Term
Monocular trials for glaucoma meds are…
A. A terrible idea
B. Not as great as we used to think
C. A preferred way to start glaucoma treatment
D. The only way to start glaucoma treatment |
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Definition
B.
Folks today are shying away from monocular trials. I mean, if the patient is super nervous about taking drops, you could always go with just the one eye, but… yeah. |
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Term
| First-line DOC for glaucoma is: |
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Definition
Prostaglandins
They're safe (like if the patient has a pacemaker), you only have to take it once a day, and they reduce pressure the most. Also, Latanoprost is generic now. |
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Term
| How do you determine target IOPs? |
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Definition
Dr. Timpone takes the IOP, rounds to the nearest number that’s divisible by 3, then chops off the top third. (eg. If IOP = 26, round to 27, divide by 3, subtracts that (9) from 27: target IOP = 18.
If advanced, target IOP is just 12.
If NTG, shoot very low - at least 30%. |
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Term
| What are the neuroprotective glaucoma drugs? |
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Definition
Betaxolol (beta 1-selective beta blocker)
Brimonidine/Alphagan (adronergic agonist) |
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Term
Your patient has an 80% risk of developing glaucoma. The drops you put them on lower their IOP from 25 to 22.
What is their new risk? |
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Definition
25-22 = 3 mmHg change
1 mmHg change = 10% risk reduction
80% - 30% = 50%
Or, at least, I think that's how it works... |
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Term
You freak out to your attending because your glaucoma patient returns for a post-op cataract surgery appointment and you see a disc with more pallor than they've ever had!
Your attending's mocking laughter would have hurt your feelings if you had had any. Why is your alarm so apparently unfounded? |
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Definition
| Post cataract surgery can make a disc look pale because you as the examiner are no longer observing the disc through a brunesced lens, you naiive student, you... |
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Term
VF defects in normotensive glaucoma tend to be more:
A) Diffuse
B) Focal
C) Random |
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Definition
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Term
Which two are NOT risk factors for NTG?
Hyperopia
Sleep apnea
BP fluctuations
Migraines
Being a tard |
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Definition
Hyperopia and Being a tard
Myopia, instead, is another risk factor for NTG.
Also, being a tard doesn't logically fit because Oliver is still glaucoma-free. |
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Term
Regarding treating younger patients with NTG (Choose 3):
A) Betoptic can increase blood flow
B) Alphagan is neuroprotective
C) Pressures are our primary focus
D) Side effects are easier to muscle through
E) Avoid beta blockers |
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Definition
A, B, E
It's actually less important to drop pressures all by themselves here. Consider other effects of the drug wrt helpful things for NTG (eg A & B).
Also, SEs are the reason for E |
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Term
| What family of glaucoma meds is likely to level out diurnal variations? |
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Definition
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Term
True or False?
Regardless of their pigmentary side effects, prostaglandins are not contraindicated in pigmentary dispersion glaucoma. |
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Definition
True.
Prostaglandins are A-OK for pigmentary dispersion glaucoma. |
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Term
| Jimmy has a diurnal IOP fluctuation of 3.1 mm Hg. John, however, has a 5.4 mm Hg diurnal fluctuation. Over the next 5 years and based solely on diurnal fluctuation, John has how much higher a risk of glaucoma progression? |
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Definition
| 6 times the risk (with just that 2.3 mm Hg difference from 3.1 to 5.4) |
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Term
Choose one:
If the patient's on a systemic beta-blocker, a topical beta-blocker will give (a fair amount of / very little) added IOP reduction. |
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Definition
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Term
| Who's the newest kid on the beta-block? What's his dosing? |
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Definition
| Istalol 0.5% (a formulation of timolol maleate), FDA approved for qd |
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Term
| Levobunolol (Betagan) 0.25%/0.5% is the longest acting beta-blocker and FDA approved for what dosing? |
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Definition
Betagan = qd
After the one dose, you won't have to take it '-agan' all day. |
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Term
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Definition
bid
Think of how there's two heads to the Timbers (bet)AX(on). (This also applies to betAXolol.) |
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Term
| What's the catch to Iopidine, the alpha-agonist glaucoma drop? |
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Definition
| Tachyphylaxis in up to 50% of patients, so it's only really good to use for short-term IOP reduction. |
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Term
| What prostaglandin is targeted as the one that can darken your iris or increase eyelash length? |
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Definition
| Well, Bimatoprost is Latisse, but Latanoprost (Xalatan) was the one in lecture right before this information. Really, it's just all prostaglandins. |
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Term
| If you need IOP reduction TOMORROW, should you go for Travatan or Timolol? |
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Definition
| Timolol, since Travatan (a prostaglandin) will take two weeks to kick in. |
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Term
| What's the typical dosing on a prostaglandin? |
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Definition
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Term
| What preservative do you find in Travatan Z? |
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Definition
| Sofzia (replaced the BAK in the original Travatan) |
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Term
Typical prostaglandin dosing is qd. What would happen if you bumped it to bid?
What about bumping a qd beta-blocker to bid? |
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Definition
Prostaglandins bid will actually limit the drug's effectiveness.
Actually not sure about the beta-blocker, but I seem to remember it having little effect (it's not bad, anyway…). |
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Term
| What's unique about the newest prograglandin, Tafluprost (Zioptan) 0.0015% |
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Definition
| Tafluprost is unpreserved. |
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Term
| Avoid topical CAIs in patients allergic to what? |
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Definition
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Term
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Definition
| Dorsolamide 2% (CAI) and Timolol 0.5% |
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Term
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Definition
| Latanoprost 0.005% (prostaglandin) and Timolol 0.5% |
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Term
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Definition
| Brimonidine 2% (A-agonist) and Timolol 0.5% |
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Term
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Definition
Travoprost 0.004% (prostaglandin) and Timolol 0.5%
(Not available in the U.S.) |
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Term
| According to Dr. Timpone, what are the 6 big pitfalls in glaucoma medical management? |
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Definition
1. Not establishing target IOPs
2. Changing meds too quickly if target IOP isn't met (re: compliance / user error)
3. Adding meds without removing the ineffective ones
4. Relying on a single VF or nerve fiber analysis (vs serial)
5. IOP checks at the same time of the day
6. Not ruling out other reasons for nerve damage (eg. vascular occlusions, ON compression, congenital) |
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