Chapter 18, Intro to Pharmacology

Which category of drug may exacerbate glaucoma?

Anticholinergic

The purpose of an ophthalmic decongestant medication is:

Blood vessel vasoconstriction

Which medication would be the best choice for a patient who requires an antibiotic and steroid otic preparation?

Ciprodex

What will the nurse instruct Pia to do after self-administering eye drops?

Close the eye gently so as not to squeeze the medication out.

The physician is preparing to write Leena a prescription for glaucoma treatment. She explains that the treatment will:

Continue for her lifetime

Pia is cautioned to follow up with her physician if the pain continues. This is because prolonged use of an ophthalmic anesthetic can cause which complication?

Corneal erosion

The primary action of drugs for glaucoma is to:

Decrease intraocular pressure

The physician determines that the best medication to treat Leena is a carbonic anhydrase inhibitor, which acts by:

Decreasing the formation of aqueous humor

What is the best form of ophthalmic medication for adults?

Drops

The ophthalmologist explains to Leena that glaucoma is a condition that results from:

Obstruction of the outflow of the aqueous humor

What ophthalmic medication will cause the aggravation of preexisting cardiovascular or pulmonary disorders, which may cause bradycardia, hypotension, dizziness, and bronchospasm, including those with congestive heart failure?

timolol (Timoptic)

Why is pilocarpine used after ophthalmic examinations in glaucoma patients?

to constrict the pupil and counteract the mydriatic (pupil-dilating) effects of other agents

atropine, condition:

to dilate pupils

phenylephrine, condition:

to dilate pupils

What is the goal of antiglaucoma agents?

to lower intraocular pressure

Following the application of a local ophthalmic anesthetics, such as tetracaine (TetraVisc) or proparacaine (Alcaine), the patient would be instructed to:

wear an eyepatch

prednisolone, condition:

allergic reaction of eyes

The physician applies a local ophthalmic anesthetic. What side effect may Pia experience?

anaphylaxis

What five categories can medications for the eye be classified into?

anti-infectives, anti-inflammatory agents, antiglaucoma agents, mydriatics (pupil dilation), local anesthetics

local ophthalmic anesthetics

applied topically to the eye for minor surgical and diagnostic procedures, removal of foreign bodies, or painful injury; include tetracaine (TetraVisc) and proparacaine (Alcaine)

mydriatics

are used topically to dilate the pupil for ophthalmic examinations; include atropine and cyclopentolate (Cyclogyl)

What medication is preferred for dilating the pupils of children during ophthalmic examinations?

atropine

miotics

medications that cause the pupil to contract; reduce IOP by increasing the aqueous humor outflow; they act by contracting the ciliary muscle (this mechanism also leads to blurred vision); includes pilocarpine

What is the treatment for chronic/open-angle glaucoma?

miotics (e.g., pilocarpine), carbonic anhydrase inhibitors (e.g., acetazolamide), and a local beta-adrenergic blocker, such as timolol (Timoptic) eye drops

What is the treatment for acute/angle-closure glaucoma?

miotics (e.g., pilocarpine), osmotic agents (e.g., mannitol), carbonic anhydrase inhibitors (e.g., acetazolamide), and surgery to open a pathway for the release of aqueous humor

chronic/open-angle glaucoma

much more common and often bilateral, this condition develops slowly over a period of years with few symptoms except a gradual loss of peripheral vision and possibly blurred vision; halos around lights and central blindness are late manifestations

What type of glaucoma is timolol (Timoptic) used to treat?

open-angle/chronic glaucoma

Which medication is used at the end of an eye exam to constrict the pupil?

pilocarpine

Acular, condition:

postoperative inflammation

What medications may exacerbate glaucoma?

potent corticosteroids, anticholinergics, and antihistamines

What are the first-line agents in the treatment of glaucoma?

prostaglandin analogs, such as latanoprost (Xalatan) and travoprost (Travatan Z)

carbonic anhydrase inhibitors (CAIs)

reduce the formation of hydrogen and bicarbonate ions, which have a diuretic effect and reduce the production of aqueous humor; includes acetazolamide and dorzolamide (Trusopt)

Which medication would most likely be given to Pia to act as a local ophthalmic anesthetic?

tetracaine (TetraVisc)

What would a patient receive trifluridine (Viroptic) ophthalmic solution for?

the treatment of herpes simplex, keratitis, or conjunctivitis; it's an antiviral ophthalmic preparation

What are miotics used for?

the treatment of open-angle glaucoma (considered third-line therapy due to side effects) or in the short-term treatment of angle-closure glaucoma before surgery

When are flurbiprofen (Ocufen) and ketorolac (Acular) ophthalmic drops used?

these NSAIDs are used postoperatively to treat inflammation after cataract surgery

What class of drugs do Naphcon-A and Visine-A belong to?

these medications are a combination of an antihistamine and decongestant

What type of medications are Tobradex and Blephamide?

they are corticosteroids in combination with antibiotics; Tobradex (tobramycin and dexamethasone), Blephamide (sulfacetamide and prednisolone)

When administering more than one ophthalmic medication at a time, the minimum amount of time desired between the medications is:

5 min

You can use otic drops in the eyes but you cannot use ophthalmic drops in the ears?

False; you can use ophthalmic drops in the ears, but not otic drops in the eyes

Leena's physician starts her on acetazolamide at a low dose but explains that she may need to increase her dose. If her dose is increased, Leena may experience which side effect?

Taste alteration

Patients who have earwax buildup should be instructed to:

Use Debrox OTC

After being administered proparacaine (Alcaine), the nurse should instruct Pia to:

Wear an eye patch

What type of drug is dorzolamide (Trusopt)?

a carbonic anhydrase inhibitor (CAI), applied topically to treat open-angle glaucoma; used as an adjunct to beta-blockers and is available as a combination product with timolol (Cosopt)

What type of drug is acetazolamide?

a carbonic anhydrase inhibitor (CAI), used to treat glaucoma

What is glaucoma?

a group of sight-threatening diseases of the eye in which there is increased intraocular pressure (IOP) due to obstruction of the outflow of aqueous humor; this causes deterioration of and damage to the optic nerve (which carries images on the retina to the brain), resulting in vision loss; there are two main types (acute/angle-closure and chronic/open-angle)

timolol (Timoptic)

a nonselective beta-adrenergic blocker that is used topically to lower IOP in open-angle (chronic) glaucoma by decreasing the rate of aqueous humor production

brimonidine (Alphagan-P)

a selective alpha2-agonist that decreases the formation and increases the outflow of aqueous humor; it does this without causing mydriasis and with minimal effects on cardiovascular or pulmonary hemodynamics

What are the two main types of glaucoma?

acute/angle-closure and chronic/open-angle

What are miotics usually administered with?

acetazolamide and/or timolol

What are the five main categories of antiglaucoma agents and how are they divided?

they are divided based on their mode of action; - carbonic anhydrase inhibitors (CAIs) - miotics - beta-adrenergic blockers - alpha-agonists - prostaglandin analogs

Why may pilocarpine hydrochloride gel (Pilopine HS) provide advantages over ophthalmic solutions?

because of its increased duration of effect and less frequent administration, especially for long-term use with noncompliant patients

What effect does the ophthalmic administration of antihistamines have?

blocks histamine receptors in the conjunctiva, relieving ocular pruritis associated allergic conjunctivitis

prostaglandin analogs

cause the greatest reduction in IOP by increasing the outflow of aqueous humor; they may be used concomitantly with other topical ophthalmic drugs to lower IOP (administer the drugs at least 5 min apart); include latanoprost (Xalatan) and travoprost (Travatan Z)

What effect does the ophthalmic administration of decongestants have?

causes vasoconstriction of blood vessels, thereby providing relief from minor eye irritation and redness

acute/angle-closure glaucoma

characterized by a sudden onset of pain, blurred vision, and a dilated pupil, this condition is considered a medical emergency; although uncommon, if left untreated, blindness can result in a few hours or days.

What type of action does pilocarpine exhibit?

cholinergic action and side effects

What medication is preferred for dilating the pupils of adults during ophthalmic examinations?

cyclopentolate (Cyclogyl) (because of its faster action and faster recovery time)

Who is brimonidine (Alphagan-P) an alternative for?

those for whom topical beta-blocker therapy is contraindicated

tetracaine, condition:

eye injury pain

Cosopt, condition:

glaucoma

Diamox Sequels, condition:

glaucoma

Timoptic, condition:

glaucoma

Travatan Z, condition:

glaucoma

What would latanoprost (Xalatan) be used to treat?

glaucoma

What would travoprost (Travatan Z) be used to treat?

glaucoma

pilocarpine, condition:

glaucoma

What is topical cyclosporine (Restasis) used for?

increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation

What actions does atropine have?

it dilates the pupil and acts as a cycloplegic (paralyzes the muscles of accommodation)

What is cyclosporine used for when administered systematically?

it is an immunosuppressive agent for organ transplant rejection prophylaxis when administered systemically