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Ocular Pharma # 11
Glaucoma
| Question | Answer |
|---|---|
| What is the glaucoma triad? | IOP, Optic Nerve Damage, VF Damage |
| What are the two ways that drugs reduce IOP? | Decrease aqueous production / Increase aqueous outflow |
| What are the main 5 classes of glaucoma drugs? | Prostaglandin Analogues, Beta Blockers, Alpha Agonists, Calcium Anhydrous Inhibitors, Hyperosmotics, Cholinergics (seldom used) |
| What are the four sympathetic receptors? | Alpha 1, Alpha 2, Beta 1, Beta 2 |
| Stimulation of the Alpha receptors causes ___________. | Increase aqueous outflow (Alpha agonists) |
| Stimulation of Beta receptors causes _____________________. | Decrease in aqueous production. |
| Cholinergics are not used in glaucoma today because of what serious ocular side effects? | Extreme miosis, iris cysts, retinal detachment, cataracts, myopia, headaches |
| Name two direct acting Cholinergics used in surgery? | Carbachol (Miostat) and Acetylcholine (Miostat) |
| What are the two direct acting Cholinergics used for and what are their differences? | To produce miosis at the end of cataract surgery. Carbachol is longer acting. |
| Name the 2 Alpha Adrenergic Agonists drugs. | Brimonidine (Alphagan) and Apraclonidine (Iopidine) |
| What are the side effects of Alpha Adrenergic Agonist drugs? | Apraclonidine has the most incidence of side effects. 75% develop allergy, most lose effect with time, red eyes, dry eyes, dry mouth, bad taste, fatigue. Side effects are much less with Brimonidine. |
| What is Aproclonidine used for? | To reduce pressure spikes at laser surgery and to test for Horner's Syndrome. |
| Name several Beta Blockers. | Timolol, Betaxolol, Carteolol, Levobunolol, Metipranolol |
| What are the systemic side effects of Beta Blockers and when are they contraindicated? | Slow the heart and breathing, depression, deceased libido, dry eye, contraindicated or used with utmost caution in CV disease, asthma, COPD, Arrythmias, Bradycardia. |
| Name several Prostaglandin Analogues. | Latanoprost, Bimatoprost, Travoprost, Tafluprost |
| What are the side effects of Prostaglandin Analogues and when should they be used with caution? | Red eye, dry eye, sting, growth and pigmentation of lashes, iris pigmentation, PAP, URI and flu symptoms. Use with caution with ocular inflammation (uveitis, CME) |
| What are the advantages of Prostaglandin Analogues? | Most effective in lowering pressure and fewer side effects |
| Name a CAI drug. | Topical: Dorzolamide and Brinzolamide. System: Acetazolamide and Methazolalmide |
| What are the side effects of CAI drugs? | Topical: dry eye, itching, redness, bitter taste. Systemic: renal stones, sulfa allergy, depression, impotence, tingling of extremities (very common), metallic taste, GI upset. 50% will need to DC (discontinue) within months of Rx. |
| What do CAI drugs have a cross-allergy with? | Sulfa |
| Name several oral hyperosmotic agents. | Glycerine (Glyrol, Osmoglyn) and Isosorbide |
| What is Isosorbide used? | In Diabetes |
| Name I.V. Hyperosmotic agent? | Mannitol |
| What other drugs can be given I.V. for acute glaucoma? | Acetazolamide (Diamox) |
| Can you name which classes of drugs DECREASES aqueous production? | Beta Blockers and CAI |
| Which classes INCREASE aqueous OUTFLOW? | Alpha Agonists, Prostaglandin Analogues, and Cholinergics |
| What are the combination drugs in Cosopt and Combigan? | Cosopt: Timolol and Dorzolamide (CAI) Combigan: Timolol and Alphagan (Brimonidine- and Alpha Agonist) |
| If medical therapy for glaucoma fails, what are other possible choices? | SLT, ALT, Surgery- Trabeculectomy, Shunts, Inserts |
| Why are Epinephrine drugs not used today for glaucoma? | Ineffective, too many side effects (Sympathomimetic), red eyes, conjunctival deposits. |
| What color top for the Beta Blockers? | Usually Yellow. Blue sometimes |
| What drugs are used for oral reduction of IOP (Two classes)? | Hyperosmotics (Glycerine and Isosorbide) and CAI agents (Dorzolamide, Brinzolamide, Acetazolamide, Methazolalmide) |
| Which glaucoma drug may have neuro-protective properties? | Brimonidine (Alphagan) |
| What are the side effects of hyperosmotic agents? | Headache, nausea, and vomiting when given orally. |
| Name possible causes of poor patient compliance. | Too many drops to manage, forget, can't afford new drops. |
Created by:
Leequa
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