Glaucoma_Test1 Flashcards by Caleb Saint

What does blocking nor-epinephrine do?

Blocks the formation of aqueous.

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Which two category of drugs work via blocking nor-epinephrine?

Beta blockers

Alpha-2 agonists

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What concentration is yellow cap for beta blockers?

0.50%

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What concentration is blue cap for beta blockers?

0.25%

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Are there more beta specific or non-specific glaucoma drugs available?

Beta non-specific

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Are there bilateral effects when using beta blockers?

Yes.

Due to systemic absorption.

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Which two categories work during the night time?

CAIs

PGAs

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Describe short term escape of beta blockers?

There is an initial drop in pressure, then rise.

Takes 2-4 weeks to see a true decrease in pressure after that.

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Describe long term drift?

Beta blockers become ineffective.

IOP steadily rises after long-term trt.

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T/F?

Long term drift is a common problem with beta blockers?

True

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Blocking nor-epinephrine results in a reduced (blank) activity?

Sympathetic

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What are some Ocular allergic rxns associated with beta blocker usage?

Hyperemia
Stinging
Corneal hypoaesthesia
Punctate keratitis

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What is a general laundry list of adverse effects found in beta blockers?

BP decrease
Bradycardia
Pulmonary bronchiole contraction
Anything mental(drowsiness, depression, anxiety)
Death
Impotence
Altered lipid profiles
Depression

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What are some contraindications for Beta blockers?

Bradycardia(symptomatic and asymptomatic w/ heart block)
COPD/Asthma/Emphysema
MG
Athletes
CHF(in the past)

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If you want to prescribe to a pt beta blockers, what must you need to do?

Baseline BP
Pulse measurement
Review medical hx

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When do you need physician approval for beta blocker?

When giving topical along with oral form of beta blocker.

This will result in a greater form of bradycardia.

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T/F?

Beta blockers are beneficial to those with CHF and anti-arrhythmia

True

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Can diabetics use beta blockers?

Yes

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What is the oral equivalence of the usage of topical beta blockers?

20 mg.

It will produce the same systemic effects

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T/F?

Beta blockers work well in children?

True

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T/F?

Beta blockers work well in uveitic glaucoma?

False

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Give me two reasons why not to prescribe beta blockers qhs

Pts with Nocturnal hypotension; may lower BP further

2. Have no IOP lowering effect at night/during sleep

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Name a site that produces bicarbonate?

Secretory neuroepithelial cells of ciliary body

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CAI systemic contraindications?

Sulfa allergies
Sickle cell disease
Hypokalemia
Renal disease
Liver disase

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When do you use Acetazolamide?

post surgically | Acute angle closure (250mg)

T/F? | Methazolamide is better tolerated than Acetazolamide?

True

Timolol Maleate IOP Reduction?

25-30%

CAI top IOP reduction?

10-26%

Trusopt is better tolerated than Azopt?

False

Which category of glaucoma drugs work well in uveitic glaucoma?

Topical CAIs

Are you allowed to use top CAIs in children?

Yes | Also Beta blockers

What are the three main things you should look out for in pts before prescribing topcial CAIs?

Compromised corneal endothelium (perform specular reflection) Allergy to sulfa medications Hx of renal stones.

Caleb, will you use Oral CAIs for the chronic care of glaucoma?

NO | Use topical CAIs

Which is the best class of glauc meds to combine with PGAs?

Top CAIs

``` Prasymathetic effects on Iris: CB: TM Ciliary meshwork: (uveal meshwork-uveoscleral pathway) ```

Iris: miosis CB: accommodation and TM opening TM: aq outflow increase Ciliay meshwork: aq outflow decrease

What are some contraindications of miotics?

Uveitic glaucoma and any other sig oc inflamm Aphakia Pre-presbyopia (not tolerated) Posterior subcapsular cataract present

Why is it that pilocarpine can mimi the blinding effects of glaucoma?

Miosis. This increases field constriction.

List the side effects of pilocarpine

``` Miosis Brow ache: CB contraction Globe and orbital pain Allergic rxns Increased myopia due to accommodative spasm Vision reduction Posterior synechia Ret detach: Angle closure: due to pupil block with a changing cataract lens Field constriction ```

What is 4% Pilopine Gel HS:

Side effects occur during sleep and may be better tolerated.

When do you use miotics?

When surgery is not an option in advanced stage glaucoma. Primary angle closure glaucoma just before laser surgery. NOT FOR LONG TERM GLAUCOMA CARE NOT FOR UVEITIS

What happens if you pour pilocarpine into pt's eye?

Diarrhea

What are the two forms of Fixed combos?

Topical beta blocker/CAI | Topical beta blocker/ Alpha2 agonist

Why is there only 2 fixed combo agents?

FDA | They demand that combo lowers IOP by 2mmHg than both solo drug

When do you use osmotics?

Emergency Care: Acute angle closure One time usage. No chronic care of glaucoma

Serious side effect of osmotics?

Emesis (vomitting). | This fill further reduce IOP

What does BAK stand for?

Benzalkonium chloride

Side effects of BAK?

Disruption of corneal integrity Chronic low grade conj inflammation Burn out of goblet cells Dry eye & Ocular surface disease

Which drugs are not used commonly for current glauc therapy?

Oral CAIs Pilocarpine Iopidine

Which drugs are not used in glauc current therapy?

All other miotics | Epinephrines

What is our only therapeutic option for glaucoma?

Reduction of IOP

T/F? | Prostaglandins are chemical mediators of inflammation?

True

What is the cap color for PGAs

Teal

T/F? | PGAs are dependent of episcleral venous pressure?

False

What are some ocular adverse effects of PGAs?

``` Hyperemia Punctate keratopathy Increased eyelash and nose hair growth Blurred vision Dry eye Increased iris coloration Cells/flares Periorbitopathy CME ```

How do you avoid periorbitopathy?

By drying the skin immediately. | May not be reversible.

What are some components of periorbitopathy?

Periorbital skin darkening | Deepening of ocular sulcus

What percentage of population do not respond to PGAs?

10-20%

Are there any systemic side effects associated with PGA?

NO | Short half life

Who cannot use PGAs

Children | Pregnant chicks

What is the max amt of time PGAs can work after taking the drop?

60 hours

What is absolutely irreversible with PGAs?

Iris coloration. | Be careful of monocular usage.

Organize concentration of PGAs from highest to lowest

Bimatoprost 0.01% Latanoprost 0.005% Travoprost 0.004% Tafluprost 0.0015%

Relating to PGA.... T/F? Any medication that reduces IOP will increase perfusion by reducing blood flow impedance?

True

T/F? | You are able to use PGAs in uveitic pts?

False

What special cases should one use PGA?

Elevated episcleral venous pressure | IOP rise secondary to carotid cavernous sinus fistula.

T/F? | Hyperemia is an allergic rxn to PGA?

False. | It is a response to the prostglandin, which mitigates inflammation.

What was Rescula developed from?

PGA metabolite

T/F? | Sympathomimetic is norepinephrine based.

True

What is alpha 1 action on blood vessels of CB?

Vasoconstriction: Reduces blood flow Reduces aqueous production These are epinephrine like drugs

Where does alpha 2 agonists act?

Nerve terminal | Stimulation results in diminished release of nor-epinephrine

What happens when there is a reduction in norepinephrine release?

There is a decrease in aqueous production due to a reduction in sympathetic tone

What happens if you block beta receptors?

There is a decrease in aqueous production.

What are the two uses for 1% Iopidine?

Acute angle closure Prevention of IOP spike during laser surgery Horner's Syndrome

What was the effect of adding Purite to Alphagan?

The incidence of local toxic adverse effects got reduced by 40%

T/F? | Allergic responses can happen at any time with alphagan usage?

True

What are the most sig side effects of Alphagan?

``` Drowsiness Fatigue Dry mouth Crosses BBB coma in children ```

Other side effects of alphagan?

Conjunctivitis Blurring Burning Headache

Glaucoma_Test1 Flashcards

(77 cards)