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NURS 133 Travoprost and Timolol

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jasmine's version from 2016-05-01 16:25

Section 1

Question Answer
Travoprost (Travatan) A clear, colorless to slightly yellow oil that is very soluble in acetonitrile, methanol, octanol, and chloroform; It is practically insoluble in water; A topical medication used for controlling the progression of glaucoma (increased pressure within the eye, causing gradual loss of sight) or ocular hypertension (pressure inside the eye is higher than normal: >21 mm Hg), by reducing intraocular pressure; It a synthetic prostaglandin F2alpha analogue (a group of hormone-like substances that participate in a wide range of body functions such as the contraction and relaxation of smooth muscle, the dilation and constriction of blood vessels, control of blood pressure, and modulation of inflammation. Prostaglandin F2-alpha(PGF-2 alpha) is a stable prostaglandin that stimulates the contraction of uterine and bronchial smooth muscle and produces vasoconstriction [tightening] in some blood vessels. As a pharmaceutical, the generic name of PGF-2 alpha is dinoprost. It is used for the induction of abortion, for evacuation of the uterus after a missed abortion, and in the treatment of hydatidiform mole [A tumor that forms in the uterus as a mass of cysts resembling a bunch of grapes. Hydatidiform moles occur during the childbearing years, and they do not spread outside the uterus. However, a malignancy called choriocarcinoma may start from a hydatidiform mole. In its early stages, a hydatidiform mole may look like a normal pregnancy. Diagnosis is based on a history of lack of fetal movement, a pelvic examination, an ultrasound, and a blood test to look for high levels of the hormone beta human chorionic gonadotropin (hCG). hCG in the blood of a woman who is not pregnant can be a sign of a hydatidiform mole. Treatment includes removal of the mole by dilation and curettage (D & C) and suction evacuation and surgery to remove the uterus (hysterectomy). Also known as molar pregnancy
Travoprost actions A selective FP prostanoid receptor agonist and is believed to reduce intraocular pressure by increasing the drainage of aqueous humor, which is done primarily through increased uveoscleral outflow and to a lesser extent, trabecular outflow facility; The exact mechanism of action is unknown at this time
Travoprost therapeutic uses Used for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension who are intolerant of other intraocular pressure lowering medications or insufficiently responsive (failed to achieve target IOP determined after multiple measurements over time) to another intraocular pressure lowering medication
Elimination/Excretion of Travoprost Metabolized to inactive metabolites; Less than 2 percent of the topical ocular dose excreted in the urine within 4 hours as the travoprost free acid
Adverse/Side Effects of Travoprost Most common observed in controlled clinical studies: Ocular hyperemia (reported in 30-50 percent of patients); Decreased visual acuity, eye discomfort, foreign body sensation, pain and pruritus (5-10 percent of patients) Conjunctival hyperemia (3 percent reported in patients); Redness, swelling, itching, or pain in or around eye; Oozing or discharge from eye; Increased sensitivity to light; Vision changes; Chest pain; Headache; Stinging or burning of eyes; dry or watery eyes; blurred vision
Contraindications of Travoprost Hypersensitivity; Pregnancy (Category C) and breast feeding warnings
Drug/Food interactions of Travoprost Therapeutic efficacy can be decreased when used in combination with Infliximab; Bimatoprost may interfere with the pressure-lowering effect of travoprost
Medication administration of Travoprost Topical; Drops (Polypropylene dispenser bottle with a natural polypropylene dropper tip)
Nursing interventions of Travoprost Assess for allergies; Assess the eyes (potential for increased brown pigmentation of iris, eyelid skin darkening, changes in eyelashes; important if only one eye is being treated); If contact lenses, patient should remove (patient recommended to leave contact lenses out of eyes at least 15 minutes after using drops); Determine type and degree of visual loss; Immediately after administering eye drops, press on tear duct (at corner of the eye closest to nose) for approximately one minute to minimize the amount of Travoprost that may be absorbed into the blood stream; When using eye drops, take care to not touch dropper tip to any surface, or to the eye in order to avoid contaminating; Individual containers should be provided for each patient, however a separate bottle need only be supplied for each eye if there are special concerns about contamination; Evaluate anxiety level, degree of pain experienced or suddenness of onset of symptoms, and current knowledge of condition
Client education of Travoprost Administer as directed; Advise patient of information contained in the Warnings and Precautions sections; Instruct patient to avoid allowing the tip of the dispensing container to contact the eye or surrounding structures due to bacteria/contamination; Advise patient to not administer if eye inflammation or eyelid reactions; Advise patient if develop an inter-current ocular condition (e.g., trauma or infection), have ocular surgery, or any ocular reactions (particularly conjunctivitis and lid reactions), to immediately consult health care professional; Instruct patient is more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart; Instruct patient to discard medication 6 months after opening; Allow patient to acknowledge concerns and express feelings; Implement measures to assist patient to manage visual limitations such as reducing clutter, arranging furniture and out of travel path; turning head to view subjects; Correcting for dim light and problems of night vision; Advise patient to carry identification describing disease process and medication regimen at all times; Advise patient to consult health care professional if any adverse effects occur; Emphasize the importance of a follow up exam
Warnings and Precautions of Travoprost Prostaglandin analogues, including travoprost ophthalmic solution, 0.004% have been reported to cause changes to pigmented tissues. The most frequently reported changes have been increased pigmentation of the iris and periorbital tissue (eyelid) and increased pigmentation and growth of eyelashes. These changes may be permanent. Prostaglandin analogues, including travoprost ophthalmic solution, 0.004% may gradually change eye color, increasing the amount of brown pigmentation in the iris by increasing the number of melanosomes (pigment granules) in melanocytes. The long term effects on the melanocytes and the consequences of potential injury to the melanocytes and/or deposition of pigment granules to other areas of the eye are currently unknown. The change in iris color occurs slowly and may not be noticeable for months to years. Patients should be informed of the possibility of iris color change. Eyelid skin darkening has been reported in association with the use of prostaglandin analogues, including travoprost ophthalmic solution, 0.004%. Prostaglandin analogues, including travoprost ophthalmic solution, 0.004% may gradually change eyelashes in the treated eye; these changes include increased length, thickness, pigmentation, and/or number of lashes. Patients who are expected to receive treatment in only one eye should be informed about the potential for increased brown pigmentation of the iris, periorbital and/or eyelid tissue, and eyelashes in the treated eye and thus heterochromia between the eyes. Patient should also be advised of the potential for a disparity between the eyes in length, thickness, and/or number of eyelashes
Evaluation/Desired outcomes of Travoprost Reduced intraocular pressure; Controlled progression of glaucoma or ocular hypertension; Maintain current visual field/acuity without further loss
Potential nursing diagnoses of Travoprost Sensory Perception, disturbed: visual; Risk of infection; Risk of injury; Anxiety; Deficient Knowledge
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Section 2

Question Answer
Timolol (Betimol) Beta-blocker; Non-selective, beta-adrenergic receptor antagonist; Treatment of open-angle glaucoma and ocular hypertension; Other causes of high pressure inside the eye; Timolol does not have significant intrinsic sympathomimetic, direct myocardial depressant, or local anesthetic (membrane-stabilizing) activity, but does possess a relatively high degree of lipid solubility. Timolol, when applied topically to the eye, has the action of reducing elevated, as well as normal, intraocular pressure, whether or not accompanied by glaucoma. (Elevated intraocular pressure is a major risk factor in the pathogenesis of glaucomatous visual field loss and optic nerve damage)
Timolol actions Competes with adrenergic neurotransmitters such as catecholamines for binding at beta(1)-adrenergic receptors in the heart and vascular smooth muscle and beta(2)-receptors in the bronchial and vascular smooth muscle. Beta(1)-receptor blockade results in a decrease in resting and exercise heart rate and cardiac output, a decrease in both systolic and diastolic blood pressure, and, possibly, a reduction in reflex orthostatic hypotension. Beta (2)-blockade results in an increase in peripheral vascular resistance. The exact mechanism whereby timolol reduces ocular pressure is still not known. The most likely action is by decreasing the secretion of aqueous humor
Timolol therapeutic uses Used to treat high pressure inside the eye due to glaucoma (open angle-type) or other eye diseases (e.g., ocular hypertension); Lowering high pressure inside the eye helps to prevent blindness; This medication works by decreasing the amount of fluid within the eye
Elimination/Excretion of Timolol Primarily hepatic (80 percent) via the cytochrome P450 2D6 isoenzyme; Timolos and its metabolites primarily excreted in urine
Adverse/Side Effects of Timolol Hypersensitivity; Anaphylaxis and blepharoconjunctivitis; Swelling or redness of eyelids; Eye redness, discomfort, or sensitivity to light; Drainage, crusting, or oozing of eyes or eyelids; Depressed mood, confusion, hallucinations, unusual thoughts or behavior; Wheezing, gasping, or other breathing problems; Swelling, rapid weight gain; Chest pain, slow or uneven heart rate; Feeling short of breath, even with mild exertion; Fatigue, weakness, hypotension, burning and stinging of eye, bradycardia
Contraindications of Timolol Hypersensitivity; Overt HF; Cardiogenic shock; Sinus bradycardia; Second or third degree atrioventricular block; Bronchial asthma or history of bronchial asthma; Severe chronic obstructive pulmonary disease (COPD). Should not be used in patients with asthma or a history of obstructive airways disease, unless no alternative treatment is available
Drug/Food interactions of Timolol Additive effect (an effect of two chemicals equal to the sum of the effect of two chemicals taken separately) with beta-adrenergic blocking agent in combination with Betimol either on the intraocular pressure or on the known systemic effects of beta-blockade; Catecholamine-depleting drugs such as reserpine in combination with Betimol due to possible additive effects and the production of hypotension and/or marked bradycardia, which may produce vertigo, syncope, or postural hypotension; Calcium antagonists in combination with Betimol due to possible atrioventricular conduction disturbances, left ventricular failure, and hypotension-should avoid co-administration in patients with impaired cardiac function; Concomitant use of beta-adrenergic blocking agents with digitalis and calcium antagonists may have additive effects in prolonging atrioventricular conduction time; Increased risk of anaphylaxis with injectable epinephrine; 79 drug-drug interactions from the drug bank website
Medication administration of Timolol Drops; Supplied in a white, opaque, plastic, ophthalmic dispenser bottle with a controlled drop tip
Nursing interventions of Timolol Assess for allergies; Assess the eyes; If contact lenses, patient should remove (patient recommended to leave contact lenses out of eyes at least 15 minutes after using drops); Determine type and degree of visual loss; Immediately after administering eye drops, press on tear duct (at corner of the eye closest to nose) for approximately one minute to minimize the amount of Timolol that may be absorbed into the blood stream; When using eye drops, take care to not touch dropper tip to any surface, or to the eye in order to avoid contaminating; Eye drops for hospital use are normally discarded one week after first opening (check agency policy); Individual containers should be provided for each patient, however a separate bottle need only be supplied for each eye if there are special concerns about contamination
Client education of Timolol Administer as directed; Advise patient the correct application of eye drops; Inform patient eye-drop dispenser devices are available for patients who need help with the instillation of eye drops from plastic bottles; Patients who wear contact lenses should check whether their lenses are compatible with the formulation of the eye drops as some preservatives may accumulate in some lenses such as hydrogel lenses and induce toxic reactions; Instruct patient to avoid allowing the tip of the dispensing container to contact the eye or surrounding structures due to bacteria/contamination; Advise patient to not administer if eye inflammation or eyelid reactions; Advise patient if develop an inter-current ocular condition (e.g., trauma or infection), have ocular surgery, or any ocular reactions (particularly conjunctivitis and lid reactions), to immediately consult health care professional; Instruct patient is more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 minutes apart; Implement measures to assist patient to manage visual limitations such as reducing clutter, arranging furniture out of travel path; turning head to view subjects; Correcting for dim light and problems of night vision; Advise patient to carry identification describing disease process and medication regimen at all times; Advise patient to consult health care professional if any adverse effects occur; Emphasize the importance of a follow up exam
Evaluation/Desired outcomes of Timolol Reduced intraocular pressure; Maintain current visual field/acuity without further loss
Potential nursing diagnoses of Timolol Sensory Perception, disturbed: visual; Risk of infection; Risk of injury; Anxiety; Deficient Knowledge
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