Flashcards in Glaucoma Deck (32):
Elevated IOP without glaucomatous changes
Primary Open-Angle Glaucoma (POAG)
Normal anterior chamber angles
Glaucomatous changes of the optic disc
Peripheral visual field loss
Primary Angle-Closure Glaucoma (PACG)
Obstruciton of the anterior angle by the iris
Moderate to high elevations in IOP
Examination of the anterior chamber angle
Measure of the field of vision
Does not test for glaucomatous changes.
Initial Target Estimate for IOP
20% of baseline
30-50% in Severe disease or Normal Tension Glaucoma
Well Tolerated Starting Pharmacotherapy Agents
When giving topical ocular solution how long must you wait to give another drug?
Removal of trabecular meshwork
These two drugs are given during surgery to decrease scaring.
Treatment of Choice for PACG
Medical Therapy is used to do what in acute PACG?
Reverse corneal edema
Agents used to lower IOP in Acute PACG
Prostaglandin F2alpha analog
Systemic Carbonic Anhydrase Inhibitors
In Acute PACG, once IOP is under control this medication is used to break through the pupillary block.
These two drugs can induce PAOG
These 3 drug classes can induce PACG
MOA of Prostaglandin Analogs
Increase uveoscleral outflow
Lower IOP 25-35%
Contraindications for prostaglandin analogs
Rare ADR of prostaglandin analogs
MOA of Beta-adrenergic antagonists
Decrease aqueous production and IOP by 20-25%
Contraindications of Beta-adrenergic antagonists
Greater than first-degree AV block
Overt Cardiac failure
Non-selective drugs are contraindicated for bronchial asthma or severe COPD.
MOA of Alpha2-Adrenergic Agonists
Decrease production of aqueous humor
Lowering IOP by 18-2&%
Contraindications for Alpha2-Adrenergic Agonists
Pt. on MAO inhibitors
MOA of Carbonic Anhydrase Inhibitors
Causes a decrease in sodium and water outflow from the ciliary body, but 99% of CAs must be inhibited
IOP lowering by 15-25%
Precautions of CAIs
Don't use in renal impairment
Caution in patients with hepatic impairment
Caution in patients with sickle cell anemia.
Contraindications for CAIs
Marked renal or hepatic impairment
Long term use in PACG
Special Instructions for CAIs
Monitor patient on the following:
Malaise or fatigue, Creatinine, serum potassium, serum carbon dioxide, baseline CBC and platelet count
MOA of Cholinergics and Cholinesterase Inhibitors
Carbachol and pilocarpine are direct cholinergic agonists that act on ACh receptors to stimulate ciliary muscle
Cholinesterase Inhibitors act indirectly bin inhibiting AChE.
Ease the restriction of outflow of aqueous humor through the trabecular meshwork.
Precautions for Cholinergics and cholinesterase inhibitors
Pregnancy and lactation
Pts with retinal detachment, asthma, bradycardia, hypotension