Question

CRITICAL THINRING CASE STUDT MH, a 70-year-old woman with postoperative acute glaucoma. 3. Although systemic absorption of ophthalmic beta-adrenere is prescribed one drop of latanoprost 0.005% ophthalmic solu antagonists is usually small, it may potentially create problems ach evening and one drop of timolol 0.25% ophthalmic for patients with certain conditions. Which conditions create solution each morning and evening. a risk, and how will the nurse monitor for complications? 1. What is the purpose of giving two different medications to 4. After a few months on these medications, MH notices manage MH's glaucoma? changes in the appearance of her eyes. Describe the changes 2. What special concerns related to medication timing are that MH is likely experiencing, and explain which drug is important for MH to consider when administering the eve responsible, ning dose of these medications?

Answer 1

1. Timolol is a beta adrenergic blocker. Ophthalmic drops of Timolol can used to lower the pressure in the eye their by reducing the amount of fluid that make to fills the aqueous humour. By reducing the amount of fluid ,it reduce pressure with in the eye.

Latanoprost is a prostagladin F2 alpha analogue that reduce the intraocular pressure by increasing the outflow of aqueous humour through the uveosceleral tract. Increase pressure inside the eye is called as ocular hypertension and open angle glaucoma.

2. Special concern related to the timing of medication administration:

Timolol:

• It can be available in doses of 0.25% and 0.5%. Initial dose is one drops of 0.25% in the affected area twice a day.
• If the clinical response was not appropriate,that dosage might be changed to one drop of 0.5% solution the affected area of the eye.
• If the intraocular pressure is maintained at a satisfactory level,the dosage timing may be changed to one drop once a day in the affected eye.
• If intraocular pressure is still unsatisfactory level in the regimen,concomitant therapy with pilocarpine or any other systemically administered Carbonic anhydrase inhibitors ,such as acetazolamide can be initiated.
• Intraocular pressure should be monitored for 4 weeks after starting therapy.

Latanoprost: One drop of 0.005% solution in the affected area of eye once a day in the evening.

• If one dose was missed continue the same treatment with next dose as normal.
• The dose should not be exceeded one drop in the affected eye once daily as more frequently administration may lessen the intraocular pressure effect.
• Reduction of intraocular pressure start with in 2 to 4 hrs after the initial administration with the maximum effect reached after 12hrs.
• If one or more ophthalmic drug is being used,each one should be administered at least 5min after the 1st ophthalmic solution used.

3. Beta adrenergic antagonist can be used in the therapy of glaucoma.The formation of aqueous humor in the ciliary body mediated by tonic sympathetic stimulation. Beta adrenergic antagonist can decrease the production of aqueous humor.These ophthalmic preparation in not commonly associated with systemic side effects,most of their are pulmonary and cardiac effects.Complication that has been create when the systemic absorption of beta adrenergic antagonist is usually small.Cardiac and pulmonary side effects are:

Pulmonary:

• Bronchospasm
• Reduced pulmonary function.

Cardiovascular effects:

• Bradycardia
• Syncope
• Hypotension
• Congestive heart failure
• Alteration in lipoprotein profile
• Nightmares

Nurse should monitor for side effects:

• Monitor for glaucoma
• Monitor cardiovascular problems
• Use caution if patient had respiratory problems
• Monitor for eye irritation
• Monitor glucose level.

4.Latanoprost is responsible for change in the appearance of her eyes.

When they are using latanoprost,the iris of eye may slowly become brown in color. This is more likely to be happen if she have blue-brown,green-brown,gray-brown eyes.She may also have darkening of the eyelids skin color,thicker,darker eyelashes. The changes should be permanent if she stopped using latanoprost.