Ch. 57 Ophthalmic Drugs

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

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

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 prepares to administer daily medications to a female patient who takes furosemide (Lasix) for heart failure and uses brinzolamide (Azopt) ophthalmic drops for glaucoma. The nurse notes that the patient's serum potassium level is 3.0 mEq/L. What should the nurse do next? A. Assess the patient's cardiac rhythm B. Withhold the brinzolamide C. Withhold the furosemide D. Administer the medications

A. Assess the patient's cardiac rhythm Before administering or withholding the medications, the nurse should assess the patient for clinical indicators of hypokalemia, including the cardiac rhythm, because hypokalemia increases the risk of ventricular dysrhythmias. Once the assessment is complete, the nurse can determine if medication should be administered or withheld.

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

A patient with type 2 diabetes mellitus who takes metformin (Glucophage) daily has excessively high intraocular pressure (IOP). Which medication used in the treatment of increased IOP should the nurse avoid administering to this patient to prevent a serious adverse effect of therapy? A. Mannitol (Osmitrol) B. Betaxolol (Betoptic) C. Latanoprost (Xalatan) D. Brinzolamide (Azopt)

A. Mannitol (Osmitrol) The nurse avoids administering an osmotic diuretic such as mannitol to the patient taking metformin as a means of preventing metabolic acidosis because acidosis is an adverse effect of mannitol and metformin. Betaxolol is indicated in the treatment of chronic glaucoma. Lantanoprost is used in the treatment of open-angle glaucoma and ocular hypertension when other treatments have failed. Brinzolamide is a carbonic anhydrase inhibitor used in the treatment of open-angle and angle-closure glaucoma but not usually for the treatment of acute intraocular hypertension.

A patient requires dorzolamide (Trusopt) for glaucoma. What is the nurse's priority patient assessment before therapy is begun? A. Medication list B. Fine motor skills C. Eyelid condition D. Systemic illnesses

A. Medication list The nurse's priority is the compilation of a list of the patient's medications to help identify potential drug interactions and the potential for cross-sensitivity to sulfa drugs. The nurse will analyze the medication list for sulfa drugs and sulfonamides and diuretics because these medications have side-effect profiles similar to the hematologic, gastrointestinal, integumentary, and metabolic effects of carbonic anhydrase inhibitors. It is important to assess fine motor skills to determine whether the patient will be able to self-administer the dorzolamide. The condition of the eyelid is a reasonable nursing assessment before the start of any ophthalmic medication regimen. Listing of comorbid illnesses is an important means of identifying conditions that might affect therapy.

The nurse is teaching patients with glaucoma to self-administer their medications. Which patient teaching should the nurse provide? A. Apply an ointment under the upper eyelid. B. Allow eyedrops to fall on the conjunctival sac. C. Allow all excess medication to be absorbed slowly. D. Wipe the eyes with a warm compress after administering eyedrops.

B. Allow eyedrops to fall on the conjunctival sac. The nurse instructs the patients to allow the medication to fall on the conjunctival sac and not directly on the eye. Ointment is applied under the lower eyelid. Excess medication may be dabbed away with a tissue, provided the patient is careful not to allow the tissue to remove medication from the eye. The nurse avoids instructing patients to wipe the eyes with a warm compress because the heat may affect the absorption of the medication.

A patient's intraocular pressure (IOP) is dangerously high. Which patient assessment data should the nurse use as baseline data before administering treatment for the IOP? A. Gastrointestinal (GI) function B. Breath sounds C. Renal function D. Peripheral edema

B. Breath sounds An osmotic diuretic such as mannitol is indicated in the treatment of acute intraocular hypertension. The nurse assesses the patient's breath sounds before administering mannitol for the acute reduction of IOP because osmotic diuretics are contraindicated in pulmonary edema. Assessments of GI function, renal function, and peripheral edema are reasonable nursing assessments before the administration of an osmotic diuretic but do not reveal contraindications to therapy.

Which glaucoma ophthalmic drops reduce increased intraocular pressure without affecting pupil size? A. Timolol (Timoptic) B. Dipivefrin (Propine) C. Pilocarpine (Pilocar) D. Epinephryl (Epinal)

A. Timolol (Timoptic) Beta-adrenergic blockers such as timolol reduce increased intraocular pressure by slowing the formation of aqueous humor. Dipivefrin, pilocarpine, and epinephryl decrease intraocular pressure by means of mydriatic and miotic actions.

Which medication used as maintenance therapy in the treatment of glaucoma works by providing another exit route of aqueous humor besides the trabecular network? A. Isosorbide (Ismotic) B. Latanoprost (Xalatan) C. Dorzolamide (Trusopt) D. Levobetaxolol (Betagan)

B. Latanoprost (Xalatan) Lantanoprost is a prostaglandin agonist that relieves intraocular pressure (IOP) by increasing the outflow of aqueous humor between the uvea and the sclera in addition to the trabecular network. Isosorbide is an osmotic diuretic that reduces IOP by drawing water from the aqueous humor by means of osmotic pressure. Dorzolamide is a carbonic anhydrase inhibitor, and levobetaxolol is a beta-adrenergic blocker that reduces the formation of aqueous 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.

A female patient who has glaucoma and has used dipivefrin (Propine) ophthalmic drops for 6 months tells the nurse that she is experiencing palpitations. Which action should the nurse implement? A. Checking for over-the-counter medication B. Telling the patient to visit her health care provider C. Asking the patient about excessive caffeine intake D. Assessing the patient for signs of cardiac stimulation

D. Assessing the patient for signs of cardiac stimulation With prolonged use or excessive dosing, a sympathomimetic agent such as dipivefrin can cause systemic effects, including extrasystoles, hypertension, and tachycardia; although this is uncommon, the nurse assesses the patient for clinical indicators of sympathetic stimulation.

Which statement about use of corticosteroids for ocular inflammation does the nurse identify as being true? A. They are used during the acute phase of the injury process to prevent fibrosis and scarring, which result in visual impairment. B. Corticosteroids produce a lesser immunosuppressant effect than the NSAIDs. C. They are used for the treatment of minor abrasions and wounds of the eye. D. Use of corticosteroids for ocular inflammation results in discoloration of the iris.

a

After administering an ophthalmic anesthetic drug, which adverse effects does the nurse anticipate as possibly developing in the patient? (Select all that apply.) a. Stinging b. Burning c. Redness d. Lacrimation e. Blurred vision

a, b, c, d, e

A patient has undergone an eye procedure during which ophthalmic mydriatics and anesthetic drops were used. The nurse gives which instructions to the patient prior to discharge? (Select all that apply.) a "Do not rub or touch the numb eye." b "You may reinsert your contact lenses before you leave." c "Be sure to wear sunglasses when you go outside." d "Your pupils will appear very tiny until the medication wears off." e "Report any increase in eye pain or drainage to the ophthalmologist immediately."

a, c, e

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.

Sympathomimetic mydriatics have the potential to react with other drugs if sufficient topical absorption occurs. When given concurrently, drugs in which class may interact with the sympathomimetic mydriatics? a. Thyroid hormones b. Oral contraceptives c. Calcium channel blockers d. Nonsteroidal antiinflammatory drugs

a. Thyroid hormones With sufficient topical absorption, sympathomimetic mydriatics have the potential to react with other drugs. Cardiac dysrhythmias are potentiated when mydriatic drugs are given with halogenated anesthetics, cardiac glycosides, thyroid hormones, or tricyclic antidepressants.

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 is providing education to a client with a diagnosis of bilateral conjunctivitis (pink eye) who is prescribed sulfacetamide (Bleph-10). What information in the client history is MOST important and should be reported immediately to the health care provider? a. The client does not like eyedrops b. The client is allergic to sulfa drugs. c. The client has never had pink eye before. d. The client wears colored soft contact lenses.

b. The client is allergic to sulfa drugs. The other data are important for education and teaching; however, a client allergic to sulfa drugs should not be prescribed a sulfa drug for treatment. The health care provider would need to be alerted immediately.

When giving latanoprost (Xalatan) eyedrops, the nurse will advise the patient of which possible adverse effects? a. Temporary eye color changes, from light eye colors to brown b. Permanent eye color changes, from light eye colors to brown c. Photosensitivity d. Bradycardia and hypotension

b.) permanent eye color changes, from light eye colors to brown

A newborn infant is about to receive medication that prevents gonorrheal eye infection. The nurse will prepare to administer which drug? a. dexamethasone (Maxidex) ointment b. gentamicin (Genoptic) solution c. erythromycin ointment d. sulfacetamide (Cetamide) solution

c

The nurse wants to decrease the risk of secondary infections and complications associated with the use of antimicrobial eyedrops. What is the nurse's priority instruction during teaching of patients who are beginning to use the eyedrops? A. Tilt the head up and open the eye wide. B. Apply gentle pressure to the inner canthus. C. Retract the lower eyelid to instill the eyedrops. D. Avoid touching the medication container to the eye.

D. Avoid touching the medication container to the eye. The nurse stresses the importance of avoiding contact between the medication container and the infected tissue as a means of preventing both contamination of the medication and secondary infections. Tilting the head, applying gentle pressure, and retracting the lower eyelid are reasonable nursing instructions for a patient using eyedrops; however, these measures are unrelated to infection control.

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 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.

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."

A 60-year-old man with a history of benign prostatic hypertrophy and hypertension is seen in the emergency department because he was trimming his shrubs and got something in his right eye. He complains of a pain rating of 8 on a scale of 1 to 10 in the right eye. Which medication does the nurse anticipate administering via eyedrop to help control the patient's pain? tetracaine atropine morphine lidocaine

tetracaine Rationale: Tetracaine is a local anesthetic of the ester type. It is applied as an eyedrop to numb the eye for various ophthalmic procedures. Tetracaine begins to work in about 25 seconds and lasts for about 15 to 20 minutes. Additional drops are applied as needed. It is currently available only in solution form.

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 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 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."

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.

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.

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

Congenital

During an ophthalmic procedure, the patient receives ophthalmic acetylcholine. The nurse is aware that which effect is the purpose of administering this drug? a. To produce mydriasis for ophthalmic examination b. To produce immediate miosis during ophthalmic surgery c. To cause cycloplegia to allow for measurement of intraocular pressure d. To provide topical anesthesia during ophthalmic surgery

b

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 cholinergic will cause miosis, pupil constriction

The client is prescribed olopatadine (Patanol) for treatment of allergic conjunctivitis. The nurse knows the medication works though which action? a. Inhibits release of mast cells b. Lubricates the surface of the eye c. Competes at histamine receptor sites d. Stimulates the dilator muscle to contract

c. Competes at histamine receptor sites Patanol is an ocular antihistamine and works by competing at histamine receptor sites.

The nurse is educating a client who was administered atropine sulfate solution for an eye examination. The nurse includes which information in the education? a. Instruct that a common adverse effect is dry eyes. b. Instruct to wait 72 hours to wear contact lenses. c. Encourage use of sunglasses to decrease sunlight sensitivity. d. Advise that pupils may remain small for 12 hours after administration.

c. Encourage use of sunglasses to decrease sunlight sensitivity. The medication is a mydriatic and is used to dilate the pupils for eye exams. The client may have increased sunlight sensitivity and should wear sunglasses until the pupils return to normal size.

The ophthamologist tells the patient that she is going to place a dye onto the patient's eye to help identify the location of the foreign object. Which drug does the nurse anticipate the ophthamologist will use? A. olopatadine (Patanol) B. cromolyn sodium (Crolom) C. tetrahydrozoline D. fluorescein (AK-Fluor)

fluorescein (AK-Fluor) Rationale: Fluorescein (AK-Fluor) is an ophthalmic diagnostic dye used to identify corneal defects and to locate foreign objects in the eye. Olopatadine (Patanol) is an ocular antihistamine used to treat symptoms of allergic conjunctivitis (hay fever). Cromolyn sodium (Crolom) is an antiallergic drug that inhibits the release of inflammation-producing mediators from sensitized inflammatory cells called mast cells. Tetrahydrozoline is an ocular decongestant. It works by promoting vasoconstriction of blood vessels in and around the eye.

The nurse is preparing to administer ketorolac (Acular) eyedrops. The patient asks, "Why am I getting these eyedrops?" Which is the correct answer by the nurse? a "These drops will reduce the pressure inside your eye as part of treatment for glaucoma." b "These drops are for a bacterial eye infection." c "These drops will relieve your dry eyes." d "These drops work to reduce the inflammation in your eyes."

d

The ophthalmologist has given a patient a dose of ocular atropine drops before an eye examination. Which statement by the nurse accurately explains to the patient the reason for these drops? a "These drops will cause the surface of your eye to become numb so that the doctor can do the examination." b "These drops are used to check for any possible foreign bodies or corneal defects that may be in your eye." c "These drops will reduce your tear production for the eye examination." d "These drops will cause your pupils to dilate, which makes the eye examination easier."

d

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.

At the time of birth, infants are often treated with erythromycin eye ointment as prophylactic treatment against what possible organism? a. Candida albicans b. Malassezia furfur c. Aspergillus fumigatus d. Neisseria gonorrhoeae

d. Neisseria gonorrhoeae Erythromycin eye ointment is indicated for the treatment of neonatal conjunctivitis caused by Chlamydia trachomatis and for the prevention of eye infections in newborns that may be caused by N. gonorrhoeae or other susceptible organisms.