Pharm Ch 42 Drugs Used to Treat Glaucoma and Other Eye Disorders -EVOLVE ?s

The nurse is teaching a patient with open-angle glaucoma about the disease and its treatment. Which statement by the patient best indicates that teaching has been successful?

"I will use a separate bottle of eyedrops for each eye so I can't spread the infection." Because visual impairment related to glaucoma is a result of intraocular pressure, it is critically important to control this pressure. This is achieved by the regular use of prescribed ophthalmic drops. When drops are not used as scheduled, pressure increases. Thus, it is important for the patient to refill prescriptions before using the last drops so that the schedule of administration can be maintained. Changes in vision caused by glaucoma are irreversible, so vision is not regained. Glaucoma is not an infection. Touching the eyes does not affect glaucoma.

The nurse is teaching a patient with glaucoma about the use of cholinergic agents. Which statement by the patient indicates a need for further teaching?

"If my vision gets blurred, I'll need to notify my doctor." This statement indicates the need for more patient education. Blurred vision is expected for 1 to 2 hours after the medication is instilled in the eye. The other statements indicate the patient understands the use of cholinergic agents.

A patient is prescribed brimonidine (Alphagan P) for treatment of open-angle glaucoma. The nurse questions the order after finding that the patient is also taking which medication?

Amitriptyline (Elavil) Brimonidine is an adrenergic agent. Tricyclic antidepressants such as amitriptyline may cause additive hypertensive effects. Atropine, cimetidine, and penicillin do not interact with brimonidine.

A patient is taking bimatoprost (Lumigan) and timolol maleate (Timoptic) eyedrops. How does the nurse instruct the patient to administer the drops?

At least 5 minutes apart Eyedrops taken with prostaglandin agonists should be given at least 5 minutes apart. Eyedrops taken with prostaglandin agonists should not be administered at the same time, 1 minute (too close together) apart, or 30 minutes apart (too long apart).

What does the nurse monitor for in a patient who is taking a systemic beta blocker and carteolol (Ocupress)?

Bradycardia This combination of medications may enhance the systemic therapeutic and toxic effects of ophthalmic beta-adrenergic-blocking agents. The nurse should monitor for an increase in the severity of side effects such as fatigue, hypotension, bronchospasm, and bradycardia. This combination of medications does not cause increased blood pressure, heart rate, or incidence of headaches.

Which medication may be useful for patients who are resistant to pilocarpine (Pilocar)?

Carbachol topical (Carboptic) The miotic action of carbachol topical lasts for 4 to 8 hours and may be useful in patients who are resistant to pilocarpine. Acetylcholine chloride, intraocular is used only during surgery to produce complete miosis within seconds. Duration of action is only a few minutes. Demecarium bromide is not useful in patients who are resistant to pilocarpine. Echothiophate iodide is not the correct medication. This drug has a higher incidence of adverse effects.

The nurse is teaching a patient with herpes simplex keratitis in the left eye about the use of trifluridine (Viroptic). Which instructions does the nurse include in the patient's teaching plan? (Select all that apply.)

Do not exceed 9 drops daily Store the medication in the refrigerator Drops should be continued for 7 additional days Nine drops daily of prescribed trifluridine is the maximum dosage and should not be exceeded. Trifluridine should be taken for 7 additional days. Trifluridine should be stored in the refrigerator. One drop should be instilled into the affected eye, not two. Drops should be instilled every 2 hours, not 4. Drops should be applied to the cornea, not the sclera.

Which ophthalmic medication does the nurse expect to administer when preparing a patient for cataract surgery?

Flurbiprofen sodium (Ocufen) Flurbiprofen sodium is used before cataract surgery to inhibit miosis (pupil constriction). Ketorolac tromethamine is used to relieve itchy eyes associated with seasonal allergies. Timolol maleate is a beta-adrenergic-blocking agent used to treat glaucoma. Diclofenac sodium is used after cataract surgery to decrease inflammation.

What is the best measure of drug effectiveness in the treatment of open-angle glaucoma?

Intraocular pressure Visual impairment in glaucoma is caused by damage to the optic disc from increased intraocular pressure. The goal of drug therapy in open-angle glaucoma is to decrease intraocular pressure. Intraocular pressure measurement is therefore the best measure of the drug's effectiveness. Visual acuity and speed of convergence are unrelated to the effectiveness of drugs used to treat glaucoma. Changes in peripheral vision occur with glaucoma, but this is a measure of damage, not of drug effectiveness.

A patient admitted to the eye clinic has been diagnosed with "wet" macular degeneration (exudative) in the right eye. Which medication does the nurse anticipate the ophthalmologist will order for this patient?

Ranibizumab (Lucentis) Ranibizumab is a selective vascular endothelial growth fact antagonist. It reduces blood vessel growth, increases vascular permeability and inflammation, and is used to treat "wet" macular degeneration. Latanoprost is a prostaglandin agonist and is used to reduce intraocular pressure. Metipranolol is a beta-adrenergic blocker and is not used to treat "wet" macular degeneration. Tropicamide is an anticholinergic agent and is not used to treat "wet" macular degeneration.

The nurse is teaching a patient with fungal blepharitis about the use of natamycin (Natacyn). Which instruction does the nurse include in the patient's teaching plan?

Wear sunglasses to reduce brightness Natamycin may cause slight mydriasis, and wearing sunglasses will reduce brightness and squinting. The eye should not be rubbed after administering natamycin. If eye pain develops with the use of natamycin, discontinue use and contact the healthcare provider. Natamcyin eyedrops are administered into the conjunctival sac.