Glaucoma, Ophthalmics & Otics

Front 1

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?

Back 1

Remove the contact lenses prior to using the medication.

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.

Front 2

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?

Back 2

The generic name of Xalatan is latanoprost.

Front 3

Brandy Melville has COPD. She is on the verge of needing oxygen; the COPD is advanced and Ms. Melville continues to smoke a half-pack daily. Brandy Melville 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?

Back 3

Betaxolol

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.

Front 4

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?

Back 4

Digoxin

Front 5

Which of the following drugs is used for tuberculosis and can cause possible vision loss due to optic neuritis?

Back 5

Isoniazid

Front 6

Lilly Mitchell is a 59 year-old female who uses latanoprost for glaucoma. Ms. Mitchell 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. Ms. Mitchell has brought the Latisse prescription to the pharmacy. Which of the following statements are correct? (Select ALL that apply.)

Back 6

-Latisse, taken in addition to a prostaglandin analog for glaucoma, could make the glaucoma medication less effective.

-The pharmacist should check with the patient's eye doctor prior to filling the Latisse.

Bimatoprost (Latisse) is indicated for eyelash hypotrichosis (to increase eyelash growth); it should not be used with same class for glaucoma without a physician's knowledge and approval (using PAs more frequently decreases effectiveness). Latisse is not applied to the lower lid or in the eye and excess solution around the eye during application should be blotted with a tissue.

Front 7

Which of the following drugs covers MRSA and VRE faecium and can cause optic neuropathy, with possible vision loss?

Back 7

Linezolid

Front 8

When Lilly Mitchell 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 Ms. Mitchell timolol drops. Choose the correct statement concerning timolol drops:

Back 8

Timolol can cause burning or stinging when the drop is placed in the eye.

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.

Front 9

Which of the following counseling statements concerning eye drop administration is not correct?

Back 9

If using another medicine, wait at least two minutes before using the second eye drop.

Instructions are: If the patient needs to take more than one glaucoma medicine, wait at least 10 minutes to put the second medicine in the eye. If the patient is taking three medicines, wait 10 more minutes before putting the third medicine in the eye. Some of the medications state to wait at least five minutes, which may be acceptable.

Front 10

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?

Back 10

Hydroxychloroquine

Front 11

Choose the correct counseling statement that a pharmacist should provide to a patient beginning prostaglandin analog therapy for glaucoma:

Back 11

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.

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.

Front 12

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"?

Back 12

Voriconazole

Front 13

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".

Back 13

Isotretinoin

Front 14

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.)

Back 14

-To avoid contamination, do not let the dropper tip touch any surface (true for all eye drops).

-Some patients get an allergic reaction to the antibiotic; if the eye becomes red or feels worse, contact a physician.

-As this is an antibiotic, finish the course of therapy; do not stop until the treatment is complete, rather than when the eye feels better.

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.

Front 15

Choose the correct counseling statement concerning glaucoma medications:

Back 15

The brand name of dorzolamide/timolol is Co-opt.

Many diseases can be treated, at least partially, with alternative therapies. Unfortunately, nothing seems to lower IOP except medications or surgery.

Front 16

Timolol comes in a gel formulation called Timoptic XE. Choose the correct counseling statement/s for this formulation: (Select ALL that apply.)

Back 16

-If the patient uses other topically applied ophthalmic medications, they should be administered at least 10 minutes before Timoptic XE.

-Turn the container upside down and shake the contents once prior to use (the gel is a suspension and needs to be mixed; user does not need to shake more than once.)

-The gel is used once daily.

-The dispenser tip is designed to provide a single drop; therefore, do not enlarge the hole of the dispenser tip.

Front 17

What is the preferred treatment for most cases of blepharitis?

Back 17

Warm compresses

Front 18

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?

Back 18

Phenytoin (Dilantin)

Phenytoin is not known to raise intraocular pressure. Use extreme caution with steroid eye drops and any anticholinergic medication.

Front 19

Choose the correct counseling statement concerning dorzolamide:

Back 19

A-Dorzolamide comes in a combination glaucoma medication with timolol called Co-opt.

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.

Front 20

The primary goal of therapy when treating a patient with glaucoma is to:

Back 20

Decrease intraocular pressure

Increased intraocular pressure (IOP) is a key risk factor for glaucoma. 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.

Front 21

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.)

Back 21

-The patient can keep the bottle in use at room temperature.

-In the pharmacy the bottles are stored in the refrigerator.

-The patient should store unopened bottles in the refrigerator.

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.

Front 22

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?

Back 22

Sildenafil

Front 23

Each of the following drugs is known to cause some type of visual damage. Which drug can cause corneal micro-deposits and optic neuropathy?

Back 23

Amiodarone