Term
| target an IOP for most patients |
|
Definition
|
|
Term
| Lumigan generic and class |
|
Definition
|
|
Term
| Xalatan generic and class |
|
Definition
|
|
Term
| Travatan and Travatan Z generic and class |
|
Definition
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|
Term
| Zioptan generic and class |
|
Definition
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|
Term
|
Definition
either
1. agonist at prostanoid FP receptor
or
2. prostamide analog (only bimatoprost)
OVERALL increase uveoscleral outflow |
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|
Term
| Counseling points/ADRs of PG analogs |
|
Definition
increased pigmentation of the iris--irreversible
darkening of eyelids/longer eyelashes
common eye irritation but relatively low ADR |
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Term
|
Definition
|
|
Term
| How well do PG analogs lower IOP? |
|
Definition
| 25-35%--they are the best |
|
|
Term
| Difference between Travatan and Travatan Z |
|
Definition
Travatan has benzalkonium chloride (irritating)
Trav Z does NOT, but has ionic buffer system |
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|
Term
| What are the beta-blockers |
|
Definition
betaxolol
levobunolol (Betagan)
metipranolol (Betanol)
timolol |
|
|
Term
|
Definition
block beta-2 receptors in cilliary body-->decrease in aqueous humor production=decreased IOP
IOP Lowering = 20-25% |
|
|
Term
| Administration of ophth beta-blockers |
|
Definition
1bid
except timolol gel forming: 1QD |
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|
Term
| Contraindications of beta-blockers (ophth) |
|
Definition
because potential nasolacrimal drainage can cause systemic exposure
bradycardia
>1st degree block
cardiogenic shock
overt cardiac failure
non-selective:
Hx of bronchial asthma
severe COPD
Best to assess severity of disease state |
|
|
Term
| ADR of ophth beta-blockers |
|
Definition
Frequent: burning, stinging, temporary blurred vision
Occasional: granulomatous anterior uveitis, bradycardia, CHF, heart block, cerebral vascular ischemia
Decrease systemic by nasolacrimal occlusion but many ADR (comparatively) |
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|
Term
| big benefit to beta-blockers for glaucoma |
|
Definition
|
|
Term
|
Definition
apraclonidine
brimonidine (alphalgan)
both have multiple strengths |
|
|
Term
|
Definition
interact with alpha-2 sites in ciliary body to inhibit NE release--> decrease in aqueous humor production
IOP Lowering: 18-27% |
|
|
Term
|
Definition
local conjunctival blanching, eyelid retraction, mydriasis
Systemic: not very severe, may mildly decrease BP |
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|
Term
| Administration of alpha-2 agonists |
|
Definition
TID (drawback)
**Good add-on therapy to PG analog or beta-blocker |
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|
Term
| Carbonic Anhydrase inhibitors |
|
Definition
Brinzolamide (Azopt)
Dorzolamide (Trusopt, Cosopt w/Timolol)
Acetazolamide (PO/inj)
Methazolamide (PO) |
|
|
Term
| Administration of Ophth Carbonic Anhydrase Inhibitors |
|
Definition
1TID
BUT when used as adjunct-BID |
|
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Term
| MOA or Carbonic Anhydrase inhibitors |
|
Definition
inhibit Carbonic anhydrase II isoenzyme in the ciliary epithelium-->blocks formation of bicarb--> decreased Na and water outflow from ciliary body
NOTE 99% of CA must be inhibited to be effective
IOP Lowering: 15-25% |
|
|
Term
| ADRs with Carbonic Anhydrase inhibitors |
|
Definition
Ophth: typical eye drop ADR (burning, stinging, foreign body sensation, pain; bitter taste; HA; Nausea, fatigue, rarely-urolithiasis and iridocyclitis
Systemic: Paresthesias, GI, anorexia, drowsiness
Rare-metabolic acidosis, hypoK, aplastic anemia, thrombocytopenia
B/C bid ADRs with Systemic thearpy- LAST LINE (open angle) and much monitoring
-occasionally use PO or closed angle |
|
|
Term
| Contraindications for carbonic anhydrase inhibitors (PO and Ophth) |
|
Definition
Ophth: hypersensitivity
PO:sulfonamide allergy, hypoK, hypoNa, COPD, renal or hepatic impairment |
|
|
Term
| What is last line for glaucoma |
|
Definition
| cholinergics and cholinesterase inhibitors (and PO carbonic anhydrase inhibitors) |
|
|
Term
| Which ophth glaucoma meds have multiple dose? |
|
Definition
Beta-Blockers
Betaxolol
Levobunolol
Timolol
Alpha-2 Agonists [All]
Apraclonidine
Brimonidine
Cholinergics/Cholinesterase Inhibitors [All]
Carbachol
Echothiophate Iodine
Pilocarpine
Pilocarpine Nitrate |
|
|
Term
| What are the Cholinergics/Cholinesterase inhibitors used for Glaucoma? |
|
Definition
Carbachol
Echothiophate Iodide
Pilocarpine (Salagen)
Pilocarpine Nitrate |
|
|
Term
| What are the two direct cholinergic agonists and what is their MOA? |
|
Definition
carbachol and pilocarpine
act at Ach receptors and stimulate ciliary muscle |
|
|
Term
| What is carbachol's dual MOA |
|
Definition
1. direct stimulation at Ach Receptor to stimulate ciliary muscle
2. Ach esterase inhibitor (weaker) |
|
|
Term
| When is pilocarpine ususally used? |
|
Definition
| for primary angle CLOSURE glaucoma once pupillary block is broken, not used any earlier |
|
|
Term
| Administration of cholinergic agonists |
|
Definition
1tid/1qid
big negative for these meds are their multiple dosing schedules |
|
|
Term
| ADR for cholinergic agonists |
|
Definition
reduced visual acuity (especially in poor lighting)
HA
lacrimaption effects
myopia
retinal detachment
iris cysts
cataracts (echothiophate)
cholinergic syndrome (weakness, nausea, diaphoresis, dyspnea)
Big drawback to this class |
|
|
Term
| Contraindications of cholinergic agonists |
|
Definition
acute iritis
uveal inflammation
pupillary block glaucoma (use one block broken) |
|
|
Term
| Precautions with cholinergic agonists |
|
Definition
pregnancy
lactation
night driving/other activities in poor light (will make this worse)
Hx of...
-retinal detachment
-asthma
-bradycardia
-hypotension
-parkinsonism
-recent MI
-patients using systemic cholinesterase inhibitors for myasthenia gravi |
|
|
Term
| Precautions with carbonic anhydrase inhibitors |
|
Definition
Ophth and PO not recommnended in patients with severe renal impairment
caution in hepatic impairement
acidosis-can cause sickling for RBC in ppl with sickle cell |
|
|
Term
| Precautions with alpha-2 agonists |
|
Definition
severe cardiac disease
cerebrovascular disease
chronic renal failure
Raynaud's disease
Children |
|
|
Term
| Precautions with beta-blockers |
|
Definition
diabetes mellitus
cerebrovascular insufficiency
myasthenia gravis |
|
|
Term
| Precautions with PG analogs |
|
Definition
| diabetic rentinopathy or ocular surgery complications--greater risk of developing cystoid macular edema, anterior uveitis, or vitreous hemorrhage |
|
|
Term
| What is first line in glaucoma |
|
Definition
| PG analog-->if wont work then beta blockers |
|
|
Term
| how long should you try each agent before adding another agent or switching? |
|
Definition
|
|
Term
| What are alternative treatments to drug therapy? |
|
Definition
|
|
Term
| What is a good add on therapy to PG analogs or beta-blockers? |
|
Definition
|
|
Term
| T or F: after surgery you are cured. |
|
Definition
| F- you may need a second surgery or be put on medication |
|
|
Term
| What are risk factors for POAG |
|
Definition
elevated IOP
african or hispanic
family Hx of glaucoma
Old age
thinner central corneal thickness |
|
|
Term
| What are risk factors for PACG |
|
Definition
hyperopia
family history
age (>30)
gender
asian/eskimo ethnicity |
|
|
Term
|
Definition
slow vision loss (may be unnoticed for long time)-years
peripheral vision lost first
scotoma (blind spots)-can be peripheral or central
Exam:
cupping (Cup:disk ratio >0.5)
disorganized rim
IOP~20-30 (not always) |
|
|
Term
|
Definition
blurred vision/hazy vision
ocular pain/discomfort
N/V
abdominal pain
can progress to same visual findings as POAG
Quick onset
Exam:
edematous cornea
closed angles
optic disc changes
High IOP: 40-50+ |
|
|
Term
| How often should someone over age 65 get an dilated eye exam? |
|
Definition
with glaucoma risk factors: 6-12 months
without risk factors: 1-2 years |
|
|
Term
| If patient is at target IOP but still has disease progression what should be done? |
|
Definition
Further work-up
establish a lower IOP goal |
|
|
Term
| what specific agent is usually added/tried after beta-blockers |
|
Definition
brimonidie (alphagan)-alpha-2 agonist
(then try Carbonic anhydrase inhibitors the cholinergics) |
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