Glaucoma

Question 1

open angle treatment: which drugs reduce aqueous humor production?

Answer 1

1. beta blockers
2. carbonic anhydrase inhibitors

Question 2

open angle treatment: which drugs increase aqueous humor outflow?

Answer 2

1. prostaglandin analogs
2. cholinergics
3. rho kinase inhibitors

Question 3

open angle treatment: which drugs both reduce aqueous humor production and increase aqueous humor outflow?

Answer 3

alpha-2 agonists

Question 4

open angle treatment: which drugs are first line?

Answer 4

1. prostaglandin analogs
2. beta-blockers
3. alpha-2 analogs (1st/2nd line)

Question 5

list 4 prostaglandin analogs

Answer 5

1. bimatoprost (lumigan)
2. travaprost (travatan)
3. latanoprost (xalatan)
4. tafluprost (zioptan)

Question 6

how much do prostaglandin analogs reduce IOP?

Answer 6

reduce IOP by 30%

Question 7

dosing frequency for prostaglandin analogs

Answer 7

1 drop QHS

Question 8

prostaglandin analogs side effects

Answer 8

-blurred vision
-stinging
-increased pigmentation of iris/eyelashes
-eyelash growth/thickness
-light sensitivity
-foreign body sensation

Question 9

list 4 beta-blockers (used for glaucoma) and whether they are selective or non-selective

Answer 9

Non-selective
1. timolol (Timoptic)
2. Carteolol
3. Levobunolol (Betagan)

Selective
1. Betaxalol (Betoptic S)

Question 10

how much do beta blockers reduce IOP?

Answer 10

reduce IOP by 20-30%

Question 11

dosing frequency for beta blockers (for glaucoma)

Answer 11

1 drop daily or BID

Question 12

beta blockers side effects

Answer 12

1. blurred vision
2. stinging
3. bradycardia
4. hypotension
5. dizziness
6. fatigue

Question 13

list 2 alpha-2 agonists and 2 combo products containing alpha-2 agonists used for glaucoma

Answer 13

1. brimonidine (alphagan P)
2. aprachlonidine (iopidine)

combo products:
1. brimonidine + timolol (Combigan)
2. brimonidine + brinzolamide (Simbrinza)

Question 14

how much alpha-2 agonists reduce IOP?

Answer 14

reduce IOP by 25%

Question 15

dosing frequency for alpha-2 agonists (for glaucoma)

Answer 15

1 drop TID

Question 16

alpha-2 agonists side effects

Answer 16

-dry eyes
-dry mouth
-blurry vision
-confusion
-conjunctival hyperemia
-hypertension
-sedation

Question 17

list three options for treatment of closed-angle glaucoma

Answer 17

hyperosmotic agents:
1. mannitol (IV) - 1.5-2g/kg/dose over 30 minutes
2. glycerin (PO) - 1-2g/kg/dose every 5 hours prn

surgery : iridotomy

Question 18

drugs that can increase IOP

Answer 18

-anticholinergics (i.e., oxybutynin, tolterodine)
-chronic steroids
-pseudoephedrine
-topiramate
-antidepressants (i.e., fluoxetine, amitriptyline)