Endo Exam 1: Sharma Glaucoma

The anterior chamber is the space between the __________ and __________ and contains about __________ μL of aqueous humor. The posterior chamber is between the __________ and __________ and contains about __________ μL

Cornea, iris, 250, iris, lens, 50

KNOW — Aqueous Humor Pathway
Aqueous humor is secreted by the __________ → enters the __________ chamber → travels through the __________ → enters the __________ chamber → drains through the __________ → __________ of Schlemm.

Ciliary body, posterior, pupil, anterior, trabecular, canal

Aqueous humor is synthesized by the __________ epithelium and production is mediated by / ATPase and __________. Secretion is regulated by __________ and __________ receptors.

Ciliary, Na/K, CA, alpha, beta

Aqueous humor is produced at approximately – μL/min and normally drains through the __________ meshwork into the __________ of Schlemm. Normal IOP is – mmHg.

Aqueous humor is the __________ component contributing to IOP, while vitreous humor is relatively __________

Dynamic, static

Glaucoma is a group of diseases that damage the __________, causing loss of visual acuity and __________ field

Optic nerve, visual

In primary open-angle glaucoma, __________ changes in the trabecular meshwork cause __________ aqueous outflow, increasing __________

Degenerative, subnormal, IOP

Angle-closure glaucoma involves a genetically __________ angle that can cause intermittent blockage of aqueous outflow and intermittent increases in __________

Narrow, IOP

Normal-tension glaucoma involves glaucoma/optic nerve damage occurring despite __________ IOP

normal

Important glaucoma risk factors include age >__________ years, family __________, thin central __________, and increased __________

60, history, cornea, IOP

__________ can cause elevated IOP and drug-induced glaucoma

Steroids/corticosteroids

In the early stages of open-angle and normal-tension glaucoma, patients usually have __________ symptoms, and >__________% may not know they have glaucoma

No, 50

An acute angle-closure episode can cause severe eye __________, N/V, __________, hazy cornea, hyperemic conjunctiva, blurred vision, halos around lights, and profuse __________

Pain, headache, tearing

Later-stage glaucoma can cause a __________ due to damage to peripheral optic nerve fibers, and untreated disease can lead to complete __________

Peripheral scotoma, blindness

Increased IOP → pressure-sensitive __________ initiate optic nerve remodeling → decreased retinal __________ → disrupted axoplasm flow → apoptosis of retinal __________

Additional contributors to optic nerve damage include __________, complement activation, and __________ components, especially in normal-tension glaucoma

Astrocytes, blood flow, ganglion cells, Excitotoxicity, autoimmune

Prostaglandin analogs bind __________ receptors and primarily increase aqueous drainage through the __________ pathway, with a minor increase through the __________ meshwork. They are typically __________-line therapy and are dosed __________ daily at __________

Examples include __________, __________, __________, and __________ LTBT

FP, uveoscleral, trabecular, 1st, once, bedtime, Latanoprost, travoprost, bimatoprost, tafluprost

BBs block __________ receptors in the ciliary body epithelium, decreasing aqueous humor __________. Examples include β1-selective __________ and nonselective __________, __________, and __________ LMT

Beta, production, betaxolol, levobunolol, metipranolol, timolol

The nonselective BB with ISA is __________

BBs are generally dosed – times daily and are minimally effective on __________ IOP

Carteolol, 1-2, nocturnal

Alpha-2 agonists stimulate __________ receptors on the ciliary epithelium to decrease aqueous production, with a minor increase in __________ drainage. Examples are __________ and __________

Alpha-2, uveoscleral, brimonidine, apraclonidine

Alpha agonists are generally dosed __________ times daily and are minimally effective on __________ IOP.

3, nocturnal

CAIs inhibit CA __________ in the ciliary process → decrease __________ production → decrease Na/fluid transport → decrease aqueous secretion → lower __________.

II, bicarbonate, IOP

CAIs include __________ and __________ and are generally dosed __________ times daily

Dorzolamide, brinzolamide, 3

Cholinergic agents activate muscarinic __________ receptors → ciliary muscle __________ → opening of the __________ → increased aqueous outflow

M3, contraction, trabecular meshwork

Cholinergic Medication Examples include __________ and __________, with pilocarpine generally dosed – times daily

Pilocarpine, carbachol, 3-4

Dipivefrin is a __________ for EPI. It decreases aqueous production and increases __________ drainage

Prodrug, uveoscleral

Netarsudil is a __________ inhibitor that relaxes the __________ and lowers scleral vascular pressure to increase aqueous drainage. It also inhibits the __________ transporter, decreasing aqueous production

Netarsudil is given __________ drop __________ daily in the __________

Rho kinase, trabecular meshwork, NE, 1, once, evening

Prostaglandin analogs have __________ contraindications listed in the lecture

None

BBs are contraindicated with __________ and __________. Use caution with __________ diseases such as asthma/COPD, diabetes, hyperthyroidism, and decompensated HF

Bradycardia, heart block, bronchospastic

Alpha agonists are contraindicated with __________ inhibitors. Use caution in severe CV/cerebrovascular disease and __________ hypotension

MAO, orthostatic

CAIs have no listed formal contraindications, but should be avoided with previous __________ allergy and renal dysfunction with CrCl <__________ mL/min

sulfa, 30

Cholinergic agents have no listed formal contraindications, but should be avoided/cautioned in recent __________, __________, and GI spasm or peptic ulcer

MI, asthma

Netarsudil/latanoprost has __________ contraindications listed in the lecture

None

Prostaglandin analogs can cause conjunctival Hyperemia, __________, loss of orbital fat, and __________

Patients should be told eyelashes may become darker, thicker, and fuller but this is __________, while iris hyperpigmentation is __________

eyelash darkening/elongation, iris darkening, Reversible, irreversible

BBs can cause decreased HR and BP, bronchospasm, dizziness, and Fatigue

BBs may mask symptoms of __________ and __________. Use __________ occlusion to reduce systemic absorption

Hypoglycemia, hyperthyroidism, nasolacrimal

Alpha agonists can cause dizziness, fatigue, Somnolence, dry mouth, mild decreases in BP and HR, and __________ (__________ rxns)

Patients should use __________ occlusion and avoid activities requiring mental alertness until they know how the medication affects them

eyelid edema/itching, allergic-type, Nasolacrimal

Cholinergics can cause increased GI motility, nausea/vomiting/diarrhea, urinary frequency, sweating, headache, and __________.

Because miosis can decrease visual acuity, patients should use caution when __________ at night. Proper administration helps reduce __________ adverse effects.

Miosis, Driving, systemic

Netarsudil can cause conjunctival __________, conjunctival __________, and eyelid erythema.

Hyperemia, hemorrhage

Nasolacrimal occlusion is used to maximize drug __________ and minimize systemic __________ effects.

Effectiveness, adverse

After inserting the drop, __________ the eye, place a finger at the inner corner of the eyelid near the __________, and press gently for __________ full minutes

Close, nose, 2

According to the lecture summary, use nasolacrimal occlusion for glaucoma eye drops for everything __________ inhibitors

But carbonic anhydrase

Before and after using eye drops, __________ your hands. Remove __________ lenses and wait at least __________ minutes before reinserting them.

Wash, contact, 15

Do not touch the container __________ to the eye or eyelid. Tilt your head __________, apply the drop, close the eye, and perform __________ occlusion

Tip, back, nasolacrimal

After administration, keep the eye closed with nasolacrimal occlusion for at least __________ minutes and __________ excess solution from the eyelid

Wait at least __________ minutes before administering a second ophthalmic medication

2, blot, 10

Unused bottles of __________, __________, and __________ should be stored in the refrigerator.

Latanoprost, latanoprostene bunod, tafluprost

Cosopt = __________ + __________, Combigan = __________ + __________, Simbrinza = __________ + __________

Timolol, dorzolamide, timolol, brimonidine, brinzolamide, brimonidine

Cosopt is dosed __________ drop __________ times daily, Combigan __________ drop __________ times daily, and Simbrinza __________ drop __________ times daily.

1, 2, 1, 2, 1, 3

Rocklatan contains __________ 0.02% + __________ 0.005% and is dosed __________ drop once daily in the __________

Netarsudil, latanoprost, 1, evening

Hyperosmotic agents lower IOP by creating an osmotic gradient between __________ and __________ humor, moving fluid from aqueous humor into plasma. Oral options include __________ and __________, while IV therapy uses __________

Plasma, aqueous, glycerol, isosorbide, mannitol

__________ is the drug of choice among the oral hyperosmotics in diabetics. Hyperosmotics cause diuresis and __________

Isosorbide, dehydration

For an acute angle-closure episode, pilocarpine may be given as 1 drop every __________ minutes for – doses. Its onset may be delayed because the iris is __________

5, 4-6, ischemic

Laser __________ creates a permanent hole in the iris, facilitating additional __________ drainage.

Iridectomy, aqueous

A patient with POAG on latanoprost still has high IOP and has a severe sulfa allergy. Avoid __________. Other possible classes include __________ blockers, __________ agonists, and __________ agents.

CAIs, beta, alpha, cholinergic

A diabetic patient is started on a beta blocker. Key counseling includes possible masking of __________ symptoms, using __________ occlusion, and monitoring for reduced / and bronchospasm.

oglycemia, nasolacrimal, HR, BP

A patient starting brimonidine should be counseled about __________/somnolence, dry mouth, possible lower BP/HR, eyelid __________/itching, using nasolacrimal occlusion, and avoiding activities requiring mental __________ until effects are known.

Dizziness/fatigue, edema, alertness

A patient using pilocarpine should know that it may cause GI effects and __________, and should use caution when __________ at night because of decreased visual acuity.

Miosis, driving

The major glaucoma drug classes either decrease aqueous __________, increase aqueous __________, or both.

Production, drainage

The classes that decrease aqueous humor production include __________ blockers, __________ agonists, and carbonic __________ inhibitors.

The major classes that increase aqueous humor drainage include __________ analogs, __________ agents, and __________ kinase inhibitors

Beta, alpha-2, anhydrase, Prostaglandin, cholinergic, Rho

__________ and __________ can decrease aqueous production while also increasing aqueous drainage

Dipivefrin, netarsudil

Prostaglandins = increase __________ drainage, beta blockers = decrease __________ production, alpha-2 agonists = decrease __________ production, CAIs = decrease __________ production, cholinergics = increase __________ drainage, netarsudil = increase __________ drainage

Uveoscleral, aqueous, aqueous, aqueous, aqueous, aqueous

For glaucoma eye drops, remember: wash hands, remove contacts for at least __________ minutes, avoid touching the tip, perform __________ occlusion for at least __________ minutes, and wait at least __________ minutes between different eye medications

15, nasolacrimal, 2, 10

Beta blockers → /heart block, alpha agonists → __________ inhibitors, CAIs → sulfa allergy/CrCl <, cholinergics → recent MI/asthma/GI ulcer

Bradycardia, MAO, 30