Opthamology:Glaucoma

Question 1

What are risk factors for glaucoma

Answer 1

increased IOP, central corneal thickness (thinner), optic nerve damage, age, race, gender, family history

Question 2

What drugs are most likely to cause open-angle glaucoma

Answer 2

Opthalmci corticosteriods, systemic/nasal/inhaled corticosteroids, opthalmic anticholinergics

Question 3

Which glaucoma is considered a medical emergency, what side effects are seen

Answer 3

Angle closure (IOP greater than 40 and sudden), nausea/vomiting, orbital pain, halos

Question 4

What are high risk meds that can cause angle closure glaucoma

Answer 4

Topical anticholinergics and sympathomimetics, systemic anticholinergics, anti-depressants, antihistamines

Question 5

What is the pathophysiology of closed angle gluacoma

Answer 5

Iris bends inward to hit the cornea to cause a physical blockage that doesn’t leave the posterior chamber

Question 6

What is the determining factor to diagnose glaucoma

Answer 6

If cup-disc ratio is GREATER than 0.5 (sign of optic nerve damage)

Question 7

T/F: Patients who are starting to get glaucoma will have tunnel vision (no periphery/only central)

Answer 7

True

Question 8

What is the goal change in IOP for treating glaucoma, what value is related to reduction in visual field defects

Answer 8

30% decrease from baseline, less than 18 mmHg

Question 9

What are the targets of glaucoma treatment

Answer 9

Inflow (ciliary body), Trabecular outflow (conventional passage 85%), Uveoscleral outlfow (unconventional passage 15%)

Question 10

What are the beta- blockers used in glaucoma, what is the MOA

Answer 10

timolol, betaxolol, carteolol, leveunolol, metipranolol/ Reduce the aqueous humor production of the ciliary body

Question 11

What is the only beta-blocker that is selective, selective for what, when would it be preferred

Answer 11

Betaxolol Beta-1 selective, pulmonary disorder

Question 12

How often are the beta-blockers dosed, what is the exception

Answer 12

1 gtt BID,

istalol timoptic XE (1 gtt every day)

Question 13

T/F: Timolol has the best efficacy

Answer 13

False: All the beta-blockers are equally efficacious

Question 14

What are the AE of beta blockers for glaucoma

Answer 14

blurred vision, stinging, dry eyes, corneal anesthesia, eyelid inflammation

Question 15

What patients should have caution when taking beta blockers

Answer 15

Pulmonary disorders, cardiovascular diseases, diabetes, concurrent use of oral beta-blockers

Question 16

What are the prostaglandin analogs, prostamide analog

Answer 16

Latanoprost, latanoprostene bunod, travaprost, tafluprost/ Bimatoprost

Question 17

What is the MOA prostaglandin/prostamide analog

Answer 17

INCREASE UVEOSCLERAL OUTFLOW of the aqueous humor and to a lesser extent tradecular outflow

Question 18

What is special about latanoprostene bunod

Answer 18

Releases nitric oxide which can relax the trabecular meshwork increasing drainage of aqueous humor

Question 19

How are the prostaglandin and prostamide analogs dosed, stored

Answer 19

1 gtt qhs, In refrigerator until opened (latanoprost, latanoprostene bunod, taflupost) then stable for 6 weeks at room temperature

Question 20

Which prostaglandin and prostamide analogs have benzalkonium chloride

Answer 20

Latanoprost, latanoprostene bunod and bimatoprost

Question 21

Which prostaglandin analog is preservative free, contains sofzia

Answer 21

Tafluprost, travoprost

Question 22

What are the three unique side effects of prostaglandin and prostamide analogs

Answer 22

Altered iris pigmentation (permenant), hypertrichosis (increasing eyelashes/temporary), hyperpigmentation around lids (reversible)

Question 23

What are the alpha-2 adrenergic agonists, which increases uveoscleral outflow, dosing

Answer 23

Birmonidine and apraclonidine, brimonidine, 1 gtt BID to TID

Question 24

What are the adverse effects related to alpha-2 adrenergic agonists

Answer 24

Allergic type reaction: lid edema, eye discomfort, foreign body-sensation, itching, hyperemia (DISCONTINUE IMMEDIATELY)

Question 25

When should alpha-2 adrenergic agonists be used with caution

Answer 25

Cardiovascular disease, cerebrovascular disease, antihypertensives, MAO-Is, TCAs

Question 26

What is the MOA of carbonic anhydrase inhibitors (CAIs),

Answer 26

Block active secretion of the sodium and bicarbonate ions from the ciliary body to the aqueous humor

Question 27

What are the topical (eye drop) CAIs, oral

Answer 27

Brinzolamide and dorzolamide/ acetazolamide and methazolamide

Question 28

How are the CAIs dosed topically, oral

Answer 28

1 gtt BID to TID, 1 tab BID to QID

Question 29

T/F: Brinzolamide is associated with stinging while dorzolamide is associated with blurry vision

Answer 29

False: Brinzolamide is associated with blurry vision while dorzolamide is associated with stinging

Question 30

T/F: Topical and oral solutions of CAIs should not be taken at the same time

Answer 30

True

Question 31

What is the adverse effect seen whether using oral or topical CAIs, others

Answer 31

Metallic taste, NVD, less eating, renal stones, metabolic acidosis, malaise fatigue

Question 32

What patients cannot take CAIs, what patients should be cautioned

Answer 32

Patient’s with gout/ sulfa allergies, pulmonary disorders, hepatic and/or renal disease, history of renal calculi

Question 33

What are the parasympathetic agents, dosing, changes to dosing

Answer 33

Carbachol and pilocarpine, 1 gtt BID to TID, higher concentrations used for darker pigmented eyes

Question 34

What is the Rho Kinase inhibitor, dose

Answer 34

Netarsudil, 1 gtt daily in evening

Question 35

How should treatment be monitored

Answer 35

Start with one medication, follow up in 2-4 weeks, once target IOP reached then follow up every 3-6 months

Question 36

What is ocular hypertension

Answer 36

Elevated IOP greater than 22 mmHg but no disk changes or visual field loss