Glaucoma Flashcards Preview

PPS 946 > Glaucoma > Flashcards

Flashcards in Glaucoma Deck (32):
1

Ocular Hypertension

Elevated IOP without glaucomatous changes

2

Primary Open-Angle Glaucoma (POAG)

Normal anterior chamber angles
Glaucomatous changes of the optic disc
Peripheral visual field loss

3

Primary Angle-Closure Glaucoma (PACG)

Obstruciton of the anterior angle by the iris
Moderate to high elevations in IOP

4

Gonioscopy

Examination of the anterior chamber angle

5

Perimetry

Measure of the field of vision

6

Tonometry

Measures IOP
Does not test for glaucomatous changes.

7

Initial Target Estimate for IOP

20% of baseline
30-50% in Severe disease or Normal Tension Glaucoma

8

Well Tolerated Starting Pharmacotherapy Agents

Prostaglandins
Beta-Blockers
Brimonidine

9

When giving topical ocular solution how long must you wait to give another drug?

5 minutes

10

Trabeculoplasty

Laser Surgery

11

Trabeculoectomy

Surgery
Removal of trabecular meshwork

12

These two drugs are given during surgery to decrease scaring.

Mitomycin C
Antifibrotic agent

13

Treatment of Choice for PACG

Laser Iridotomy

14

Medical Therapy is used to do what in acute PACG?

Lower IOP
Reduce pain
Reverse corneal edema

15

Agents used to lower IOP in Acute PACG

Topical Beta-Blockers
Topical Alpha-agonists
Prostaglandin F2alpha analog
Systemic Carbonic Anhydrase Inhibitors
Hyperosmotic Agents

16

In Acute PACG, once IOP is under control this medication is used to break through the pupillary block.

Pilocarpine

17

These two drugs can induce PAOG

Docetaxel/Paclitaxel
Corticosteroids

18

These 3 drug classes can induce PACG

Adrenergic Agents
Anticholinergics
Sulfa-drugs

19

MOA of Prostaglandin Analogs

Increase uveoscleral outflow
Lower IOP 25-35%

20

Contraindications for prostaglandin analogs

Hypersensitivity

21

Rare ADR of prostaglandin analogs

Diplopia
Retinal detachment
Vitreous Hemorrhage

22

MOA of Beta-adrenergic antagonists

Decrease aqueous production and IOP by 20-25%

23

Contraindications of Beta-adrenergic antagonists

Sinus Bradycardia
Greater than first-degree AV block
Cardiogenic shock
Overt Cardiac failure

Non-selective drugs are contraindicated for bronchial asthma or severe COPD.

24

MOA of Alpha2-Adrenergic Agonists

Decrease production of aqueous humor
Lowering IOP by 18-2&%

25

Contraindications for Alpha2-Adrenergic Agonists

Hypersensitivity
Pt. on MAO inhibitors

26

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%

27

Precautions of CAIs

Don't use in renal impairment
Caution in patients with hepatic impairment
Caution in patients with sickle cell anemia.

28

Contraindications for CAIs

Sulfonamide allergy
Hypokalemia
Hyponatremia
Hyperchloremic acidosis
Adrenocortical insufficiency
Marked renal or hepatic impairment
Severe COPD
Long term use in PACG

29

Special Instructions for CAIs

Monitor patient on the following:
Malaise or fatigue, Creatinine, serum potassium, serum carbon dioxide, baseline CBC and platelet count

30

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.

31

Precautions for Cholinergics and cholinesterase inhibitors

Pregnancy and lactation
Night driving
Pts with retinal detachment, asthma, bradycardia, hypotension

32

Contraindications for Cholinergics and cholinesterase inhibitors

Acute iritis
Uveal inflammation
Pupillary block glaucoma