Glaucoma Treatment and Pathophysiology Quiz
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Questions and Answers

What is the blood pressure classification for Stage 2 hypertension?

  • Between 140-159/90-99
  • Between 120-139/80-89
  • Less than 120/80
  • Greater than 160/100 (correct)

    • Which condition is NOT listed as a known cause of secondary hypertension?

  • Obesity (correct)
  • Thyroid or parathyroid disease
  • Chronic steroid therapy
  • Pheochromocytoma

    • What are the recommended blood pressure goals for individuals with cardiac failure?

  • $<$125/$<$75
  • $<$130/$<$85 (correct)
  • $<$130/$<$80
  • $<$140/$<$90

    • What is the most prevalent demographic for hypertension?

    <p>Elderly African-American females</p> Signup and view all the answers

    What percentage of patients miss at least 10% of TID or QID doses?

    <p>40%</p> Signup and view all the answers

    What is the primary action of VYZULTA (Latanoprostene bunod ophthalmic solution) 0.024%?

    <p>Decrease intraocular pressure (IOP)</p> Signup and view all the answers

    What is the action of Butanediol Mononitrate in VYZULTA?

    <p>Increase NO release</p> Signup and view all the answers

    What is the mechanism of action of Rhopressa (netasudil) 0.02% solution?

    <p>Inhibit Rho Kinase and NE transporter</p> Signup and view all the answers

    What is the primary effect of DSLT (Direct Selective Trabeculoplasty)?

    <p>Lower IOP</p> Signup and view all the answers

    What is the most common cause of Iron Deficiency Anemia?

    <p>Chronic blood loss</p> Signup and view all the answers

    What is the storage form of Fe++ in intestinal mucosal cells?

    <p>Ferritin</p> Signup and view all the answers

    What is the primary action of soluble Guanylyl cyclase in VYZULTA?

    <p>Increase TM/Schlemm’s Canal outflow</p> Signup and view all the answers

    Which type of drugs decrease peripheral vascular resistance (PVR) and heart rate (HR) by acting on the CNS?

    <p>a-Methyldopa and clonidine</p> Signup and view all the answers

    Which class of drugs primarily acts on the peripheral vascular system by inhibiting Ca entry through L-type voltage gated channels?

    <p>Calcium channel blockers</p> Signup and view all the answers

    Which drug selectively blocks vascular Ca channels, causing vasodilation and lowering PVR?

    <p>Nifedipine</p> Signup and view all the answers

    Which drug class has both beta-blocking and alpha 1-blocking properties and is used in hypertensive emergencies?

    <p>Carvedilol</p> Signup and view all the answers

    Which drug class opens K-channels in vascular smooth muscle cells, causing vasodilation and lowering PVR?

    <p>Potassium channel openers</p> Signup and view all the answers

    Which drug acts as a rapid-acting venous and arteriolar vasodilator, lowering PVR and BP?

    <p>Na-nitroprusside</p> Signup and view all the answers

    Which drug class inhibits ACE, decreasing circulating Ang II and PVR?

    <p>ACE inhibitors</p> Signup and view all the answers

    Which drug selectively blocks Ang II AT-1 receptor, also decreasing PVR?

    <p>Losartan</p> Signup and view all the answers

    Which condition is characterized by optic nerve head (ONH) atrophy and retinal ganglion cell death?

    <p>Glaucoma</p> Signup and view all the answers

    What is a primary mechanism of damage (PMOD) in glaucoma?

    <p>Elevated intraocular pressure (EIOP)</p> Signup and view all the answers

    What is used to manage elevated intraocular pressure (EIOP) in glaucoma?

    <p>Ocular anti-hypertensive drugs</p> Signup and view all the answers

    Which drug class decreases HR and cardiac output, with one member also having coronary vasodilatory effects?

    <p>Non-dihydropyridine calcium channel blockers</p> Signup and view all the answers

    Which factor is NOT listed as a glaucoma risk factor?

    <p>Thyroid disease</p> Signup and view all the answers

    What is the primary goal of pharmacological therapy for glaucoma?

    <p>Stable control of IOP</p> Signup and view all the answers

    Which class of topical medication is considered first-line therapy for glaucoma treatment?

    <p>Prostaglandin analogues</p> Signup and view all the answers

    What are the two types of aqueous outflow methods mentioned in the text?

    <p>Trabecular and uveoscleral</p> Signup and view all the answers

    What is the primary impact of biomechanical properties on glaucoma risk?

    <p>Corneal hysteresis</p> Signup and view all the answers

    What is the mechanism of action of prostaglandin analogues in reducing elevated IOP?

    <p>Enhancing uveoscleral outflow</p> Signup and view all the answers

    Which medication class is NOT a topical medication for lowering IOP?

    <p>Cholinergic agonists</p> Signup and view all the answers

    What are the secondary mechanisms of damage in glaucoma, besides elevated IOP?

    <p>Ischemic insult</p> Signup and view all the answers

    Which factor is NOT related to glaucoma risk?

    <p>Thyroid disease</p> Signup and view all the answers

    What is the vascular concept of ocular blood flow (OBF) related to in glaucoma?

    <p>Diastolic blood pressure (DBP)</p> Signup and view all the answers

    What are the specific prostaglandin analogues mentioned in the text?

    <p>Latanoprost, travoprost, bimatoprost</p> Signup and view all the answers

    What is the primary impact of neuronal damage in glaucoma?

    <p>Glutamate excitotoxicity</p> Signup and view all the answers

    Which drug class is commonly used for hypertension treatment and can be used alone or in combination with other drugs?

    <p>Diuretics</p> Signup and view all the answers

    What is the formula to calculate Mean Arterial Pressure (MAP)?

    <p>$MAP = \rac{{2 \ imes DP + SP}},{{3}}$</p> Signup and view all the answers

    Which trial found that diuretics are as effective as other agents in preventing cardiovascular complications associated with hypertension?

    <p>Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)</p> Signup and view all the answers

    Which drug class inhibits adrenergic transmission and includes reserpine and guanethidine?

    <p>Sympatholytic agents</p> Signup and view all the answers

    Which beta-adrenergic blocking agent is classified as a first-generation non-selective agent?

    <p>Propranolol</p> Signup and view all the answers

    Which drug is a third-generation hybrid beta-adrenergic blocking agent used for hypertensive emergencies and heart failure?

    <p>Labetalol</p> Signup and view all the answers

    What is the specific mechanism of action of labetalol?

    <p>Combined alpha-1, beta-1, and beta-2 blockade</p> Signup and view all the answers

    Which type of adrenergic receptor blockers are used for stage 1 and stage 2 hypertension in combination regimens?

    <p>Selective alpha-1 adrenergic receptor blockers</p> Signup and view all the answers

    Which drug class is classified into nonselective, cardio-selective, and hybrid categories with proposed mechanisms of action?

    <p>Beta-adrenergic blocking agents</p> Signup and view all the answers

    Which drug is a second-generation cardio-selective beta-adrenergic blocking agent?

    <p>Metoprolol</p> Signup and view all the answers

    Which drug is a first-generation beta-adrenergic blocking agent used in stage 1 and 2 hypertension alone or in combination?

    <p>Propranolol</p> Signup and view all the answers

    Which medication class may cause atrophy of eyelid receptors and periorbital fat cells as potential side effects?

    <p>Alpha adrenergic agonists</p> Signup and view all the answers

    Which medication class is contraindicated in pregnancy, history of miscarriage, and inflammatory conditions like chronic uveitis?

    <p>Prostaglandin analogs</p> Signup and view all the answers

    Which medication class is NOT used in open-angle glaucoma but can prevent acute angle closure by increasing aqueous outflow through pupil constriction and accommodation?

    <p>Pilocarpine</p> Signup and view all the answers

    Which medication class is used as first-line or adjunctive therapy, but has side effects such as exacerbation of asthma and heart failure?

    <p>Beta blockers</p> Signup and view all the answers

    Which medication class can enhance trabecular outflow and have a direct effect on Schlemm’s canal endothelial cell barrier function, impacting the conventional trabecular meshwork aqueous outflow pathway?

    <p>Prostaglandin analogs</p> Signup and view all the answers

    Which medication class reduces aqueous humor production and increases aqueous outflow, with potential side effects including allergic reactions, systemic hypertension, and dysgeusia?

    <p>Alpha adrenergic agonists</p> Signup and view all the answers

    Which medication class is contraindicated in inflammatory conditions like chronic uveitis?

    <p>Prostaglandin analogs</p> Signup and view all the answers

    Which medication class is NOT used in open-angle glaucoma?

    <p>Carbonic anhydrase inhibitors</p> Signup and view all the answers

    Which medication class has side effects such as superficial punctate keratitis and dry mouth and eyes?

    <p>Carbonic anhydrase inhibitors</p> Signup and view all the answers

    Which medication class is used to manage elevated intraocular pressure (EIOP) in glaucoma?

    <p>Prostaglandin analogs</p> Signup and view all the answers

    Which medication class is a parasympathomimetic that can prevent acute angle closure by increasing aqueous outflow through pupil constriction and accommodation?

    <p>Carbonic anhydrase inhibitors</p> Signup and view all the answers

    Study Notes

    Glaucoma Treatment and Pathophysiology Overview

    • Two types of aqueous outflow methods: trabecular and uveoscleral
    • Vascular concept of ocular blood flow (OBF) involving diastolic blood pressure (DBP) and perfusion pressure
    • Biomechanical properties impact glaucoma risk, including corneal hysteresis, resistance factor, and thickness
    • Secondary mechanisms of damage involve elevated or normal intraocular pressure (IOP) and ischemic insult
    • Neuronal damage in glaucoma related to neurovascular coupling and glutamate excitotoxicity
    • Glaucoma risk factors include elevated IOP, optic disc cupping, family history, race, increasing age, myopia, diabetes, and systemic vascular disease
    • Pharmacological therapy goals: reduction in mean IOP, stable control, and prevention of diurnal fluctuation
    • Topical medication classes and their IOP lowering abilities: prostaglandin analogues, alpha2-adrenergic agonists, beta blockers, carbonic anhydrase inhibitors
    • Prostaglandin analogues as first-line therapy for glaucoma treatment, with greater efficacy and safety
    • Details of specific prostaglandin analogues: latanoprost, travoprost, bimatoprost, tafluprost
    • Mechanism of action of prostaglandin analogues in reducing elevated IOP
    • Clinical trials and indications for tafluprost in reducing elevated IOP in patients with open-angle glaucoma or ocular hypertension

    Glaucoma Medications and Their Effects

    • Prostaglandin analogs (PGAs) convert to active free fatty acids by corneal enzymes and bind to FP receptors in the ciliary body, leading to up-regulation of matrix metalloproteinase (MMPs) and increased uveo-scleral outflow.
    • PGAs also enhance trabecular outflow and have a direct effect on Schlemm’s canal endothelial cell barrier function, impacting the conventional trabecular meshwork aqueous outflow pathway.
    • Potential side effects of PGAs include periorbital absorption causing atrophy of eyelid receptors and periorbital fat cells, increased density and subsequent loss of eyelashes, conjunctival hyperemia, and ocular surface disease.
    • Contraindications for PGAs include pregnancy, history of miscarriage, and inflammatory conditions like chronic uveitis.
    • Alpha adrenergic agonists (AAA) such as brimonidine and apraclonidine reduce aqueous humor production and increase aqueous outflow, with potential side effects including allergic reactions, systemic hypertension, and dysgeusia.
    • Beta blockers like betaxolol, carteolol, and timolol reduce aqueous humor production and are used as first-line or adjunctive therapy, but have side effects such as exacerbation of asthma and heart failure.
    • Carbonic anhydrase inhibitors like dorzolamide and brinzolamide also reduce aqueous production and have side effects including superficial punctate keratitis and dry mouth and eyes.
    • Pilocarpine, a parasympathomimetic, is not used in open-angle glaucoma but can prevent acute angle closure by increasing aqueous outflow through pupil constriction and accommodation.
    • Combination products, such as brinzolamide/brimonidine tartrate and dorzolamide/timolol, increase compliance and offer cost savings compared to using two separate medications.
    • Each medication has specific indications, dosages, and potential side effects that should be considered when prescribing for glaucoma treatment.
    • Prostaglandin analogs, alpha adrenergic agonists, beta blockers, carbonic anhydrase inhibitors, and pilocarpine all have different mechanisms of action and potential side effects that should be carefully monitored.
    • The use of combination products can simplify dosing schedules and improve patient adherence, but healthcare professionals should be aware of the specific components and potential adverse effects of each combination.

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    Pharmacology Exam 3.docx

    Description

    Test your knowledge of glaucoma treatment and pathophysiology with this comprehensive quiz. Explore topics such as aqueous outflow methods, ocular blood flow, biomechanical properties, neuronal damage, risk factors, pharmacological therapy goals, topical medication classes, prostaglandin analogues, and clinical trials for reducing elevated intraocular pressure.

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