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CH 104: Eye
| Question | Answer |
|---|---|
| Glaucoma | refers to a group of diseases characterized by visual field loss secondary to optic nerve damage |
| Primary open-angle Glaucome | - most common form of glaucoma & leading cause of blindness - characterized by progressive optic nerve damage w/ eventual impairment of vision - Painless & symptoms do not arise till optic nerve damage has been produced |
| Risk factors for OAG | - Elevated IOP - African or south american - family history of POAG - advanging age ** elevated IOP most important** |
| Most important form of prevention of blindness from OAG? | - screening! |
| Managements of OAG | - directed at reducing elevated IOP |
| Angle-Closure Glaucome | - displacement of iris such that it covers trabecular mesh-work, preventing exit of aqueous humor from the anterior chamber \ - IOP raises rapidly to dangerous levels- VERY PAINFUL - no tx leads to irreversible vision loss in 1-2 days |
| TX OF ACG | - drug therapy followed by corrective surgery - once IOP is decreased, laser iridotomy and iridectomy may be performed |
| BETA BLOCKERS | - first line drugs for glaucoma - lowers IOP by decreasing production of aqueous humor - used primarily for OPEN-ANGLE GLAUCOMA |
| Beta Blockers Adverse Effects | - Local effects (burning, conjuctivitis, blurred vision, photophobia) - Heart and lung effects : produce bradycardia & AV block (monitor pulse rate) |
| Beta blocker contradictions | - not to be used in patients with AV Block, sinus bradycardia, cardiogenic shock ** CAUTION IN PATIENTS W/ HEART FAILURE** - causes bronchostriction - betaxolol only apprived BB for patients w/ asthma & COPD |
| Prostaglandin analogs: LANTAPROST | - applied topically to lower IOP in patients w/ OPEN ANGLE GLAUCOMA & OCULAR HYPERTENSION |
| Lantaprost MOA | - lowers IOP by facilitating aqueous humor outflow in part by relaxing the ciliary muscle |
| Lantaprost SE: | - harmless BROWN pigmentation of the iris - may also increase length, thickness, and pigment of eyelashes - blurred vision, buring/stinging, conjuctival hyperemia, punctate keratopathy. |
| Other Prostaglanding analogs | - travopost, bimatoprost, taflupost reduced IOP by increasing aqueous humor outflow - more effecting in African Americans - Bimatoprost (Latisse) helps grow longer & thicker eyelashes - common SE: ocular hyperemia (engorgement of ocular blood vessels) |
| Alpha2-adrenergic agonists: Brimonidine | - LONG term reduction of elevated IOP in pt's w/ OPEN ANGULAR/ ocular hypertension MECH OF ACTION: lowers IOP by reducing aqueous humor production, and increasing outflow - may delay optic nerve damage |
| Brimonidine side effects: | - dry mouth, ocular hyperemia, burning/stinging, foreign body sensation. ocular itching - CAN CROSS B-B-B and cause drowsiness, fatigue, hypertension ** absorb into contact lenses, advise pt to administer 15 minutes before placing lenses |
| Alpha2-adrenergic agonists: Apraclonidine | - SHORT TERM THERAPY - lowers IOP by reducing aqueous humor production and increasing outflow (same as Brimonidine) - For OAG pt's who did not respond well to other drugs |
| Alpha2-adrenergic agonists: Apraclonidine side effects: | - headache, dry mouth and nose, altered taste, etc DOES NOT CROSS B-B-B = NO HYPOTENSION |
| Pilocarpine: direct acting muscarinic agonist | - stimulates cholinergic receptors producing (1) miosis (2) contraction of the ciliary muscle- IOP lowered indirectly - Patients with OAG IOP is reduced due to tension generated by contracting ciliary muscle promotes widening within the trabecular mesh |
| Pilocarpine: direct acting muscarinic agonist effect on ACG | - contraction of iris sphincter pulls iris away from the pores of the trabecular mesh, removing impediment to aqueous humor flow |
| Pilocarpine: direct acting muscarinic agonist THERAPEUTIC USES: | - 2nd line drug for OAG & used in emergencies for Acute-angle-closure glaucoma |
| Pilocarpine: direct acting muscarinic agonist ADVERSE EFFECTS: | - may need corrective lens for near vision, retinal detachment, decrease visual acuity. Systemic: bradycardia, bronchospasm, hypersalivation, diarrhea, **CAUTION USE W/ ASTHMA & bradycardia** - toxicity reversal: atropine (muscarinic antagonist) |
| Echothiophate: cholinesterase inhibitor | - long duration of action - inhibits breakdown of Acetylcholine, promoting accumulation of ACHE at muscarinic receptors - Indicated for POAG |
| Echothiophate: cholinesterase inhibitor adverse effects: | - myopia and excessive constriction ***CATARACTS*** |
| Carbonoc Anhydrase inhibitors: topical Dorzolamide | - reduces IOP in patietns w/ OAG - lower IOP by decreasing production of aqueous humor |
| Carbonoc Anhydrase inhibitors: topical Dorzolamide SIDE EFFECTS: | - BITTER TASTE & ocular stinging |
| Carbonoc Anhydrase inhibitors: systemic ACETAZOLAMIDE & METHOZOLAMIDE | - lower IOP by decreasing production of aq. humor. - for long term tx of OAG ADVERSE EFFECTS: CNS ( malaise, anorexia, fatigue) , MALAISE may be intense, GI disturbances - HARMFUL TO PETS AND PREGNANCY |
| Cycloplegics | - paralyze ciliary muscles |
| mydriatics | - dilate the pupil |
| cycloplegics and mydriatics | - use to facilitate dx and surgery |
Created by:
KristinL
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