The nurse is reviewing discharge orders in preparation for teaching patients diagnosed with open-angle glaucoma. Which order would the nurse question?
1. Timolol (Timoptic), a beta-adrenergic blocker, for a 60-year-old with congestive heart failure (CHF)
2. Dorzolamide (Trusopt), a carbonic anhydrase inhibitor, for a patient with asthma and chronic obstructive pulmonary disease (COPD)
3. Brinzolamide (Azopt) for a 20-year-old male
4. Brimonidine (Alphagan), an adrenergic agonist, for a healthy 40-year-old on no other drugs
1
Rationale 1: Timolol (Timoptic) is a selected beta-adrenergic blocker that reduces intraocular pressure. It is contraindicated for patients with COPD, asthma, sinus bradycardia, and overt cardiovascular failure.
Rationale 2: Dorzolamide (Trusopt) lowers intraocular pressure and is often an adjunctive therapy that removes fluids through kidney filtration. It is a carbonic anhydrase inhibitor that is contraindicated in renal disease, and allergy to sulfa. This order is appropriate for this patient.
Rationale 3: Brinzolamide (Azopt) is a carbonic anhydrase inhibitor used to remove fluids through kidney filtration. A healthy 20-year-old would not have contraindications unless he is allergic to sulfa drugs.
Rationale 4: Brimonidine (Alphagan) dilates the pupil and reduces the production of aqueous humor in patients with open-angled glaucoma. This drug is appropriate for a patient who is not on clonidine or monoamine oxidase inhibitor therapy, such as this healthy 40-year-old.
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