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