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54 Cards in this Set
- Front
- Back
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open angle glaucoma is common in what demographs
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african american
mexicans |
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closed angle glaucoma is common in what demograph
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Inuit
Chinese Asian-Indian |
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what is normal IOP
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<21 mmHg
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what optic disk findings may you see in glaucoma
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increase cup size
cup to disk ration > 0.5 cup to disk asymmetry > 0.2 |
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what visual field changes may be seen in glaucoma
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decrease peripheral vision
decrease contrast sensitivity color alteration |
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what type of glaucoma is due to not enough aqueous humor exiting or too much being produced
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open angle glaucoma
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what type of glaucoma is due to mechanical blockage of trabecular meshwork
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closed angle glaucoma
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what type of glaucoma is a medical emergency
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angle closure glaucoma
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what agents cause drug induced glaucoma
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anticholinergics
glucocorticoids sympathomimetics |
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Jane is experiencing blurred hazy vision, sees halos around lights, and sometimes has head aches what type of glaucoma does she have
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angle closure glaucoma
blurred vision, halos around lights, head aches are prodromal symptoms of Angle closure glaucoma |
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what is the IOP in closed angle glaucoma
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40-90
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what is the drug of choice to treat closed angle glaucoma
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pilocarpine - use till you can perform iredectomy
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when would pilocarpine be least effective
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IOP > 60
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what is the definitive form of treatment of closed angle glaucoma
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iredectomy
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other than pilocarpine what else can be used in the treatment of ___
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used to treat closed angle glaucoma
can use hyperosmotic agents (mannitol, glycerin) |
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can you diagnose open angle glaucoma based on IOP
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NO
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ocular hypertension is seen in what type of glaucoma
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open angle
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what is ocular hypertension ("glaucoma suspects")
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IOP > 22 mmHg
no change in optic disk or loss of vision |
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generally you don't treat optic hypertension unless patients have high risk factors, what are some of those risk factors
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IOP > 25
optic disk:cup ration > 0.5 corneal thickness < 555micrometers african american family history diabetes mellitus |
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what are the 1st line agents to treat ocular hypertension
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beta antagonist
alpha agonist prostaglandin analog carbonic anhydrase inhibitor |
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what is the goal of treatment of POAG
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decrease IOP by 30%
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what is the IOP in normotensive glaucoma in POAG
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IOP 10-12
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what do you do when you increase the dose of a drug when treating POAG
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increase the CONCENTRATION
not the # of drops |
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how long must you wait between administering another med when treating POAG
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5-10 mins if using more then 1 med
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Jen has blue eyes and wants to keep it that way, what drug would you prescribe for her POAG
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beta blockers
good for pt with cosmetic issues |
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what agent would you use in a patient with a past history of CME or HSV and what agent would you not give her
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beta blockers
brimonidine don't give prostaglandin analogs in patients with past CME or HSV infections |
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beta blockers should be avoided in patients with
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pulmonary disease (COPD/asthma)
diabetes CV issues (CHF, 2nd/3rd degree heart block) lactating on oral Beta blockers athlete |
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Jen has a hard time taking her medication what agent should you prescribe to treat her POAG
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beta blocker
or prostaglanding analog good for compiance |
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Jain can't afford to be drowsy at any point in the day what agent should you give her
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Prostaglandin analog - good when drowsiness is an issue
AVOID bromonidine |
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what agent should be avoided if pt has cosmetic concerns
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prostaglandin analogs
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Jain just had intraocular surgery what agent should she avoid
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prostaglandin analogs
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Jain is 8 months pregnant and has come down with POAG what agent can she not get
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prostaglandin analogs
beta blockers (maybe if she's lactating) |
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Jain's 4 year old brother just came in the get treated for POAG what agent can you not give him
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Brimonidine
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what are SE of beta blockers
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decrease HR
decrease BP bronchospasm mask hypoglycemia change serum lipids |
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non specific beta blockers are preferred over specific in treatment of POAG what are the non specific BB and specific agents
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non spicific
-timolol -levobunolol -metipranolol specific -betaxolol |
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If a patient is already on a BB for treatment of POAG what agent can you NOT add on
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epinephrine or dipiverin
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what are the prostaglandin analogs
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Latanoprost (1st line)
Travoprost (1st line) Bimatoprost (2nd line) avoid in pregnancy |
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how do prostaglandin analogs work
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reduce IOP by increasing trabecular outflow
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what are the SE of prostaglandin analogs
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change pigment color
foreign body sensation conjuctival hyperemia (Red eye) longer eyelashes |
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what is the order of SE in prostaglandin analogs
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bimatoprost > travoprost > latanoprost
SAME EFFICACY IN DECREASING IOP |
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what are the alpha agonist for treatment of POAG
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brimonidine
apraclonidine |
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Jain just came back from intraocular surgery and her IOP has increased what agent should you give her (she has POAG)
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alpha agonist (indicated for post surgical IOP increase)
avoid prostaglandin agonist |
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what can alpha agonist be used in combo with
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beta blockers
carbonic anhydrase inhibitors latanoprost |
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what are the local SE of alpha agonist
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lid edema
hyperemia |
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what are the carbonic anhydrase inhibitors
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dorzolamide
brinzolamide |
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what are the local SE of carbonic anhydrase inhibitors
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keratitis
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Oral Carbonic anhydrase inhibitors are recommended for patients who failed topical what are their SE
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increase uric acid production (avoid in gout pt)
altered taste |
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carbonic anhydrase inhibitors are contraindicated in patients with
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electrolyte imbalance
sulfa allergy respiratory acidosis |
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how do parasympathetic agents work
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lower IOP by increasing aqueous humor outflow
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Jane has brown eyes but Bill has blue who needs a higher dose of pilocarpine
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Jane
Higher dose of pilocarpine needed in pt with darkly pigmented eyes |
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what agents can cause cataracts
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cholinesterase inhibitors
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cholinesterase inhibitors are contraindicated in patients with
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asthma
narrow angles hypotension parkinsons |
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if a patient doesn't tolerate pilocarpine what can be given instead
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carbachol
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what agents decrease aqueous humor
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beta blockers
alpha agonist prostaglandin analogs dopamine antagonist |
