glaucoma

[BrooklynDO]

ok i know this got posted before but im confused
i thought the MOA for bblockers and acetozolamide in glaucoma was to decrease secretion of humor, and the MOA for pilocarpine increases outflow and contracts muscles...
so why does qbank say pilocarpine is the DOC for acute closed angle glaucoma???????

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[nuclearrabbit77]

ok i know this got posted before but im confused
i thought the MOA for bblockers and acetozolamide in glaucoma was to decrease secretion of humor, and the MOA for pilocarpine increases outflow and contracts muscles...
so why does qbank say pilocarpine is the DOC for acute closed angle glaucoma???????

it will contract the cillary muscle, and constrict the iris and open access to the canal of schlemm. this allows the accumulated humor to leave the anterior chamber and decrease pressure.

acetazolamide decreases production of humor, and beta blockers do this as well. alpha agonist effects can vasoconstrict blood to the cillary body and decrease production as well. the drug of choice in an acute situation will be pilocarpine.

 

[nuclearrabbit77]

ok i know this got posted before but im confused
i thought the MOA for bblockers and acetozolamide in glaucoma was to decrease secretion of humor, and the MOA for pilocarpine increases outflow and contracts muscles...
so why does qbank say pilocarpine is the DOC for acute closed angle glaucoma???????

i think i see where you might have been confused...when they mean increased outflow, they don't mean increased production of aqueous humor, 'outflow' means that it leaves the eye at the canal of schlemm.

 

[AlexRusso]

I just had a qbank question about the acute tx of closed angle glaucoma and the answer was 550mg Acetozolamide (IV) followed by 250mg PO bid. Osamotic diuretics such as oral glycerol, urea IVor mannitol may also be used. Kaplan needs to make up their mind.

 

[BrooklynDO]

ok but A2 agonists aka epi which supposedly also increaces outflow, is contraindicated...ok im tired...but why does this make sense?

 

[nuclearrabbit77]

epinephrine does not increase outflow..although first aid says that it does, the main effect it has is due to vasoconstriction of vessels to the cillary body and thus decreasing production..inaddition,.. epinephrine causes dilation of the iris, and would prevent outflow at the canal of schlemm, and would be contraindicated in acute closed angle glaucoma. alpha agonists aren't used to treat glaucoma that often, and would only be reserved for use in an open angle glaucoma.

 

[BrooklynDO]

ok i hate it when both kaplan and FA is wrong grrrrrrrrr

 

[AlexRusso]

Just a simple rule to keep in mind is never to use drugs that dilate the pupil in closed angle glaucoma b/c by dilating the pupil you will further "close" the "narrow" angle.