Unit 6 Chapter 57 Ophthalmic drugs

How do miotics work

increase drainage (there are direct and indirect-acting cholinergics)

intraocular pressure

internal pressure of all fluids against the tunics (retina, choroid, sclera) of the eye

Tears drain into the nasal cavity through the:

lacrimal ducts.

what produces tears?

lacrimal glands

Drugs that constrict the pupil are called

miotics (e.g., acetylcholine, pilocarpine)

How often is pilocarpine ocular insert system (Ocusert Pilo-20) applied

once a week

How do antiglaucoma Drugs work

reducing intraocular pressure by either increasing the drainage of aqueous humor, or decreasing its production, or by doing both

With any ophthalmic drug, instruct the patient to report to the prescriber any:

severe stinging burning itching redness of the eye excessive tearing or excessive dryness of the eye puffiness of the eye/eyelids discharge from the eye fever eye pain loss of or change in vision.

Tetracaine drug classification:

-topical anesthesia

Pilocaropixne contraindication:

- *drug allergy -*any serious active eye disorder in which induction of miosis might be harmful.

Pilocaropixne MOA:

- allows for changes in the eye leading to aqueous humor drainage

Pilocaropine adverse effects:

- blurred vision - Prolonged use can result in iris cysts, lens opacities, and, rarely, retinal detachment.

Timolol (Timoptic) MOA:

- reduces elevated and normal intraocular pressure.--> may increase the outflow of aqueous humor as well as decrease its formation

Tetracaine MOA:

- stabilize the membranes of nerves, which results in a decrease in the movement of ions into and out of the nerve endings

Timolol (Timoptic) adverse effects:

-*blurred vision -*pain -*photophobia

Timolol (Timoptic) contraindications:

-*drug allergy

Timolol (Timoptic) indication:

-*elevated intraocular pressure - open-angle glaucoma

Pilocaropixne indication :

-*open angle glaucoma - secondary glaucoma after iridectomy -reversal of cycloplegia

Pilocaropixne drug classification:

-antiglaucoma drug: Direct-acting cholinergics

Timolol (Timoptic) drug classification:

-antiglaucoma drug: beta- adrenergic blockers (**acts on both beta1 and beta2)

Gentamicin (Garamycin) drug classification:

-antimicrobial (gram-negative and gram-positive organism)

Gentamicin (Garamycin) adverse effects:

-burning and stinging

Gentamicin (Garamycin) MOA:

-destroy the invading microbe

Gentamicin (Garamycin) contraindications:

-drug allergy

Tetracaine contraindication:

-drug allergy -not intended for long term use

Gentamicin (Garamycin) indication:

-infection

Tetracaine indication:

-pain (prevent pain during surgical procedures and certain painful ophthalmic examinations, including removal of imbedded foreign objects)

Tetracaine adverse effects:

-stinging -burning -redness -and lacrimation

The primary mechanism of action of Timolol (Timoptic) in the treatment of intraocular pressure 1. increase the outflow of aqueous humor. 2. constrict the pupil. 3. dilate the pupil to increase outflow. 4. reduce production of aqueous humor.

1, 4. reduce production of aqueous humor. and increase the outflow of aqueous humor as well as decrease its formation

The client asks the nurse how glaucoma develops. What is the best response by the nurse? Select all that apply.

1. "Having diabetes is a risk factor in the development of glaucoma." 2. "Glaucoma exists when the pressure in your eye is high enough to cause optic nerve damage." 3. "High blood pressure can certainly lead to the development of glaucoma." 5. "Drugs like antihistamines and antidepressants can contribute to glaucoma."

The client receives timolol (Timoptic) eyedrops for glaucoma. The nurse has completed medication education and evaluates learning has occurred when the client makes which statement? 1. "I will discuss use of over-the-counter (OTC) medications with my physician." 2. "I will store my drops in the refrigerator to keep them fresh." 3. "I will restrict my caffeine to one cup of coffee per day." 4. "I will discontinue the drops if my eye looks red."

1. "I will discuss use of over-the-counter (OTC) medications with my physician."

Which statements would the nurse interpret as indicating that the client understands the diagnosis of open-angle glaucoma? Select all that apply. 1. "My eye cannot drain the fluid that it produces." 2. "One of the first signs of this is pain behind my eyes." 3. "My type of glaucoma is a medical emergency." 4. "This is a gradual process; it may take years to develop." 5. "This is the most common kind of glaucoma."

1. "My eye cannot drain the fluid that it produces." 4. "This is a gradual process; it may take years to develop." 5. "This is the most common kind of glaucoma."

The client receives eyedrops as treatment for glaucoma. The client calls the clinic one day and tells the nurse that his eye color is changing. What is the best response by the nurse? 1. "This is an expected side effect of the medication." 2. "This is unusual; please come in for an evaluation." 3. "Are you sure that your eyes have changed color?" 4. "What do you mean that your eyes have changed color?"

1. "This is an expected side effect of the medication."

A client is prescribed a beta-adrenergic blocker for treatment of glaucoma. The nurse provides specific information on administration technique to avoid which adverse effects? Select all that apply. 1. Bronchoconstriction 2. Cardiac dysrhythmias 3. Low blood pressure 4. Rash 5. Vomiting

1. Bronchoconstriction 2. Cardiac dysrhythmias 3. Low blood pressure

Which of the following best describes open-angle glaucoma? 1. It is bilateral with a slow onset. 2. It is less common than closed-angle glaucoma. 3. It is accompanied by eye pain. 4. It is unilateral with a rapid onset.

1. It is bilateral with a slow onset.

The client wears contact lenses and has been prescribed eyedrops for glaucoma. What will the best education by the nurse include with regard to contact lenses? 1. Remove lenses before instilling eyedrops; do not reinsert lenses for 15 minutes. 2. Instill the drops with the contacts in as long as they are the hard kind of contacts. 3. Eyeglasses must be worn for as long as the client must have the eyedrops. 4. Instill the drops with the contacts in as long as they are the soft kind of contacts.

1. Remove lenses before instilling eyedrops; do not reinsert lenses for 15 minutes.

A client presents to the emergency department with symptoms of closed-angle glaucoma. Intraocular pressure is measured at 30 mmHg. Which assessment findings would the nurse anticipate? Select all that apply. 1. Absence of eye pain 2. Headache 3. Bloodshot eyes 4. Vomiting 5. Bruising around the orbit

2. Headache 3. Bloodshot eyes 4. Vomiting

The client tells the nurse that when he uses his timolol (Timoptic) eyedrops, they sting his eyes. What is the best response by the nurse? 1. "Hold the next dose and contact your physician." 2. "This is a normal and expected effect of the drops." 3. "Your eyedrops may have expired; check the date." 4. "You should wash your eyes immediately with saline."

2. "This is a normal and expected effect of the drops."

The client tells the nurse that he experiences frequent eye irritation even after using over-the-counter (OTC) medications. What is the best recommendation by the nurse? 1. Increase your fluid intake; you are probably dehydrated. 2. See your eye doctor for further evaluation. 3. This sounds like an allergic response; try an antihistamine. 4. Use normal saline rinses instead of over-the-counter (OTC) preparations

2. See your eye doctor for further evaluation.

A client has been diagnosed with closed-angle glaucoma. Which findings would the nurse interpret as indicating that the pharmacologic treatment regimen has been successful? Select all that apply. 1. The client reports being hungry. 2. The client's last two intraocular pressure readings have been 19 mmHg and 18 mmHg. 3. The client's eye is not as bloodshot. 4. The client reports a sensation of drainage down the nose. 5. The client's cough has diminished.

2. The client's last two intraocular pressure readings have been 19 mmHg and 18 mmHg. 3. The client's eye is not as bloodshot.

The client is to receive eyedrops for glaucoma. What is the correct method of administration? 1. Place the drop in the center of the eye. 2. Place the drop so it falls on the white part of the eye. 3. Place the drop in the conjunctival sac below the eye. 4. Turn the head to the side so that the drop flows to the outer corner.

3. Place the drop in the conjunctival sac below the eye.

The nurse has taught the client about open-angle glaucoma. The nurse evaluates learning has occurred when the client makes which statement? 1. "The eyedrops only need to be used when my eyes hurt." 2. "I will need to continually increase the dose of my eyedrops." 3. "I can stop the eyedrops when the glaucoma has resolved." 4. "I must use my eyedrops as prescribed for the rest of my life."

4. "I must use my eyedrops as prescribed for the rest of my life."

A client has had several measurements of intraocular pressure. Which measurements would the nurse interpret as indicating need for pharmacologic intervention? Select all that apply. 1. A single reading of 14 mmHg 2. A consistent reading trending between 15 and 16 mmHg. 3. A single reading of 19 mmHg. 4. Readings consistently higher than 21 mmHg. 5. A single reading of 32 mmHg.

4. Readings consistently higher than 21 mmHg. 5. A single reading of 32 mmHg.

The client has glaucoma. Which assessment finding indicates to the nurse that a client's medical regimen could have contributed to onset of glaucoma? 1. Taking a beta blocker to treat hypertension 2. Occasional use of antihistamines for allergies 3. Taking glucocorticoids to treat arthritis 4. Regular use of an antidepressant drug

4. Regular use of an antidepressant drug

The nurse is counseling a client with glaucoma. The nurse explains that, if left untreated, the condition can lead to 1. myopia. 2. nearsightedness. 3. diabetes mellitus. 4. blindness.

4. blindness.

A patient is prescribed epinephrine eye drops for treatment of chronic open-angle glaucoma. The patient complains of burning with instillation of the drops. How would the nurse respond to the patient? A. "This is a typical adverse effect and may lessen over time. If this continues, we need to schedule an appointment with your provider." B. "That should not occur. Come to the office now." C. "This only occurs if the drop is not placed in the correct area of the eye." D. "This is normal and will continue as long as you use the drops."

A. "This is a typical adverse effect and may lessen over time. If this continues, we need to schedule an appointment with your provider."

The nurse is educating a patient newly diagnosed with open-angle glaucoma on the adverse effects of the indirect-acting miotic eye drops prescribed. What will the nurse include in the teaching as possible adverse effects? (Select all that apply.) A. Blurred vision B. Farsightedness C. Stinging on instillation D. Decreased nighttime vision E. Paralysis of eyelids

A. Blurred vision C. Stinging on instillation D. Decreased nighttime vision

which humors affect intraocular pressure

Aqueous humor and vitreous humor,

When applying opthalmic drugs, the nurse will follow which instructions. Select all that apply.... A. apply drops directly onto the cornea B. apply drops into the conjunctival sac C. apply pressure to the inner canthus for 1 minute after medication administration D. apply ointments in a thin layer E. avoid touching the eye with the tip of the medication dropper

B. apply drops into the conjunctival sac C. apply pressure to the inner canthus for 1 minute after medication administration D. apply ointments in a thin layer E. avoid touching the eye with the tip of the medication dropper

Direct-acting cholinergics are usually in a bottle that has a? A. purple lid B. green lid C. teal/clear lid D. orange lid

B. green lid

Which statement, made by a patient, indicates the need for further patient teaching regarding proper administration of eyedrops? A. "I will put pressure on the inside corner of my eye after I administer the drops." B. "I will be careful not to touch my eye with the dropper." C. "I will rinse the eyedropper with tap water after each use." D. "I will turn my head slightly toward the outside of the eye I am putting the drops in."

C. "I will rinse the eyedropper with tap water after each use.

child born with increased intraocular pressure is likely to be diagnosed with which type of glaucoma? Congenital Pigmentary Open angle Angle closure

Congenital

Pt is using gentamicin for an eye infection. What drug may a nurse question if ordered

Corticosteroids such as Dexamethasone--> have immunosuppressive effects that may impede the therapeutic effects of ocular antimicrobials

angle-closure glaucoma vs open-angle glaucoma.

Glaucoma : disorder of the eye caused by inhibition of the normal flow and drainage of aqueous humor angle-closure glaucoma : closure of the anterior angle due to contact between the iris and the trabecular meshwork prevents aqueous humor from exiting through the canal of Schlemm, which leads to increased intraocular pressure open-angle glaucoma: the anterior angle remains open, but the canal of Schlemm is obstructed by tissue abnormalities

Tears are composed of

Isotonic, aqueous solution that contains an enzyme called lysozyme

Parasympathomimetic ophthalmic drugs such as pilocarpine (Pilocar) reduce intraocular pressure in the treatment of glaucoma by which mechanism of action? Miosis Mydriasis Cause the pupils to get larger Decrease in drainage of aqueous humor

Miosis

The nurse prepares a health teaching plan for the client with glaucoma. Which important nursing intervention are included for this client? (Select all that apply.) a. Instruct the client to report changes in vision and breathing. b. Maintain sterile technique and prevent dropper contamination during administration of eyedrops. c. Include return demonstration only with geriatric clients. d. Wait 10 minutes to instill the second eye medication to be given at the same time.

a. Instruct the client to report changes in vision and breathing. b. Maintain sterile technique and prevent dropper contamination during administration of eyedrops.

When the nurse is providing teaching about eye medications for glaucoma, the nurse tells the patient that miotics help glaucoma by which mechanism of action? a. Decreasing intracranial pressure b. Decreasing intraocular pressure c. Increasing tear production d. Causing pupillary dilation

b. Decreasing intraocular pressure

The nurse evaluates the client using eyedrops. The client puts two drops into his eye. What is the nurse's best action? a. Continue to observe the client. b. Instruct the client that one drop is optimal. c. Have the client irrigate his eye to remove excess medication. d. Have the client close his eye and rub to assist in absorption.

b. Instruct the client that one drop is optimal.

When assessing a patient who is receiving a direct-acting cholinergic eyedrop as part of treatment for glaucoma, the nurse anticipates that the drug affects the pupil in which way? a. It causes mydriasis, or pupil dilation. b. It causes miosis, or pupil constriction. c. It changes the color of the pupil. d. It causes no change in pupil size.

b. It causes miosis, or pupil constriction.

The nurse administers pilocarpine (Pilocar) to a client with glaucoma. Which assessment finding would indicate a therapeutic effect of the medication? a. Client's eyes appear clear, without drainage. b. Client states that her eyes feel very dry. c. Client's pupils are dilated to 4 mm. d. Client's pupils are constricted to 2 mm.

d. Client's pupils are constricted to 2 mm.