Therapeutics - Glaucoma

Question 1

glaucoma is the ___ leading cause of blindness worldwide

Answer 1

2nd

Question 2

true or false

the treatment for glaucoma is well established

Answer 2

true

Question 3

name some risk factors for glaucoma

Answer 3

old
family history
high IOP
diabetes
myopia
long term steroid use
african-american and hispanic
previous eye injury

Question 4

what is normal IOP

Answer 4

10-21 mmHg

Question 5

2 main types of glaucoma and 3 other types

Answer 5

2 main is open angle and angle closure

congenital
normal tension
drug-induced

Question 6

what is the most common type of glaucoma

Answer 6

open angle

Question 7

how does open angle glaucoma occur

Answer 7

usually occurs insidiously (slowly without noticing) and asymptomatic

people dont notice they have it until they start losing their peripheral vision

Question 8

how does the anterior chamber look in open angle glaucoma

Answer 8

it looks normal

Question 9

how does the optic disk look in open angle glaucoma

Answer 9

has cupping and damage

Question 10

which type of glaucoma is a diagnosis of exclusion

Answer 10

open angle

Question 11

which glaucoma is an ophthalmic emergency and immediate treatment is needed for else vision will be lost

Answer 11

angle closure glaucoma

aqueous humor can’t get into anterior chamber from the posterior chamber (through the pupil)

Question 12

angle-closure glaucoma is most common in which patients

Answer 12

women
older adults
asians
ppl wit fam history

Question 13

20% of glaucoma diagnoses are which kind?

Answer 13

angle closure glaucoma

Question 14

when the pupil _______, angle-closure glaucoma is worsened

thus, what drugs are avoided?

Answer 14

when the pupil DILATES

avoid anticholinergics - they will dilate the pupil

Question 15

true or false

angle-closure glaucoma has dramatic signs and symptoms

Answer 15

TRUE

ocular pain, redness, blurred vision, NV, headaches, seeing halos around lights

IOP is extremely elevated

Question 16

in treating angle closure glaucoma, what meds should be given immediately?

Answer 16

ocular and systemic meds

pilocarpine (cholinergic) and hyperosmotic agents (fluid buildup goes into bloodstream)

Question 17

what is the definitive treatment for angle closure glaucoma

Answer 17

surgial — iridectomy

opening made in the peripheral iris to allow aqueous humor to flow outward

Question 18

main drugs that cause:

-open angle glaucoma
-angle closure glaucoma

Answer 18

open angle - STEROIDS (systemic, ophthalmic, or nasal/inhaled). also opthalmic anticholinergivs and vasodilators

angle closure - ANTICHOLINERGICS, ssris, and some antidepressants

Question 19

true or false

even topical anticholinergics can cause drug-induced closed angle glaucoma

Answer 19

TRUE

Question 20

name a systemic anticholinergic that can cause drug-induced closed angle glaucoma

Answer 20

diphenhydramine

Question 21

true or false

steroids are a known cause of angle-closure glaucoma

Answer 21

FALSE

open angle

Question 22

name the 3 goals in treating open angle glaucoma

Answer 22

-decrease IOP

-prevent/reduce risk of glaucoma progressing

-prevent damage to the optic disk!!

Question 23

as mentioned, one of the goals of therapy in treating open angle glaucoma is to decrease IOP

how is this done and what is the typical goal?

Answer 23

use topical ocular hypotensive agents

goal is 25-30% decrease from baseline

Question 24

first line for open angle glaucoma

Answer 24

topical prostaglandin analogs

topical beta blockers

Question 25

2nd line for open angle glaucoma

Answer 25

a2 adrenergic agonists topical carbonic anhydrous inhibitors rho kinase inhibitors

Question 26

3rd line for open angle glaucoma

Answer 26

cholinergic agents (mitotics) ie - pilocarpine

Question 27

name systemic agent for open angle glaucoma

Answer 27

carbonic anhydrase inhibitors --- acetazolamide

Question 28

place for topical carbonic anhydrase inhibitors in treating open angle glaucoma

Answer 28

2nd line

Question 29

what class is brimonidine? it is ____ line for treating open angle glaucoma

Answer 29

a2 adrenergic agonist 2nd line

Question 30

name 2 topical carbonic anhydrase inhibitors they are ___ line for treating open angle glaucoma

Answer 30

dorzolamide and brinzolamide 2nd line

Question 31

after initiating therapy, when should IOP be measured again and compared to the baseline?

Answer 31

after 2-4 weeks if unchanged from baseline or ADR, dc and start different medication class if IOP reduced but target not reached, continue the med and add another of different class

Question 32

what is a very important consideration with eye drops

Answer 32

important to ensure that the patient has proper technique and adherence

Question 33

true or false adherence is a big issue with glaucoma medication

Answer 33

false - usually not -- ppl care about keeping their sight

Question 34

mechanism of prostaglandin analogs to treat glaucoma

Answer 34

increase aqueous humor outflow

Question 35

true or false prostaglandin analogs are 1st line in treating glaucoma

Answer 35

true - along with beta blockers

Question 36

3 disadvantages of prostaglandin analogs

Answer 36

-increase iris pigmentation -hypertrichosis of eyelashes -intraocular inflammation (like any topical drop or ointment)

Question 37

true or false prostaglandin analogs have many systemic adverse effects

Answer 37

false - have few

Question 38

how often are prostaglandin analogs used? do they affect pupil size?

Answer 38

QHS (usually at bedtime) do not affect pupil size - therefore, do not affect night vision

Question 39

how to recognize prostaglandin analogs by looking at name

Answer 39

"prost"

Question 40

what's the most common prostaglandin analog for glaucoma

Answer 40

latanoprost

Question 41

true or false all the prostaglandin analogs are applied QHS

Answer 41

true this is an advantage

Question 42

mechanism of beta blockers in glaucoma

Answer 42

decrease the PRODUCTION of aqueous humor, reducing IOP

Question 43

true or false beta blockers are 1st line for glaucoma

Answer 43

true

Question 44

how often are beta blocking agents applied for glaucoma

Answer 44

QD-BID

Question 45

do beta blockers affect pupil size?

Answer 45

NO therefore do not affect night vision

Question 46

name some disadvantages of beta blockers for glaucoma

Answer 46

irritation ( like all) also can have systemic effects!! can go straight to the heart with no metabolism by liver -- cause side effects like hypotension, exacerbation of asthma and COPD, bradycardia, depression impotence systemic side effects are worse if taking an oral beta blocker as well

Question 47

how to recognize beta blockers

Answer 47

"lol" at end most common is timolol

Question 48

how do a2 adrenergic agonists work in glaucoma

Answer 48

they decrease aqueous humor production and increase aqueous humor outflow

Question 49

place in therapy for a2 adrenergic agonists in open angle glaucoma

Answer 49

2nd line may be ADDED TO a beta blocker or prostaglandin analog

Question 50

how often are a2 adrenergic agonists applied

Answer 50

2-3 times a day

Question 51

true or false a2 adrenergic agonists for glaucoma have few systemic adverse effects

Answer 51

true

Question 52

2 disadvantages of a2 adrenergic agonists

Answer 52

more ocular irritation occurd 10-15% pts develop an intolerance to it

Question 53

name 2 alpha adrenergic agonists and what used for

Answer 53

only one for glaucoma is brimonidine apraclonidine is an a2 agonist but not used for glaucoma - used after surgery to decrease IOP