The nurse is reviewing medications prescribed for patients with open-angle glaucoma. Which medication should the nurse question?
1. timolol (Timoptic), 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. acetazolamide (Diamox) for a 20-year-old male
4. brimonidine (Alphagan), an adrenergic agonist, for a healthy 40-year-old
Correct Answer: 1
Timolol (Timoptic) is a selected beta-adrenergic blocker that will reduce the intraocular pressure by decreasing production of aqueous humor. Its systemic effects might limit its use for patients with congestive heart failure (CHF). The nurse should question the use of this medication with a patient with CHF. 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 closed-angle glaucoma, renal disease, and allergy to sulfa, but is indicated for open-angle glaucoma. This order is appropriate for this patient. Acetazolamide (Diamox) is a carbonic anhydrase inhibitor used as an adjunctive therapy to remove fluids through kidney filtration. A healthy 20-year-old would not have contraindications unless allergic to sulfa drugs. This would not be questioned by the nurse. Brimonidine (Alphagan) is based on an epinephrine, sympathomimetic drug action to dilate the pupil and reduce the production of aqueous humor in patients with open-angle glaucoma. This drug is appropriate if no hypertension or cardiac disease is present, such as in a healthy 40-year-old.
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