Antiglaucoma medications: Nursing pharmacology

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Notes

Notes

ANTIGLAUCOMA MEDICATIONS, PART 1
DRUG NAME
timolol (Istalol, Betimol); levobunolol; betaxolol (Betoptic-S)
brinzolamide (Azopt); acetazolamide
latanoprost (Xalatan, Xelpros); bimatoprost (Lumigan)
CLASS
Beta-adrenergic blockers
Carbonic anhydrase inhibitors
Prostaglandin analogs
MECHANISM OF ACTION
Decreased aqueous humor production
Increased aqueous humor outflow
INDICATIONS
  • Treatment of chronic open-angle and closed-angle glaucoma
  • Initial treatment of acute closed-angle glaucoma
ROUTE(S) OF ADMINISTRATION
  • TOP
  • brinzolamide - TOP
  • acetazolamide - PO,  IV
  • TOP
SIDE EFFECTS
  • Common side effects: blurred vision, stinging, eye redness, and itching after topical use
  • Hypotension
  • Decreased cardiac output
  • Bradycardia
  • Shortness of breath
  • Boxed warning: Stevens-Johnson syndrome and blood dyscrasias
  • Paresthesias
  • Upset stomach
  • Metabolic acidosis
  • Frequent urination
  • Darkening of iris and eyelids
  • Eyelash growth
  • Droopy eyelids
  • Sunken eyes
CONTRAINDICATIONS AND CAUTIONS
  • AV block
  • Decompensated heart failure
  • Bradycardia
  • Asthma
  • Sickle cell anemia
  • Renal failure
  • Addison disease
-
ANTIGLAUCOMA MEDICATIONS, PART 2
DRUG NAME
pilocarpine (Isopto Carpine)
brimonidine (Alphagan P); apraclonidine (Iopidine)
mannitol (Osmitrol)
CLASS
Cholinergic agents
Alpha-adrenergic agonists
Hyperosmotic agents
MECHANISM OF ACTION
Increased aqueous humor outflow
Decreased aqueous humor production

Increased aqueous outflow
Osmotic gradient dehydrates vitreous humor, thus lowering intraocular pressure
INDICATIONS
  • Treatment of chronic open-angle and closed-angle glaucoma
  • Initial treatment of acute closed-angle glaucoma
ROUTE(S) OF ADMINISTRATION
  • TOP
  • TOP

  • Mannitol - IV

SIDE EFFECTS
  • Common side effects: blurred vision, stinging, eye redness, and itching after topical use
  • Miosis, increased lacrimation, decreased night vision
  • Sweating, drooling, GI problems
  • Headache
  • Drowsiness
  • Dry mouth / nose
  • Nausea and vomiting
  • Frequent urination
  • Cardiovascular overload
  • Fever
  • Pulmonary edema
CONTRAINDICATIONS AND CAUTIONS
-
  • AV block
  • Decompensated heart failure
  • Bradycardia
  • Severe dehydration
  • Renal failure
  • Cardiac diseases
NURSING CONSIDERATIONS: ANTIGLAUCOMA MEDICATIONS
ASSESSMENT AND MONITORING
Assessment
  • Current symptoms of glaucoma
  • Laboratory test results:  CBC, renal and hepatic function, electrolytes
  • Diagnostic test results: visual acuity, intraocular pressure

Monitoring
  • Development of side effects, resolution of glaucoma symptoms
  • Evaluate for decreased intraocular pressure
CLIENT EDUCATION
  • Purpose of medication: to help reduce the pressure in their eyes, preventing loss of vision caused by glaucoma
  • Correct technique for self-administration
  • Side effects
  • Take medication exactly as prescribed
  • Caution against stopping the medication abruptly
  • Keep their regularly scheduled appointments to monitor their intraocular pressure
  • Timolol
    • Instill one drop in each affected eye as directed; either once daily in the morning or twice daily, depending on the solution
    • Symptoms of systemic absorption: bronchoconstriction, hypotension, bradycardia
      • Contact healthcare provider
  • Latanoprost
    • Instill one drop in each affected eye once daily in the evening
    • Side effects: heightened brown pigmentation of iris; increased eyelid pigmentation; length, thickness and coloration of eyelashes
    • Dry eye
      • Contact their healthcare provider for advice

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Transcript

Antiglaucoma medications are used to treat glaucoma, which refers to a group of eye conditions in which drainage of aqueous humor out of the eye is restricted, causing an increased intraocular pressure.

Now, antiglaucoma medications can be divided based on their mechanism of action into two classes: those that decrease aqueous humor production, and those that increase aqueous outflow.

Medications to decrease aqueous humor production include beta-adrenergic blockers, like timolol, levobunolol, and betaxolol; and carbonic anhydrase inhibitors, like brinzolamide and acetazolamide.

On the other hand, medications to improve aqueous outflow include prostaglandin analogs, like latanoprost and bimatoprost; and cholinergic agents, like pilocarpine.

Additionally, some medications can work by both decreasing the production and increasing the outflow of aqueous humor, including alpha-adrenergic agonists like brimonidine and apraclonidine. Finally, acute cases can be treated with osmotic diuretics, like mannitol.

After administration, osmotic diuretics act as hyperosmotic agents by creating an osmotic gradient that attracts water out of the eyes and into the blood, to rapidly decrease intraocular pressure.

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