Glaucoma therapeutics

Question 1

1. Elevated IOP
2. Thinning of retinal nerve fibre and macular ganglion layer
3. optic disk cupping and peripheral vision loss

What is this called?

Answer 1

Glaucoma

Question 2

What are the 3 types of glaucoma?

Answer 2

1. open angle
2. angle closure
3. secondary/acquired

Question 3

This blockage in the trabecular meshwork results in the eye’s inability to drain the aqueous humor, leading to increased intraocular pressure

Answer 3

open angle glaucoma

Question 4

T or F: the iris blocks the flow of aqueous humor in open angle glaucoma

Answer 4

False: the drainage system is blocked. The iris is not blocking it

Question 5

5 risk factors for glaucoma

Answer 5

Demographics: Older age, Female, African, Irish, Russian, Japanese, Hispanic, Inuit, or Scandinavian descent
Family history
Medical history: Diabetes, High blood pressure, Chronic corticosteroids
Prior eye injury or surgery
Increased IOP

Question 6

Ages + screening of open-angle glaucoma

Answer 6

< 40, every 10 years
40-49 every 3 years
50-59 every 2 years
60+ annually

Question 7

Closure of the angle between the iris and cornea, obstructing the outflow of aqueous humour

Answer 7

angle-closure glaucoma

Question 8

What kind of glaucoma is it when the trabecular meshwork is blocked by the iris and the aqueous humour cant drain properly

Answer 8

closed-angle glaucoma

Question 9

Symptoms of acute attacks in closed-angle glaucoma and what can happen if untreated?

Answer 9

pain, blurry vision, halos around lights,
headache, N/V

can become blind in 24 hours

Question 10

Risk factors for closed-angle glaucoma

Answer 10

Demographics: Older age , Female, East Asian ancestry •
Family history •
Other ocular factors

Question 11

• Congenital defects
  • Trauma, surgery, insult/infection
  • Corticosteroid use

Answer 11

secondary or acquired glaucoma

Question 12

2 goals of therapy

Answer 12

Preserve visual function by slowing or halting the progression of
disease: Lower IOP and Preserve structure & function of the optic nerve

Maintain or enhance health-related quality of life

Question 13

What is the pressure that is likely to stop further damage to the optic nerve
(don’t give a number)

Answer 13

target IOP

Question 14

Treatment for angle-closure glaucoma?

Answer 14

Referral! Pt needs surgery asap

Question 15

What is the function of prostaglandin analogue?

a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production
d) Increased aqueous humor outflow

Answer 15

b) increase aqueous humor outflow

Question 16

What is the function of beta blockers?

a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production

Answer 16

c) Decreased aqueous humor production

Question 17

What is the function of Alpha 2 agonists?

a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production
d) Increased aqueous humor outflow

Answer 17

a) decrease production and increase outflow

Question 18

What is the function of cholinergic?

a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production

Answer 18

b) Increased aqueous humor outflow

Question 19

What is the function of carbonic anhydrase?

a) Decreased production & increased outflow
b) Increased aqueous humor outflow
c) Decreased aqueous humor production

Answer 19

c) decrease aqueous humor production

Question 20

List the order of medications in most efficacy

bimatoprost, pilocarpine, timolol, brinzolamide, dorzolamide, latanoprost. brimondine, surgery

Answer 20

latanoprost
bimatoprost
timolol
dorzolamide
brinzolamide 
brimonidine 
pilocarpine 
surgery

Question 21

Which prostaglandin analogue may increase trabecular flow?

Answer 21

bimatoprost

Question 22

Increase uveoscleral outflow which med?

Answer 22

prostaglandins (latanoprost)

Question 23

The side effects of prostaglandin analogue?

Answer 23

iris colour change
eyelash changes

hyperemia
migraine-like headache
flu like symptoms

Question 24

Contraindications in prostaglandin analogues

Answer 24

pregnancy
macular edema
history of herpetic keratitis
active uveitis

Question 25

The function of Beta-Adrenergic Antagonists in glaucoma

Answer 25

Inhibit formation of aqueous humor

Question 26

Betaxolol Timolol which one is selective which one is non-selective

Answer 26

betaxolol is selective | timolol is selective

Question 27

Side effects of Beta-Adrenergic Antagonists

Answer 27

``` Allergic conjunctivitis --> know this one for sure Bradycardia Bronchospasm Hypotension May mask symptoms of hypoglycemia ```

Question 28

contraindications to beta-blockers

Answer 28

* Asthma, severe COPD * Sinus bradycardia * 2nd or 3rd-degree heart block * Heart Failure * Hypotension * Myasthenia gravis caution in pregnancy but can be used in lactation

Question 29

Function of alpha 2 adrenergic agonists?

Answer 29

decrease AH production | increase uveoscleral outflow

Question 30

Side effects of Alpha 2 adrenergic agonists?

Answer 30

``` allergic conjunctivitis bitter taste dry mouth and nose hypotension headache fatigue ```

Question 31

contraindications of alpha 2 adrenergic agonists

Answer 31

With MAOIs | use with caution in pregnancy

Question 32

The function of carbonic anhydrase inhibitor

Answer 32

inhibit bicarbonate ion to form in aqueous humor

Question 33

Side effects of Carbonic Anhydrase Inhibitors

Answer 33

Allergic/ dermatitis/conjunctivitis •Burning •Corneal edema •Metallic/sour taste

Question 34

Contraindications of carbonic anhydrase inhibitors

Answer 34

``` Kidney stones •Aplastic anemia •Sickle cell anemia •Thrombocytopenia ?Sulfa allergy ```

Question 35

Function of Parasympathomimetics (Cholinergics)

Answer 35

Directly stimulate muscarinic receptors to contract the ciliary muscle and increase trabecular outflow

Question 36

Side Effects of Parasympathomimetics (Cholinergics)

Answer 36

intestinal cramps blurred vision bronchospasm retinal detachment

Question 37

Contraindications Parasympathomimetics (Cholinergics)

Answer 37

neovascular, uveitc, or malignant glaucoma | use in caution with pregnancy

Question 38

3 methods to intensify therapy for glaucoma

Answer 38

1. combine topical medications 2. Laser therapy 3. surgery

Question 39

how long to wait before putting in eye contacts after drops

Answer 39

Need to wait at least 15 minutes after drops before contacts lens insertion

Question 40

List 2 preservative free eye drops

Answer 40

travoprost | brimonidine

Question 41

``` Efficacy points to monitor for – IOP/visual field/optic nerve head • early: at least every ____ months • moderate: at least every ___ months • severe: at least every ___ months ```

Answer 41

* early: at least every 12 months * moderate: at least every 6 months * severe: at least every 4 months

Question 42

Medications to avoid with open-angle glaucoma

Answer 42

Corticosteroids (all formulations)

Question 43

Medications to avoid in closed-angle glaucoma

Answer 43

``` Antidepressants Anticholinergic medications such as 1st gen antihistamines, some antipsychotics Antispasmodics Adrenergic agents such as decongestants ``` Sulfonamides --> allergic reaction