Glaucoma

Question 1

Ocular Hypertension

Answer 1

Elevated IOP without glaucomatous changes

Question 2

Primary Open-Angle Glaucoma (POAG)

Answer 2

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

Question 3

Primary Angle-Closure Glaucoma (PACG)

Answer 3

Obstruciton of the anterior angle by the iris

Moderate to high elevations in IOP

Question 4

Gonioscopy

Answer 4

Examination of the anterior chamber angle

Question 5

Perimetry

Answer 5

Measure of the field of vision

Question 6

Tonometry

Answer 6

Measures IOP

Does not test for glaucomatous changes.

Question 7

Initial Target Estimate for IOP

Answer 7

20% of baseline

30-50% in Severe disease or Normal Tension Glaucoma

Question 8

Well Tolerated Starting Pharmacotherapy Agents

Answer 8

Prostaglandins
Beta-Blockers
Brimonidine

Question 9

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

Answer 9

5 minutes

Question 10

Trabeculoplasty

Answer 10

Laser Surgery

Question 11

Trabeculoectomy

Answer 11

Surgery

Removal of trabecular meshwork

Question 12

These two drugs are given during surgery to decrease scaring.

Answer 12

Mitomycin C

Antifibrotic agent

Question 13

Treatment of Choice for PACG

Answer 13

Laser Iridotomy

Question 14

Medical Therapy is used to do what in acute PACG?

Answer 14

Lower IOP
Reduce pain
Reverse corneal edema

Question 15

Agents used to lower IOP in Acute PACG

Answer 15

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

Question 16

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

Answer 16

Pilocarpine

Question 17

These two drugs can induce PAOG

Answer 17

Docetaxel/Paclitaxel

Corticosteroids

Question 18

These 3 drug classes can induce PACG

Answer 18

Adrenergic Agents
Anticholinergics
Sulfa-drugs

Question 19

MOA of Prostaglandin Analogs

Answer 19

Increase uveoscleral outflow

Lower IOP 25-35%

Question 20

Contraindications for prostaglandin analogs

Answer 20

Hypersensitivity

Question 21

Rare ADR of prostaglandin analogs

Answer 21

Diplopia
Retinal detachment
Vitreous Hemorrhage

Question 22

MOA of Beta-adrenergic antagonists

Answer 22

Decrease aqueous production and IOP by 20-25%

Question 23

Contraindications of Beta-adrenergic antagonists

Answer 23

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

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

Question 24

MOA of Alpha2-Adrenergic Agonists

Answer 24

Decrease production of aqueous humor

Lowering IOP by 18-2&%

Question 25

Contraindications for Alpha2-Adrenergic Agonists

Answer 25

Hypersensitivity | Pt. on MAO inhibitors

Question 26

MOA of Carbonic Anhydrase Inhibitors

Answer 26

Causes a decrease in sodium and water outflow from the ciliary body, but 99% of CAs must be inhibited IOP lowering by 15-25%

Question 27

Precautions of CAIs

Answer 27

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

Question 28

Contraindications for CAIs

Answer 28

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

Question 29

Special Instructions for CAIs

Answer 29

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

Question 30

MOA of Cholinergics and Cholinesterase Inhibitors

Answer 30

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.

Question 31

Precautions for Cholinergics and cholinesterase inhibitors

Answer 31

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

Question 32

Contraindications for Cholinergics and cholinesterase inhibitors

Answer 32

Acute iritis Uveal inflammation Pupillary block glaucoma