• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/19

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

19 Cards in this Set

  • Front
  • Back
GLAUCOMA
What is it? (3)
Changes in
-visual field
-Optic nerve head
-increased IOP
GLAUCOMA
Classification
Associated with ocular/systemic disease
Secondary
GLAUCOMA
Classification
Angle
Open or closed
GLAUCOMA
Classification
Acquired or...
Congenital
GLAUCOMA
Medication
Aim
Decrease IOP through decreasing aqueous production or increasing outflow
Some medications have neuroprotective properties
GLAUCOMA
Outflow Routes (2)
Conventional; Trabecular, 80-90% aqueous, from CB to TM & Schlemm's canal, exit eye through episcleral veins

Unconventional; Uveoscleral, 10-20%, aqueous enters tissue in AC angle, passes through CM into supraciliary and suprachoroid space, exits eye via sclera
GLAUCOMA
Topical Medication Classes (5)
- Prostaglandin Analogues
- Beta Blockers
- Alpha Adrenergic Agents
- Carbonic Anhydrase Inhibitors
- Miotics
GLAUCOMA
Medications that decrease Aqueous production
B-Blockers, Alpha-adrenergic agents and CAI's
GLAUCOMA
Medications that increase trabecular outflow
Miotics, and alpha-adrenergic agents
GLAUCOMA
Medications that increase uveoscleral outflow
Prostaglandins
GLAUCOMA
Prostaglandins
Commercial Preparations
Latanoprost 0.005% (ester based) - Xalatan GOLD STANDARD
Travoprost 0.004% (ester based) - Travatan
Bimatoprost 0.03% (amide based) - Lumigan
Tafluprost 0.0015% (ester based) - Saflutan
All (except tafluprost - minims) BAK-preserved
Lumigan avail in minims
GLAUCOMA
Prostaglandins
Efficacy
Dose
Onset
Time to Peak
27% (Xalatan), 31% (Travatan), 33% (Lumigan) - only glauc drug with no crossover effect (mono therapy does not affect contralateral eye)
qd, more effective PM then AM (efficacy reduced if used more than once a day)
8-12 hrs
~1mth
GLAUCOMA
Prostaglandins
Mechanism
Pro-inflammatory compounds
unknown mechanism
low diurnal variation
GLAUCOMA
Prostaglandins
Local SE's
- Conjunctival hyperaemia
- Iris pigmentation
- Stinging, burning, FB sensation
- Epithelial erosion (BAK preservative)
- Hypertrichosis (longer, thicker lashes, distichiasis)
- Vellus hair (hair of lids) growth
- Periorbital pigmentation (skin around lids)
- Cystoid Macular Oedema (CME, rare, exacerbated in aphakia/IOL's)
- Iritis
- HSV-1 Keratitis reactivation
GLAUCOMA
Prostaglandins
Systemic Side Effects
Few; rapidly metabolised out of eye, reduced with punctal occlusion
- Headaches
- Upper Resp. Tract symptoms (dry cough)
- Skin rash on face, neck or torso (Xalatan)
- Diarrhoea (Lumigan)
GLAUCOMA
Prostaglandins
Comparing the prostaglandins
Travoprost: most effective in African-Americans
Lumigan; greatest initial redness
Xalatan; greatest periorbital and iris pigmentation
GLAUCOMA
Prostaglandins
Precautions
Pregnancy (B3)
Lactation
Children
GLAUCOMA
Prostaglandins
Contraindications
- History of uveitis, CME, HSV Keratitis, complicated Cataract surgery
- Inflammatory glaucoma; Possner Schlossman, acute angle closure, neovascular glaucoma, uveitic glaucoma
- No systemic contraindications
GLAUCOMA
Prostaglandins
Interactions
Topical NSAIDs have antagonistic effect