a) What is considered normal IOP?

b) What is high IOP?

c) What cup to disc ratio correlates to glaucoma?

a) 16

b) >20

c) >0.5

Topical anticholinergics

Glucocorticoids

Laser surgery

Iridotomy

What are the Nonselective β-blockers used for glaucoma?

Which ones are better?

Levobunolol, Timolol and metipranolol

levo and Timolol are better

What are the selective β-blockers for glaucoma?

Why are they better than non-selective?

Betaxolol and Cartelol

Less systemic absorption and side effects

T/F

β-blockers have large systemic absorption through the eye

T/F

THe initial drop in pressure after using a B-blocker can be predictive of its response

FALSE

not predictive of its response

T/F

25% of pts using a B blocker for glaucoma suffer from tachyphylaxis

TRUE

Their bodies get used to the drug and need to switch to something else

β-Blockers

a) MOA

b) drug interactions

c) administration

d) Economic considerations

e) monitoring

f) contraindications

a) reduce aqueous humor production

b) theophilline(blunts effect), methacholine, α and β agonists(increases effect)

c) 1-2x/day

d) cheap, timolol more expensive because gel formulation

e) heart rate, IOP,visual field testing

f) pts. with asthma

a) Which is better apraclonidine or brimonidine?

b) why

a) Brimonidine

b) Apraclonidine has 30% allergic rxn rates and high rate of tachyphylaxis

Adrenergic Antagonists α₂ and β

a) MOA

b) Drug interactions

c) Administration

d) Monitoring

e) place in therapy

a) decrease production of aqueous humor

b) MAOI risk X

c) 2-3 times/day

d) IOP, fatigue level (may worsen depression)

e) used after failure of B blocker, brimonidine is equivalent to timolol

Cholinergic agonists

a) MOA

b) Drug interactions

c) administration

d) monitoring

e) place in therapy

a) physically opens canal to allow fluid to leave

b) Antichloinesterase inhibitors

c) 1-2 gtts up to 6 times daily

d) IOP eye exams

e) 4th line, low because of high ADE

What are the cholinergic drugs used to treat glaucoma?

What do they cause in younger patients?

Pilocarpine, Carbachol

accomodative spasms

a) What are the prostaglandin analogs used for glaucoma?

b) How do they compare to B Blockers?

c) MOA

d) Interactions

e) Administration

f) Monitoring

a) Latanoprost, bimatoprost, travaprost (prost=prostaglandin)

b) Decrease IOP more than B Blockers

c) increase outflow of aqueous humor

d) opthalmic NSAIDs

e) once daily

f) iris pigmentation

a) What are the carbonic anhydrase inhibitors used for glaucoma?

b) MOA

c) drug interactions

d) Administration

e) Monitoring

a) acetazolamine, brinzolamide, dorzolamide

b) decrease production of aqueous humor

c) other carbonic anhydrase inhibitors, salicylates (metabolic acidosis)

d) 2-3 times/day

e) hepatic/renal dysfunction and sulfa allergy

What is the place in therpay of the combination products?

How does Closed angle glaucoma present itslef?

Quick and abrupt

must be dealt with right away

Pilocarpine+ hyperosmotic agent+ a secretory inhibitor

or

iridectomy (hole in the iris)

Type of conjuctivitis

a) Bilateral, itchy, serous discharge

b) Purulent, thick yellow/green, edema, rapid

c) abrupt onset, watery discharge, unilateral

d) rare, unilateral, mucopurulent

a) allergic

b) hyperacute gonoccocal, chlamydial

c) viral

d) bacterial

Opthalmic lubricants or irrigants

cold compress

alpha agonists

antihistamines

mast cell stabilizers

NSAIDs

T/F

You shouldnt use a corticosteroid for allergic conjunctavitis

FALSE

you may use it

When should each be used?

a) NSAIDs

b) Mast Cell Stabilizers

a) only is symptoms persist

b) used for recurrent allergies

Cold compress, usually self limiting

if needed: oral acyclovir, valacyclovir, famacyclovir

NO corticosteroids

Ceftriaxone 1g IM

Cefixime 400mg PO

Azithromycin 2g

If PCN allergy give fluoroquinolone (Cipro 500mg)

Azithromycin 1 g

Doxycycline 100mg BID x 7 days

alt. Erythromycin 500 QID x 7days

Levofloxacin 500 QD x7 days