Glaucoma, Ophthalmic, Rheumatologic Drugs

Know how to administer eye drops

• Drop prescribed number of drops into conjunctival sac; do NOT allow dropper bottle to touch the eye (contamination)

• Ask patient to close eyes and lightly press on inside corners of eyes for 30-60 

Goals of treatment used to manage glaucoma

LOWER IO by facilitating aqueous humor outflow and reduce aqueous humor production

Miotic medication

Pilocarpine/cholinergic agonist

• Causes pupils to constrict and manage glaucoma by reducing IOP

Effect of miotic medication and when it is difficult to see

the smaller pupil size limits the amount of light entering the eye → makes it difficult to see in dark

Pilocarpine MOA

mimics acetylcholine

Pilocarpine effect on pupil size

causes pupillary constriction (miosis) → leads to reduced IOP caused by enhanced outflow of aqueous humor, and contraction of ciliary muscles

Pilocarpine duration of action

up to 8 hours

Pilocarpine ADR/SE:

Difficulty seeing in the dark (careful driving), tearing of the eye

Know the cholinergic system: pilocarpine, physostigmine, rivastigmine.

Pilocarpine: acts like Ach

Physotigmine: increases Ach by blocking its breakdown

Rivastigmine used in early Alzheimer’s

what happens when we have increased cholinergic activity.

• “Rest and digest” system

• Increased PNS response → miosis

• SLUDGE: Salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, emesis

• Decreased HR, vasodilation, bronchospasm, narrowed airways

mannitol (osmotic diuretic) MOA

• Draws fluid out of tissues into tubules for excretion

• drug stays in nephron → producing an osmotic effect

mannitol (osmotic diuretic) uses

• Cerebral edema, promote diuresis

• Severe head injury to decrease ICP

• Induce renal excretion of toxic substances

• Acute glaucoma to decrease IOP

mannitol (osmotic diuretic) ADR

Worsened HF & PE due to rapid fluid shifts

mannitol (osmotic diuretic) nursing

• listen to lung sounds for crackles/dyspnea

• monitor urine output, renal function

• vision changes/IOP and electrolyte imbalance

prostaglandin analogs drugs

-prost

prostaglandin analogs: MOA

Reduce IOP by enhancing aqueous humor outflow

prostaglandin analogs ADR

• foreign body sensation

• increased pigmentation

• erythema/itching/burning

• blurred vision

prostaglandin nursing

single dose can reduce IOP for 20-24 hours; take drops same time daily in the evening

 beta-adrenergic blockers: drugs

Timolol & Levobetaxolol

 beta-adrenergic blockers MOA

Reduce IOP by reducing aqueous humor formation

 beta-adrenergic blockers: ADR

• Transient burning

• tearing

• temporary blurred vision

• dry/itchy/red eyes

• photophobia

• bradycardia

• hypotension

• heart block

• bronchospasm

carbonic anhydrase inhibitors DRUGS

-Lamide

carbonic anhydrase inhibitors: MOA

Reduce production of aqueous humor by causing diuresis

carbonic anhydrase inhibitors: warnings

 anaphylaxis allergy & possible cross sensitivity w/ sulfa antibiotics (sulfonamides)

Apraclonidine MOA

• drainage of aqueous flow, reduction of IOP

• LOWERS BP

drugs for conjunctivitis & rhinitis

• montekulast

• mydriatic meds

montelukast – MOA

Leukotriene receptor antagonist; does not treat acute asthma attacks

montelukast - time of effectiveness

takes 3-7 days

montelukast - monitor

Changes in mood or behaviors; anxiety, depression, and hepatotoxicity

treatment for bacterial conjunctivitis

MACROLIDES: Erythromycin

FLUROQUINOLONES: “-Floxain”

AMINOGLYCOSIDES: “-micin, -mycin”

mydriatic medication, effect on pupil size/light

• causes pupils to DILATE

• prevents them from constriction in response in light → leads to increased sensitivity to light and discomfort

Atropine use

to treat bradycardia & to decrease secretions

Ipratropium inhaler use

treats COPD

Tiotropium inhaler (long-acting anticholinergic): use

maintenance therapy for COPD

Scopolamine: use

prevents motion sickness

Atropine contraindication

Glaucoma

atropine ADR

Tachycardia, drying of secretions

 DMARDs check again

 autoimmune, reduce inflammation & pain, reduce speed of disease progression

Drugs for rheumatoid arthritis

• DMARDS

• Adalimumab

• Cyclosporine

Methotrexate monitoring

• CBC for signs of infection

• liver & kidney function

Methotrexate teaching

• avoid sick contacts

• report mouth sores

• sun protection needed

Methotrexate pregnancy category

X

Adalimumab nursing; which vaccines patients CANNOT receive/ contraindicated

• May stop while being treated

• Patients cannot receive live vaccines (Flu-mist, varicella) while on this medication

• Contraindicated in patients w/ any infectious processes

Cyclosporine ADR

• Nephrotoxicity

• tremor

• increased risk of infection

Cyclosporine interaction

ST. John’s wort can decrease levels of cyclosporine

when should patients notify providers immediately when taking cyclosporine?

Notify providers during any manifestations of infection!

When reviewing the medications a patient is taking, why does the nurse need to consider which herbals a patient may be taking?

• Treat it as if it’s a medication

• Ask what herbals a patient is currently taking & share information w/ physician

• If pregnant/breastfeeding, encourage women to stop the herbal until discussed w/ their physician whether or not it is safe for fetus/infant

• May have drug-drug interactions w/ prescribed medications

How does St. John’s wort affect other medications? What could happen?

• Decreases effectiveness of digoxin, warfarin, cyclosporine, & oral contraceptives

• Can cause serotonin syndrome when combined w/ other antidepressants

• Interferes w/ absorption of iron; should be taken separately

What are some uses of echinacea? Review topical use of echinacea

• TOPICAL USE: For wounds (canker sores)

• ORAL USE: Common colds (may stimulate immune system)

melatonin and its use

• insomnia

• jet lag

• assess sleep patterns.

ginkgo biloba use & its side/adverse effects.

• improves memory; antiplatelet effects

• Increased risk of bleeding in patients taking NSAIDs, antiplatelets, anticoagulants

feverfew; potential risks and drug interactions.

• known for anti-inflammatory properties & relieving migraines

• possible increase in bleeding w/ aspirin and other NSAIDs & anticoagulants