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Clinical Pharmacy > Glaucoma Pharmacology > Flashcards

Glaucoma Pharmacology Flashcards

1
Q

What are strong risk factors for getting glaucoma?

A
  • high IOP
  • aging (>40 y)
  • family history - first degree relative
  • race (blacks 4x)
  • optic disc appearance
  • corneal thickness >0.5 mm
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2
Q

What are the possible risk factors for getting glaucoma?

A
  • high myopia (near sightedness)
  • diabetes
  • hypertension
  • eye injury/surgery
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3
Q

What are the other risk factors that are possible for getting glaucoma?

A
  • history of steroid use
  • sleep apnea
  • gender = male
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4
Q

What is the basic pathophysiology of experiencing glaucoma?

A
  • when the axons going to the eye die off
  • the axon plasma flows within the structures get cut off- nothing going to the eye
  • the vasculature within the eyes gets pinched off and stops the blood flow from being carried to the rain
  • when pressure within the eye increases, then there is a cut off of messengers from going outside of the eye
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5
Q

What is the upper limit of normal for IOP?

A
  • 21 mm Hg is the upper limit of normal
  • some are safe at 22-30 mm Hg
  • some may have damage at < 21 mm Hg
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6
Q

What ethnic groups have a high rate of closed angle glaucoma?

A
  • inuit of the north and Chinese or east indian groups
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7
Q

What is normal IOP?

A
  • 10-21 mm Hg
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8
Q

Pressure within the eye is due to a pressure balance of ________. What produces this?

A 
aqueous humor (AH)
- ciliary body
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9
Q

What helps with drainage of IOP from the eye?

A
  • trabecular meshwork
  • canal of schlemm (80%)
  • uveoscleral outflow (20%)
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10
Q

Open angle glaucoma is primarily a defect in what?

A
  • primary a defect in decreased drainage

- tx: drainage and/or humour production

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11
Q

Closed angle glaucoma is primarily a defect of what?

A
  • ballooning of the iris, aqueous humour flow is:
  • increased pressure
  • in an emergency situation acute drug treatment followed by surgery
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12
Q

What are the 2 main approaches to treating glaucoma?

A
  • decrease production of AH
    (receptors on ciliary body, carbonic anhydrase)
  • increase drainage
    (trabecular meshwork and canal of scheme, uveoscleral outflow and surgical intervention)
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13
Q

For drugs to penetrate the epithelial layer, the drug should be ____

A

hydrophobic

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14
Q

For drugs to penetrate the stroma, the drug should be _____

A

hydrophilic

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15
Q

For drugs to penetrate the epithelial layer or the endothelial layer, the drug should be _____

A

hydrophobic

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16
Q

What should patients be counselled to do to stop the drug from getting into the systemic circulation?

A
  • should always counsel the patient on how to compress the teat ducts- then this way you will stop the drug from going systemic
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17
Q

What is an example of a parasympathetic drug (miotics)?

A
  • pilocarpine (receptor agonists), carbachol (receptor agonists)
  • the peripheral vision starts to decrease to start off
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18
Q

What are common symptoms when the IOP gets over 60 mm of Hg?

A
  • N/V, cramping, the person can see halos, the iris becomes unresponsive and will not move
  • these attacks can occur intermittently or can occur all the time
  • over time the person will need to receive treatment for this in order to stop the progression - will make a surgical tunnel going out tot he sclera, creating a bleb that drains fluid all the time
  • can also use lasers to punch holes in the eyes to drain fluid
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19
Q

What are the most common SE of pilocarpine?

A
  • increased outflow of aqueous humour pilocarpine for OAG and CAG
  • poor night vision, blurred vision and aching
  • loss of accompodative spasm with pilocarpine
  • brow ache (this clears after about 2 weeks)
  • contraindicated with miosis (this is undesirable)
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20
Q

Avoid strong miotics in _______

A

retinal detachment

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21
Q

What are some of the main SE of miotics?

A

GI, salivation

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22
Q

Why is nasolacrimal occlusion so important in drugs that are miotics?

A
  • they can cause heart block, cramping and salivation

- if you decrease the amount of blood you get into the systemic circulation then you decrease the SE profile

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23
Q

What is a common complication of closed angle glaucoma?

A
  • floppy iris
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24
Q

What is the MOA of epinephrine?

A
  • improves outflow (uveoscleral and TM)
  • acts on the alpha and beta adrenoreceptors in the ciliary body
  • increased outflow (yet mydriasis) but may actually increase the aqueous humour production
  • avoid in CAG
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25
Q

What are the systemic problems associated with drugs used for glaucoma?

A
  • avoid in hypertension and heart disease

- adrenochrome deposits

26
Q

What is the use of aproclonidine?

A
  • used post eye surgery
  • peak IOP
  • aqueous humor production
27
Q

What is the use of brimonidine?

A
  • most common of this class
  • aqueous humor production and increases outflow (uveoscleral)
  • lowers IOP with minimal systemic effects
28
Q

What is the class of a drug like timolol?

A
  • beta adrenoreceptor blocker
29
Q

What is timolol useful in?

A
  • useful in OAG and CAG

- decreases the production of aqueous humour

30
Q

What are the contraindications of beta adrenoreceptor blockers?

A
  • heart failure
  • asthma
  • COPD
  • diabetes
  • heart block
  • sinus bradycardia
31
Q

What are examples of carbonic anhydrase inhibitors?

A
  • topical is most frequent
  • acetazolamide is used both orally and by IV
  • inhibits HCO3 from forming in the ciliary body- aqueous humour production
  • oral not for chronic use- useful for emergencies
  • SE: metabolic acidosis, K depletion, fatigue, depression, allergies
32
Q

Prostaglandin analogues are a ____ class of drugs for glaucoma

A
  • novel
33
Q

What is the MOA of prostaglandin analogues?

A
  • decrease the IOP by increasing the uveoscleral outflow in humans - 20% of AH drained from this route
  • increase this outflow by both relaxing the ciliary muscle and directly altering the extracellular matrix to decrease outflow resistance
34
Q

Pilocarpine causes ciliary muscle ______ leading to outflow

A

contraction

35
Q

Atropine causes ciliary muscle ______ leading to outflow

A

relaxation

36
Q

What are the topical SE of prostaglandin analogues?

A
  • allergy and conjunctival redness
  • may increase/change iris pigmentation (brown)
  • may produce eyelid darkening
  • can increase eyelash thickness, number, pigmentation, size
37
Q

What are the systemic SE of prostaglandin analogues?

A
  • skin reaction, chest pain, muscle and joint pain, GI disturbances
38
Q

What is the main use of hyper osmotic solutions?

A
  • emergency management of angle closure
  • may be used to decrease pressure pre-operatively
  • avoid in severe dehydration, pulmonary edema and CHF
39
Q

What kind of drug is considered the gold standard for treating glaucoma?

A
  • beta blockers

- switch out for something else only if beta blockers are contra-indicated or ineffective

40
Q

Try monotherapy with glaucoma drugs with what drugs?

A
  • prostaglandins, local CAI’s, alpha2 agonist, if ineffective
41
Q

Therapy should be started with _______

A

one eye

42
Q

How often should the IOP be monitored once a patient is stabilized?

A
  • the IOP should be monitored every 2-4 months

- visual field and optic disc should be monitored once yearly

43
Q

_____ agents are useful for eye examinations

A

Mydriatic

44
Q

_______ agents are useful for accurate refractions and providing relief from ciliary spasm during inflammation

A

Cycloplegic

45
Q

______ drugs produce both mydriasis and cycloplegia

A

Parasympathetic

these are contraindicated in glaucoma

46
Q

What are 2 examples of drugs that are parasympathetic?

A
  • atropine and tropicamide
47
Q

_____ drugs are mydriatic with little/no cycloplegia

A

Sympathetic

use caution of these drugs in glaucoma, heart disease and hypertension

48
Q

What is an example of a drug that is sympathetic?

A
  • phenylephrine
49
Q

What is the function of the lens in the eye?

A
  • the lens in the eye can focus light onto the retina and adjusts to focus objects both up close or far away providing for clear vision
50
Q

Describe a sub-capsular cataract

A
  • occurs at the back of the lens
  • people with diabetes or those taking high doses of steroid medications have a greater risk of developing a sub capsular cataract
51
Q

Describe a nuclear cataract

A
  • forms deep in the central zone (nucleus) of the lens

- associated with aging

52
Q

Describe a cortical cataract

A
  • characterized by white, wedge-like opacities that start in the periphery of the lens and work their way in to the centre in a spoke like fashion
53
Q

What is the most common cause of cataracts?

A
  • aging
54
Q

What are other causes associated with cataracts?

A
  • prolonged use of corticosteroids
  • statins
  • phenothiazines
  • inflammation
  • trauma
  • radiation exposure
  • systemic disease(diabetes, wilson’s disease)
55
Q

What are the clinical symptoms of cataracts?

A

-reduced vision, glare while driving during the dat and at night with headlights, dulling colours, double images

56
Q

What is the most common post op complication?

A
  • uveitis
57
Q

Describe uveitis

A
  • some inflammation in the anterior chamber is to be expected post op, however persistent inflammation beyond 4 weeks and or unusual severity early post op is not typical
58
Q

What are some of the most common causes of uveitis?

A
  • infectious endophthalmitis
  • phacoanaphylaxis
  • abrupt taper to corticosteroids
  • patient non-adherence to corticosteroid drops
  • pre-existing uveitis
  • use of prostaglandin hypotentsive drugs
59
Q

Describe infectious endophthalmitis?

A
  • presents: worsening redness, pain, photosensitivity, and decreasing vision
  • treatment: intravitreal ABs
60
Q

What are the signs of post op intraocular pressure spikes?

A
  • redness, pain, photophobia, IOP >35 mmHg, N/V can occur
61
Q

What is the drug of choice in post op intraocular pressure spikes?

A
  • beta blockers drug of choice

- avoid prostaglandins

62
Q

What is the treatment to be used for a posterior capsule opacification?

A
  • YAG capsulotomy (creates a hold in posterior opaque membrane)
  • patient adherence to eye drop instructions is crucial to having a successful outcome in cataract surgery

Clinical Pharmacy (24 decks)

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