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113 Cards in this Set
- Front
- Back
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risk factors open angle
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age > 65
family hx african american IOP > 30 mmHg thin central corneal thickness (CCT < 555 um) myopia |
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possbile risk factors for open angle
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cup to disk ratio > 0.5
systemic vascular disease DM |
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risk factor for close angle glaucoma
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age
asian or eskimo female hyperopia (too short or long eyeball) shallow anterior chamber family hx of CAG |
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dx of glaucoma include: evaluation of the ---- disk
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optic
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glaucoma has increased/decreased cup to disk ratio
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increased
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in glaucoma the optic disk is --------
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asymmetric
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there's degeneraion fo the ---- nerve fibers
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retinal
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what do you used to assess teh optic disk
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opthalmoscopy
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assessment of the visual fields is done w/ a
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perimetry
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glucoma pts have blind spots aka
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scotomas
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glucoma have altered ---- vision
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color
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t/f
glaucoma pts have reduced peripheral vision |
t
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---- acuity lost in the late stages
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central
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t/f
measurement of IOP is a good screening tool |
f
poor screening tool insensitive and nonspecific |
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21-30 mmHG
how many develop opitc disk changes |
1%
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> 30 mmHG
how many develop visual field defects |
28%
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t/f
all pts w/ optic disk changes and/or visual field loss should be treated |
t
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what's the most common initial tx
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topical med
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t/f
when starting tx a single topical agent in both eyes is necessary |
f
start in only one eye monocular trial use the other eye as a control also, if there's intolerance avoid both eyes |
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when will you assess the efficacy once tx is started
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4-6 weeks
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if there's no response or intolerance what happens
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change to alternative
usu the class is switched |
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if there's partial response what happens
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add a second drug
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if you increase the dose what happens? do it help w/ efficacy
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no
only increases side effects |
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what do you monitor w/ tx
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IOP
optic disk changes visual fields ADRs compliance |
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why is tx of ocular htn controversial
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cuz only 0.5 - 1% develop visual loss
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how many pt's w/ ocular htn develop open angle at 5 yrs
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about 10%
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who do you tx w/ ocular htn
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moderate to high risk
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risk factors of ocular htn
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thin CCT < 555um
family hx of glaucoma over 65 AA IOP > 30 mmHg severe myopia solitary eye |
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in txment use agents w/ most favorable -----
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risk:benefit
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1st line tx of glaucoma
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beta adrenergic antagonist
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moa of beta adrenergic antagonist is --- blockade in the ciliary body leads to decreased production of ------ ----
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B
aqueous humor |
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w/ B adrenergics antagonists there's a 20-30% decrease in ---- w/ fewer local ocular side effects
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IOP
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most B adrenergic antagonist frequecy of dosing
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BID
this may cause noncompliance |
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there's also ---- considerations
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systemic
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t/f
B adrenergic antags are expensive |
f
cheap |
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nonselective B adrenergic antagonists
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timolol
levobunolol metipranolol |
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B-1 selective med
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betaxaolol
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nonselective B adrenergic antag w/ ISA
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carteolol
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t/f
the B adrenergic antagonists all have similar efficacy |
f
they all have similar efficacy except taxalol ( except this has lower side effect profile) |
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differences in the B antag
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SE
patient profile cost |
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---- may produce smaller changes in IOP (+/- corresponding lower risk of ADR's
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betaxolol
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timolol GFS Qdaily is as effective as timolol soln. ----
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BID
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which two eye drops can be given q day
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levobunolol 0.5% (betagan)
timolol GFS 0.25% or 0.5% (timoptic -XE) |
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AE
systemic rxn: |
bradycardia
decreased BP decreased CO conduction defects bronchospasms masking hypoglycemia CNS |
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local AE:
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stinging
dry eyes coreneal anesthesia blepharitis (inflammation of the eyelash follicle) blurred vision rarely conjunctivitis uvelitis keratitis (inflammed cornea) |
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b antags use should be cautioned in
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pulmonary disease
sinus bradycardia 2 or 3 degree block CHF PO B blockers myastenia gravis DM |
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------- w/ B anta in 20-25% of patients
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tachyphylaxis
may need to switch meds or add one |
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t/f
prostaglandin analogs is a 2nd line tx |
f
1st line |
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prostaglands increase ----- outflow
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uveoscleral
thought to relex the ciliary muscle |
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prostaglandin minor use
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increase trabecular
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the efficacy of q day dosing is the same as ----
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timolol 0.5% BID
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two prostaglandin meds
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latanoprost (xalatan)
travaprost (travatan) |
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a prostamide med
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bimatoprost (lumigan)
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strenght and dose
latanoprost travoprost bimatoprost |
Latanoprost (xalatan) 0.005% q hs 1 drop
Travoprost (travatan) 0.004% 1 drop q hs Bimatopost (lumigan) 0.03% 1 drop q hs |
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cosmetic adr of prostaglandin
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darkening of iris (irreversible)
increased eyelash growth |
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local effects of prosta
(favorable compared to B blockers) |
diplopia
conjunctival hyperemia foreign body sensation ocular irritation punctate corneal keratopathy cystoid macular edema uvetis |
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systemic side effects of prosta
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rare reporst of HA
upper resp tact sx |
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t/f
prostaglandins + b blockers there are drug interactions |
f
there are additive effects |
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how long til you see IOP reduction in prostaglandins
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about 24 hrs
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which is more expensive b blockers or prostaglandins
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prostaglandins
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carbonic anhydrase inhibitors block secretion of --- and --- from the ciliary body
this decreases aq humour production |
Na
HCO3 |
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CAI's decrease IOP by -----
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15-26%
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CAI's rarely used as -----
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monotherapy
used as adjunctive tx |
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AE of CAI's
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burning/stinging/tearing
transient blurred vision superficial punctate keratitis dysgeusia (distortion of taste) HA nausea asthemia fatigue |
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systemic CAI's decrease OP by 25-40%, but are limited due to -----
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AE
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CAI's are -------
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sulfonamides
watch out for sulfa allergy |
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CAI meds
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Dorzolamide (Trusopt) 2% 1 drop tid
brinzolamdie 1% 1 drop tid timolol + dorzolamide (cosopt) 0.5-2% 1 drop bid |
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selective a 2 adrenergic agents is ----- or ------- tx
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adjunctive or post-surgical
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a2 adrenergic agents decrease ---- ----- production
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aq humor
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a2 increase ------ outflow
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uvescleral (minor pathway)
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which decreases IOP more b blockers or a2 agents
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B blockers
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w/ a2 there's a high rate of ----- w/ apraclonidine
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tacyphylaxis
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which has more ADR's apraclonidine or brimonidine
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appraclonidine
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local ADR's w/ a2
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hypersenstitivity: lid edema, hyperemia, eye discomfort
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systemic ADR's
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dizziness
fatigue somnolence dry mouth |
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precautions w/
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cerebrovascular
renal CV disease DM antiHTN TCA MAO-I |
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meds a2 agents
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brimonidine 0.15%, 0.1% 1 drop bid to tid
apraclonidine 0.5%, 0.1% 1 drop bid to tid timolol + brimonidine (combingan) 0.5% + 0.2% 1 drop bid |
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cholinergic agents are parasymptho------- agents
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mimetics
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cholinergic agents cause --- muscle contraction, opening trabecular meshwork: increased trabecular outflow
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ciliary
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direct acting agents
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pilocarpine
carbachol |
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use limited by AE's
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pilocarpine<carbachol<cholinesterase inhibitors
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pilocarpine decrease IOP similar to
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B blockers
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pt's w/ darkly pigmented eyes may need more/less conc of pilocarpine
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higher
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ocular AE w/ pilo
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irritation
tearing miosis |
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systemic AE's w/ pilo
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HA
browache N/V/D decreased HR decreased BP |
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2nd line after pilo
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carbachol
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carbachol has the same AE's but more/less pronounced
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more
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Carbachol can cause -----
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bronchospasm
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contraindications of cholinergic agents
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preop
pulmonary disease myopia (retinal detachment) cataracts closed angle glaucoma |
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know cholinergic agents
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know chart
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two nonselective adrenergic agonist
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epinerpherine
dipivefrim |
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moa:B receptor mediated increase in trabecular and ----- outlfow
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uveoscleral
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do nonselective adrener have better decrease in IOP
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no
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t/f
nonselective adrenergics are used as add-on tx for pt's w/ low IOP |
t
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epi dose
dipiverfrin dose |
EPI 0.5-2% 1 drop bid
dipivefrin 0.1% drop bid (more lipophilic so less conc, also less SE than epi) |
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adr's of nonselective adrenergic agonist
local |
tearing
burning conjunctival hyperemia browache loss of eyelashes blurred vision hyperpigmentation |
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systemic ADR's of nonselective adrenergic agoist
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decrease bp
decrease hr arrhythmias tremor anxiety sweating ha |
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relative Contraindications of nonselective adrenergic agonist
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aphakia
lens dislocation CV cerebrovascular disease CAG DM hyperthyroidism |
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w/ combo tx what do you choose
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agents w/ complementary MOA
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combo tx: w/ ---- response to max dose
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partial
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which meds decrease aq humor production
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a agonist
b blocker CAI's |
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which drugs increase aq humor outflow
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B agonist
cholinergics prostaglandins analogs |
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what do you add to B blockers
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PG analogs
cholinergics CAI |
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what do you add to adrenergic agents
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PG analog
CAI B1 selective |
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Add to cholinergics:
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B blocker
PG analog |
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how often do you monitor IOP
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q 4 weeks intially
then q 3-4 mo once target IOP reached |
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inspeck optic disk and visual fields q --- months
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12
but more frequently if glaucoma unstable or suspicion of progression |
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monitor for AE
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every visit
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monitor for compliance
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q visit
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when giving eye drops how long should you hold eye close for
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1-3 min
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for systemically acitve drugs what should you do when administering
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nasolacrimal occlusion
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how long should you wait between drops of the same meds
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1-2 mins
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how long should you wait before giving another med
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5-10 min
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