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16 Cards in this Set

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What three classes of drug are considered first line therapy for primary open angle glaucoma?
Beta-blockers
Prostaglandin analogs
Alpha - 2 agonists
***These agents can be used as monotherapy or in combination***
What two classes are considered second line in treating glaucoma?
Topical carbonic anhydrase inhibitors
Cholinergic agonists (last night due to side effects)
How do beta blockers decrease intraocular pressure?
Decreased production by aqueous humor
Name the 5 beta blockers used in glaucoma
Which agent is selective for beta 1?
Betaxolol (Betoptic) - Beta 1 selective
Carteolol (generic only)
Levobunolol (Betagan)
Metipranolol (Optipranolol)
Timolol (Timoptic)
***All have similar efficacy***
What are the contraindications to these agents?
Sinus bradycardia
2nd degree or greater heart block
Decompensated heart failure
Severe COPD/Asthma
Describe the side effects of these agents (local and systemic)
Local: Burning, stinging, blurred vision, dry eyes
Systemic: Bradycardia, Heart block, Hypotension, Heart failure exacerbation, Bronchospasm, Fatigue
Name the 3 prostaglandin analogs used in glaucoma
Bimatoprost (Lumigan)
Latanoprost (Xalatan)
Travaprost (Travatan)
Describe the primary side effects of these agents
Typical side effects (redness, blurred vision etc.)
Growth of eyelashes
Iris darkening (not reversible), Eyelid discoloration and eyelash changes
What is the mechanism of prostaglandin analogs?
Increased outflow of aqueous humor
Name the 2 alpha - 2 agonists used in glaucoma
Apraclonidine (Iopidine)
Brimonidine (Alphagan)
What is the mechanism by which alpha - 2 agonists work?
Carbonic anhydrase inhibitors?
Cholinergic agonists?
Increased outflow of aqueous humor
Decreased production of aqueous humor
Increased outflow of aqueous humor
What two carbonic anhydrase inhibitors are used in glaucoma?
Brinzolamide (Azopt)
Dorzolamide (Trusopt)
What two cholinergic agonists are used in glaucoma?
Carbachol (Isopto Carbachol)
Pilocarpine (Isopto Carpine)
What points are important in counseling a patient on eye drops?
Wash hands
If a suspension - shake well
Remove contact lenses
Title head back and look at ceiling
Pull down lower eyelid to form pocket
Look up and place a single drop
Close eye for several minutes
How long do you want to separate one eye drop medication from the other?
10 minutes
What is nasolacrimal occlusion?
Once the eye drop is instilled, instruct the patient to close their eye and place their index finger over the nasolacrimal drainage system in the inner corner of the eye for 1-3 minutes - To decrease systemic side effects