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Pharm - Clinical Neuro > Tx of Glaucoma > Flashcards

Flashcards in Tx of Glaucoma Deck (22)
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1

open angle glaucoma

- gradual loss of peripheral vision
- usually in both eyes
- tunnel vision in advanced stage

2

acute angle closure glaucoma

- eye pain, sudden onset (usually in low light)
- N/V, blurred vision, halos around lights, red eyes

3

risk factors for developing glaucoma

- IOP: generally increased in glaucoma pts but can happen w/ normal IOP
- age: older = more likely
- ethnicity: most common in blacks
- genetics: higher risk if family member has it
- drugs: corticosteroid eye drops

4

what classes of drugs can be used for glaucoma?

- beta blockers (timolol, betaxolol)
- carbonic anhydrase inhibitors (CAIs)
- alpha-2 agonists
- cholinergic agents
- prostaglandin analogs
- non-selective adrenergic agents

5

cholinergic agents: mechanism of action, how they work for the types of glaucoma

- stimulate contraction of sphincter and ciliary mm. = mitosis = decreased IOP
- in open angle: ciliary mm. contract = increased flow through intertrabecular spaces
- close angle: contraction of sphincter mm. increases angle of sclera and iris
- direct = pilocarpine, carbachol
- indirect = physostigmine, echothiophate

6

cholinergic agents: mechanism of action

- stimulate contraction of sphincter and ciliary mm. = mitosis = decreased IOP
- in open angle: ciliary mm. contract = increased flow through intertrabecular spaces
- close angle: contraction of sphincter mm. increases angle of sclera and iris

7

acute angle closure glaucoma

- eye pain, sudden onset (usually in low light)
- N/V, blurred vision, halos around lights, red eyes

8

risk factors for developing glaucoma

- IOP: generally increased in glaucoma pts but can happen w/ normal IOP
- age: older = more likely
- ethnicity: most common in blacks
- genetics: higher risk if family member has it
- drugs: corticosteroid eye drops

9

what classes of drugs can be used for glaucoma?

- beta blockers (timolol, betaxolol)
- carbonic anhydrase inhibitors (CAIs)
- alpha-2 agonists
- cholinergic agents
- prostaglandin analogs
- non-selective adrenergic agents

10

cholinergic agents: mechanism of action

- stimulate contraction of sphincter and ciliary mm. = mitosis = decreased IOP
- in open angle: ciliary mm. contract = increased flow through intertrabecular spaces
- close angle: contraction of sphincter mm. increases angle of sclera and iris

11

pilocarpine: when it's used and s/e

- direct acting cholinergic agent
- used in emergencies
- works on open and close angle
- s/e = HTN, tachycardia

12

s/e of cholinergic agents

- pilocarpine has it's own card
- carbachol = autonomic disturbances if in systemic circulation
- physostigmine = crosses BBB - can cause seizures and abnormal defecation
- ecothiophate = night blindness and frontal headache

13

beta blockers

- betaxolol, carteolol, timolol
- MOA: interact w/ ciliary epithelium = decrease production of aqueous
- betaxolol = BETA-1 SELECTIVE; timolol and carteolol = non selective
- used for open angle, ocular HTN
- use betaxolol in asthmatics

14

s/e of beta blockers

- timolol = bradycardia, confusion, blurred vision, dry eye, hallucination, BRONCHOSPASM
- carteolol = insomnia, BRONCHOSPASM
- betaxolol = AV block, MI!!; use in asthmatics b/c only one that DOESN'T cause bronchospasm

15

prostaglandin analogs

- lantanoprost, bimatoprost, travoprost
- MOA: act on suspensory ligament; increase drainage of aqueous
- used for open angle and intraocular HTN

16

s/e of prostaglandin analogs

- darkens color of iris (browning)
- macular retinal edema
- conjunctival hyperemia (w/ bimatoprost and travoprost)

17

carbonic anhydrase inhibitors (CAIs)

- acetazolamide, brinzolamide, dorzolamide
- MOA: decrease aqueous production secondary to decrease in bicarb b/c inhibiting carbonic anhydrase II
- no effect on pupil or vision
- used for open angle and ocular HTN

18

s/e of CAIs

- metabolic acidosis, urolithiasis (kidney stones)
- acetazolamide = agranulocytosis, aplastic anemia, thrombocytopenia
- dorzolamide = immune hypersensitivity rxns, burning in eye, visual discomfort

19

alpha-2 selective agonists

- apraclonidine, brimonidine
- MOA: decrease production and increase outflow of aqueous = decreased IOP
- apraclonidine given pre and post surgery to decrease ocular pressure
- brimonidine used in open angle and for ocular HTN

20

s/e of alpha-2 selective agonists

- irregular HR, fatigue, dry mouth, red/itchy/swollen eyes
- apraclonidine: depression, dizziness, chest pain
- brimonidine = xerostomia, somnolence, syncope

21

non-selective adrenergic agonists

- dipivefrin, epinephrine
- MOA: decrease aqueous production and decrease blood flow to ciliary bodies (epi)
- dipivefrin = pro-drug; gets hydrolyzed to epi in the eye
- used for open angle

22

s/e of non-selective adrenergic agonists

- dipivefrin = burning in eyes, follicular conjunctiva
- epi = mydriasis, stinging; NOT for close angle