OPTHALMIC MEDICATIONS FOR GLAUCOMA

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OPTHALMIC MEDICATIONS FOR GLAUCOMA

• BARBARA REES

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GLAUCOMA PATHOLOGY

• INCREASED INTRAOCULAR PRESSURE
• AQUEOUS HUMOR PRODUCTION CONTROLLED BY ENZYME
  CARBONIC ANHYDRASE
• OPEN ANGLE- DEGENERATIVE CHANGES IMPAIR OUTFLOW

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AGENTS DECREASE FORMATION OF AQUEOUS HUMOR

• CARBONIC ANHYDRASE INHIBITORS- DIAMOX
• OSMOTIC DIURETICS
• BETA-ADRENERGIC BLOCKING AGENTS- TIMOPTIC,
  BETOPTIC, BETAGAN

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DRUGS WHICH INCREASE OUTFLOW OF AQUEOUS HUMOR

• ACTS TO CONSTRICT PUPIL AND CONTRACT THE CILIARY
  MUSCLE
• pilocarpine (Isopto Carpine)

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CARDIOVASCULAR MEDICATIONS- CARDIAC GLYCOSIDES

• DIGITALSIS ACTION- for CHF, increases force of
  myocardial contraction
• Slows the heart

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COMMON SIDE EFFECTS

• GASTROINTESTINAL DISTRESS
• NEUROLOGICAL EFFECTS
• VISUAL DISTRUBANCES
• CARDIAC EFFECTS

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FACTORS PREDISPOSING A PATIENT TO TOXICITY

• HYPOKALEMIA
• RENAL IMPAIRMENT
• IV DRUG ADMINISTRATION

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NURSING IMPLICATIONS

• EVALUATE FOR INTERACTIONS WITH OTHER DRUGS OR
  FOOD
• ASSESS APICAL PULSE FOR 1 MINUTE- HOLD IN ADULTS
  lt60, CHILDRENlt70, INFANTSlt90
• ASSESS FOR TOXICITY

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PATIENT TEACHING

• TAKE MED AT SAME TIME EVERY DAY
• DO NOT CHANGE, SKIP OR STOP DOSE
• NOTIFY DOCTOR IF PULSElt60, gt120, IF ERRATIC OR
  OTHER SE
• REPORT WEIGHT GAIN OF 2 LB OR gt PER DAY
• TAKE 2 HOURS BEFORE OR AFTER TAKING ANTACIDS,
  MILK PRODUCTS, ICE CREAM, YOGURT, OR CHEESES

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ANTIHYPERLIPEDEMIC DRUGS

• BILE ACID SEQUESTRANTS- (QUESTRAN, COLESTID) BIND
  BILE AND PREVENT REABSORPTION OF BILE ACIDS
• HMG-CoA- (MECACOR) BINDS THE PRODUCTION OF THE
  ENZYME FOR PRODUCING CHOLESTEROL
• FIBRIC ACID DERIVATIVES- (LOPID) ACTIVATES ENZYME
  THAT BREAKS DOWN CHOLESTEROL
• NICOTINIC ACID- (Niacin. Nicotinic Acid) PREVENTS
  UNOXIDIZED LDL FROM BEING OXIDIZED

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NURSING IMPLICATIONS

• OBTAIN THOROUGH HEALTH AND MEDICATION HISTORY
• CHECK FOR CONTRAINDICATIONS TO USE
• FOLLOW UP WITH LIVER FUNCTION TESTS

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PATIENT TEACHING

• TAKE MEDICATIONS AS ORDER
• DIET TEACHING- LOW FAT DIET, HIGH FIBER, DRINK
  LOTS OF FLUID
• FOLLOW UP WITH LIVER FUNCTION TESTS
• TAKE OTHER MEDICATIONS 1 HOUR BEFORE OR 4-6 HOURS
  AFTER

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ANTIANGINAL AGENTS

• NITROGLYCERIN- DILATES BLOOD VESSELS SE- HA,
  POSTURAL HYPOTENSION, TACHYCARDIA
• BETA-ADRENERGIC BLOCKING AGENTS

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REVIEW

• NERVOUS SYSTEM HAS 2 PARTS - SNS PNS
• RECEPTOR SITES FOR CATECHOLAMINES NE EPI -
  THESE ARE ADRENERGIC RECEPTORS
• THESE ARE DIVIDED INTO BETA1 (HEART) BETA2
  (BRONCHIOLES, ARTERIOLES VISCERAL ORGANS)

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BETA BLOCKERSGENERIC BRAND

• atentolol.............Tenormin
• metroprolol.........Lopressor
• nadolol................Corgard
• propranolol..........Inderal

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HOW BETA BLOCKERS WORK FOR ANGINA

• SLOW THE HEART RATE
• DECREASE CONTRACTILITY
• GOOD RESULTS
• a. decrease myocardial O2 demand and increase O2
  delivered to heart
• b. decrease contractility conserve energy

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BETA BLOCKERS

• OFTEN COMBINED WITH NITRATES
• ALSO USED AS ANTIHYPERTENSIVES
• TREAT EXERTIONAL ANGINA
• SE FATIGUE LETHARGY

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CALCIUM CHANNEL BLOCKERS

• INHIBITS PASSAGE OF CALCIUM INTO VASCULAR SMOOTH
  MUSCLE
• CAUSES VASODILATION
• REDUCES MYOCARDIAL CONTRACTILITY
• HELPS TREAT CORONARY ARTERY SPASMS

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GENERIC BRAND

• amlodipine......Norvasc
• nifedipine........Adalat, Procardia
• diltiazem.........Cardizem
• verapamil........Calan, Isoptin

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NURSING IMPLICATIONS

• CAUTIOUS USE IN PATIENTS WITH HEAD INJURIES,
  POSTURAL HYPOTENSION, PREGNANCY OR LACTATION
• TOBACCO COLD TEMPERATURE REDUCE EFFECTIVENESS
• CHECK FOR CONDITIONS WITH SLOW HEART RATE OR
  HYPOTENSION- CHECK VS

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PATIENT TEACHING

• TAKE AT FIRST SIGN OF ANGINA
• SIT OR LIE DOWN
• SE- HA, FLUSHING, DROP IN BP, NAUSEA
• IF NOT RELIEVED TAKE TABLET Q 5 MINS. UP TO 3-5
• KEEP FRESH SUPPLY
• KEEP RECORD OF FREQUENCY AND CHARACTERISTICS OF
  ATTACKS

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PERIPHERAL VASODILATORS

• VASOSPACTIC DISORDERS ARE MORE LIKELY TO RESPOND
• AFFECT SYMPATHETIC NERVOUS SYSTEM OR ACT ON
  VASCULAR SMOOTH MUSCLE
• TAZOL, TENSIN, ISMELIN

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ANTICOAGULANTS

• HEPARIN
• COUMADIN(warfarin sodium)
• NURSING IMPLICATIONS- CONTRAINDICATED IN
  CONDITIONS WITH RISK OF HEMORRHAGE, CHECK PTT OR
  PT, SIGNS OF BLEEDING

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ANTICOAGULANT PATIENT TEACHING

• GIVE HEPARIN PROPERLY
• CHECK FOR ADVERSE EFFECTS
• TEACH SAFETY AND COMFORT
• DO NOT TAKE ASA OR ASA CONTAINING PRODUCTS
• REGULAR ADMINISTRATION
• DO NOT TAKE WITH OTHER DRUGS OR ALCOHOL
• INFORM OTHER HEALTH PERSONNEL ON ANTICOAGULANTS
• AVOID DANGEROUS ACTIVITIES

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DIURETICS ANTIHYPERTENSIVES

• ADRENERGIC AGENTS
• ANGIOTENSIN-CONVERTING ENZYME INHIBITORS-inhibit
  enzyme responsible for converting Angiotensin I
  to II
• THIAZIDE AND THIAZIDE-LIKE
• LOOP DIURETICS

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NURSING IMPLICATIONS

• OFTEN NEED TO BE ON LOW NA DIET
• EVALUATE FOR LOW K
• EVALUATE FOR HYPOTENSION AND TAKE SAFETY
  PRECAUTIONS

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PATIENT TEACHING

• DIURETICS OFTEN CAUSE K LOSS- EAT K FOODS OR MEDS
• IF DIABETIC OR HAVE GOUT- CAN CAUSE HYPERGLYCEMIA
  OR URIC ACID INCREASE
• AVOID ALCOHOL, BARBITURATES AND NARCOTICS

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HYPOGLYCEMIC AGENTS

• RAPID ACTING INSULIN
• INTERMEDIATE ACTING
• LONG ACTING
• FIXED COMBINATION
• ORAL ANTIDIABETIC AGENTS

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NURSING IMPLICATIONS

• CHECK FOR DRUGS THAT INTERACT CAUSING HYPO OR
  HYPERGLYCEMIA
• CHECK ALLERGY TO INSULIN PROPER OR SULFONYLUREAS
• HYPOGLYCEMIA MOST LIKELY DURING INSULIN PEAK
  ACTION
• CHECK FOR SYMPTOMS OR HYPO AND HYPERGLYCEMIA

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PATIENT TEACHING

• SIGNS AND SYMPTOMS OF HYPER AND HYPOGLYCEMIA
• CARRY ID
• AVOID ALCOHOL
• CHECK BLOOD GLUCOSE
• FOOT CARE ETC.