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Flashcards in Glaucoma Deck (45):
1

What is intraocular pressure? (IOP)

Balance of between rate of formation of aqueous humor and amount of resistance to its outflow

2

What is IOP considered?

The only modifiable risk factor of glaucoma

3

What percentage of cases of primary glaucoma is open angle?

90-95%

4

Is primary open angle glaucoma quick or slow progressing?

Slow

5

What percentage of cases of primary glaucoma is angle closure?

10%

6

Is angle closure glaucoma an emergency?

YES

7

What is the MC agent used in glaucoma?

Beta blockers

8

What to beta blockers do for glaucoma?

Affects on beta receptors in ciliary processes which leads to reduction of aqueous humor production

9

How do you reduce systemic side effects of beta blockers?

Using punctal occlusion -> holding the lacrimal duct for 3-5 minutes

10

What line of tx are beta blockers for glaucoma?

First line agent

11

How effective is Betaxolol as a BB for glaucoma?

Doesnt lower IOP as much as other products

12

What is the gold standard of tx for glaucoma?

Timolol solution

13

Is Timolol solution selective or non-selective?

Non-selective

14

What kind of solution is Timolol?

Gel-forming

15

How often does a pt use Timolol?

Once a day

16

What is the benefit of adrenergic agents?

They act on alpha and beta receptors

17

What affect do adrenergic agents have on alpha receptors?

Decrease aqueous humor production

18

What affect do adrenergic agents have on beta receptors?

Increase in outflow

19

What adrenergic agents are commonly used?

Epinephrine
Dipivefrin

20

What are some SEs of adrenergic agents?

Systemic:
- palpations
- tachycardia
- headache
- anxiety
- increased sweating

21

What is dipivefrin?

A prodrug of epinephrine

22

When is dipivefrin shown to be effective?

When in combo w/ a non-selective beta blocker
*more pronounced IOP decrease*

23

MOA of selective alpha 2 agonists

Decreases aqueous humor production
Increases uveoscleral outflow

24

Two selective alpha 2 agonists

Apraclonidine
Brimonidine

25

When are select alpha 2 agonists used?

W/ other agents if used at all

26

Issue with apraclonidine

Tachyphylaxis develops rapidly

27

When can you use brimonidine alone?

With pts who are intolerant to beta blockers

28

What do cholinergics do to the eye?

Stimulation of sphincter pupillae
and causes miosis

29

What happens when cholinergics work on the eye?

Pulls open the meshwork and increases outflow

30

What does Pilocarpine do?

Reduces IOP by 20-30%

31

What are two cholinergic agents?

Pilocarpine
Carbachol

32

What is a different name for Pilocarpine and how is it released?

Ocusert
Slow-release

33

What is the MOA of cholinergic anticholinesterase agents?

Binds to enzyme which breaks down endogenous acetylcholine
*Cholinesterase inhibitor*

34

When do you use anticholinesterases?

When pts are unresponsive or intolerant of other therapies

35

What is the effect of carbonic anhydrase inhbitors (CAIs)

Inhibit carbonic anhydrase in ciliary body to decrease aqueous formation by 40-60%

36

CAI agents

Dorzolamide and Brinzolamide
Acetazolamide

37

How are dorzolamide and brinzolamide given and how large is the effect?

Topically
Reduced IOP and 15-26%

38

How is acetazolamide given and how large is its effect?

Orally
Reduce IOP by 25-40%

39

What is an issue with acetazolamide?

It has a higher incidence of SEs

40

What do prostaglandin F2-alpha analogues do?

Increase uveoscleral outflow of aqueous humor

41

How many side effects do prostaglandin F2 meds have and what are they?

Fewer than Timolol
Iris pigmentation
Eyelash thickening

42

How efficacious are prostaglandin F2 meds?

Decrease IOP similarly to beta blockers if not MORE

43

Prostaglandin F2 example and dosing

Latanoprost solution 0.05%
Dose q24 hours

44

Tx of angle-closure glaucoma

Go to ER
Iridectomy = definitive tx

45

What are the 3 meds of choice for glaucoma

Beta blockers
Prostaglandin F2-alpha analogues
Carbonic Anhydrase Inhibiton