Pharmacology - Chapter 57 - Ophthalmic Drugs
Information about which adverse effects would the nurse include in the teaching about indirect-acting miotic eyedrops? Select all that apply. 1 Blurred vision 2 Farsightedness 3 Paralysis of eyelids 4 Stinging on instillation 5 Decreased night time vision
1 Blurred vision 4 Stinging on instillation 5 Decreased night time vision Adverse effects are more likely to occur with indirect-acting miotics because they have longer-lasting effects. Adverse effects include blurred vision, temporary stinging upon drug instillation, reduced night time or low-light vision, drug-induced myopia (near sightedness), and accommodative spasms. Such effects are secondary to contraction of the ciliary muscle. Miotic drugs also cause vasodilation of blood vessels supplying the conjunctiva, iris, and ciliary body, which may lead to vascular congestion and ocular inflammation. Other undesirable effects include conjunctivitis, lacrimation (tearing), twitching of the eyelids (blepharospasm), and eye or brow pain. Prolonged use can result in iris cysts, lens opacities, and, rarely, retinal detachment.
Which type of glaucoma occurs in infants? 1 Congenital glaucoma 2 Pigmentary glaucoma 3 Open-angle glaucoma 4 Angle-closure glaucoma
1 Congenital glaucoma An infant may be born with congenital glaucoma. Infants do not typically have pigmentary, open-angle, or angle-closure glaucoma.
Which drug will decrease postoperative intraocular hypertension? 1 Dipivefrin 2 Pilocarpine 3 Acetylcholine 4 Brimonidine
2 Pilocarpine Pilocarpine is a direct-acting cholinergic drug used to treat postoperative intraocular hypertension. Dipivefrin is used to treat chronic open-angle glaucoma. Acetylcholine is used for surgical miosis. Brimonidine is used primarily for glaucoma.
Which sympathomimetic drugs are used in the treatment of glaucoma? Select all that apply. 1 Dipivefrin 2 Carbachol 3 Epinephryl 4 Pilocarpine 5 Acetylcholine
1 Dipivefrin 3 Epinephryl Dipivefrin and epinephryl are sympathomimetic drugs used in the treatment of glaucoma. Carbachol and pilocarpine are direct-acting cholinergic drugs used in the treatment of open- and closed-angle glaucoma. Acetylcholine is a direct-acting cholinergic drug used in producing miosis during ophthalmic surgery.
Which effects are expected from therapy with direct- and indirect-acting miotics? Select all that apply. 1 Mydriasis 2 Eye numbness 3 Pupillary dilation 4 Enhanced aqueous humor drainage 5 Ciliary muscle contraction
4 Enhanced aqueous humor drainage 5 Ciliary muscle contraction Both direct- and indirect-acting miotics have effects similar to those of acetylcholine, but their actions are more prolonged. The direct-acting miotics can directly stimulate ocular cholinergic receptors and mimic acetylcholine. Indirect-acting miotics work by binding to and inactivating the cholinesterases acetylcholinesterase and pseudocholinesterase, the enzymes that break down acetylcholine. As a result, acetylcholine accumulates and acts longer at the cholinergic receptor sites. This leads to drug effects that include miosis, enhanced aqueous humor drainage, ciliary muscle contraction, and reduced intraocular pressure by an average of 20% to 30%. Drug-induced miotic effects may be less pronounced in individuals with dark eyes (e.g., brown or hazel). Miotics are not used to numb the eye.
Which drug is prescribed to newborns for preventing ocular infections caused by Neisseria gonorrhoeae? 1 Natamycin 2 Gentamicin 3 Trifluridine 4 Erythromycin
4 Erythromycin Erythromycin is a macrolide antibiotic. It is used for preventing infections in newborns caused by N. gonorrhoeae. Natamycin is an antifungal drug used in the treatment of blepharitis, conjunctivitis, and keratitis, which are caused by the Candida and Aspergillus species. Gentamicin is an aminoglycoside used in the treatment of Pseudomonas, Proteus, and Klebsiella infections. Trifluridine is an antiviral drug indicated for keratitis and keratoconjunctivitis, which are caused by the herpes simplex virus.
Parasympathomimetic ophthalmic drugs such as pilocarpine reduce intraocular pressure in the treatment of glaucoma by which mechanism of action? 1 Miosis 2 Mydriasis 3 Pupillary dilatation 4 Decrease in drainage of aqueous humor
1 Miosis Pilocarpine is a direct-acting parasympathomimetic drug that is used as a miotic in the treatment of open-angle glaucoma. Miosis causes pupillary constriction, increasing the outflow of aqueous humor.
Which mechanism causes the eye to dilate? 1 The iris dilator muscle constricts the iris to cause pupil dilation. 2 The sympathetic nervous system causes constriction of the pupil. 3 The parasympathetic nervous system causes dilation of the pupil. 4 The sphincter pupillae muscle constricts the iris to cause pupil constriction.
1 The iris dilator muscle constricts the iris to cause pupil dilation. The pupillary size changes in response to the light due to the constriction and dilation of the pupil. To achieve better vision in low light, the iris dilator muscles constrict the iris and increase the size of the pupil (dilatation). The sympathetic nervous system dilates the pupil by sending impulses to the dilator muscles to contract. This increases the size of the pupil. The parasympathetic nervous system causes constriction of the pupil by sending impulses to the sphincter pupillae muscle. This expands the iris and decreases the pupil size.
Which medication decreases the production of aqueous humor and increases its outflow? 1 Timolol 2 Betaxolol 3 Metipranolol 4 Levobetaxolol
1 Timolol Timolol is a beta-adrenergic blocker class of drug used for treating disorders like open-angle glaucoma. Timolol is the only beta blocker that reduces the intraocular pressure by decreasing the production of aqueous humor and increasing its outflow. It is available in formulations that are devoid of benzalkonium chloride (preservative) to prevent allergic reactions in patients sensitive to this preservative. Betaxolol, metipranolol, and levobetaxolol do not have an effect on the outflow of aqueous humor. These medications also contain benzalkonium chloride as a preservative. Therefore to avoid hypersensitive reactions, these medications cannot be prescribed for the patient.
Which structure(s) located in the eye play(s) a major role in central vision and enable(s) a person to perceive colors? 1 Lens 2 Rods 3 Pupil 4 Cones
4 Cones Cones are the photoreceptive cells located in the retina of the eye. These cells play a major role in central vision and enable the perception of colors. The lens is the biconvex transparent crystalline structure of the eye, located directly behind the iris and the pupil. Rods are the photoreceptive cells in the retina and are responsible for light vision. The pupil is a circular opening in the iris of the eye that allows light to enter the eyeball when the eyelids are open.
The nurse is assessing a patient with angle-closure glaucoma who has been prescribed mydriatics. Which point is essential to include in teaching? 1 "Ensure that the tip of the dropper touches the eye." 2 "Wear sunglasses after administering your eyedrops." 3 "Avoid applying pressure to the inner canthus with a tissue." 4 "You can wear contact lenses immediately after administering the eyedrops."
2 "Wear sunglasses after administering your eyedrops." Photosensitivity is an expected adverse effect of mydriatics; therefore, when these drugs are administered, encourage the patient to wear sunglasses to help minimize eye discomfort and/or headaches while in sunlight. Touching the eye with the tip of the dropper or container should be avoided to prevent contamination. Pressure should be applied to the inner canthus with a tissue or 2-inch gauze pad for 1 full minute. This helps remove any excess drug and prevents the outflow of the medication from the eye. Contact lenses may cause irritation, so these should be avoided after administering antiglaucoma drugs.
Which medication is an example of an ocular sympathomimetic drug? 1 Latanoprost 2 Dorzolamide 3 Apraclonidine 4 Levobetaxolol
3 Apraclonidine Apraclonidine is a direct-acting ocular sympathomimetic drug. It is used as short-term adjunctive therapy for glaucoma. Latanoprost is a prostaglandin agonist. Dorzolamide is a carbonic anhydrase inhibitor. Levobetaxolol is an ophthalmic beta-blocking drug.
A patient newly diagnosed with open-angle glaucoma asks about the purpose of epinephrine therapy. Which information would the nurse teach the patient? 1 "Epinephrine stops ocular deterioration." 2 "Epinephrine decreases spasms in the eye." 3 "Epinephrine increases your ability to blink." 4 "Epinephrine decreases intraocular pressure."
4 "Epinephrine decreases intraocular pressure." Both epinephrine and dipivefrin are used to reduce elevated intraocular pressure in the treatment of chronic open-angle glaucoma, either as initial or long-term therapy. This is the mainstay of therapy for this condition. The medications do not stop ocular deterioration, decrease spasms in the eye, or affect the ability to blink.
A patient is started on olopatadine drops. What assessment finding indicates the medication is having a therapeutic effect? 1 Dilated pupils 2 Absence of pain 3 Increased tearing 4 Absence of itching
4 Absence of itching Olopatadine is an ocular antihistamine used to treat symptoms of allergic conjunctivitis (hay fever), which can be seasonal or nonseasonal. It works by competing at the receptor sites for histamine. Histamine normally produces ocular symptoms such as itching and tearing. Olopatadine is not used to dilate pupils or reduce pain.
In a patient admitted with an ocular problem, the nurse performs an assessment of extraocular eye movement. Which purpose does this assessment serve? 1 Determines if the patient is in pain 2 Determines if the eye is sensitive to stimuli 3 Determines if eye movement causes accommodation 4 Determines if the patient has the ability to move eyes in all directions
4 Determines if the patient has the ability to move eyes in all directions Each eye is held in place and moved by six muscles that are controlled by cranial nerves. These muscles include the rectus and oblique muscles. There are four types of rectus muscles: inferior, superior, medial, and lateral. There are two types of oblique muscles: inferior and superior. The nurse would assess a patient with ocular problems by asking him or her to follow an object as the patient moves the eye. This assessment allows the nurse to determine if the patient has any deficits in muscle movement. This assessment does not show if the patient is in pain or sensitive to stimuli. This assessment is not used to determine if eye movement causes accommodation.
Which drug is used to treat accommodative esotropia? 1 Carbachol 2 Pilocarpine 3 Acetylcholine 4 Echothiophate
4 Echothiophate Echothiophate is used to treat accommodative esotropia. Carbachol is used to treat open-angle glaucoma. Pilocarpine is used to treat secondary glaucoma after iridectomy. Acetylcholine is used for rapid miosis after cataract lens extraction.
Which information is essential for the nurse to teach the patient about glaucoma? 1 Damages the optic nerve 2 Caused by loss of transparency of the lens 3 Caused by destruction of cone cells in the eye 4 Caused by impaired function of the lacrimal ducts
1 Damages the optic nerve Glaucoma is characterized by increased intraocular pressure that damages the optic nerve due to accumulation of aqueous humor. The patient needs to understand that without treatment, the optic nerve is damaged, and blindness can result. The lens, cones, and lacrimal ducts are not involved in glaucoma. Loss of transparency of lenses is caused by cataract. Destruction of cone cells affects central vision and causes color blindness. Lacrimal ducts are the channels arising from lacrimal glands; they drain tears. Impaired functioning of lacrimal ducts does not cause glaucoma.
Which assessment finding is expected in a patient admitted with a cataract? Select all that apply. 1 Diplopia 2 Blurred vision 3 Severe eye pain 4 Photosensitivity 5 Gray-white color within the lens
1 Diplopia 2 Blurred vision 5 Gray-white color within the lens A cataract is a gray-white opacity that can be seen within the lens. If cataracts are untreated, sight may eventually be completely lost. Diplopia, or double vision, may also develop. At the onset of a cataract, vision is blurred and may be further worsened by the glare of bright lights. The patient with a cataract does not typically have severe pain or photosensitivity.
Which drug is used to identify corneal defects? 1 Fluorescein 2 Atropine sulfate 3 Cromolyn sodium 4 Cyclopentolate solution
1 Fluorescein Fluorescein is an ophthalmic diagnostic dye used to identify corneal defects. Atropine sulfate is a mydriatic and cycloplegic drug used to assist eye examination and to treat uveal tract inflammation. Cromolyn sodium is an antiallergic drug used in the treatment of vernal (spring time) keratoconjunctivitis. Cyclopentolate solution is used in diagnostics as a mydriatic and cycloplegic drug.
Antiglaucoma beta blockers have which side effects? Select all that apply. 1 Keratitis 2 Faintness 3 Blepharitis 4 Photophobia 5 Tachycardia
1 Keratitis 3 Blepharitis 4 Photophobia The adverse effects of antiglaucoma beta blockers are primarily limited to ocular effects. The most common ocular effects are transient burning and discomfort. Other effects include keratitis (inflammation of the cornea), blepharitis, photophobia, blurred vision, pain, lacrimation, and decreased corneal sensitivity. Because these drugs are administered topically, few, if any, systemic effects such as faintness or tachycardia are expected.
Which medication is administered intravenously to decrease intraocular pressure prior to surgery when other medications have been unsuccessful? 1 Mannitol 2 Latanoprost 3 Dorzolamide 4 Lansoprazole
1 Mannitol Mannitol is administered by intravenous infusion to reduce elevated intraocular pressure when the pressure cannot be lowered by other methods. It is effective in lowering intraocular pressure before intraocular surgery. It is also used in treating acute episodes of angle-closure, absolute, or secondary glaucoma. Mannitol does not penetrate the eye and, unlike some of the other osmotic drugs, may be used when irritation is present, such as urea.
Which response indicates a therapeutic effect from administering atropine sulfate eyedrops to a patient with uveitis? 1 Pupil dilation 2 Pupil constriction 3 Increased accommodation 4 Change in color of the iris
1 Pupil dilation Atropine sulfate solution and ointment are used as mydriatic and cycloplegic drugs. The drug dilates the pupil (mydriasis) and paralyzes the ciliary muscle (cycloplegic refraction), which prevents accommodation. It is used to assist with eye examinations or to treat uveal tract inflammatory states. The usual dosage for uveitis (inflammation of the choroid, iris, or ciliary body) in children and adults is 1 to 2 drops of the solution, or 0.3 to 0.5 cm of ointment, two to three times daily. The dosage for eye examination is 1 drop of solution, ideally 1 hour before the procedure. It is classified as a pregnancy category C drug. Atropine sulfate is not used to change the color of the iris.
Which structure causes mydriasis? 1 Ciliary muscle 2 Dilator muscle 3 Lacrimal caruncle 4 Sphincter papillae
2 Dilator muscle The pupil is opened (called mydriasis) by a radial smooth muscle called the dilator muscle. It is composed of radiating fibers, like spokes of a wheel, which converge from the circumference of the iris toward its center. Sympathetic nervous system impulses control this muscle. Ciliary muscles are the circular muscles between the anterior and the posterior chambers of the eye behind the iris. They control the curvature of the lens. Lacrimal caruncle is a small, red, rounded elevation covered by modified skin at the medial angle of the eye. The sphincter papillae muscle is a smooth muscle controlled by the parasympathetic nervous system. It constricts the diameter of the pupil.
Which structure covers the exposed anterior surface of the eyeball? 1 Pupil 2 Sclera 3 Conjunctiva 4 Lacrimal caruncle
3 Conjunctiva The conjunctiva is the mucous membrane that lines the eyelids and covers the exposed anterior surface of the eyeball. The pupil is a circular opening in the iris of the eye that allows the light to enter the eyeball when the eyelids are open. Sclera is a tough, white coat of fibrous tissue that surrounds the entire eyeball except the cornea. It helps maintain the shape of the eye. Lacrimal caruncle is a small, red, rounded elevation covered by modified skin at the medial angle of the eye.
Which information would be included when teaching a patient about latanoprost? 1 This medication is administered orally. 2 Eyedrops are to be given three times a day. 3 Eye color may darken while on this medication. 4 This medication has a very short duration of action.
3 Eye color may darken while on this medication. Latanoprost is a prodrug of a naturally occurring prostaglandin known as prostaglandin F2-alpha. When it is administered, it is converted by hydrolysis (with water from ocular fluids) to prostaglandin F2-alpha, which in turn reduces intraocular pressure. About 3% to 10% of patients treated with latanoprost have shown increased iris pigmentation after 3 to 4½ months of treatment. Latanoprost is available only in eyedrop form. The eyedrops are given once a day in the evening. The medication has a long duration of action of 24 hours.
Which eye component is the jelly-like fluid in the large chamber behind the lens of the eye? 1 Uvea 2 Lysozyme 3 Vitreous body 4 Aqueous humor
3 Vitreous body The vitreous body is the jelly-like fluid that fills the large chamber behind the lens of the eye. The uvea is a structure in the eye consisting of the iris, ciliary body, and choroid. Lysozyme is an enzyme that destroys foreign organisms; it is present in the tears, saliva, sweat, and breast milk. Aqueous humor is a clear, watery fluid produced by the ciliary body. It circulates in the anterior and posterior chambers of the eye.
Which information would the nurse teach the patient prior to receiving atropine sulfate drops for an ophthalmic exam? 1 Wait 72 hours to wear contacts. 2 A common side effect is dry eyes. 3 Wear sunglasses when you leave the exam room. 4 Your pupils will appear small after you receive the drops.
3 Wear sunglasses when you leave the exam room.
Which medication is used for the treatment of accommodative esotropia? 1 Carbachol 2 Pilocarpine 3 Acetylcholine 4 Echothiophate
4 Echothiophate Echothiophate is an indirect-acting cholinergic drug. It is used in the treatment of accommodative esotropia and obstructive aqueous humor outflow. It is also used in open-angle and angle-closure glaucoma after iridectomy. Carbachol is a direct-acting cholinergic drug. It is used for the treatment of open-angle glaucoma. Pilocarpine is a direct-acting cholinergic drug used for the treatment of cycloplegia, open-angle glaucoma, and secondary glaucoma after iridectomy. Acetylcholine is a direct-acting cholinergic drug used for producing miosis during ophthalmic surgery.
Which ocular infection is characterized by the formation of a single cyst at the follicles of the eyelashes? 1 Keratitis 2 Blepharitis 3 Conjunctivitis 4 Hordeolum (sty)
4 Hordeolum (sty) Hordeolum (sty) is an acute localized ocular infection that is characterized by the formation of a small cyst at the eyelash follicles. It usually affects the eyelash follicles and glands of the anterior lid. Keratitis is caused by bacterial and viral infections, and its symptoms are intense pain and inflammation of the cornea. Blepharitis is the inflammation of both eyelids where the eyelashes grow. Conjunctivitis is the inflammation of the conjunctiva, the mucous membrane lining the back of the eyelids and the front of the eye except the cornea.
Which information would the nurse teach the patient prescribed glycerin therapy for an ocular problem? 1 It will treat eye infections. 2 It will cure your eye condition. 3 It is instilled into each eye twice a day. 4 It will cause you to urinate more frequently.
4 It will cause you to urinate more frequently. Glycerin is an osmotic diuretic given orally to lower intraocular pressure or topically to reduce superficial corneal edema. The patient should be taught that the medication is a diuretic that causes increased urination. Osmotic diuretics include glycerin, mannitol, urea, and isosorbide. These drugs are normally reserved for acute reduction of intraocular pressure during glaucoma crises and perioperative reduction of intraocular pressure in ophthalmic surgery. Another use is before iridectomy in individuals with acute narrow-angle glaucoma. It is also used preoperatively and/or postoperatively in procedures such as treatment of congenital glaucoma, repair of retinal detachment, cataract extraction, and keratoplasty (corneal transplant). It may also be used in the management of secondary glaucoma. It is not an antibiotic and does not cure eye infections. It is administered orally, not by eyedrops.
Which assessment finding will the nurse determine is consistent with cycloplegia? 1 Pupil dilation 2 Pupil constriction 3 Absence of lacrimation 4 Lack of accommodation
4 Lack of accommodation Cycloplegia is paralysis of the ciliary muscles preventing the accommodation of the lens for variations in distance. Cycloplegia is not pupil dilation, constriction, or absence of lacrimation.
At the time of birth, infants are often treated with erythromycin eye ointment as prophylactic treatment against what possible organism? 1 C. albicans 2 M. furfur 3 A fumigatus 4 N. gonorrhoeae
4 N. gonorrhoeae Erythromycin eye ointment is indicated for the treatment of neonatal conjunctivitis caused by C. trachomatis and for the prevention of eye infections in newborns that may be caused by N. gonorrhoeae or other susceptible organisms. It is not used for prophylaxis against C. albicans, M. furfur, or A. fumigatus.
The nurse is teaching the patient to utilize cromolyn for keratitis. What instruction is correct? 1 Put 2 to 4 drops in each eye daily. 2 Put 1 to 2 drops in affected eye daily. 3 Take 2 tablets daily in the morning. 4 Put 1 to 2 drops in affected eye 4 to 6 times daily.
4 Put 1 to 2 drops in affected eye 4 to 6 times daily. Cromolyn is utilized as eyedrops to treat keratitis. The correct dose is to put 1 to 2 drops in the affected eye only 4 to 6 times daily. The other administrations are incorrect.
