A new user of Xalatan wears contact lenses. How should the pharmacist instruct the patient regarding contact lenses and the use of a prostaglandin analog for glaucoma?
A. You cannot use this medication if you wear contact lenses.
B. Remove the contact lenses prior to using the medication.
C. Xalatan is taken in the morning; wait five minutes after inserting the medication before putting in contact lenses.
D. Xalatan is taken in the morning; wait 30 minutes after inserting the medication before putting in contact lenses.
E. If patients use contact lenses they should use Lumigan instead.
B. This medication is taken at night, as are the other PG analogues (except Rescula is twice daily) and can be used after the lenses are removed for the day. If they need to be re-inserted, wait fifteen minutes after using the medication.
Each of the following drugs is known to cause some type of visual damage. Which drug is used for lupus and rheumatoid arthritis and can cause retinopathy?
Which of the following drugs is used for tuberculosis and can cause possible vision loss due to optic neuritis?
A patient gave the pharmacist a prescription for Xalatan 2.5 mL, insert 1 drop in both eyes once daily in the evening. Which of the following is an appropriate generic substitution for Xalatan?
C. The generic name of Xalatan is latanoprost.
Which of the following counseling statements concerning eye drop administration is not correct?
A. After washing your hands thoroughly, hold the bottle in one hand, resting your thumb against your eyebrow or the bridge of your nose.
B. Use the index finger of your other hand to gently pull down your lower lid and make a pocket for the drop. Gently squeeze the bottle to dispense 1 drop into the pocket of your lower lid.
C. If you tend to blink before the drop hits your eye, try looking to the side rather than straight at the dropper.
D. Press down on the "bump" on the inside of your eye (near the nose) for one minute-this is the drainage duct and by pressing it down closed (gently) you are allowing the medicine to stay in the eye and get absorbed.
E. If using another medicine, wait at least two minutes before using the second eye drop.
E. Instructions are: If you need to take more than one glaucoma medicine, wait at least 10 minutes to put the second medicine in your eye. If you're taking three medicines, wait 10 more minutes before putting the third medicine in your eye. Some of the medications state to wait at least five minutes, which may be acceptable.
Many drugs can raise intraocular pressure. The use of these medications can be dangerous if the patient has glaucoma. Which of the following medication classes does not pose a risk of increasing the intraocular pressure?
A. Cough/cold/motion sickness medications (antihistamines)
B. Anticholinergics used for a variety of conditions, including centrally-acting agents and incontinence drugs
C. Prednisolone and other steroid eye drops
D. Topiramate (Topamax)
E. Phenytoin (Dilantin)
E. Phenytoin is not known to raise intraocular pressure. Use extreme caution with steroid eye drops and any anticholinergic medication.
Which of the following drugs covers MRSA and VRE faecium and can cause optic neuropathy, with possible vision loss?
Which of the following drugs has this warning: May impair your vision, especially at night. Be careful if you drive or do anything that requires you to see clearly.
Each of the following drugs is known to cause some type of visual damage. Which drug can cause yellow-green vision, blurriness and halos around objects when toxic?
A patient gave the pharmacist a prescription for Xalatan 2.5 mL, insert 1 drop in both eyes once daily in the evening. How should the bottles be stored (Select ALL that apply.)
A. The patient should keep all bottles, including the one in use, in the refrigerator.
B. The patient can keep the bottle in use at room temperature.
C. The unused bottles should be kept frozen.
D. In the pharmacy the bottles are stored in the refrigerator.
E. The patient should store unopened bottles in the refrigerator.
B, D, E. Once a bottle is opened, it can be stored at room temperature for up to six weeks. It would not be pleasant to insert a cold eye drop.
Brandy has COPD. She is on the verge of needing oxygen; the COPD is advanced and Brandy continues to smoke a half-pack daily. Brandy has been diagnosed with glaucoma. If a beta blocker is required, which medication would be the best option in a patient with breathing problems, such as asthma or COPD?
E. Except for betaxolol, the beta blockers used for glaucoma are non-selective beta blockers. Most of the medicine stays local, but it is best to try and avoid in asthma, COPD, chronic bronchitis, emphysema, or advanced cardiac disease-some patients will notice the difference if using a non-selective agent.
Choose the correct counseling statement concerning glaucoma medications:
A. Glaucoma can be treated successfully with yoga and meditation, rather than with medications.
B. Glaucoma medications lower intraocular pressure by reducing vascular resistance in the coronary arteries.
C. The brand name of brimonidine is Miostat.
D. The brand name of dorzolamide/timolol is Cosopt.
E. The brand name of acetazolamide is Azopt.
D. Many diseases can be treated, at least partially, with alternative therapies. Unfortunately, nothing seems to lower IOP except medications or surgery.
What is the primary diagnostic criteria used for glaucoma?
A. Decreased intraocular pressure
B. Increased intraocular pressure
C. "Floaters" in the field of vision
D. Decrease in vision
E. Damage to the optic nerve
B. Glaucoma is an eye disease caused by an increase in intraocular pressure (IOP). If left untreated, glaucoma can result in damage to the optic nerve and loss of vision. There may be no symptoms felt by the patient, although some may experience eye pain.
When Lilly initially had glaucoma, it was just in one eye and the physician did not want to use a prostaglandin analog because if the medicine was used in one eye only it would make the one eye darker than the other. He prescribed Lilly timolol drops. Choose the correct statement concerning timolol drops:
A. Timolol is dosed three times daily.
B. Timolol is a beta-1 selective blocker.
C. Timolol can cause burning or stinging when the drop is placed in the eye.
D. The brand name is Ocupress.
E. The brand name is Betagan.
C. Timolol (Timoptic) is a non-selective beta blocker. Levobunolol (Betagan) and carteolol (Ocupress) are other beta blocker glaucoma medications. In this class, timolol is used most frequently.
Lilly is a 59 year-old female who uses latanoprost for glaucoma. Lilly has noticed that her eyelashes are thicker than they used to be and she likes it. She asked her primary physician for a prescription for Latisse in order to make her eyelashes even thicker, and the physician complied. Lilly has brought the Latisse prescription to the pharmacy. Which of the following statements are correct? (Select ALL that apply.)
A. The Latisse prescription will increase the IOP.
B. Latisse, taken in addition to a prostaglandin analog for glaucoma, could make the glaucoma medication less effective.
C. The pharmacist should check with the patient's eye doctor prior to filling the Latisse.
D. Latisse contains acetazolamide.
E. Latisse is applied to the lower lid only, once daily.
B, C. Bimatoprost (Latisse) is indicated for eyelash hypotrichosis (to increase eyelash growth)-do not use concurrently with same class for glaucoma without doctor's knowledge and approval (using PAs more frequently decreases effectiveness). Latisseis not applied to the lower lid or in the eye and excess solution around the eye during application should be blotted with a tissue.
Which of the following drugs causes abnormal vision, color vision change and/or photophobia in about 20% of patients and comes with this warning to patients: Can cause vision problems. If used more than 28 days you need to have your vision checked?
There are many topical antibiotic eye drops, including moxifloxacin (Vigamox) and tobramycin/dexamethasone (antibiotic and steroid), among others. Counseling for ophthalmic antibiotics should include the following: (Select ALL that apply.)
A. To avoid contamination, do not let the dropper tip touch any surface (true for all eye drops).
B. To avoid resistance, use only until symptoms disappear.
C. Some patients get an allergic reaction to the antibiotic; if your eye becomes red or feels worse, contact the doctor
D. As this is an antibiotic, finish the course of therapy-do not stop until the treatment is complete, rather than when your eye feels better.
E. All antibiotic drops should be kept refrigerated.
A, C, D. Most of the antibiotic eye drops suggest that contact lenses should not be worn while using the medication. If the patient is going to use them anyway they will need to sterilize the lenses carefully if they are not daily disposables, or they could keep re-introducing the infection.
What is the preferred treatment for most cases of blepharitis?
A. Topical NSAIDs
B. Warm compresses
C. Systemic NSAIDs
D. Tobrex eye drops
E. Vigamox eye drops
B. Blepharitis is a common eye condition, causing the eyelids to be reddened, itchy and somewhat swollen and scaly-appearing at the base of the eyelashes. Most patients get relief by loosening the debris with a warm compress, followed by cleansing with a dilute solution.
Each of the following drugs is known to cause some type of visual damage. Which drug can cause corneal micro-deposits and optic neuropathy?
Choose the correct counseling statement that a pharmacist should provide to a patient beginning prostaglandin analog therapy for glaucoma:
A. Insert once daily each morning.
B. If you have light eyes and your doctor has prescribed the medication for use in one eye, it is not a concern as both eyes will darken evenly; the medication is absorbed systemically.
C. You can leave contact lens in when administering this medication.
D. If using Rescula, you should administer three times daily.
E. An increase in brown pigment in the iris and gradual changes in eye color may occur, eyelash growth and pigmentation may increase and the skin on the eyelids and around the eyes may darken.
E. An increase in brown pigment in the iris and gradual changes in eye color may occur; eyelash growth and pigmentation may increase; skin on the eyelids and around the eyes may darken. What happens most commonly is eyelash growth, and many patients do not mind this effect; however, it must be included with counseling.
Choose the correct counseling statement concerning dorzolamide:
A. Dorzolamide comes in a combination glaucoma medication with timolol called Cosopt.
B. The most frequent adverse events are ocular burning, stinging, or discomfort immediately following administration.
C. Many patients get a bitter taste following administration.
D. This drug, along with acetazolamide (Diamox) and brinzolamide (Azopt), are carbonic anhydrase inhibitors.
E. All of the above.
E. The carbonic anhydrase inhibitors often cause bitter taste, and possible eye burning and stinging.
Which of the following drugs causes a greenish tinge around objects and a rare, but possible risk of permanent vision loss in one or both eyes?
Timolol comes in a gel formulation called Timoptic XE. Choose the correct counseling statement/s for this formulation: (Select ALL that apply.)
A. If you use other topically applied ophthalmic medications, they should be administered at least 10 minutes before Timoptic XE.
B. Turn the container upside down and shake the contents once prior to use (the gel is a suspension and needs to be mixed-you do not need to shake more than once.)
C. It should be stored in the refrigerator.
D. The gel is used once daily.
E. The dispenser tip is designed to provide a single drop; therefore, do not enlarge the hole of the dispenser tip.
A, B, D, E.