1. Drugs Used to Treat Glaucoma and Other Eye Disorders Chapter 43 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2 Chapter 43 Lesson 43.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Slide 3 Objectives Describe the anatomy and physiology of the eye Describe the normal flow of aqueous humor in the eye Identify the changes in normal flow of aqueous humor caused by open-angle and closed-angle glaucoma Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Slide 4 Anatomy and Physiology of the Eye Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Slide 5 Anatomy and Physiology of the Eye (cont’d) The cornea  Outermost part of the eyeball  Transparent, allows light to enter  Lacks blood vessels  Diffused air provides oxygen to the cornea  Resistance to infections  Contains sensory fibers that release pain if damaged  Injury to corneal tissue is replaced by scar tissue Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Slide 6 Flow of Aqueous Humor Produced by the ciliary body, it bathes and feeds the lens Flows between the lens and the iris into the anterior chamber of the eye Drains through channels located near the cornea and the sclera, and then drains into a meshwork that leads into Schlemm’s canal and into the venous system of the eye Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Slide 7 Major Types of Glaucoma Glaucoma characterized by elevated intraocular pressure (IOP); caused by an increased production of aqueous humor or an outflow obstruction Primary  Closed-angle glaucoma  Open-angle glaucoma Secondary Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Slide 8 Effect of Light or Ophthalmic Agents on the Iris of the Eye Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Slide 9 Chapter 43 Lesson 43.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

10. Slide 10 Objectives Explain baseline data that should be gathered when an eye disorder exists Develop teaching plans for a person with an eye infection and a person receiving glaucoma medication Review the correct procedure for instilling eye drops or eye ointments Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Slide 11 General Considerations for Topical Ophthalmic Drug Therapy Topical application Safety and color coding Check which eye is being medicated Proper administration  Wash hands  Tilt patient’s head back slightly  Administer near inner portion of eye  Have patient close eye for a minute after administration Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Slide 12 Drugs Class: Osmotic Agents Actions  Reduce volume of intraocular fluid Uses  Reduce IOP in patients with acute narrow- angle glaucoma Serious adverse effects  Thirst, nausea, dehydration, electrolyte imbalance, headache, circulatory overload Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Slide 13 Drug Class: Carbonic Anhydrase Inhibitors Actions  Inhibit the enzyme carbonic anhydrase, decreasing the production of aqueous humor Uses  In conjunction with other medications to control IOP Serious adverse effects  Electrolyte imbalance, dehydration, dermatologic, hematologic, neurologic reactions, confusion, drowsiness Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

14. Drug Class: Cholinergic Agents Actions  Produce strong contractions of the iris and ciliary body Uses  Lower IOP by widening the angle to allow outflow of aqueous humor Common adverse effects  Reduced visual acuity, conjunctival irritation, erythema, headache, pain, discomfort Serious adverse effects  Systemic toxicity Slide 14 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

15. Drug Class: Cholinesterase Inhibitors Drug: echothiophate iodide (Phospholine Iodide) Actions  Prevent metabolism of acetylcholine resulting in increased cholinergic activity which decreases IOP Uses  Treat open-angle glaucoma Common adverse effects  Reduced visual acuity, conjunctival irritation, erythema, headache, lacrimation Serious adverse effects  Systemic adverse effects Slide 15 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

16. Drug Class: Adrenergic Agents Actions  Cause pupil dilation, increased outflow of aqueous humor, vasoconstriction, relaxation of ciliary muscle Uses  Lower IOP in open-angle glaucoma Common adverse effects  Sensitivity to bright lights, conjunctival irritation, lacrimation Serious adverse effects  Systemic adverse effects, diaphoresis, trembling Slide 16 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

17. Drug Class: Beta-Adrenergic Blocking Agents Actions  Exact mechanism unknown; thought to reduce production of aqueous humor Uses  Reduce IOP with chronic open-angle glaucoma Common adverse effects  Conjunctival irritation, lacrimation Serious adverse effects  Systemic adverse effects Slide 17 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

18. Drug Class: Prostaglandin Agonists Actions  Increase the outflow of aqueous humor Uses  Reduce IOP in patients with chronic open- angle glaucoma not responding to other agents Common and serious adverse effects  Conjunctival irritation, lacrimation, burning and stinging, eye pigment changes Slide 18 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

19. Drug Class: Anticholinergic Agents Actions  Relax smooth muscle of the ciliary body and iris to produce mydriasis and cycloplegia Uses  To examine the interior of the eye, measure refraction, and rest the eye in inflammatory conditions Common adverse effects  Sensitivity to bright light, conjunctival irritation, lacrimation Serious adverse effects  Systemic adverse effects Slide 19 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

20. Drug Class: Antifungal Agents Drug: natamycin (Natacyn) Actions  Alter the cell wall of fungus causing death of the fungus Uses  Effective against Candida, Asperigillus, and Fusarium infections Common adverse effects  Sensitivity to bright light, blurred vision, lacrimation, redness Serious adverse effects  Eye pain, worsening of symptoms Slide 20 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

21. Drug Class: Antiviral Agents Drugs: ganciclovir (Vitrasert), trifluridine (Viroptic) Actions  Inhibit viral replication Uses  Treat herpes simplex keratitis, treat recurrent infections Common adverse effects  Visual haze, lacrimation, redness, burning, sensitivity to bright light Serious adverse effects  Allergic reactions Slide 21 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.