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Glaucoma
Pharm
53
Medical
Kindergarten
04/27/2010

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Cards

Term
What used to be the definition of Glaucoma but is not always true?
Definition
elevated IOP. Some have normal pressure though.
Term
What can tip you off to glaucoma? (what are the risk factors)
Definition
family Hx, ethnicity: Hispanics and Blacks, especially, corneal thickness, iris flexibility, miopia, HTN (positive family Hx, ethnicity, and increased IOP are most important)
Term
What is nomral IOP? elevated?
Definition
12-20 mmHg. >20mmHg
Term
What is the main symptom complained of with Glaucoma?
Definition
loss of visual field
Term
There will be a question on ethnicity and glaucoma:
Definition
leading cause of blindness in Hispanics, 2nd leading in Af. Americans, 3rd in Caucasians
Term
What is acute angle closure glaucoma? (AACG)
Definition
opthalamic emergency; characerized by periorbital pain, headaches, frequently by visual disturbances with halos around objects in visual field. Can have systemic symptoms of nausea, etc. as well
Term
What is the visual impairemnt with glaucoma due to?
Definition
not just due to increased IOP. due to glaucomatous nerve damage to the optic nerve
Term
What is glaucomatous nerve damage?
Definition
not really known; may have inflammatory component; may have ischemia reperfusion damage
Term
IS there a relationship between extent of damage and IOP?
Definition
No
Term
what are the 2 forms of glaucoma and which is more comment?
Definition
Open-angle glaucoma and angle closure glaucoma. open angle glaucoma is most common
Term
How is angle closure glaucoma treated? Open closure glaucoma?
Definition
surgery. open angle can be treated surgically or with medication
Term
What is ocular HTN?
Definition
elevated IOP but no signs of nerve damage
Term
The emergent cases of glaucoma are which type?
Definition
angle-closure glaucoma progresses to AACG.
Term
What secretes aqueous humor?
Definition
ciliary processes; they have high degree of surface area with mnany mitochondria and ER
Term
where does MOST humor outflow occur?
Definition
Canal of Schlemm; remainder flows through the uveoscleral route
Term
What makes up the Canal of Schlemm?
Definition
trabeculae; size of pores here controls outflow of humor
Term
IOP is determined by a balance of what 2 processes?
Definition
how fast humor is made by ciliary processes and how fast it is reabsorbed by trabeculae in Canal of Schlemm.
Term
What is surgical treatment of glaucoma and which type is it used for?
Definition
Iridectomy. used more commonly for angle closure but can be used for both types
Term
What are the 2 general aims of medical treatment of open angle glaucoma?
Definition
decrease aqueous humor production OR increase outflow through the trabecularnetwork and the uveoscleral pathway
Term
What decrease in IOP will stop disease progression of glaucoma from 35 % of patients?
Definition
30% decrease
Term
What things affect ocular bioavailability?
Definition
pH, salt form of the drug, chemical structure, osmolality, tonicity, and viscocity
Term
How are undesirable systemic effects possible with eye drop medications?
Definition
they can be absorbed into the systemic circulation
Term
Miotic agents interact with what systemp?
Definition
cholinergic
Term
What is a cholinergic agonist used as a miotic agent?
Definition
pilocarpine
Term
what is an ACH-ase inhibitor that acts as a miotic agent?
Definition
Physostigmine
Term
What is the MOA of cholinergic miotic drugs for glaucoma?
Definition
enlarge the iridio-corneal angle, enhancing aqueous outflow
Term
How do cholinergic drugs enlarge the iridio-corneal angle
Definition
enhancing aqueous outflow?,promote contraction of ciliary muscle and sphincter muscles of the iris
Term
Drugs that activate adrenergic system exert what effects on glaucoma?
Definition
decrease iridio-corneal angle, exacerbating glaucoma
Term
What is the fxn of the ciliary muscle?
Definition
controls convexity of the lens. when it contracts, it decreases the tension on the suspensory ligaments, allowing the lens to round up for near vision.
Term
What is the toxicity of miotic agents that are cholinergic?
Definition
ciliary muscle spasm, which is very painful
Term
When are cholinergic miotic agents for glaucoma?
Definition
young patients are intolerant of visual blurring*** and patients with increased risk of retinal damage
Term
What adrenergic drugs are used for glaucoma?
Definition
Beta antagonists
Term
What is the MOA of Beta antagonists used for glaucoma?
Definition
reduce production of aqueous humor by ciliary epithelium
Term
When are Beta antagonists contraindicated in the treatment of glaucoma?
Definition
Asthma and COPD with bronchospasm. Brady-arhythmias
Term
What is the MOA of epinepherine agnents and Alpha-2 agonists for glaucoma treatment?
Definition
enhance uveosclearl humor reabsorption. May alter trabecular function to enhance absorpiton and may act on ciliary epithelium to reduce production
Term
What are 2 epinepherine-related agents used for glaucoma treatment?
Definition
Dipivefrin, Epinephrine
Term
What is an alpha-2 agonist used for glaucoma?
Definition
Apraclonidine
Term
What type of drugs have emerged as 1st line drugs for glaucoma treatment because of good tolerance?
Definition
Prostaglandin pro-drugs
Term
Why are prostaglandins given as a pro-drug for glaucoma?
Definition
prostaglandins have side effects in the eye in their true form
Term
What is an example of a prostaglandin prodrug used for treatment of glaucoma?
Definition
LatanoPROST
Term
What is Latanoprost?
Definition
PGF2alpha prodrug used for glaucoma
Term
what is the MOA of Prostaglandin prodrugs used for glaucoma?
Definition
enhance uveoscleral absorption of aqueous humor; how they acutally do this is unknown
Term
What is the 1st line drug for patient with IOP of 22mmHg and they are Hispanic?
Definition
PROST's.... Prostaglandin prodrug*** on exam
Term
What are 2 carbonic anhydrase inhibitors used for treatment of glaucoma?
Definition
Acetazolamide, Methazolamide
Term
What is the MOA of carbonic anhydrase inhibitors used for glaucoma?
Definition
reduce production of aqueous humor by ciliary epithelium
Term
What glaucoma drug class has the worst side effect profile
Definition
even when given topically?,Carbonic Anhydrase inhibitors; only given as last resort
Term
What are toxicities/contraindications of Carbonic Anhydrase inhibitors?
Definition
malaise, fatigue, depression, parasthesias, kidney stones
Term
Which drug classes increase aqueous humor outflow?
Definition
cholinergic agents, latanoprost, epi-related agents
Term
Which drug classes decrease aqueous humor production?
Definition
B-antagonists, Carbonic Anhydrase inhibitors
Term
How is medical management of progressive galucoma different than acute?
Definition
initially- Latanoprost, then B-antagonists, then TOPICAL carbonic anhydrase inhibitors, epi-related drugs, and miotic/cholinergic agents, then finally SYSTEMIC carbonic anhydrase inhibitors
Term
If someone comes in with symptoms of glaucoma (headache
Definition
visual disturbance, etc.) what is necessary,complete eye exam. measurement of IOP. Occulomotor exam. CT scan.
Term
If acute angle closure glaucoma is diagnosed
Definition
what things should be given?,oral carbonic anhydrase inhibitors, glucocorticoid eye drops, Topical Prostaglandin pro-drugs, B-antagonist drops.
Term
Test questions: First line drug for glaucoma?
Definition
Prostaglandin prodrug
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