2. GLAUCOMA TREATMENT

3. Glaucoma Drug Therapy Purpose: - constrict the pupil -reduce production or increase absorption of aqueous humor DRUGS Prostaglandin agonists Adrenergic agonists Beta-adrenergic blockers Cholinergic agonists Carbonic anhydrase inhibitors

4. DRUGS: PROSTAGLANDIN AGONIST HOW DO THESE TREAT GLAUCOMA? EXAMPLES OF DRUGS: -Latanoprost (Xalatan) -bimatoprost (Lumigan) -travoprost (Travatan): not to be used with pregnancy

5. DRUGS: Adrenergic Agonists EXAMPLES: -brimonidine tartrate ( Alphagan): Nursing Implications: -cannot combine with MAOI (monoamine oxidase inhibitor) -Can precipitate hypertensive crisis -Instill without contact lens in

6. DRUGS: BETA ADRENERGIC BLOCKERS EXAMPLES: -levobunolol HCl (Betagen Liquifilm) -betaxolol HCl (Betoptic) -timolol (Betimol, Timoptic) Nursing Implications - WHAT PRECAUTIONS MUST BE USED WITH ORAL BETA BLOCKERS AND CALCIUM CHANNEL BLOCKERS?

7. Drugs: Cholinergics EXAMPLES -carbochol(Carboptic, Isopto Carbachol, Miostat) -pilocarpine(Adsorbocarpine, Piloptic, Pilopine) Nursing Considerations: -can cause increase with saliva, sweating -pupil becomes smaller (miosis)

8. DRUGS: CARBONIC ANHYDRASE INHIBITORS: EXAMPLES: -brinzolamide (Azopt), -dorzolamide (Trusopt) Nursing Implications : -check if allergic to sulfonamide -has a diuretic effect -don’t use with contacts

9. SURGERY FOR BOTH TYPES OF GLAUCOMA PURPOSE: to create a permanent way to drain fluid TYPES (Open Angle Glaucoma) -Laser trabeculectomy: laser burns trabecular meshwork -Filtering microsurgery: creates drainage hole in iris If patient doesn’t respond to surgery, then a shunt or glaucoma drainage device may be implanted Closed Angle Glaucoma: peripheral iridectomy

10. Glaucoma Surgical Treatment

11. Glaucoma Video http://video.google.com/videoplay?docid=- 2504983511038511848#

12. POSTOP NURSING CARE Clinical setting: outpatient services Precautions: measures to prevent increased IOP Postop complications: choroidal hemorrhage