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PHRM 844 Module #2 > Eye Lecture Part 2 > Flashcards

Eye Lecture Part 2 Flashcards

1
Q

Compare differences between closed-angle and open-angle glaucoma

A

open angle: “slowly clogging drain”
closed angle: “putting foot on drain”

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2
Q

Open-angle gluacoma

A

obstructed drainage canal
most common type, happens gradually over time
no pain associated with it
30% of retinal cells have to be lost before vision loss

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3
Q

Close-angle glaucoma

A

pressure pushes iris against cornea
iris close to lens or drainage angle completely blocks
can cause permanent vision loss

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4
Q

Development of glaucoma

A

drainage canal blocked –> fluid build up –> damage to blood vessels and optic nerve from the pressure buildup

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5
Q

Risk factors

A

over 40 yrs old: leading cause of blindness in those greater than 60
eye injury
high blood pressure
asian or african american
use of steroids: steroids closest to the eye increase intraocular pressure
sickle cell anemia
corneal thickness
nearsighted or farsighted
diabetes

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6
Q

Symptoms of open-angle glaucoma

A

no symptoms in early stages
patchy blind spots in peripheral vision
difficulty seeing in central vision

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7
Q

Diagnosis of open-angle glaucoma

A

getting dilated comprehensive eye exam is only way to catch glaucoma early
measuring intraocular pressure: tonometry
testing for optic nerve damage: ophthalmoscopy
checking for vision loss: perimetry
measuring corneal thickness: pachymetry
inspecting drainage canal: gonioscopy

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8
Q

Open-angle treatment

A

reduce aqueous humor production
increase aqueous humor outflow
both

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9
Q

Reduce aqueous humor production

A

beta blockers
carbonic anhydrase inhibitors

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10
Q

Increase aqueous humor outflow

A

prostaglandin analogs
cholinergics
rho kinase inhibitors

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11
Q

Both

A

alpha 2 agonists

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12
Q

1st line: prostaglandin analogs: drugs

A

bimatoprost (lumigan)
travaprost (travatan Z, travatan)
latanoprost (xalatan, xelpros)
tafluprost (zioptan)
bimatoprost (latisse) - indicated for eyelash hypotrichosis

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13
Q

1st line: prostaglandin analogs: dosing

A

1 drop QHS
reduce IOP by 30%

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14
Q

1st line: prostaglandin analogs: warnings

A

darkening of iris, eyelid, skin, and eyelashes
increase in eyelash length and number

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15
Q

1st line: prostaglandin analogs: side effects

A

blurred vision, stinging, increased pigmentation of iris/eyelashes, eyelash growth/thickening, light sensitivity, foreign body sensation

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16
Q

1st line: beta blockers: drugs

A

can mask hypoglycemia or hypothyroidism
non-selective: timolol (timoptic, timoptic-XE, isatol); carteolol; levobunolol (betagan)
selective: betaxolol (betoptic S)

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17
Q

1st line: beta blockers: dosing

A

1 drop daily or BID
reduce IOP by 20-30%

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18
Q

1st line: beta blockers: contraindications

A

sinus bradycardia
2nd or 3rd degree heart block
cardiogenic shock
uncompensated cardiac failure
bronchospastic disease

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19
Q

1st line: beta blockers: side effects

A

stinging, blurred vision, bradycardia, breathing problems, hypotension, dizziness, fatigue, impotence

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20
Q

Alternative 1st/2nd line: alpha-2 agonists

A

not more effective than single MOA meds
can also be on beta blockers or prostaglandin analogs at the same time

21
Q

Alternative 1st/2nd line: alpha-2 agonists: drugs

A

brimonidine (alphagan P) + timolol (combigan) + brinzolamide (simbrinza)
aprachlonidine (lopidine)
brimonidine (lumify) - OTC for redness of eye

22
Q

Alternative 1st/2nd line: alpha-2 agonists: dosing

A

1 drop TID
reduce IOP by 25%

23
Q

Alternative 1st/2nd line: alpha-2 agonists: contraindications & warnings

A

CNS depression

24
Q

Alternative 1st/2nd line: alpha-2 agonists: side effects

A

dry eyes, xerostomia, blurry vision, conjunctival hyperemia, sedation, confusion

25
2nd line: carbonic anhydrase inhibitors
bottles of these meds must be capped to prevent crystallization
26
2nd line: carbonic anhydrase inhibitors: drugs
ophthalmic: dorzolamide (trusopt) + timolol (cosopt, cosopt PF); brinzolamide (azopt) + brimonidine (simbrinza) oral: acetazolamide; methazolamide
27
2nd line: carbonic anhydrase inhibitors: dosing
ophthalmic: 1 drop TID reduce IOP by 15-20% not recommended for CrCl < 30 oral: 50-100 mg PO 2 to 3 times daily
28
2nd line: carbonic anhydrase inhibitors: warnings
sulfonamide allergy
29
2nd line: carbonic anhydrase inhibitors: side effects
ophthalmic: burning, blurred vision, blepharitis, taste disturbances oral: ataxia, confusion, photosensitivity, nausea, metabolic acidosis
30
3rd line: rho kinase inhibitors: drugs
netarsudil (rhopressa) + latanoprost (rocklatan)
31
3rd line: rho kinase inhibitors: dosing
1 drop QPM reduce IOP by 25-30%
32
3rd line: rho kinase inhibitors: side effects
burning, corneal disease, conjunctival hemorrhage, conjunctival hyperemia
33
Last line: cholinergics: drugs
carbachol (milostat) pilocarpine (isopto carpine)
34
Last line: cholinergics: dosing
carbachol: 1-2 drops up to TID pilocarpine: 1-2 drops up to QID reduce IOP by 15-25%
35
Last line: cholinergics: contraindications & warnings
use in caution in patients with history of retinal detachment or corneal abrasion
36
Last line: cholinergics: side effects
pupil constriction, corneal clouding, hypotension, bronchospasm, abdominal cramps
37
Treatment recommendations
1st line: prostaglandin analog, beta blocker, alternative - brimonidine inadequate response: no response - different 1st line option; partial response - add additional 1st or 2nd line option inadequate response again: increase concentration/frequency; add 3rd and/or 4th line agent; consider replacing topical CAI with oral CAI inadequate response to maximally tolerated therapy: laser or surgical procedure
38
Assess response every
2-4 weeks always ensure compliance, proper administration techinque
39
Intolerance present
reduce dose/concentration change formulation switch to class alternative or different combination
40
Close-angle glaucoma is a
medical emergency
41
Symptoms of closed-angled glaucoma
severe headache severe pain N/V blurred vision halos around light eye redness or cloudy cornea
42
Treatment of closed-angle
hyperosmotic agents surgery
43
Hyperosmotic agents
mannitol (IV): 1.5-2 g/kg/dose over 30 minutes glycerin (PO): 1-2 g/kg/dose every 5 hours as required
44
Surgery
iridotomy: laser to creater tiny hole in iris to drain it
45
Recognize which medications can increase the intraocular pressure in the eye
anticholinergics chronic steroids decongestants topiramate antidepressants
46
Anticholinergics
oxybutynin tolterodine benztropine scopolamine
47
Decongestants
pseudoephedrine
48
Antidepressants
fluoxetine paroxetine amitriptyline duloxetine

PHRM 844 Module #2 (23 decks)

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