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19 Cards in this Set
- Front
- Back
GLAUCOMA
What is it? (3) |
Changes in
-visual field -Optic nerve head -increased IOP |
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GLAUCOMA
Classification Associated with ocular/systemic disease |
Secondary
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GLAUCOMA
Classification Angle |
Open or closed
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GLAUCOMA
Classification Acquired or... |
Congenital
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GLAUCOMA
Medication Aim |
Decrease IOP through decreasing aqueous production or increasing outflow
Some medications have neuroprotective properties |
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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 |
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GLAUCOMA
Topical Medication Classes (5) |
- Prostaglandin Analogues
- Beta Blockers - Alpha Adrenergic Agents - Carbonic Anhydrase Inhibitors - Miotics |
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GLAUCOMA
Medications that decrease Aqueous production |
B-Blockers, Alpha-adrenergic agents and CAI's
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GLAUCOMA
Medications that increase trabecular outflow |
Miotics, and alpha-adrenergic agents
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GLAUCOMA
Medications that increase uveoscleral outflow |
Prostaglandins
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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 |
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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 |
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GLAUCOMA
Prostaglandins Mechanism |
Pro-inflammatory compounds
unknown mechanism low diurnal variation |
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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 |
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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) |
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GLAUCOMA
Prostaglandins Comparing the prostaglandins |
Travoprost: most effective in African-Americans
Lumigan; greatest initial redness Xalatan; greatest periorbital and iris pigmentation |
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GLAUCOMA
Prostaglandins Precautions |
Pregnancy (B3)
Lactation Children |
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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 |
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GLAUCOMA
Prostaglandins Interactions |
Topical NSAIDs have antagonistic effect
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