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Chapter 68. Ocular Pharmacology

KM is a 44-year-old African American female with decreased peripheral vision and a blind spot on the left side. She was in a motor vehicle accident because she did not see the car in the left lane. She complains of brow ache and headaches that have become worse over the past 2 weeks. Intraocular pressure (IOP) measures 28 in the right eye and 26 in the left eye. She is on a fixed income and paying for medications is often difficult. She works odd jobs with varying shifts.

Blood pressure is 140/95.

Diagnosis: Primary open angle glaucoma (POAG), hypertension, and insomnia

Medications: Amlodipine 5 mg daily, Pilocarpine 2% both eyes four times daily, Tylenol PM® 2 at bedtime.

Allergies: Sulfa. Blue eyes turned brown on Xalatan® and she refused treatment.

Which of the following are true about KM? Select all that apply.

a. She has at least two risk factors for glaucoma

b. Pilocar® is first-line therapy for POAG.

c. She could have drug-induced glaucoma.

d. Diphenhydramine may worsen glaucoma.

e. Amlodipine may worsen glaucoma.

Answer a is correct. KM risks for glaucoma include age > 40 years, African American, elevated IOP, and family history.

Answers c and d are correct. She is taking the antihistamine diphenhydramine (Tylenol PM), which can worsen glaucoma.

Answer b is incorrect. Pilocarpine is last-line therapy due to side effects.

Answer e is incorrect. Amlodipine does not worsen glaucoma.

KM is a 44-year-old African American female with decreased peripheral vision and a blind spot on the left side. She was in a motor vehicle accident because she did not see the car in the left lane. She complains of brow ache and headaches that have become worse over the past two weeks. Intraocular pressure (IOP) measures 28 in the right eye and 26 in the left eye. She is on a fixed income and paying for medications is often difficult. She works odd jobs with varying shifts.

Blood pressure is 140/95.

Diagnosis: Primary open angle glaucoma (POAG), hypertension, and insomnia

Medications: Amlodipine 5 mg daily, pilocarpine 2% both eyes four times daily, Tylenol PM® 2 at bedtime.

Allergies: Sulfa. Blue eyes turned brown on Xalatan® and she refused treatment.

Which of the following could affect KM’s glaucoma therapy? Select all that apply.

a. Titration of the blood pressure medication can affect IOPs.

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