Charter College, Anchorage - NURSING NU1005

Chapter 29: Drug Therapy for Eye Problems

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)Which statement regarding primary open-angle glaucoma (POAG) is true?

1. 1. It is most common in children.
   2. The major cause is trauma to the eye.
   3. The problem usually affects both eyes.
   4. The first symptom is chronic eye pain.

2. Which term means constriction of the pupil of the eye?
   1. Miosis
   2. Punctum
   3. Glaucoma
   4. Mydriasis

3. Which drug group for glaucoma should be avoided in children long-term because they slow growth?
   1. Adrenergic agonists
   2. Beta blockers
   3. Carbonic anhydrase inhibitors
   4. Prostaglandin agonists

4. What is the main problem of glaucoma?
   1. Cloudiness of the lens
   2. Cloudiness of the cornea
   3. Increased intraocular pressure
   4. Increased intracranial pressure

5. Where in or on the eye should eye drops be placed?
   1. Under the upper lid
   2. In a pocket of the lower lid
   3. Directly over the center of the eye
   4. In the corner of the eye closest to the nose

6. Which drug group for glaucoma has the side effect of darkening the iris color?
   1. Adrenergic agonists
   2. Beta blockers
   3. Cholinergics
   4. Prostaglandin agonists

7. Which drug for glaucoma is a beta blocker?
   1. Timolol (Timoptic)
   2. Travoprost (Travatan)
   3. Apraclonidine (Iopidine)
   4. Pilocarpine (Adsorbocarpine)

8. Which drug group for glaucoma can worsen asthma?

1. 1. Adrenergic agonists
   2. Beta blockers
   3. Cholinergics
   4. Prostaglandin agonists

9. With which patient should a carbonic anhydrase inhibitor be avoided as a treatment of glaucoma?
   1. A patient with reduced vision
   2. A patient with sulfa allergy
   3. A patient with hypertension
   4. A patient with diabetes

10. Which class of drugs for glaucoma therapy generally is used short term to prevent or reduce increases in intraocular pressure (IOP) after eye surgery rather than for long-term IOP control?
    1. Adrenergic agonists
    2. Beta adrenergic blockers
    3. Cholinergic drugs
    4. Prostaglandins agonists

ADVANCED CONCEPTS

11. How does untreated elevated intraocular pressure eventually lead to visual impairment?
    1. It compresses blood vessels and causes hypoxia of the photoreceptors.
    2. It clouds the lens and prevents light from striking the photoreceptors.
    3. It constricts the pupil and prevents light from entering the posterior chamber.
    4. It pushes the cornea forward and distorts the placement of the image on the retina.

12. Which precaution is most important to teach a patient who is prescribed any type of eye drug administered as eye drops?
    1. Apply only the number of drops prescribed.
    2. Stop the drug immediately if eye redness occurs.
    3. Wear dark glasses for 1 hour after placing the eye drops.
    4. Apply pressure to the corner of the eye after the drug has been placed.

13. Which safety precaution should you teach a patient who is prescribed eye drops or eye ointment?
    1. “Wash your hands before and after applying the drug.”
    2. “Do not share your eye medications with anyone else.”
    3. “Avoid drinking alcoholic beverages while taking this drug.”
    4. “Do not drive or use heavy equipment while your vision is blurred.”

14. Which statement made by a patient prescribed drug therapy for glaucoma indicates more teaching is needed?
    1. “I am so glad my glaucoma has been cured with bimatoprost (Lumigan) in time to prevent blindness.”
    2. “I will take care never to touch the tip of the applicator to my eye to prevent infection.”
    3. “I will only call my doctor for eye redness if it lasts longer than just an hour or two.”
    4. “I understand that I should wait for my vision to clear once the eye drops are in before I drive the car.”

15. What is the most important precaution to teach a patient prescribed brimonidine (Alphagan P) eye drops for glaucoma?
    1. Increase the room lighting when reading or doing close work.
    2. Stop using the drug and notify your prescriber if crusts form on the eye lid.
    3. Do not take this drug beyond the period your doctor prescribed even if some drug remains in the bottle.
    4. Avoid wearing prescription reading glasses or sun glasses while you are taking this drug.

16. Which assessment is most important to perform before instilling latanoprost (Xalatan) into a patient’s eyes?
    1. Measure the patient’s temperature.
    2. Measure the patient’s intraocular pressure.
    3. Check the cornea for abrasions or open areas.
    4. Assess heart rate and rhythm for 1 full minute.

17. A patient has been taking bimatoprost (Lumigan) for the last 2 months. Which statement by the patient indicates a correct understanding of this drug therapy?
    1. “When my eyes are red or itchy, I should wait until the next day to use my glaucoma medicine.”
    2. “Even though my intraocular pressure is now normal, I will continue to take the drug once daily.”
    3. “One indication that I have used too much of this drug is when my vision becomes blurry or fuzzy.”
    4. “If I forget to take the eye drops one day, I should apply them as soon as I remember them the next day and also take the regular dose for that day.”

18. Which problem indicates a patient may be overusing apraclonidine (Iopidine) eye drops for glaucoma?
    1. Anorexia
    2. Blurred vision
    3. Conjunctival itching
    4. Drowsiness

19. A patient who has been using travoprost (Travatan) eye drops for glaucoma reports that the eye lashes seem longer and thicker. What is your best action?
    1. Teach the patient that the drug is absorbed by the blood vessels of the eye and has no effect on other eye or lid structures.
    2. Instruct the patient to apply only the number of drops prescribed and to blot the area with a tissue after each dose.
    3. Remind the patient that eye drops are liquid and that wet lashes appear both longer and thicker.
    4. Reassure the patient that this is an expected response to the drug and no action is needed.

20. How do beta-adrenergic blocking agents (antagonists) lower intraocular pressure?
    1. They increase the rate that the vitreous humor is reabsorbed.
    2. They slow the production of aqueous humor inside the eye.
    3. They reduce systemic blood pressure, which results in lower intraocular pressure.
    4. They increase the movement of aqueous humor from the posterior chamber into the anterior chamber.

21. A patient is prescribed an ophthalmic beta blocking agent for the treatment of glaucoma. Which precaution is most important to teach the patient to prevent orthostatic hypotension?
    1. “Change positions slowly.”
    2. “Take your pulse rate at least four times each day.”
    3. “Be sure to lie down for at least 10 minutes after putting the drops into your eyes.”
    4. “Apply pressure to the inside corner of your eye when putting the drops into the eye.”

22. A patient who has been prescribed timolol (Timoptic) for the last month reports that his asthma is worse. What is your best response?
    1. Check the patient’s breath sounds and pulse rate.
    2. Hold the dose and notify the prescriber immediately.
    3. Ask the patient what drugs he takes to control his asthma.
    4. Reassure the patient that this is an expected response and requires no action.

23. Which drug reduces the production of aqueous humor to the greatest degree?
    1. Acetazolamide (Diamox)
    2. Pilocarpine (Isopto)
    3. Dipivefrin (AK-Pro)
    4. Travoprost (Travatan)

24. What is the most important assessment question to ask a patient who is newly prescribed apraclonidine (Iopidine) for glaucoma?
    1. “How long have you had glaucoma?”
    2. “What other medications are you currently taking?”
    3. “Have you had any difficulty with retaining urine?”
    4. “Do you have asthma or any chronic respiratory problem?”

25. Which assessment is most important to perform after administering the first dose of dipivefrin (Propine) to a patient with glaucoma?
    1. Compare urine output with fluid intake.
    2. Listen to breath sounds bilaterally.
    3. Assess level of consciousness.
    4. Check pupil size.

26. Which drug for glaucoma control would be the best choice for a patient who has only one arm and whose daughter visits every evening?
    1. Timolol (Timoptic)
    2. Travoprost (Travatan)
    3. Apraclonidine (Iopidine)
    4. Pilocarpine (Adsorbocarpine)

27. When a penlight is shined into the eyes of a patient who is prescribed brimonidine (Alphagan P), the pupils of both eyes remain equally dilated. What is your best action?
    1. Document the response as the only action.
    2. Hold the next dose and notify the prescriber.
    3. Assess the patient’s hand grasp strength bilaterally.
    4. Remind the patient to wear sunglasses when outdoors.

28. What is the most important action to perform after administering eye drops to a patient who is prescribed pilocarpine (Ocu-Carpine)?
    1. Place the patient in the supine position.
    2. Wipe the excess drug from the patient’s skin.
    3. Instruct the patient to keep the eyes closed for 2 minutes.
    4. Check pupillary responses by shining a penlight into each eye.

29. A patient who has been prescribed echothiophate (Phospholine Iodide) for the last 2 weeks reports all of the following symptoms or conditions. Which symptom or condition should be reported immediately to the prescriber?
    1. Excessive drooling
    2. Pinpoint pupils
    3. Cold hands
    4. Dry mouth

30. What is the most important precaution to teach an older patient who is prescribed a glaucoma drug that causes miosis?
    1. “Wear sunglasses until the drug wears off.”

1. 2. “Use at least a 30 SPF sunscreen when going outdoors.”
   3. “Avoid driving or operating hazardous machinery until the drug wears off.”
   4. “Increase the light indoors because vision will be decreased in low-light environments.”

31. Which question is most important to ask a patient who is prescribed acetazolamide (Diamox) before administering the first dose?
    1. “Do you have diabetes?”
    2. “Are you allergic to sulfa drugs?”
    3. “How long have you had glaucoma?”
    4. “Do you eat grapefruit or drink grapefruit juice?”

32. What is the most important precaution to teach the parents of a 4-year-old who is prescribed eye drops for glaucoma in the right eye as a result of facial trauma?
    1. “Only place the drops in the affected eye.”
    2. “Check the eye for signs of infection daily.”
    3. “Keep sunglasses on the child for 1 hour after placing the drops.”
    4. “Refrigerate the drug to prevent a stinging sensation in the eye during instillation.”

MULTIPLE RESPONSE

ADVANCED CONCEPTS

1. Which drugs for glaucoma cause marked mydriasis? (select all that apply)
   1. Apraclonidine (Iopidine)
   2. Bimatoprost (Lumigan)
   3. Brimonidine (Alphagan P)
   4. Carbachol (Carboptic)

1. 5. Cartrol (Ocupress)
   6. Dipivefrin (AK-Pro)
   7. Levobunolol (Betagan)

2. Which actions help prevent infection when placing ointments into a patient’s eye? (select all that apply)
   1. Having the patient remove contact lenses.
   2. Avoiding touching the tip of the applicator.
   3. Using separate drug tubes for the right and the left eye.
   4. Applying pressure over the punctum for 1 minute after instilling the drug.
   5. Waiting 10 minutes between the administrations of more than one type of eye drug.
   6. Squeezing out and discarding a small amount of ointment before instilling the drug.

COMPLETION

ADVANCED CONCEPTS

1. A patient is prescribed methazolamide (Neptazane) 75 mg orally. The drug available is methazolamide 25 mg/tablet. How many tablets should be administered to the patient?

           tablet(s)