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43 Tom extra

drugs used to treat glaucoma and other eye disorders

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how many eyelashes are there for each eye?
200 for each
why is eyecup use discouraged?
risk of contamination
the 3 layers of the eyeball
the protective external, or corneoscleral coat; the nutritive middle vascular layer, called Choroid; and the light sensitive inner layer, or retina
for near vision....
the cilary muscle fibers contract, relaxing the pull on the ligaments, & allowing the lens to become thick
what to check for with carbonic anhydrase?
check for allergy to SULFONAMIDE ANTIBIOTICS.....w/hold the med & contact Doc
when to use caution w/ Adrenergic Agents?
in Pt's w/ hypertension, diabetes mellitus, hyperthyrodism, heart disease, arteriosclerosis, or long standing bronchial asthma
when an infection is present, how do you prevent cross contamination?
always use s separate source of medication and droppers for each eye
Prostaglandin Agonist admin not to do?
do not admin. in eyes while wearing contacts....they may be reinserted 15 min following administration
CARBONIC ANHYDRASE INHIBITORS action?
inhibitors of the enzyme carbonic anhydrase.....result in a decrease in the production of aqueous humor...lowering IOP
Osmotic Agents....tell about them
can be admin. IV, orally, or topically to reduce IOP. these agents elevate the osmitic pressure of the plasma, causing fluid from the extravascular spaces to be drawn into the blood, the effect on the eye is reduction of volume of intraocular fluid, which produces a decrease in IOP
Prostaglandin Agonist...action?
reduce IOP by increasing outflow of aqueous humor
if intraocular pressure builds up and if not treated what will happen?
damage to the optic disc
what do you never what to touch with the tip of the dropper?
the eyeball or face....and the opening of the of the ointment container
Prostaglandin Agonist...uses?
reduce IOP in Pt's w/ CHRONIC OPEN-ANGLE glaucoma or OCULAR HYPERTENSION, who have NOT responded well to other IOP lowering agents
what to teach the Pt after an eye surgery?
notify the Doc of pain not relieved by pain meds, use of aseptic tech. when changing dressings or admin. meds, the Pt should notify the Doc as any signs of infection
CHOLINESTERASE INHIBITORS ....PHOSPHOLINE IODIDE action?
Cholinesterase is an enzyme that destroys acethlcholine, the cholinergic neurotransmitter......this prevents the metabolism of acetylcholine w/in the eye.....causing increased cholinergic activity, which results in decreased IOP and miosis
Prostaglandin Agonist outcome?
like all the rest...to reduce IOP
If the Pt is being treated for glaucoma what do you need to stress?
the need for lifelong treatment and the use of meds.......adherence w/ the drug regimen can help prevent blindness
what to do if gastric irritation when using carbonic anhydrase inhibitors?
admin. w/ food or milk
the therapeutic outcome when instilling an adrenergic agent in the eyes is to?
produce mydriasis....(dilating)
what electolytes are altered w/ Carbonic Anhydrase Inhibitors?
K+, Na+, and Cl- Hypokalemia is most likely to occur
how do you minimize systemic absorption of ophthalmic drops?
compress the lacrimal sac for 1-2 min. after instillation
to remove an eye patch what do you need?
an order from the Doc
Adrenergic Agents uses?
lower IOP in OPENANGLE glaucoma, relieve congestion and hyperemia, & produce mydriasis for ocular examinations.....and reduce redness of eyes form irritation
ADRENERGIC AGENTS action?
Sympathomimetic agents cause pupil dilation, increase outflow of aqueous humor, vasoconstriction, relaxation of ciliary muscle, & a decreased in the formation of aqueous humor
Carbonic Anhydrase Inhibitors uses?
used in conjunction with other treatments to control IOP in cases of intraocular hypertension & CLOSED-ANGLE & OPEN-ANGLE glaucoma
when should drops be administered?
before ointments....they (the oint) impede delivery of other opthalmic drugs....they are a barrier as they are thick
Hypokalemia
deficiency of K+. The K+ diffuses out of the myocytes, their membrane potential is more negative than normal, and they are harder to stimulate
what is the most common drug to treat OPEN ANGLE glaucoma?
it is the maintenance of the IOP to prevent further blindness.......MIOTIC AGENTS ...(pilocarpine)...this drug increases the outflow of aqueous humor.........recent years beta adrenergic blocking agents (timolol maleate)...have become the initial drug choice.........other agents that may be used are SYMPATHOMIMETIC AGENTS (brimonidine)CARBONIC ANHYDRASE INHIBITORS (acetazolamide), and CHOLINESTERASE INHIBITORS ( echothiophate iodide)
Mannitol crystals
check the mannitol solution for crystals....do not admin. if present. Use an in-line filter because mannitol has a tendency to crystallize
Sodium flourescein is used to?
stain the eye for examination
if you need to admin. 2 meds into the eye, how long should you wait to admin. the 2nd one?
5 min.
how do osmotic agents act?
bu pulling fluid from the extravascular spaces into the blood
Beta-Adrenergic blocker uses?
reduce IOP in Pt's w/ CHRONIC OPEN-ANGLE glaucoma or OCULAR HYPERTENSION....unlike anticholinergic agents, there is NO blurred or dim vision or night blindness because IOP is reduced w/ little or no effect on pupil size or visual acuity
if meds are to admin. at about teh same time what are you to do?
wait 5 min after the 1st one. this ensures that the 1st med is not washed away by the 2nd, or that the 2nds med. is not diluted by the 1st. ALSO to minimize systemic absortion of opthalmic drops...compress the lacrimal sac for 3-5 min after instillation
Cholinergic Agents uses?
lower IOP in Pt's w/ glaucoma by widening the filtration angle, which permits outflow of aqueous humor........they give better control of IOP w/ fewer fluctuation in pressure
Uses for Cholinesterase Inhibitors?
treatment of OPEN-ANGLE glaucoma ...onset may occur w/in 10-45 min and may last for several days. Tolerance may develope...rest period will restore response.....THIS DRUG IS RESERVED FOR PT's WHO DO NOT RESPOND WELL TO CHOLINERGIC AGENTS
mydriasis
reflex pupillary dilation as a muscle pulls the iris outward
Osmotic Agent outcome?
reduced intraocular pressure (IOP)
what to check for before admin. beta-adrenergic blocker for reducing IOP...the nurse should check to see if the Pt has a Hx of?
diabetes mellitus, cardiac disease, hypertension or respiratory disorders
Acute closure glaucoma requires immediate treatment w/ admin. of Miotic AGENTS to relieve pressure of iris against the trabecular network, & allow drainage or aqueous humor....what drug helps this?
MANNITOL.......an osmotic diuretic.....and ACETAZOLAMIDE may be admin. to reduce formation of aqueous humor
what bathes and feeds the lens?
ciliary body secretes aqueous humor...it is drained out the meshwork that leads to the Schlemm's canal
does the cornea have blood vessels?
no, it recieves nutrients from aqueous humor and its oxygen supply by diffusion from the air and surrounding vascular structures
CHOLINERGIC AGENTS actions?
produce strong contractions of the iris (miosis) & ciliary body musculature
Cholinesterase Inhibitors effects to expect?
difficulty in adjusting quickly to changes in light intensity, reduced visual acuity...most noticeable at night, particularly in area of poor lighting, older Pt's develope lens opacities
Osmotic Agents uses?
used to reduce IOP in Pt's w/ ACUTE NARROW-ANGLE GLAUCOMA; before iridectomy; pre-op and post-op in conditions like congenital glaucoma, retinal detachment, cataract extraction, & keratoplasty
Beta-Adrenergic Blocking Agents actions?
to reduce elevate IOP...exact mech. is not known...but they are thought to reduce production of aqueous humor
what is the most common route of administration for opthalmic drugs?
topical application....but they do not penetrate adequately for posterior eye diseases.....so topical admin. is not used for diseases with the optic nerve or retina
Cholinergic Agents effects to expect?
difficulty in adjusting quickly to changes in light intensity....reduced visual acuity may be most noticeable at night, particularly in area of poor lighting, in older Pt's lens opacities may develope, blurred vision occurs particlarly during the 1st 1-2 hours after instilling the med. Ability to read to long periods is decreased because of impairment of NEAR-VISION accommodation
what is an abraded cornea?
the thin layer of epithelial cells (the layer that is quite resistant to infection) is damaged and is highly susceptible to infection
what about stopping Cholinergic Agents?
encourage Pt not to disc. w/o consulting the Doc

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