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SCOT > Medical Management Of Glaucoma > Flashcards

Medical Management Of Glaucoma Flashcards

1
Q

Methods for managing glaucoma

A
  • reduce IOP
  • reduce inflow
  • increase outflow
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2
Q

What treatment options are avaliable excluding ocular medication

A
  • topical hypotensives
  • YAG laser
  • trabeculectomy
  • deep sclerectomy
  • oral azetazolamide
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3
Q

What are the 6 classes of topical drugs available

A
  • prostaglandin
  • beta blocker
  • carbonic anhydrase
  • alpha 2 agonist
  • miotic
  • ROCK inhibitor
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4
Q

Examples of prostaglandin analogues and mechanism

A

Increased uveoscleral outflow by ciliary muscle relaxation

  • latanaprost (xalatan)
  • travoprost (travastan)
  • bimatoprost (lumigan)
  • talfuprost
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5
Q

Mechanism of action PG

A
  • pro inflammatory molecules
  • act at F2 inhibitors In ciliary muscle
  • increase aqueous outflow by indicating ciliary muscle relaxation
  • initial effect after 2 hours
  • peak effect after 8 hours
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6
Q

Prostaglandin contraindications

A
  • uveitis
  • CMO
  • pseudophakic
  • HSK
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7
Q

Prostaglandin side effects

A
  • conjunctival hyperaemia
  • mild punctate keratopathy
  • foreign body sensation
  • ocular irritation
  • increased iris pigmentation
  • lengthening of eyelashes
  • CMO
  • reactivate HSK
  • exacerbate uveitis
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8
Q

Carbonic anhydrase inhibitor examples

A
  • Dorzolamide
  • brinzolamide
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9
Q

Carbonic anhydrase inhibitor mechanism

A
  • reduce aqueous production by inhibiting enzyme carbonic anhydrase
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10
Q

CAI side effects

A
  • blurred vision
  • eye irritation
  • eye pain
  • FB sensation
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11
Q

Beta blockers example

A
  • timolol
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12
Q

Beta blocker mechanism of action

A
  • decreases aqueous production by reducing ultra filtration
  • ultra filtration is a process by which aqueous is produced
  • 20/30% reduction
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13
Q

Beta blocker ocular side effects

A
  • Corneal hypaethesia
  • punctate keratopathy
  • dry eye syndromes
  • burning/stinging
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14
Q

BB systemic side effects

A
  • anxiety
  • hallucinations
  • skin disorders
  • depression
  • GI disturbance
  • bradycardia
  • systemic hypotension
  • heart failure
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15
Q

Beta blocker contraindications

A
  • arrhythmias
  • cardiac failure
  • COPD
  • asthma
  • calcium channel blockers
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16
Q

Alpha 2 agonist examples

A
  • apraclonidine
  • brimonidine
17
Q

A2A mechanism of action

A
  • reduction in aqueous production and increased uveoscleral outflow
  • acts on alpha 2 receptors which inhibit enzymes involved in production of aqueous
  • 20-25% reduction
18
Q

Ocular and systemic side effects of A2A

A
  • conjunctival hyperaemia
  • follicular conjunctivitis
  • dry mouth
  • blood pressure reduction
  • fatigue
19
Q

A2A contraindications

A
  • px on mono amine oxidase inhibitors
  • px on tricyclic antidepressants
  • severe cardiac disease
20
Q

Cholinergic agent (miotic) examples

A
  • pilocarpine
21
Q

CA mechanism of action

A
  • increase trabecular outflow via ciliary muscle contraction
  • plus minor decrease in aqueous inflow
  • 20% reduction in IOP
22
Q

Pilocarpine side effects

A
  • ciliary muscle spasms,
  • brow ache
  • accommodative myopia
  • miosis with constricted VF
  • higher risk of retinal detachment
  • keratopathy
  • acute or chronic angle closure
  • bradycardia
23
Q

ROCK inhibitor mechanism

A
  • Rho Kinase inhibitor
  • this is a protein involved in regulation of cell shape and size by acting on the cytoskeleton
  • increases aqueous outflow by reducing outflow resistance
  • reducing cell stiffness in schlemms canal
24
Q

Rock inhibitor side effects

A
  • conjunctival hyperaemia
  • conjunctival haemorrhages
25
Q

Preservative free preparations

A
  • timolol
  • pilocarpine
  • dorzolamide
  • bimatoprost
  • ganfort
26
Q

Order of prescribing for the 6 drug types

A

1st line
- prostaglandin
2nd line
- beta blocker
- carbonic anhydrase
- alpha agonist
3rd line
- add from a different class
4th line
- pilocarpine

SCOT (17 decks)

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