Lecture 11 - Medical management of Glaucoma 2 Flashcards Preview

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Flashcards in Lecture 11 - Medical management of Glaucoma 2 Deck (42)
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1

What initial beta blocker lowered IOP but caused corneal anesthesia?

Propranol

2

Practolo was developed, in the wake of Propranol, even though it didn't cause corneal anesthesia, what was a major sideffect it created?

Occulomucuataneous syndrome

3

What type of beta adrenoreceptor causes dilation of bronchi and blood vessels?

Beta 2

4

OBB's are what type of beta drug, agonist or antagonist?

Antagonist

5

What is the mechanism of action of a OBB?

Exact mechanism not known but it will reduce aqueous formation

6

What type of stimulation of the Ciliary process interfere with?

Tonic stimulation

Note: This is speculative

7

What type of Glaucoma(s) are OBB's used for?

OAG, Secondary glaucoma, ACG and Ocular HTN

8

What type of Betaxolol is not contraindicated for 1. Pulmonary disease
2. Bronchial Asthma
3. Severe COPD?

Selective OBB's

9

True or False. Taking OBB's twice a day will have a larger impact than once a day?

True

Note: Exception to this rule are:
Isatalol qam
Timoptic XE or GFS (gels) qd
Betagan qd

10

What is the commonly used non-selective OBB?

Timolol 0.5%

11

What is the maximal effect regarding Timolol instillation?

12 hours but IOP lowering will stick around for 24 hours

Note: Onset is 30 minutes

12

When is the best time to to instill Timolol to get the best result?

In the AM

13

True or False. In all pts, short term escape of timolol will occur?

False. Not all pts but the efficacy of Timolol will decrease over a period of time, due to constant antagonism

14

What does Long term drift mean?

Control of IOP is not as good as once, as it use to be. Takes about months to year to occur.

15

What is washout period?

IOP lowering effects may persist for 2 weeks.
Aqueous flow upto 6 weeks

Note: Clinically a 4 week wash out period is acceptable

16

What are the benefits of using gels and disadvantage of using gels?

Advantage: Improve bioavailability, decrease systemic absorption, and once a day drop

Disadvantage: Blurry vision in the morning, has a preservative

17

What is the major difference between Istalol vs. Timoptic XE?

Istalol = BAK
Timpotic XE = Benzododdecinium

18

What does Betaxolol suspension have that the solution does not have?

resin coated beads

Note: Betaxolol is not available in the USA

19

True or False. You can use a selective BB with pts who have pulmonary disease?

True.

Note: Betxolol can used for this process and is less effective compared to Timolol

20

What are three benefits of betaxolol properties?

1. May possess calcium channel blocker properties
2. Thus may have neuroprotectic effect*
3. Highly lipid soluble, binds well with plasma proteins

21

What are three ocular sideeffects of propranolol?

Discomfort, Burning and stinging

22

What OBB is associated with granulomarous uveitis?

Metipranolol

23

What are 4 local sideffects regarding BAK usage?

1. Decreased tear production
2. Decreased goblet cell density
3. Dry eye symptoms
4. Ocular cicatrical pemphigoid.

24

Which method do OBB's enter the systemic system?

Nasolacrimal system

25

True or False. One of the major CNS adverse effects is the decrease in libido in men.

True but its also true in women aswell

26

What do OBB's do to cardiovascular effects?

Reduce blood pressure
Bradycardia

27

What receptor is blocked that causes pulmonary effects?

Beta 2 receptor

28

True or False. OBB's affect hypoglycemia?

True

29

Why is clonidine not used in IOP lowering?

Causes sedation, systemic hypotension and narrow therapeutic index

30

Apraclonidine would be a great IOP recducer but why is it not used?

Very hydrophillic, therefore does not penetrate eyes and BBB

Note: Use Post-laser surgery