Glaucoma Pharmacology Mnemonics in 10 minutes

Glaucoma is one of those topics that you see a lot of contraindications with, but not necessarily a good explanation of the pathophysiology. I do a 10-minute run down of the most important aspects of glaucoma with a few mnemonics to help out.

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Auto Generated Transcript:

Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingpharm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Let's get started with the show.

Alright, welcome to the Memorizing Pharmacology podcast. Tony Guerra, we're going to do glaucoma pharmacology mnemonics and talk a little bit about the eye. So let's get started here. So the first thing is what are we really doing with these treatments? The first thing we're doing is we're either decreasing aqueous humor out or we are increasing aqueous humor outflow. So we're actually decreasing the amount of the fluid or we're helping it get out of there and the big issue is that usually this drainage canal is going to be blocked and it's just too much fluid in there and that increases pressure. Increased pressure creates damage to the optic nerve.

So let's start with acute angle closure glaucoma. So there's the two types: there's open angle where we see it wide open here just before the cornea and then there's closed angle where it's a bit sharper in the angle here and the real issue is some form of mydriasis so pupillary dilation and that might be that someone put in eye drops so atropine, epinephrine drops which are an anticholinergic or an adrenergic agonist respectively. So atropine is an anticholinergic, epinephrine is an adrenergic agonist that open the eye really wide.

If you go into a dark room what happens to your eye? Well your eye goes really wide so got our anticholinergic Bud cat here with this really wide open eyes and then excitement and stress. So if there's some kind of something that makes your fight or flight open up and your body's epinephrine going then your eyes open up wide there maybe is a crisis. So not only is the crisis causing the excitement and stress but this is an emergency so this acute angle closure glaucoma is something that needs to be treated right away. We'll talk about some treatments in a bit.

So let's talk about or contrast that with open angle glaucoma. So open angle glaucoma is where this angle is still wide open so not an emergency this is going to be something that's a lot slower. So what's happening here is the fluid can't get out okay so it's just this decrease of aqueous humor outflow and because of that outflow is not happening we have an open ankle glaucoma so it's much slower than the acute angle closure.

And causes could be family history, age, ancestry, myopia or you're nearsighted or elevated intraocular pressure so the FAME mnemonic: F for family history, A for age ancestry, M for myopia and then E for elevated intraocular pressure but again a much slower thing.

And when we talk about what happens you know what you would expect I was just thinking of the DC Metro and anyone that's ridden the DC Metro can knows this kind of tunnel that it's just iconic these concrete tunnels and you can't help but look down the line and you can't really see what's going on in the left you can't really see what's going on on the right.

So not only do you have this kind of tunnel vision but it's really a synonym for losing that peripheral vision so if you're a glass half full person you know you have tunnel vision you can still see what's in the middle if you're a glass half empty person you can't see to the sides so just peripheral vision tunnel loss of peripheral vision tunnel vision those are synonyms really.

Well let's use this ABCD and two P's glaucoma stems as a way to memorize which medications work how. So first we could decrease aqueous humor production: You can use an alpha agonist like brimonidine and this works both to decrease aqueous production or increase aqueous outflow beta blockers like timolol also decrease aqueous humor.

Carbonic anhydrase inhibitors so dorzolamide or dorzolamide really acetazolamide this IV dorzolamide is the eye drop and then a diuretic like mannitol it's a little more complicated but it made the ABCD mnemonic work but mannitol as well.

So when you talk about increasing outflow we think of two P's so you've got cholinergic pilocarpine again sludge cat was our cholinergic cat and then prostaglandin and that's what PG is for and then F2 alpha that's the receptor so the pH GF2 Alpha analogs, so Latina Pros, there are some other ones but you can see the Prost ending that helps you with that one. So again, the endings on these really help you distinguish Alpha Agonist versus beta blocker versus Carbonic anhydrase inhibitor versus maybe a prostaglandin analog. Alright, so getting into the much bigger ones and we're really just going to focus on the indication, the mechanism, and the adverse effect. The alpha Agonist promonidine, that's you know it's open angle glaucoma and that's kind of a thing to take home which is some of these are for open angle, some are foreclosed, some are for both. This mechanism is to decrease aqueous humor and increase aqueous humor outflow so it'll do both but you really have to watch for hypertension and then fatigue. What really might help you with this is that clonidine has those issues in clonidine is that one that kind of stopped the faucet of norepinephrine and if you look at the endings, the CL of clonidine and the brim of bromonidine they're really really close together.

Okay, the beta blocker timolol, okay so open angle or acute closed angle glaucoma. Let me get my head out of the way so it's not blocking the slide. It decreases aqueous humor by blocking beta receptors as it sounds and a lot of times you can use the drug class as the mechanism and then bradycardia is really what we're worried about again this stimul can get into the systemic system C so Carbonic anhydrous inhibitor dorsolamid which is the trusop or the IV acetozolomide either of those can help with our open angle glaucoma or acute closed angle glaucoma. It decreases that aqueous humor by inhibiting Carbonic anhydrase and again so many times the mechanism and the drug class are the same but watch out you can get quite a bit of blurry vision.

Our diuretic Mannitol or osmetrol, I don't want to go into kind of the weeds on this one but it it's really an emergency drug. The acute closed angle glaucoma, it decreases aqueous humor through a bit of a complex process and with Mannitol because it is such a potent diuretic so close to the glomerulus where where it works in that proximal convoluted tubule hypovolemia is a real concern.

Okay, the two P's okay so the first p is cholinergic so pilocarpine or pilocar that's closed angle glaucoma and it works by contrasting Contracting so ciliary contraction to increase the outflow of aqueous humor kind of squeezes it out through the canal slim and we want to think about the adverse effects as our sludge cat here so those are supposed to be pinpoint pupils. I know cats don't really have pinpoint pupils the way humans do but think of sludge B so that salivation, bradycardia but pinpoint pupil pilocarpine and I'll say that 10 times fast that might be an easier way. Pinpoint pupil pilocarpine pinpoint pupil pilocarpine easier way to remember this is the one that's going to help with that closed angle glaucoma by really narrowing the pupil and ciliary contraction.

Our second P P2 is a prostaglandin analog so it's going to mimic that effect so latinoprost or xeletan. The indication is open angle glaucoma increases outflow of aqueous humor by mimicking taking the prostaglandin effect is an analog and then it has this weird pigmentation of the iris or lashes but again now we're probably not going to use it unilaterally because that would make one eye a different color than the other one but again maybe just a little image here to help you out.

Okay, so again this is for informational purposes only it is not medical advice so if you have a medical condition consult a medical professional. Thanks for listening to the memorizing pharmacology podcast you can find episodes cheat sheets and more at memorizingfarm.com again you can sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com forward slash P forward slash mobile thanks again for listening thank you.

Like to learn more?

Find my book here: https://geni.us/iA22iZ

or here: https://www.audible.com/pd/B01FSR7HLE/?source_code=AUDFPWS0223189MWT-BK-ACX0-059486&ref=acx_bty_BK_ACX0_059486_rh_us

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