlemm -> aqueous vein

IOP = inflow - outflow
Term
pathophysiology of glaucoma and how it may or may not related to increased intraocular pressure (IOP)
Definition
glaucoma is a group of diseases characterized by damage to the optic nerve and visual field loss; usually associated with an increased IOP

progressive loss of retinal glanglion cell axons

irreversible blindness if left untreated

IOP and glaucoma:
median IOP 15.5 +/- 2.5 mmHg
increased IOP DOES NOT EQUAL glaucoma
glaucoma DOES NOT EQUAL increased IOP
IOP is a poor diagnostic tool for glaucoma - circadian changes, pulse, BP, forced expriation or coughing, neck compression, and posture
elevated IOP (>22mmHg) is the SINGLE GREATEST modifiable risk factor for glaucoma

fundus examination:
evaluating "cupping" of fundus (cupping = hollowed out appearance of optic nerve/disc)
cup diameter > 50% of vertical disc diameter = glaucoma
thinning or narrowing of disc rim, progressive change in size/shape of cup, and nerve fiber defect may also indicate glaucoma
cupping = highest sensitivity and specificity for glaucoma than any other finding - no single cutoff criteria yield sufficiently high sensitivity and specificity to make cupping a useful diagnositc test

visual field assessment:
ideally glaucoma should be diagnosed before significant visual field loss
automated perimetry = standard of care for detection and monitoring of glaucoma - requires comprehension and cooperation from patient; caution patients with dementia and/or other mental or physical problems
time consuming with variable specificity and sensitivity
Term
identify and recommend a drug product to treat and/or prevent the formation of glaucoma
Definition
all patient with increased IOP do NOT warrant treatment

topical antihypertensives should be considered when elevated IOP, changes in disc ratio, and changes in central corneal thickness

patients with the following risk factors may warrant therapy:
family history of glaucoma
black ethnicity
severe myopia
one eye

patients with no risk factors should be monitored for glaucoma development
Term
treatment goals of glaucoma
Definition
20-30% reduction in IOP

monocular treatment - adequately assess efficacy of treatment

increase in number of medications = increase in number of ADRs; more difficult to identify which is the offending agent

OPEN ANGLE:

treatment warranted for patients with increased IOP AND optic disc +/- visual field changes

drug therapy = most common treatment

start at low concentration, well tolerated, topical therapy

instill 1 drop per dose
doses > 1 drop = increased cost and ADRs
if 2 drops warranted, separate doses by 10-15 minutes

beta blockers = 1st line
prostaglandin analogs = 1st line
alpha2 adrenergic agonists
carbonic anhydrase inhibitors
cholinergic agonists

trabeculectomy (surgical or laser)

visual field loss does not differ between medical and surgical therapy

CLOSED ANGLE

need for rapid reduction - initial management involved prompt administration of pressure lowering eye drops

allow for iridectomy - laser OR surgery to create hole in iris to allow AH to flow

available therapies:
pilocarpine - traditional drug of choice but is controversial
hyperosmotic agents

secretory inhibitor: beta blocker, alpha2 agonist, prostaglandins, CAI

if IOPP > 60 mmHg, iris may be ischemic and unresponsive to miotics

unaffected eye also treated with miotics to prevent angle closure

emergency regimen of topical agents:
0.5% timolol maleate
1% apraclonidine
2% clonidine

beta blocker, alpha2 agonist and agent to produce miosis

systemic therapy may be warranted to decrease IOP
PO or IV acetazolammide, IV mannitol, oral glycerol or isosorbide

once acute attack is controlled, laser peripheral iridotomy is warranted
Term
beta blockers
Definition
first line for open angle glaucoma

betaxolol, careolol, levobunolol, metipranolol, timolol

DECREASE IN IOP:

less potent at reducing IOP

20-25%

TIME OF DAY VARIABILITY:

IOP lowering effect may be less at night; should be dosed in the morning

USUAL DOSING FREQUENCY:

daily to BID dosing

MOA:

decrease AH production

ADRS AND COMMENTS:

local - stinging, itching, redness, blurred vision

systemic - depression, fatigue, dizziness, sexual dysfunction, bradycardia, respiratory depression, masking hypoglycemia

consider avoiding in patients with asthma, bradycardia, COPD

betaxolol - selective for beta1 -> decreased systemic effects, decreased IOP lowering

less IOP reduction possible if patient on systemic beta blockers

generic availability

cost effective
Term
prostaglandin analogs
Definition
first line for open angle glaucoma

latanoprost, travoprost, bimatoprost

DECREASE IN IOP:

BEST IOP reduction

25-30%

TIME OF DAY VARIABILITY:

stable

USUAL DOSING FREQUENCY

daily dosing

MOA:

increased outflow

ADRS AND COMMENTS:

conjunctival hyperemia

darkening of iris and periorbital skin pigmentation

increase length and number of eyelashes

local irritation, itching, dryness, blurred vision

expensive
Term
alpha2 adrenergic agonists
Definition
brimonidine, apraclonidine

DECREASE IN IOP:

similar to beta blockers in efficacy

10-25% reduction

TIME OF DAY VARIABILITY:

stable

USUAL DOSING FREQUENCY:

BID to TID

MOA:

decrease AH production

may increase outflow

ADRS AND COMMENTS:

common: fatigue, somnolence, local allergic reactions

dry eyes, stinging, conjunctival hyperemia, foreign body sensation

brimonidine can cross BBB - systemic hypotension and somnolence; respiratory arrest in children < 2 years

contraindicated with MAOIs

apraclonidine - tachyphylaxis and ocular allergy

ocular ADRs (allergic conjunctivitis, hyperemia, ocular puritis)
Term
carbonic anhydrase inhibitors
Definition
brinzolamide, dorzolamide

DECREASE IN IOP:

not as effective as previous treatments

15-20% decrease

TIME OF DAY VARIABILITY:

stable

USUAL DOSING FREQUENCY:

BID to TID

MOA:

decrease AH production

ADRS AND COMMENTS:

local - stinging, redness, dry eyes, blurred vision
Term
cholinergic agonists
Definition
pilocarpine, carbachol

DECREASE IN IOP:

20-30% decrease

USUAL DOSING FREQUENCY:

up to QID

MOA:

increase outflow

ADRS AND COMMENTS:

ciliary spasm and brow ache

corneal toxicity, conjunctival inflammation, eye redness

transient myopia and blurred vision expected

retinal detachment can occur

systemic (rare): sweating, salivation, nausea
Term
trabeculectomy (surgical or laser)
Definition
GOAL: improve inflow

warranted if patient fails or is intolerant to drug therapy

surgical creation of a channel for AH flow from anterior chamber into subconjunctival space for re-absorption into vasculature

potential complication: cataract formation

surgical site healing and scarring can lead to treatment failure

antiproliferative agents can be used to maintain patency of site

5-FU and mitomycin C:
improve success in high risk cases
prevent scarring of the fistula
poorly healed fistula -> entry portal for bacteria
simple conjunctivitis = medial emergency for patient who has had glaucoma surgery
Term
glaucoma monitoring
Definition
monitor visual fields and disc changes annually

may monitor more frequently for worsening or unstable disease

treatment goals:
prevent vision loss
target IOP
initially target 30% reduction in IOP
depends on baseline IOP and vision loss
Term
pilocarpine
Definition
traditional drug of choice for closed angle glaucoma for rapid IOP reduction

pilocarpine 1% or 2% every 5 minutes for 2-3 doses, then every 4-6 hours

produces miosis to pull iris away from meshwork

may worsen angle closure by increasing papillary block and anterior movement of the lens

can withhold pilocarpine until IOP reduced by other drugs, then give a single drop of pilocarpine
Term
identify which eye disorder a patient may have based on past medical history and presenting symptoms: open angle glaucoma
Definition
OPTIC NERVE DAMAGE

visual field loss

blindness

risk factors: elevated IOP, family history/genetics, age, African American

general: insidious onset

symptoms: none

signs:
disc changes (usually occur first, then visual loss 2nd)
visual loss
+/- elevated IOP
"white eye" glaucoma

either changes in optic nerve OR visual field defects is enough to diagnosis open angle glaucoma
Term
identify which eye disorder a patient may have based on past medical history and presenting symptoms: closed angle glaucoma
Definition
elevated IOP:
IOP >40 -> optic nerve damage
IOP >60 -> permanent visual field loss in hours or days

risk factors: Inuit, Chinese, Asian-Indian ethnicity

general: acute episodes

symptoms:
possibly asymptomatic
prodrome - blurred/hazy vision, halows around lights +/- headache
cloudy, edematous cornea
ocular pain, N/V, abdominal pain, diaphoresis

signs:
hyperemic conjunctiva (red eye)
cloudy cornea
shallow anterior chamber
+/- edematous and hyperemic optic disc
markedly elevated IOP
"red eye" glaucoma

diagnosis:
do NOT dilate the eyes
gonioscopy (lens to visualize angle) is Gold Standard
Term
recommend 1st, 2nd, and 3rd line therapies for glaucoma and when each therapy is warranted: open angle
Definition
1) drug therapy = first line

2) laser trabeculoplasty if patient fails or is intolerant to drug therapy
increases aqueous outflow thus decreases IOP

3) surgical trabeculectomy for patients that have failed both medical and laser therapies with advanced disease
Term
provide patient education on proper administration of eye drops and how to increase the drop's bioavailability
Definition
1) wash hands
goal = maintain sterile environment

2) shake well = gently roll bottle between plams

3) pull down outer portion of the lower eyelid to form a "pocket"

4) grasp the bottle with thumb and fingers, rest hand on nose or cheek

5) look up, instill drop in "pocket"
do not touch eye with bottle or dropper

6) close eye, do not rub or tighly squeeze eyes close
increases bioavailability of the drug

7) recap bottle and store in labeled condition

8) do not tough dropper tip with hands, eye, etc.
***sterility***

9) press finger over nasolacrimal duct to occlude and prevent drainage

10) press finger for 1-3 minutes
increases contact time of drug on eye
increases bioavailability
decreases systemic absorption
Term
when looking at a patient's medication list, identify medications that can affect glaucoma
Definition
INCREASE INFLOW:

beta agonists

DECREASE INFLOW:

beta blockers

alpha blockers

alpha2 blockers

carbonic anhydrase inhibitors

adenylate cyclase agonists

INCREASE OUTFLOW:

cholinergic agents

prostaglandin analogs

DRUG INDUCED OPEN ANGLE GLAUCOMA:

mydriasis

anticholinergics can increase IOP
potent - atropine, homatropin
weak - tropicamide, PHENYLEPHRINE (COMMONLY USED AND CAN EXACERBATE GLAUCOMA)

glucocorticoids can decrease outflow and increase IOP
ophthalmic > nasal, inhaled, systemic
use low potency, dose, duration

low risk:
drugs than may induce or potentiate increased IOP

medium risk:
systemic corticosteroids
succinylcholine
fenoldopam
ophthalmic anticholinergics
nasal/inhaled corticosteroids

high risk = untreated, uncontrolled disease
ophthalmic topical corticosteroids

DRUG INDUCED CLOSED ANGLE GLAUCOMA:

mydriasis:
anticholinergics
sympathomimetics

low risk:
benzodiazepines
theophylline
vasodilators
systemic sympathomimetics
CNS stimulants
carbonic anhydrase inhibitors
monoamine oxidase inhibitors
topical cholinergics

medium risk:
topical and systmic anticholinergics
topical sympathomimetics
heterocyclic antidepressants
phenothiazines
antihistamines
ipratropium
SSRIs
imipramine
topiramate
venlafaxine

high risk = untreated, uncontrolled disease:
n/a
Term
hordeolum
Definition
disorder of the eyelid/lacrimal gland

also known as a stye

acute infection involving follicle and sebaceous/sweat gland

commonly caused by Staphylococcus

appears as a "pimple" or bump

often uncomfortable, with no serious symtpoms
Term
chalazion
Definition
disorder of the eyelid/lacrimal gland

chronic granulomatous inflammation of eyelid

appears "cyst" like

usually occurs on the UPPER LID

caused by secondary obstruction of the ducts to the sebaceous gland

not always an infection

can appear after a stye
Term
blepharitis
Definition
disorder of the eyelid/lacrimal gland

caused by:
infection at base of lashes (often caused by Staphylococcus)
seborrheic dermatitis (scalp and eyebrow dandruff)
rosacea
malfunctioning oil glands around lash

symptoms:
chronic red, crusty, thickened eyelids
engorged blood vessels at the margin of the eye
crusting is often worse in the morning
hard scales at the base of eyelid
itching, burning, and excessive tearing from foreign body sensation
Term
contact dermatitis
Definition
disorder of the eyelid/lacrimal gland

periorbital rash with eyelid swelling and watery discharge

causes:
take a thorough patient history of recent activities

key = look for recent change/new product use

new ophthalmmic drops or ointment

change in cosmetic, facial soap, or shampoo

glaucoma drops - often delay in showing signs/symptoms

generally not associated with fever or tenderness to palpation
Term
preseptal cellultis
Definition
disorder of the eyelid/lacrimal gland

swelling of conjunctiva (chemosis)

presents with mild fever and tightness of eyelid

causes:
often caused by S. aureus and Streptococci
also caused by H. influenza
Term
dacryocystitis
Definition
disorder of the eyelid/lacrimal gland

acute infection of LACRIMAL SAC

results in nasolacrimal duct obstruction

OCCURS IN LOWER LID
Term
dacryodenitis
Definition
disorder of the eyelid/lacrimal gland

acute infection of the LACRIMAL GLAND

OCCURS IN UPPER EYELID

causes:
S. aureus, N. gonorrheae, Streptococcus
viruses - mumps, mono, herpes zoster
Term
orbital cellulitis
Definition
disorder of the eye orbit

OCULAR EMERGENCY!

can further travel to brain resulting in meningitis

causes:
sinusitis - direct extension
dacryocystitis/adenitis
may result after eye surgery and/or trauma
S. aureus, Streptococcus, H. influenza
fungal infections in immunocompromised patients

symptoms:
red eye, blurred vision, fever, purulent discharge
pain upon eye movement
eyelid edema
chomosis (swelling of the conjunctiva)
proptosis (exophthalmos) with restricted eye movement
Term
thyroid ophthalmopathy
Definition
disorder of the eye orbit

unilateral or bilateral proptosis (exophthalmos)

result of Grave's Disease - autoimmune complication resulting in increased thyroid levels
Term
bacterial conjunctivitis
Definition
disorder of conjunctiva/sclera

acute onset of redness, foreign body sensation, PURULENT DISCHARGE, EXCESSIVE EYELID CRUSTING

typically effects both eyes

causes:
S. aureus, S. epidermidis, S. pneumonia, and H. influenzae
spread by contact - touching, rubbing eye with hand
Term
gonococcal conjunctivitis
Definition
disorder of conjunctiva/sclera

suspected with rapid onset of extreme purulent discharge
Term
viral conjunctivitis (pink eye)
Definition
disorder of conjunctiva/sclera

causes:
adenovirus - epidemic
herpes simplex - often presents unilaterally (bacterial conjunctivitis usually effects both eyes)

symptoms:
watery mucous discharge
conjunctiva hyperemia (increased blood) gives appearance of pink eye
eyelid edema
Term
chronic conjunctivitis
Definition
disorder of conjunctiva/sclera

symptoms lasting > 4 weeks

consider alternative causes - chlamydia
Term
allergic conjunctivitis (hay fever)
Definition
disorder of conjunctiva/sclera

causes:
type I hypersensitivity reaction
airborne pollen
Ag-IgE antibody complex binds to mast cells
results in release of histamine and inflammatory mediators

symptoms:
watery discharge - normally not purulent
puritis
eyelid edema
Term
keratoconjunctivitis sicca
Definition
disorder of conjunctiva/sclera

dry and gritty eyes

can result over a course of years

manifestation of Sjogren's syndrome
Term
sunconjunctival hemorrhage
Definition
disorder of conjunctiva/sclera

ruptured blood vessel in eye

harmless

causes:
coughing, straining
trauma
high blood pressure
warfarin
Term
episcleritis
Definition
disorder of conjunctiva/sclera

benign, self limiting disorder in young adults

acute red eye in sectoral pattern

may cause mild discomfort and tenderness

excessive tearing

vision is often not affected

episceral blood vessels engorged

blood vessels are beneath conjunctiva
Term
scleritis
Definition
disorder of conjunctiva/sclera

serious inflammatory condition

severe boring eye pain

often associated with an underlying disease (i.e. rhematic arthritis)

recurrent, vision threatening conditions immediately refer to physician
Term
corneal infiltrate and ulcer
Definition
disorder of the cornea/anterior segment

causes:

bacterial keratitis = most common corneal infection
caused by Pseudomonas aeruginosa, S. aureus, and S. pneumonia

fungal keratitis possibly from corneal injury
more common in contact with plant material
Aspergillus or Fusarium
Candida in debilitated cornea WITHOUT TRAUMA

Acanthamoeba in patients with history of swimming with contact lenses in or using homemade cleaning solution instead of purchasing commercially available formulations

symptoms:

red eye, tearing/discharge, ocular pain, photophobia, foreign body sensation, decreased vision

most common in patients WEARING CONTACT LENS!

question every patient!

disregard to proper hygiene, sleeping with contacts in, overuse or extended wear of soft lens
Term
herpes simplex virus
Definition
disorder of the cornea/anterior segment

herpes keratitis and ocular opacity

red, painful eye with photophobia and decreased vision

may also present with periorbital rash

not sexually transmmitted
Term
endophthalmitis
Definition
Term
age related macular degeneration (ARMD)
Definition
idiopathic atrophy of photoreceptors and retinal pigmentated epithelium

non-exudative macular deneration (90% of all cases):
"dry"
bilateral, painless progression of central vision loss
no treatment approved at this time
most patients will wear glasses to offset vision loss

"wet" macular degeneration (minority of patients - 10%):
characterized by choroidal neovascularization
vascular endothelial growth factor (VEGF) = angiogenesis and vascular permability
Term
classify which disorders are considered an emergency and/or may be vision threatening
Definition
refer patients to physician and/or ophthalmologist

foreign body

corneal abrasion

eye injury/trauma

infective conjunctivitis

allergic conjunctivitis

lid inflammation

orbital cellultis
Term
pharmacotherapy for hordeolum
Definition
often no treatment required

resolves spontaneously

non-pharmacologic:
apply WARM compress for 15 minutes QID
homepathic "Stye Eye Relief" from Similasan - conium, graphites, and sulfur

pharmacological:

topical bacitracin or erythromycin ointmnet
apply to lid margin BID
may speed recovery, but can still take up to 4 weeks to resolve

OTC ointment "Stye"
petrolatum/mineral oil - just used to provide comfort to the patient
Term
pharmacotherapy for chalazion
Definition
similar to hordeolum

non pharmacologic:
apply WARM compress for 15 minutes QID
SURGICAL DRAINAGE IS THE 1ST LINE TREATMENT
steroid injection - alternative to drainage
if still present after 4 weeks, refer to ophthalmologist
Term
pharmacotherapy for blepharitis
Definition
maintaining lid hygiene

scrub with baby shampoo BID

erythromycin ointment

sufacetamide-prednisolone suspension or ointment: blephamide
Term
pharmacotherapy for contact dermatitis
Definition
apply COLD compress for 15 minutes QID

oral antihistamines

mild steroid creams
Term
pharmacotherapy for preseptal cellulitis
Definition
mild:
PO amoxicillin or cefuroxime

severe (children < 5 yo):
IV ceftriaxone and vancomycin
Term
pharmacotherapy for dacryocystitis
Definition
PO amoxicillin-clavulanate

TMP-polymyxin drops
Term
pharmacotherapy for dacryoadenitis
Definition
immediately seek medical treatment

requires systemic antibiotics
Term
pharmacotherapy for orbital cellultis
Definition
IV vancomycin and ceftriaxone x 14 days
Term
pharmacotherapy for thyroid ophthalmopathy
Definition
thyroid inhibition - refer to ophthalmologist and/or physician

artificial tears or ointment may decrease discomfort
Term
pharmacotherapy for bacterial conjunctivitis
Definition
self limiting - often spontaneously resolves in 10-14 days

treatment used to limit symptoms and prevent spread of bacteria

topical antibiotics:
trimethoprim-polymyxin q4-6h x5-7d
ciprofloxacin 8x/day for 1st couple days then QID x5-7d (other FQ = levofloxacin, moxifloxacin, gatifloxacin)
azithromycin BID x1d, then daily for 5-7 days
erythromycin or bacitracin ointment q HS x5-7d

similasan:
homeopathic OTC product
relieves redness, inflammation
NOT an antibiotic
Term
pharmacotherapy for gonococcal conjunctivitis
Definition
IV ceftriaxone 1g + chlamydia treatment
Term
pharmacotherapy for viral conjunctivitis (pink eye)
Definition
self limiting - may spontaneously resolve in 2-3 weeks

non-pharmacologic:
COOL compresses (warm compress can increase redness and inflammation/irritation)
artificial tears

trifluridine (Viroptic) 5x/day x7-10d
Term
pharmacotherapy for chronic conjunctivitis
Definition
PO doxycycline or tetracycline

PO erythromycin in pregnancy and children (avoid tetracyclines in children due to tooth discoloration)
Term
pharmacotherapy for allergic conjunctivitis (hay fever)
Definition
avoid triggers

topical mast cell stabilizers:
Chromoyl 4% - instill in affected eye 4-6x/day

topical antihistamines:
epinastine (elestat)
emedasting (emadine)

topical combination products (antihistamine and mast cell stabilizer):
olopatadine (Patanol BID or Patadya QD)
keotifen (Zaditor)
Azelastine (Optivar)
Term
pharmacotherapy for keratoconjunctivitis sicca
Definition
artificial tears - symptomatic relief

cyclosporine ophthalmic emulsion 0.05% (Restasis):
immunosuppressant
decreases ocular inflammation
DO NOT USE DURING AN ACTIVE EYE INFECTION <- EXAM
Term
pharmacotherapy for subconjunctival hemorrhage
Definition
usually spontaneously resolved in 2-3 weeks

artificial tears - symptomatic relief of mild irriation

if recurrent, may need to see MD for evaluation of INR
Term
pharmacotherapy for episcleritis
Definition
mild:
artificial tears
short term vasoconstrictor - naphazoline BID may result in rebound vasodilation after prolonged use

severe:
ocular NSAID - detorolac
ocular steroid - fluorometholone
oral NSAID
Term
pharmacotherapy for scleritis
Definition
oral NSAID +/- steroids, immunocuppressant
Term
pharmacotherapy for corneal infiltrate and ulcer
Definition
refer to ophthalmologist for exam

FQ or tobramycin drops q2h while awake

cyanoacrylate tissue adhesive (Dermabond) - useful if perforation present

following surgery, fibrinogen glue (tisseel) may be used
Term
pharmacotherapy for herpes simplex virus
Definition
trifluridine 1% drops (Viroptic) 9x/day x10-14d

severe:
PO acyclovir or other systemic antivirals

do NOT use topical steroid drops - may make infection worse
Term
pharmacotherapy for endophthalmitis
Definition
intravitreal antibiotics - most cases warrant intravitreal antibiotics

intravenous medications are also commonly used

prognosis can be excellent or result in blindness; depends on timely diagnosis and treatment regimen
Term
pharmacotherapy for age related macular degeneration - dry
Definition
no treatment
Term
pharmacotherapy for age related macular degeneration - wet
Definition
angiogenesis inhibitors:
pegaptanib
ranibizumab
derivative of oncology drug bevacizumab (Avastin)

laser/phototherapy:
verteporfin
Term
the objective of drug therapy of open angle glaucoma is to:
Definition
halt progression of visual field loss
Term
aqueous humor is produced by the:
Definition
ciliary body
Term
drug therapies used in glaucoma reduce intraocular pressure by:
Definition
reduction of aqueous production by ciliary body

increased outflow of aqueous humor through the trabecular meshwork and/or uveoscleral pathway
Term
first line agents for the treatment of open angle glaucoma include:
Definition
prostaglandin analogues
Term
use of nasolacrimal occlusion following application of topical glaucoma medications is potentially beneficial for:
Definition
all patients
Term
side effects associated with prostaglandin analogues include:
Definition
pigmentary changes of the iris
Term
appropriate therapeutic approaches to a 67 yo patient with an intraocular pressure of 26 mmHg in both eyes with normal visual fields and optic disc findings include:
Definition
monitor for signs of glaucoma only after assessing glaucoma risk factors
Term
side effects associated with ophthalmmic beta blockers include
Definition
depression

bradycardia

dizziness

sexual dysfunction
Term
caution should be used when administering the following medications to patients being treated for open angle glaucoma:
Definition
ophthalmic topical corticosteroids
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