Chapter 104: Drugs for the Eye
A nurse is preparing to administer timolol [Timoptic] eye drops to a patient who has open angle glaucoma. The nurse notes that the patient has a history of chronic obstructive pulmonary disease (COPD). The nurse will contact the provider to discuss changing to which medication? a.betaxolol b.carteolol c.levobunolol d.metipranolol
ANS: A Betaxolol is the only ophthalmic beta blocker that is beta1 selective, meaning that it has less chance of causing bronchial constriction. It is preferred for patients with asthma and COPD. The other agents are not beta1 selective.
A patient has been using latanoprost [Xalatan] ophthalmic drops. The patient tells the nurse, "My eyes used to be greenish-brown, but now they're brown." What will the nurse do? a.Reassure the patient that this is a harmless side effect. b.Report this toxic effect to the patient's provider. c.Tell the patient that this indicates an increased risk of migraine headaches. d.Tell the patient that this effect will reverse when the medication is withdrawn.
ANS: A Latanoprost can cause a harmless, heightened brown pigment of the iris that stops when the medication is discontinued but does not regress. It is not a sign of a toxic reaction. It does not indicate an increased risk of developing migraines. It will not reverse.
A patient with ocular hypertension will begin using brimonidine [Alphagan] for long-term reduction of increased ocular pressure (IOP). The nurse teaches the patient about this medication. Which statement by the patient indicates understanding of the teaching? a."After using the drops, I should wait 15 minutes before putting in contacts." b."Because this is a topical medication, drowsiness will not occur." c."I will not have cardiovascular side effects when using this medication." d."If my eyes begin to itch or turn red, it means I am allergic to this drug."
ANS: A Patients using this drug should wait 15 minutes before putting in contacts, because soft contacts can absorb the drug. Even though the medication is topical, it can be absorbed systemically, causing systemic side effects such as drowsiness or lowered blood pressure. Itching and hyperemia may occur and do not indicate allergy.
An older adult patient comes to an ophthalmology clinic complaining of increased difficulty reading in dim light. The provider examines the patient and notes three large yellow deposits under the patient's cornea. The nurse will expect the provider to order which treatment for this patient? a.High doses of vitamins C and E, beta-carotene, and zinc b.Laser therapy c.Pegaptanib [Macugen] d.Photodynamic therapy
ANS: A This patient has three large drusen with minor vision changes, signs of intermediate agerelated macular degeneration (ARMD). Patients with intermediate ARMD can significantly reduce their risk of developing advanced ARMD by taking high doses of vitamins C and E, beta-carotene, and zinc. Laser therapy, pegaptanib, and photodynamic therapy are used to manage wet, or neovascular, ARMD.
A patient begins using timolol [Timoptic] to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition? a.Asthma b.Atrioventricular heart block c.Pulmonary hypertension d.Sinus bradycardia
ANS: A Timolol is a beta blocker and can precipitate bronchoconstriction when absorbed systemically. Patients with asthma will develop shortness of breath and wheezing. These symptoms are not associated with AV block, pulmonary hypertension, or sinus bradycardia.
The nurse is reviewing personal knowledge of the medications used in the treatment of open-angle glaucoma. The nurse would be correct to identify which medication(s) as treatment? (Select all that apply.) a.Alpha2 agonists b.Prostaglandin analogs c.Anticholinergics d.Carbonic anhydrase inhibitors e.Beta blockers
ANS: A, B, D, E The nurse is correct to identify alpha2 agonists, prostaglandin analogs, carbonic anhydrase inhibitors, and beta blockers as the drugs used in the treatment of open-angle glaucoma. Anticholinergic agents are used to produce mydriasis and cycloplegia to facilitate intraocular examination and intraocular surgery.
A patient is about to undergo emergency surgery for acute angle-closure glaucoma. Before surgery, which agent(s) will the nurse expect to administer? (Select all that apply.) a.Acetazolamide b.Brimonidine [Alphagan] c.Mannitol d.Phenylephrine e.Timolol
ANS: A, C, E Acetazolamide is used short term, in conjunction with other agents, to produce rapid lowering of IOP in patients with angle-closure glaucoma. Mannitol is an osmotic agent used in the emergency treatment of acute angle-closure glaucoma. Timolol helps reduce the production of aqueous humor and can be used in emergency treatment of angleclosure glaucoma. Brimonidine is used for long-term therapy for glaucoma. Phenylephrine is an adrenergic agonist used as a mydriatic agent.
A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider? a.An ophthalmic demulcent b.H1-receptor antagonists c.Glucocorticoid drops d.Ocular decongestants
ANS: B Histamine receptor antagonists can be used to provide immediate symptom relief, so until the cromolyn has provided relief, they may be useful for treating symptoms. Demulcents only add moisture to the eye and do not prevent chemical mediators from causing symptoms. Glucocorticoids are used for inflammatory disorders of the eye but are not first-line agents. Ocular decongestants are used to treat redness caused by minor irritants.
A patient has had dilation of the eyes with an anticholinergic agent. What will the nurse say when preparing this patient to go home after the examination? a."Systemic side effects will not occur with this agent." b."You may experience an increased heart rate, but this is a harmless side effect." c."You may need to wear dark glasses until this medication wears off." d."You will be able to read as soon as the exam is completed."
ANS: C Because the agent causes cycloplegia, which paralyzes the iris sphincter, the eyes are unable to respond to bright light, so patients should be advised to wear sunglasses until this effect wears off. Systemic side effects do occur with these agents. Tachycardia is a systemic effect and may indicate toxicity. Mydriasis is an effect of this drug, causing the eye to be unable to focus; patients will have blurred vision until this effect wears off.
A nurse administers timolol [Timoptic] ophthalmic drops to a patient who has glaucoma. The patient reports stinging of the eyes shortly after the drops were administered. What will the nurse do? a.Monitor the patient's heart rate, respiratory rate, and blood pressure. b.Notify the provider that the patient shows signs of angle-closure glaucoma. c.Reassure the patient that these are localized, reversible effects of the drug. d.Request an order for an antihistamine to treat this allergic response to the drug.
ANS: C Local effects of timolol and other beta blockers are generally minimal, but transient ocular stinging can occur. There is no need to monitor vital signs, because this does not represent a systemic reaction. This is not a sign of angle-closure glaucoma. Antihistamines will not help.
A nurse is teaching a patient who will begin using a fixed-dose preparation of dorzolamide and timolol [Cosopt] for open-angle glaucoma. Which statement by the patient indicates a need for further teaching? a."Blurred vision, tearing, or eye dryness may occur with this medication." b."I may experience a bitter taste in my mouth after instilling these eye drops." c."I will need to instill two eye drops 3 times daily in each eye." d."If I notice redness in my eyes or eyelids, I should stop using these drops."
ANS: C The fixed-dose preparation of dorzolamide and timolol is given as 1 drop twice daily. Blurred vision, tearing, eye dryness, and a bitter aftertaste are expected side effects. Redness in the eyes or eyelids indicates an allergic conjunctivitis and means that the drops should be discontinued.
A nurse in an ophthalmology clinic instills an anticholinergic agent into a patient's eyes. The nurse provides teaching when the patient asks the reason for the drops. Which statement by the patient indicates a need for further teaching? a."The drops help prevent my lenses from moving during the exam." b."The drops will cause me to have blurred vision and sensitivity to light." c."These drops allow the ophthalmologist to see inside my eyes." d."This medication anesthetizes my eyes so that the exam won't be painful."
ANS: D Anticholinergic agents are used to provide mydriasis and cycloplegia. They do not affect the sensation of pain and do not provide anesthesia. Cycloplegia refers to paralysis of the ciliary muscle and prevents the lens from moving during the exam. The desired effects, which facilitate eye examinations, do not allow the eye to focus or to respond to light, so blurred vision and photophobia occur. Mydriasis prevents the iris sphincter from contracting, allowing the examiner to see inside the eye.
A nurse is teaching a patient diagnosed with wet ARMD who will begin receiving bevacizumab [Avastin]. Which statement by the patient indicates a need for further teaching? a."I should be able to improve my visual acuity by using this drug." b."I should report eye pain and photophobia to my provider if they occur." c."This drug will help suppress the growth of new blood vessels." d."This medication will not reduce the risk of blindness."
ANS: D Bevacizumab can help reduce the risk of further impairment and progression to blindness. It can help improve visual acuity. Eye pain and photophobia are signs of endophthalmitis, which is an inflammation caused by infection; they should be reported to the provider. Bevacizumab works by suppressing the development of new blood vessels.
A nursing student asks the nurse to discuss the differences between POAG and angle-closure glaucoma. Which statement by the nurse is correct? a."Angle-closure glaucoma may be asymptomatic until irreversible damage has occurred." b."Both types are more common in African American patients." c."Drug therapy is the definitive treatment for angle-closure glaucoma." d."Early treatment with prostaglandin analogs can stop the progression of POAG."
ANS: D Prostaglandin analogs are first-line agents for treating POAG, and early treatment can stop the progression. Angle-closure glaucoma has a rapid onset of painful symptoms. POAG is more common in African Americans but angle-closure glaucoma is not. Surgery, not drugs, is the definitive treatment for angle-closure glaucoma.