ch 87 highlights Flashcards
(79 cards)
1
Q
1st line treatment in glaucoma
A
B Blockers
2
Q
Who cannot use B Blockers
A
Asthma COPD Diabetics AV heart block cardiogenic shock hear failure (use with caution)
3
Q
What glaucoma treatment can you use for asthma and copd patients
A
Betaxolol
B1 selective
4
Q
What drugs can you use for angle closure glaucoma
A
B Blockers as adjunct
Pilocarpine
5
Q
B blockers approved for glaucoma
A
Betaxolol carteolol levobunolol metipranolol timolol
6
Q
latanoprost travoprost bimatoprost latanoprostene bunod tafluprost
A
Prostaglandin analogs for Glaucoma
considered 1st line
7
Q
what prostaglandin was more effective in the African American population
A
Travoprost
8
Q
what medication can cause a gradual increase in brown pigmentation of the iris, which may be irreversible. It can also increase pigmentation of the eyelid and growth to the eyelashes
A
Prostaglandin analogs for glaucoma
-prost
9
Q
Apraclonidine
Brimonidine
A
Alpha 2 adrenergic agonists approved for Glaucoma
10
Q
Which alpha 2 adrenergic agonist crosses the blood brain barrier and which does not
A
Brimonidine crosses the BBB
Apraclonidine does not
11
Q
which Alpha 2 adrenergic agonist is sold OTC
A
brimonidine is sold as Lumify OTC
12
Q
What Alpha 2 Adrenergic agonist is approved for short term use and which is approved for long term use
A
Apraclonidine is approved for short term use
Brimonidine is approved for long term use
13
Q
Which Alpha 2 adrenergic agonist has special considerations with contacts and what are those instructions
A
Brimonidine
Wait 15 min before inserting contacts
14
Q
Which Alpha 2 adrenergic agonist can promote hypotension
A
Brimonidine
it crosses the BBB so it can cause drowsiness, fatigue and hypotension
15
Q
Combigan
A
Brimonidine + timolol
16
Q
Simbrinza
A
Brimonidine + Brinzolamide
17
Q
2nd line treatment for open angle glaucoma
A
Pilocarpine
18
Q
Can Pilocarpine be used long term?
A
no, it can cause retinal detachment
19
Q
What pt population cannot use Pilocarpine
A
Asthma and COPD
bradycardic patients
hypotensive
20
Q
What is the reversal agent for Pilocarpine
A
Atropine
21
Q
What drug class is Pilocarpine
A
Direct-acting muscarinic agent
22
Q
what systemic effects can Pilocarpine cause
A
due to stimulation of muscarinic receptors Bradycardia bronchospasm hypotension urinary urgency diarrhea hypersalivation sweating
23
Q
what type of drug is Echothiophate
A
cholinesterase inhibitor that is approved for glaucoma
24
Q
when would you use Echothiophate
A
Due to the adverse effects this drug is reserved for patients who have not responded well to the preferred treatments (b blockers, alpha 2 agonists and prostaglandins)
25
what side effects for Echothiophate
```
stimulation of muscarinic receptors
Bradycardia
bronchospasm
hypotension
urinary urgency
diarrhea
hypersalivation
sweating
```
development of cataracts
26
Dorzolamide
| Brinzolamide
Carbonic anhydrase inhibitors: topical
| used in glaucoma and ocular hypertension
27
which carbonic anhydrase inhibitor is generally better tolerated
Brinzolamide - causes less ocular stinking and burning than dorzolamide
28
Are there any contact precautions with the Carbonic anhydrase inhibitors
yes, for both dorzolamide and brinzolamide
| wait 15 min after administering before wearing contacts
29
most common side effects for the Carbonic Anhydrase Inhibitors
ocular stinking
bitter taste immediately after dosing
transient blurred vision (Brinzolamide)
30
which Carbonic Anhydrase inhibitor do 10-15% of patients experience allergic reactions
Dorzolamide -
Conjunctivitis
lid reactions
stop med and contact provider
```
other reactions for Dorzolamide
blurred vision
tearing
eye dryness
photophobia
```
31
t/f
| If I miss a dose of my glaucoma medication, it is okay. Try not to miss again
False - It is important to take the medication according to the schedule. If days are skipped or if prescriptions are not filled, loss of vision may occur
32
symptoms of angle closure glaucoma
vision loss
severe eye pain
headache
n/v
33
what should you do for photophobia in
use sunglasses, wide-brimmed hats, visors or baseball hats
34
what is the drug that you need to allow at least 15 min to elapse between administration and insertion of contacts
Benzalkonium
35
To improve topical absorption and minimize systemic absorption for topical eye meds
close eyes for 3 min after drops and lightly press a thumb over medial canthus (inner corner of eye)
36
```
eye
itching
burning
thin, watery discharge
red and congested conjunctiva
```
allergic conjunctivitis
37
pattern of symptoms for allergic conjunctivitis
symptoms appear 20 min after exposure and stop 20 min later and come back 6+ hours later due to recruitment off immune cells
38
cromolyn
| lodoxamide
mast cell stabilizers
takes days to develop and 2 weeks to become maximally effective
39
treatment for allergic conjunctivitis
mast cell inhibitors (cromolyn, lodoxamine) - these take 2+ weeks to be effective
for immediate relief - H1 receptor antagonists (antihistamines)
If you use Azelastine and olopatadine - they do both
Toradol (NSAID) - inhibits prostaglandins
Glucocorticoids (ie) Loteprednol) -if having severe symptoms- may increase IOP if prescribed long term - also inhibits prostaglandins
ocular decongestants (naphazoline and phenylephrine) - decrease redness and edema - these are for no more than 2 weeks and are used just while the mast cell inhibitors take effect (more than 2 weeks may cause rebound congestion)
40
when are ocular decongestants contraindicated
history of angle closure glaucoma
41
if multiple topical drugs are being used, how do you apply
wait at least 5 min in between drugs so the second drug doesnt flush out the first drug
42
antiviral topical drugs
trifluridine
| gancyclovir
43
bacterial eye infections will remain contagious
until they have been treated for 24-48 hours
44
viral eye infections remain contagious
until they are completely gone
45
mild allergic conjunctivitis
mild intermittent pruritus
46
moderate allergic conjunctivitis
mild to severe pruritis lasts a few days to 2 weeks with no eye redness
47
severe allergic conjunctivitis
moderate to severe pruritis that is chronic with eye redness
48
open angle glaucoma is more common in
African American Population where angle closure is not
49
effects of dilation with anticholinergic agent
tachycardia may indicate toxicity
mydriasis is an effect causing eye unable to focus. Blurred vision until wears off
50
```
taking Dorzolamide with the following symptoms
ocular stinging
bitter taste
photophobia
eye dryness
blurred vision
```
normal
51
Taking Dorzolamide with
| redness in eyes or eyelids
Allergic conjunctivitis
| stop med
52
which med was marketed specific purpose of increasing eyelash length, darkness and thickness
Latisse (bimatoprost)
53
adverse effects of B Blocker drops for glaucoma
ocular stinging
```
occasionally
conjunctivitis
blurred vision
photophobia
dry eyes
```
54
B1 Blockade effects
bradycardia
| AV heart block
55
B2 blockade effects
bronchospasm
56
prostaglandin analogues side effects
```
iris color change
eyelashes - longer, thicker, darker
blurred vision
burning
stinging
conjunctival
hyperemia
conjunctival edema
punctate keratopathy
macular edema (rare)
```
57
Apraclonidine side effects
```
headache
dry mouth
dry nose
altered taste
conjunctivitis
lid reactions
pruritus
tearing
blurred vision
```
does not cross BBB
58
second line drug for open angle glaucoma and used for emergency treatment
Pilocarpine
59
pilocarpine side effects
decrease visual acuity
local irritation
eye pain
brow ache
```
bc its a direct acting muscarinic agonist
bradycardia
bronchospasm
hypotension
urinary urgency
diarrhea
hypersalivation
sweating
```
60
what cholinesterase inhibitor for glaucoma
echothiophate
61
pilocarpine for children
may cause paradoxical increases in intraocular pressure
62
glaucoma in pregnancy
brimonidine
63
meds for glaucoma for older adults - what drugs contraindicated and why
B Blockers can worsen heart failure even topical
A2 agonists can cause orthostatic hypotension
if marked renal impairment, no carbonic anhydrase inhibitors
cholinesterase inhibitors may cause bradycardia and hypotension
64
side effect of Dorzolamide (Trusopt) for glaucoma
| carbonic anhydrase inhibitor (topical)
ocular stinging
bitter taste after dosing
allergic reactions - conjunctivitis and lid reactions
blurred vision
tearing
eye dryness
photophobia
65
Brinzolamide (Azopt) for topical treatment of elevated IOP in open angle glaucoma or ocular HTN
Carbonic anhydrase inhibitor
adverse effect
bitter aftertaste
transient blurred vision
less ocular stinging and burning than dorzolamide
66
contact lens and brinzolamide
wait 15 min after drops to put contacts in
67
glaucoma pt teach
take according to schedule - you can lose vision if days are skipped
call if vision loss, severe eye pain, headache n/v - s/s of angle closure glaucomA
photophobia outdoors- wear sunglasses, wide brimmed hats, visors or baseball caps
check labels to see if they contain benzalkonium as a preservative. if so wait 15 min after drops to put in contacts
dont touch dropper to eyes and do not touch tip with finger. eye infection
to improve absorption, close eyes for 3 min after drops and lightly press a thumb or finger over the medial canthus (inner corner of eye)
68
iop in glaucoma pt should be checked how often
every 1-3 months
69
what can help reduce severity of symptoms for allergic conjunctivitis
avoid allergen
for example if allergic to pollen....avoid being outside on a windy day during pollen season
70
if oral antihistamines are taken for allergy symptoms what is a common side effect and what can you do (with eyes)
eye dryness
artificial tears or other eye lubricants
apply cold compresses 5-10 min
avoid rubbing eyes and wearing contacts if symptoms are bad to avoid worsening
71
when should you notify provider when being treated for allergic conjunctivitis
if no relief after 2 weeks - could indicate underlying issue
72
if using multiple topical drugs in eyes, how do you give
wait at least 5 min in between drugs
73
what prescription can be given for dry eyes due to inflammation
topical cyclosporine opthalmic emulsion (Restasis)
74
ocular decongestants for allergic conjunctivitis
```
phenylephrine
naphazoline
oxymetazoline
brimonidine
tetrahydrozoline
```
only local reactions (stingin, burning, reactive hyperemia with overuse
75
what do you need to ensure prior to giving a ocular glucocorticoid for inflammation of the eye (uveitis, iritis, conjuntivitis)
ensure there is no underlying viral or fungal infection or glucocorticoids can cause permanent vision loss
76
antiviral topical for eye infections
trifluridine
| ganciclovir
77
what is applied to eye to look for lesions on the corneal epithelium
fluorescein
makes defects bright green
78
adverse effect of fluorescein
n/v
paresthesias
pruritus
anaphylaxis
pulmonary edema
cardiac arrest
79
what is rose bengal used
| and lissamine green for
visualize abrasions of corneal and conjunctival epithelium
