Quiz - Select Medications Used in the Management of Glaucoma

Cholinergics (miotics)

Ex: pilocarpine, carbachol intraocular

Action of cholinergics (miotics) …

increase aqueous fluid outflow by contracting the ciliary muscle and causing miosis (constriction of the pupil) and opening of trabecular mesh work

Side effects of cholinergics

Preorbital pain, blurry vision, difficulty seeing in the dark

Nursing implications of cholinergics

• caution patients about diminished vision in dimly lit areas

• Pilocarpine can be stored at room temperatures for up to 8 weeks and then should be discarded

Beta-blockers

ex: timolol maleata

Action of beta-blockers

decrease aqueous humor production

Side effects of beta-blockers

can have systemic effects including bradycardia, exacerbation of pulmonary disease, and hypotension

Nursing implications of beta-blockers

• contraindicated in patients with asthma, COPD, second or third degree heart block, bradycardia, or heart failure

• Educate patients about punctual occlusion to limit systemic effects

Alpha-adrenergic agonists

ex: apraclonidine, brimonidine

Action of alpha-adrenergic agonists

decrease aqueous humor production

Side effects of alpha-adrenergic agonists

eye redness, dry mouth and nasal passages

Nursing implications of alpha-adrenergic agonists

• educate patients about punctal occlusion to limit systemic effects

Carbonic anhydrase inhibitors

ex: acetazolamide, dorzolamide

Action of carbonic anhydrase inhibitors

decrease aqueous humor production

Side effects of carbonic anhydrase inhibitors

• oral medications (acetazolamide) are associated with serious side effects including anaphylactic reactions, electrolyte loss, depression, lethargy, GI upset, impotence, and weight loss

• Side effects of topical form (dorzolamide) include topical allergy

Nursing implications of carbonic anhydrase inhibitors

• do not administer to patients with sulfa allergies

• Monitor electrolyte levels

Prostaglandin analogues

ex: latanoprost, bimatoprost

Action of prostaglandin analogs

increase uvoscleral outflow

Side effects of prostaglandin analogs

Darkening of the iris, conjunctival redness, possible rash

Nursing implications of prostaglandin analogs

• instruct patients to report any side effects