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37 Cards in this Set
- Front
- Back
What nerves innervate the eye?
What action do they cause? Which drugs block them and what is the result? |
parasymp - constrict - parasympatholytics (antichol) = dilation
symp = dilation - sympatholytics (cholinergics) = constriction |
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glaucoma def
involves changes to the... loss of ... and ... increased ... |
Ocular disorder involving optic neuropathy with changes in the optic disk and loss of visual sensitivity and field; may or may not involve increased intraocular pressure (IOP
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Acute Angle Closure Glaucoma
definition cause sxs drug thpy |
Rare
caused by increased pressure due to blockage of trabecular mesh = decr aqueous outflow Causes abrupt rise in IOP (intra-ocular pressure) Narrow angle between cornea and iris • Tight contact between the iris and lens (pupillary block) * SXS Cloudy, edematous cornea Ocular pain or discomfort Nausea, vomiting, abdominal pain, and diaphoresis IOP = 40-90 Rx Thpy: 1ST = SURGICAL / LASER -Pilocarpine 2-4% 1 drop every 5 minutes for 4-6 administrations -Hyperosmotic agents -Secretory inhibitor b-blocker, a2agonist, prostaglandin analog or topical CAI |
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Primary Open Angle Glaucoma (POAG)
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common
chronic visual loss Retinal ganglion cells perish elevated OR normal IOP |
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what is the correct predominant route of creation and flow of aqueous humor through the eye?
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ciliary body, posterior chamber, anterior chamber, trabecular meshwork, Schlem's canal, vein
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Usual outflow through:
Unconventional path: |
trabec meshwork -> schlems canal -> vein
ciliary body -> suprachoroidal space |
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Pharmacotherapy classes and drug MOAs
1. 2. 3. |
Decrease aqueous production (constrict)
BB 2-Adrenergic Agonists Carbonic anhydrase inhibitors (CAI) Increased aqueous outflow (dilate) PG analogs Parasympathomimetics Sympathomimetics |
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POAG Drug Therapy Choices
First line Adunctive or Second line agents – Last Line – Rarely |
1st line
Beta blockers PG analogs Brimonidine Adjunctive or Second line Topical CAIs carbonic anhydrasei nh Last Line Pilocarpine (gtts) Apraclonidine Systemic CAIs Echothiophate Rarely Diprivefrinor epinephrine |
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First line are dosed ____ and are well tolerated
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1-2x daily
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Nonspecific BBs:
relatively specific: Nonspecific with ISA: |
Timolol, levobunolol, metipranolol
betaxolol carteolol |
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BB's Use with caution in patients with....
Tachyphylaxis = a) • The ____ is usually checked before and after initiating therapy |
asthma/COPD, heart block, congestive heart failure, on oral beta-blockers
tolerance to bbs pulse |
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Selective 2-receptor agonists
MoA ADR Counsel pts |
Reduce IOP 18-27% at peak, less at nadir (10%)
Dont give concurrent with MAOI ADR: allergy, dry mouth, dry eye, lethargy, mydriasis, and hypotension Recommend Nasal lacrimalocclusion |
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Prostaglandin agonists
MoA ADR Counsel pts |
Latanaprost
� Works primarily onincreasing unconventional outflow path � Usually dosed at NIGHTIME � NO PREGNANCY USE � ADR: altered iris pigmentation become more brown in blended eye colors like hazel � stinging sensation � increase in eyelash length and deepening of color |
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Topical carbonic anhydrase inhibitors (CAI)�
Example ADR Counsel pts |
ADR: side effects include burning, BITTER TASTE, and topical allergy
� Same potential side effects as systemic CAI, except that more worrisome adverse effects like metabolic acidosis, hypokalemia, gastrointestinal symptoms, weight loss, and paresthesias are usually not seen � dorzolamiden |
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Systemic CAIs
Example ADR Counsel pts |
USED IN EYE EMERGENCY to quickly drop IOP
SULFA ALLERGY SE: fatigue, N, confusion, taste, parethesias MONITOR K+ if other diuretics or digitalis |
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POAG Goal of Treatment
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reducing pretreatment IOP by at least 25%
Reduce IOP by 20% lower than baseline as initial target Usual ultimate goal for IOP < 21 mmHg |
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Therapeutic Monitoring, how often?
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initial 4-6wks
chronic 3-4 mos |
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Time to Response
BBs? PG analogs? CAI? a2 agonist? |
3-6 weeks for beta-blockers, prostaglandin analogs
anytime after 3 days for topical carbonic anhydrase inhibitors, alpha-agonists, and miotics |
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Glaucoma Patient Counseling
Dont instill more than ____ at a time � If on combination therapy, separate drops by at least ___ min and ideally ____ min) � Order of drugs does/doesn't matter |
1 drop
5, 10 doesn't |
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Preservative Used Most FrequentlymHg
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Benzalkonium chloride (BAK)sts(
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Options to Reduce Ocular Exposure to Benzalkonium Chloride
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Single dose unit
Timoptic gel 1% Cosopt (unit dose not yet in US) Purite Brimonidine purite 0.15% (Alphagan P) SofZia Travaprost 0.004% (Travatan Z)ow): |
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When to Recommend Non-BAK Drops
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Patients experiencing significant irritation or local adverse effects
To reduce cumulative exposure to BAK when using more than 1 type of drops- |
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Drug Induced Glaucomat
POAG Incr IOP most likely with: ____ & ____ ______ may incr IOP, amt is dose related |
Patients with untreated or uncontrolled POAG
Can be at risk for further increases in IOP � Topical (optical) anticholinergics Increase in IOP most likely with atropine or homatropine � Corticosteroids(inhaled, nasal, topical or oral) May increase IOP in pts with POAG and those without POAG Amount increase in IOP is dose related, |
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Drug Induced Glaucomat
Most likely agents |
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Topical anticholinergics (optical) � Topical sympathomimetics (optical)2 |
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Match the glaucoma medication to the its corresponding drug class.
Beta blocker - nonselective Carbonic anhydrase inhibitor - topical Prostaglandin analog Beta blocker -B1 selective |
Dorzolamide
Timolol Latanoprost Betaxolol |
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Brimonidine reduces intraocular pressure in patients with glaucoma by:
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Both decreasing production and increasing outflow of aqueous humor
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Match the glaucoma medication with its corresponding adverse reaction or warning.
timolol latanoprost dorzolamide` |
use caution in patients with severe bradycardia
may cause iris PIGMENTATION use caution in patients with sulfa allergy |
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TJ is a 60 yo Caucasian female with recently diagnosed primary open angle glaucoma.
Remarkable findings in her routine annual ophthalmic screening by her eye care professional last month: IOP readings were 30 (OD) and 25 (OS). She was found to have minor peripheral vision loss in both eyes. Optic nerve was observed to have neurodegenerative changes signified by cupping. Other pertinent history: Controlled hypercholesterolemia (on simvastatin) Controlled blood pressure (on enalapril/hydrochlorothiazide combination) Allergies: Sulfa (nausea) Which of the following agents would be an appropriate initial monotherapy choice for her glaucoma? Select three correct answers. No partial credit. A. Apraclonidine (Iopidine) B. Brinzolamide (Azopt) C. Pilocarpine (Pilocar) D. Travaprost (Travotan) E. Timolol (Timpotic) F. Brimonidine (Alphagan P) G. Dipivefrin (Propine) H. Acetazolamide (Diamox Sequels) |
TRAVAPROST
TIMILOL BRIMONIDINE |
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*Continuation of case above*
6 months later TJ's IOP has decreased some but is still >20 in both eyes. She is now prescribed two eye drops from different classes. She asks the pharmacist if she can administer the drops right after each other. What is the best response? |
No, she should wait at least five minutes between drops since it takes that long for the drug to penetrate the eye.
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Refer/Treat
Red right eye, pupil is larger than the left, new since this AM |
Refer
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Refer/Treat
A contact lens wearer cannot open her eye spontaneously and keep it open |
Refer
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Refer/Treat
A small piece of metal is stuck in the patient's eye |
Refer
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Refer/Treat
Left red eye accompanied by headache and nausea |
Refer
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Refer/Treat
Pink eyes x 1 day, clear discharge every 8 hours, current upper respiratory infection |
TREAT - URI = VIRAL
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Over the last 2 days, he’s developed symptoms of bilateral ocular congestion, itchiness, and watery discharge. Matthew believes that symptoms started shortly after he began his new volunteer work at the animal shelter.
PMH: CAD s/p CABG 2001, erectile dysfunction, peripheral vascular disease, hypertension. Allergies: Lisinopril, simvastatin, lovastatin, ASA Meds: metoprolol 100 mg BID, sildenafil 100 mg PRN, clopidogrel 75 mg QD, losartan 25 mg QD, atorvastatin 80 mg QD Last labs 11/25/10: BP 144/66 HR 60 Na+ 137 K+ 4.4 SCr 1.0 LDL 82 HDL 39 Why are topical decongestants NOT an optimal treatment choice for Matthew? |
Decongestants should be avoided in people with cardiovascular diseases
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Which of the following symptoms is an important indicator that Matthew likely has allergic conjunctivitis (as opposed to infectious conjunctivitis)?
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Ocular itching
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Anna is a 29 year-old female who presents to your pharmacy counter for some eye relief. Since last night, she’s developed ocular pain, redness, a thick green discharge, and woke up this morning with her eye “glued shut.” She also noticed this morning that she’s not seeing as sharp in her right eye (the sticky eye). She has no other complaints currently but notes that this is her 3rd bout of conjunctivitis in the last month. She also pulls you aside to ask about what female products you could recommend for her “infection down low”.
PMH: menstrual migraine, asthma Allergies: Morphine, Ibuprofen Meds: Yasmin, propranolol LA 80 mg, Proair PRN exercise Last BP 4/2010: 110/78 Based on her presentation and history, what is the most likely diagnosis and cause of Anna’s symptoms? |
Hyperacute conjunctivitis caused by N. gonorrhoea
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