Chapter 49- Drugs for Eye and Ear Disorders

The client is prescribed timolol (Timoptic) for treatment of glaucoma. The nurse assesses for which of the following medical disorders during the history and physical, which may be a contraindication to the use of this drug? (Select all that apply.) 1. Heart block 2. Heart failure 3. Liver disease 4. COPD 5. Renal disease

Answer: 1, 2, 4 1. Heart block 2. Heart failure 4. COPD Rationale: The nurse needs to notify the health care provider if the client has a history of heart block, bradycardia , cardiac failure, HF, or COPD because timolol may be contraindicated for clients with these conditions. If the drug is absorbed systemically, it will worsen these conditions. Proper administration lessens the danger that the drug will be absorbed systemically. Options 3 and 5 are incorrect. The renal and hepatic systems are not affected by timolol.

A mechanism of action of drugs used to treat glaucoma is: a. Dilating the pupils. b. Increasing the outflow of aqueous humor. c. Decreasing production of vitreous humor. d. Increasing production of aqueous humor.

Answer: b. Increasing the outflow of aqueous humor Rationale: Most therapies are designed to reduce the amount of aqueous humor formation as quickly as possible, or to unblock its drainage. Drug therapy for glaucoma works by two mechanisms: (1) increasing the outflow of aqueous humor at the canal of Schlemm; and (2) decreasing the formation of aqueous humor at the ciliary body, in addition to increasing the outflow.

2. The nurse is planning health teaching for a client who has been prescribed latanoprost (Xalatan) drops for open angle glaucoma. The nurse should include which of the following in the teaching plan? 1. The drops may cause darkening and thickening of the eyelashes and upper lid and darkening of the iris color. 2. The drops may cause a temporary loss of eyelashes that will regrow once the drug is stopped. 3. The drops will cause dilation of pupils and darkened glasses should be worn in bright light. 4. The drops will cause a permanent bluish tint to the conjunctiva but it is harmless.

Answer: 1. The drops may cause darkening and thickening of the eyelashes and upper lid and darkening of the iris color. Rationale: Latanoprost (Xalatan) may cause darkening and thickening of the eyelashes and upper lid and darkening of the color of the iris. Options 2, 3, and 4 are incorrect. It will not cause mydriasis (dilation of the pupils), loss of eyelashes, or a bluish tint to the sclera.

Timolol (Timoptic) drops have been ordered to treat glaucoma. Because of the possibility of systemic adverse effects, what essential instruction should the client receive? 1. Monitor urine output and daily weight. Promptly report any edema. 2. Monitor blood glucose and alert the health care provider to any significant changes. 3. Hold slight pressure on the inner canthus of the eye for 1 minute after instilling the drop. 4. Monitor respiratory rate and for signs and symptoms of upper respiratory infection.

Answer: 3. Hold slight pressure on the inner canthus of the eye for 1 minute after instilling the drop. Rationale: Beta-adrenergic drugs such as timolol (Timoptic) may reduce resting heart rate and blood pressure. The client should hold slight pressure on the inner canthus of the eye to prevent the drug from entering the lacrimal duct with possible systemic absorption . Options 1, 2, and 4 are incorrect. Timolol (Timoptic) should not affect urine output or respiratory rate, increase the risk of respiratory infections, or affect glucose levels.

A client with a history of glaucoma who has been taking latanoprost (Xalatan) eyedrops comylains of severe pain in the eye, severe headache, and blurred vision. What should be the nurse's first response? 1. Document the occurrence; this symptom is expected. 2. Medicate the client with a narcotic analgesic. 3. Notify the health care provider immediately. 4. Place the client in a quiet darkened environment.

Answer: 3. Notify the health care provider immediately. Rationale: Closed-angle glaucoma is an acute type of glaucoma that is caused by stress, impact injury, or medications. Pressure inside the anterior chamber increases suddenly because the iris is pushed over the area where the aqueous fluid normally drains. Signs and symptoms include intense headaches, difficulty concentrating, bloodshot eyes, blurred vision, and a bulging iris. Closed-angle glaucoma constitutes an emergency. Options I , 2, and 4 are incorrect. All other options are inappropriate in this emergency and only delay appropriate and prompt treatment.

The nurse emphasizes to the client with glaucoma the importance of notifying the health care provider performing an eye examination of a glaucoma diagnosis because of potential adverse reactions to which of the following drugs? 1. Antibiotic drops 2. Cycloplegic drops 3. Anti-inflammatory drops 4. Anticholinergic mydriatic drops

Answer: 4. Anticholinergic mydriatic drops Rationale: Clients with glaucoma must be especially careful with anticholinergic mydriatics, because these drugs can worsen glaucoma by impairing aqueous humor outflow and thereby increasing intraocular pressure. Options 1, 2, and 3 are incorrect. Antibiotic drops, cycloplegic, and anti-inflammatory drugs may be used with caution in the client with glaucoma.

Appropriate administration is key for clients who are taking eyedrops for the treatment of glaucoma to optimize therapeutic effects and reduce adverse effects. The nurse would be concerned if the client reports administering the drops in which of the following manners? 1. Into the conjunctival sac 2. Holding slight pressure on the tear duct (lacrimal duct) for 1 minute after using the eyedrops 3. Avoiding direct contact with the eye dropper tip and the eye 4. Leaving contact lenses in to be sure the eyedrop is maintained in the eye

Answer: 4. Leaving contact lenses in to be sure the eyedrop is maintained in the eye Rationale: Contact lenses should be removed before instilling eyedrops and remain out for a minimum of 15 minutes after instilling eyedrops. Options 1, 2, and 3 are incorrect. Administering eyedrops into the conjunctival sac, applying slight pressure to the lacrimal duct for 1 full minute, and avoiding direct contact with the dropper tip and the eye are all appropriate techniques to use when administering eye drops.

A patient is prescribed timolol (Timoptic) for treatment of glaucoma. Which medical disorders, if discovered during the history and physical, could be a contraindication to the use of this drug? a. Heart block b. Renal disease c. Liver disease d. Hyperthyroidism

Answer: a. Heart block Rationale: Consult with the physician and pharmacist if the client has second- or third-degree heart block, bradycardia, cardiac failure, CHF, or COPD, as timolol might be contraindicated for patients with these conditions. If the drug is absorbed systemically, it will worsen these conditions. Proper administration lessens the danger of the drug being absorbed systemically

Patient teaching for a patient receiving travoprost (Travatan) for treatment of glaucoma should include the procedure for administration. Travoprost should be administered: a. Just before bedtime. b. In the early evening. c. In the early afternoon. d. In the early morning.

Answer: a. Just before bedtime. Rationale: Travoprost (Travatan) is a prostaglandin analogue. These medications cause cycloplegia, local irritation, and stinging of the eyes. Because of these effects, prostaglandins normally are administered just before the patient goes to bed. Although prostaglandins can be irritating to the eyes, they usually do not prevent the patient from falling asleep.

The nurse emphasizes to the patient with glaucoma the importance of informing the physician performing an eye examination of the condition, due to potential adverse reactions to which drugs? (Select all that apply.) a. Mydriatic drugs b. Cycloplegic drops c. Anti-inflammatory drops d. Anticholinergic mydriatic drops

Answer: a. Mydriatic drugs Rationale: Some drugs are specifically designed to examine the eyes of patients. These include cycloplegic drugs to relax ciliary muscles, and mydriatic drugs to dilate the pupils. One has to be especially careful with anticholinergic mydriatics because these drugs can worsen glaucoma by impairing aqueous humor outflow and thereby increasing intraocular pressure.

In evaluating a patient's risk for development of glaucoma, the nurse recognizes the normal range of intraocular pressure to be: a. 8-10 mm Hg. b. 12-20 mm Hg. c. 21-30 mm Hg. d. 30-40 mm Hg.

Answer: b. 12-20 mm Hg. Rationale: The normal range of intraocular pressure is 12-20 mm Hg, with the IP above 20 mm Hg in glaucoma. If the increased intraocular pressure is not reduced, over time, the optic nerve will be injured and eventually destroyed.

The patient with glaucoma is using an OTC eyedrop containing thimerosal. The patient is prescribed Latanoprost (Xalatan). What information concerning administration of these drops must be included in the teaching plan? a. The drops may be given at the same time. b. Leave five minutes before or after administering each drop. c. Rinse the eyes with saline, and immediately administer the next drop. d. Hold the inner canthus closed for three minutes before the next drop is administered.

Answer: b. Leave five minutes before or after administering each drop. Rationale: Latanoprost interacts with thimerosal. If mixed with eyedrops containing thimerosal, precipitation could occur. Leave five minutes before or after instillation of a different eye prescription to administer eyedrops.

The patient should be aware of potential side effects of prostaglandins used in the treatment of glaucoma. The nurse should include which of the following in the teaching plan? a. Hypertension b. Dilation of pupils c. Brow pigmentation of the treated eye d. Loss of eyelashes

Answer: c. Brow pigmentation of the treated eye Rationale: Side effects include eye irritation, conjunctival edema, burning, stinging, redness, blurred vision, pain, itching, the sensation of a foreign body in the eye, photophobia, and visual disturbances. The patient could experience the phenomenon of increasing amounts of brow pigmentation in the treated eye only, and thickening of the eyelashes and hair adjacent to the treated eye. General body symptoms such as flu-like symptoms, rash, or headache might occur.

Beta-adrenergic agents may be used to treat glaucoma. The nurse should inform the patients and family to: a. Monitor urine output. b. Monitor blood glucose. c. Monitor pulse and blood pressure. d. Monitor respiratory rate.

Answer: c. Monitor pulse and blood pressure Rationale: Beta-adrenergic drugs can reduce resting heart rate and blood pressure. The family and the patient should be taught how to check the pulse and blood pressure before administration, and to notify the physician if extremes occur.

The patient with a history of glaucoma complains of severe pain in the eye, severe headache, and blurred vision. The appropriate nursing action is to: (Select all that apply.) a. Document the occurrence; this symptom is expected. b. Medicate the patient with a narcotic analgesic. c. Notify the physician immediately. d. Place the patient in a quiet, darkened environment.

Answer: c. Thyroid disorders Rationale: Closed-angle glaucoma is an acute type of glaucoma that is caused by stress, impact injury, or medications. Pressure inside the anterior chamber increases suddenly, with the iris being pushed over the area where the aqueous fluid normally drains. Signs and symptoms include intense headaches, difficulty concentrating, bloodshot eyes, blurred vision, and a bulging iris. Closed-angle glaucoma constitutes an emergency situation.

Health promotion activities related to eye health should include discussion of the major risk factors for glaucoma. These include which of the following? a. Infancy b. Cardiac dysrhythmias c. Thyroid disorders d. Hypertension

Answer: d. Hypertension Rationale: Glaucoma often exists as a primary condition, without any identifiable precipitating cause, and it is found most frequently in persons older than 60. The major risk factors associated with glaucoma include hypertension, migraine headaches, refractive disorders such as nearsightedness or farsightedness, and older age.