MYDRIATICS AND CYCLOPEGICS
Atropine (Isopto Atropine)
Action : An anticholinergic that causes mydriasis (dilation) of the pupil and cyclopegia, which paralyzes the lens and eye muscles.
Use : Facilitate eye exams and treat uveitis.
A/E : Photophobia, reduced lacrimation, impaired distant vision, increased IOP, impaired distant vision.
Nsg. Implications:
a. Sun glasses to reduce photophobia.
b. Elderly clients should be screened prior to receiving atropine -- can increase IOP.
c. Artificial tears for reduced lacrimation.
d. Should not drive until drug effects have worn off.
MIOTICS
Acetylcholine (Miochol)
Action : A cholinergic drug that causes miosis (contraction) of the pupil and contraction of the ciliary muscles in the eye.
Use : Decreases IOP in glaucoma and achieves miosis in cataract sugery.
A/E : Low toxicity after systemic absorption; transient hypotension, decreased HR; bronchospasm; flushing, sweating.
Nsg. Implications:
a. Reconstitute just before use due to instability of solution.
b. Systemic reactions treated with intravenous atropine.
Related Drugs:
A. Carbachol (Isopto Carbachol) : Tell client of brief stinging in eye after use; sypmtoms of eye and brow pain, photophobia, and blurred vision will usually be lessened with prolonged use.
B. Echothiophate (Phospholine Iodine) : Solutions are unstable, client must wash hands before use.
C. Pilocarpine (Pilocar, Isopto Carpine) : Causes blurred vision and focusing difficulty. Client needs to understand that glaucoma treatment is long and needs adherence to prevent blindness; eyedropper tip should not be contaminated; clients with asthma and lung disorders should be observed for respiratory difficulties.
*now take the short quiz below...
1. To reduce the chance of a patient having a systemic effects related to atropine, the nurse will:
a. place a warm compress over both eyes
b. rinse the eye with water following instillation
c. maintain pressure on inner canthus for 1-2 minutes
d. have client wipe eyes with gauze after instillation
C - Applying pressure to the inner canthus (lacrimal sac) will reduce systemic effects.
2. Which of the following conditions should a patient be assessed for prior to topical atropine application?
a. cataracts
b. glaucoma
c. uveitis
d. conjunctivitis
B - Atropine can raise IOP. Clients with glaucoma have increased IOP and this could lead to an acute crisis and blindness.
3. Which statement by a patient indicates that he understands the instructions given to him following instillation of atropine?
a. "My son will drive me home after the exam."
b. "If my eyes itch, it's ok to rub them."
c. "I plan to go to the beach after this appointment."
d. "I will mow the lawn as soon as I get home."
A - Vision is temporarily impaired following the examination. This client should not drive, as distant vision is impaired.
4. Glaucoma is treated with eye medication that is:
a. both mydriatic and miotic
b. mydriatic
c. miotic
d. none of the above
C - Miotic eye medication causes a contraction of the eye pupil and contraction of the ciliary muscle, which helps to decrease intraocular pressure.
5. Which statement made by a patient indicates a need for more teaching about pilocarpine?
a. "I know a side effect of pilocarpine is blurred vision."
b. "I won't touch the eyedropper tip of the pilocarpine to my eye when instilling the drops."
c. "I will stop the pilocarpine as soon as my vision improves."
d. "I know that pilocarpine can cause side effects in my eye as well in other areas of my body."
C - Treatment for glaucoma will continue throughout the client's life. Eye medication should not be discontinued.
