Term
| What used to be the definition of Glaucoma but is not always true? |
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Definition
| elevated IOP. Some have normal pressure though. |
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Term
| What can tip you off to glaucoma? (what are the risk factors) |
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Definition
| family Hx, ethnicity: Hispanics and Blacks, especially, corneal thickness, iris flexibility, miopia, HTN (positive family Hx, ethnicity, and increased IOP are most important) |
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Term
| What is nomral IOP? elevated? |
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Definition
|
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Term
| What is the main symptom complained of with Glaucoma? |
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Definition
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Term
| There will be a question on ethnicity and glaucoma: |
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Definition
| leading cause of blindness in Hispanics, 2nd leading in Af. Americans, 3rd in Caucasians |
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Term
| What is acute angle closure glaucoma? (AACG) |
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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 |
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Term
| What is the visual impairemnt with glaucoma due to? |
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Definition
| not just due to increased IOP. due to glaucomatous nerve damage to the optic nerve |
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Term
| What is glaucomatous nerve damage? |
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Definition
| not really known; may have inflammatory component; may have ischemia reperfusion damage |
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Term
| IS there a relationship between extent of damage and IOP? |
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Definition
|
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Term
| what are the 2 forms of glaucoma and which is more comment? |
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Definition
| Open-angle glaucoma and angle closure glaucoma. open angle glaucoma is most common |
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Term
| How is angle closure glaucoma treated? Open closure glaucoma? |
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Definition
| surgery. open angle can be treated surgically or with medication |
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Term
|
Definition
| elevated IOP but no signs of nerve damage |
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Term
| The emergent cases of glaucoma are which type? |
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Definition
| angle-closure glaucoma progresses to AACG. |
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Term
| What secretes aqueous humor? |
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Definition
| ciliary processes; they have high degree of surface area with mnany mitochondria and ER |
|
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Term
| where does MOST humor outflow occur? |
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Definition
| Canal of Schlemm; remainder flows through the uveoscleral route |
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Term
| What makes up the Canal of Schlemm? |
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Definition
| trabeculae; size of pores here controls outflow of humor |
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Term
| IOP is determined by a balance of what 2 processes? |
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Definition
| how fast humor is made by ciliary processes and how fast it is reabsorbed by trabeculae in Canal of Schlemm. |
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Term
| What is surgical treatment of glaucoma and which type is it used for? |
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Definition
| Iridectomy. used more commonly for angle closure but can be used for both types |
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Term
| What are the 2 general aims of medical treatment of open angle glaucoma? |
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Definition
| decrease aqueous humor production OR increase outflow through the trabecularnetwork and the uveoscleral pathway |
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Term
| What decrease in IOP will stop disease progression of glaucoma from 35 % of patients? |
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Definition
|
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Term
| What things affect ocular bioavailability? |
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Definition
| pH, salt form of the drug, chemical structure, osmolality, tonicity, and viscocity |
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Term
| How are undesirable systemic effects possible with eye drop medications? |
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Definition
| they can be absorbed into the systemic circulation |
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Term
| Miotic agents interact with what systemp? |
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Definition
|
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Term
| What is a cholinergic agonist used as a miotic agent? |
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Definition
|
|
Term
| what is an ACH-ase inhibitor that acts as a miotic agent? |
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Definition
|
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Term
| What is the MOA of cholinergic miotic drugs for glaucoma? |
|
Definition
| enlarge the iridio-corneal angle, enhancing aqueous outflow |
|
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Term
| How do cholinergic drugs enlarge the iridio-corneal angle |
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Definition
| enhancing aqueous outflow?,promote contraction of ciliary muscle and sphincter muscles of the iris |
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Term
| Drugs that activate adrenergic system exert what effects on glaucoma? |
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Definition
| decrease iridio-corneal angle, exacerbating glaucoma |
|
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Term
| What is the fxn of the ciliary muscle? |
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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. |
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Term
| What is the toxicity of miotic agents that are cholinergic? |
|
Definition
| ciliary muscle spasm, which is very painful |
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Term
| When are cholinergic miotic agents for glaucoma? |
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Definition
| young patients are intolerant of visual blurring*** and patients with increased risk of retinal damage |
|
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Term
| What adrenergic drugs are used for glaucoma? |
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Definition
|
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Term
| What is the MOA of Beta antagonists used for glaucoma? |
|
Definition
| reduce production of aqueous humor by ciliary epithelium |
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Term
| When are Beta antagonists contraindicated in the treatment of glaucoma? |
|
Definition
| Asthma and COPD with bronchospasm. Brady-arhythmias |
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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 |
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Term
| What are 2 epinepherine-related agents used for glaucoma treatment? |
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Definition
|
|
Term
| What is an alpha-2 agonist used for glaucoma? |
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Definition
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Term
| What type of drugs have emerged as 1st line drugs for glaucoma treatment because of good tolerance? |
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Definition
|
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Term
| Why are prostaglandins given as a pro-drug for glaucoma? |
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Definition
| prostaglandins have side effects in the eye in their true form |
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|
Term
| What is an example of a prostaglandin prodrug used for treatment of glaucoma? |
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Definition
|
|
Term
|
Definition
| PGF2alpha prodrug used for glaucoma |
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|
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 |
|
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Term
| What is the 1st line drug for patient with IOP of 22mmHg and they are Hispanic? |
|
Definition
| PROST's.... Prostaglandin prodrug*** on exam |
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|
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 |
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|
Term
| What are toxicities/contraindications of Carbonic Anhydrase inhibitors? |
|
Definition
| malaise, fatigue, depression, parasthesias, kidney stones |
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|
Term
| Which drug classes increase aqueous humor outflow? |
|
Definition
| cholinergic agents, latanoprost, epi-related agents |
|
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Term
| Which drug classes decrease aqueous humor production? |
|
Definition
| B-antagonists, Carbonic Anhydrase inhibitors |
|
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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 |
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|
Term
| If someone comes in with symptoms of glaucoma (headache |
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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. |
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Term
| Test questions: First line drug for glaucoma? |
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Definition
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