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3.a. What nondrug therapies might be useful for this patient? 3.b. What feasible pharmacotherapeutic alternatives are available for treating this patient's glaucoma? 3.c. Is antioxidant supplementation beneficial in maintaining eye health?

3.a. What nondrug therapies might be useful for this patient? 3.b. What feasible pharmacotherapeutic alternatives are available for treating this patient's glaucoma? 3.c. Is antioxidant supplementation beneficial in maintaining eye health?

Phlebotomy Essentials
Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
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3.a. What nondrug therapies might be useful for this patient? 3.b. What feasible pharmacotherapeutic alternatives are available for treating this patient's glaucoma? 3.c. Is antioxidant supplementation beneficial in maintaining eye health?
Glaucoma of his PhD program S/P ultrasonic renal lithotripsy secondary to nephrolithiasis associated with acetazolamide use S/P tonsillectomy as a child Chief Complaint FH "My left eye is foggy, and I get blurred vision and Father, mother, and sister have glaucoma. Father headaches." has HTN. HPI SH Lee Angeles is a pleasant 44-year-old man with a history of advanced open-angle glaucoma who presents to his ophthalmologist with complaints of fogging and distortion of vision in the left eye lasting 6-12 hours. This occasionally progresses to tunnel vision, with chronic sensitivity to fluorescent lights and throbbing band-like squeezing headaches lasting for hours. He also complains of periodic distortion in the left eye for the past 3 months, PhD in molecular biology from Harvard. Single. No history of smoking. Drank four cans of beer per day for 3 years during postgraduate study. Currently drinks two to three cans of beer/wk. ROS Negative except for occasional episodes of erectile dysfunction sometimes associated with central area visual Meds blurring. Despite his condition, he continues to maintain self-independence. He often drives from Los Angeles to his weekend home in Palm Springs. Betoptic 0.5% in both eyes BID lopidine 0.5% in left eye TID Trusopt 2% in left eye TID FML 0.1% in both eyes TID Bion Tears in both eyes BID Nifedipine 10 mg po TID Trental 400 mg po TID Paxil 20 mg po once daily He was in his usual state of health until he had a skydiving accident 19 years ago and fractured his thoracic spine at the level of T9-10. During that hospitalization, he complained of blurred vision. Ophthalmology consult was sought, and he was ultimately diagnosed with advanced open-angle glaucoma. He was managed by a general ophthalmologist for several years, who prescribed Timoptic 0.5% in both eyes BID, Propine 0.1% in both eyes BID, and Ocusert Pilo-40 in right eye and Ocusert Pilo-20 in left eye once every week. He was Also performs eye massage on both eyes QID Past medications include pilocarpine 4%, Timoptic 0.5%, Propine, Diamox sequels 500 mg, and Pred- Forte 1% All NKDA subsequently referred to a glaucoma specialist because of worsening of his condition. He had undergone laser trabeculoplasty in both eyes prior to his referral. Physical Examination VS ВР 120/82, Р 70, R 18, T 36.8°C The glaucoma specialist examined the patient, and a complete work-up was done on the initial visit. Bilateral laser trabeculoplasty was performed 18 years ago with an initial decrease in IOP; however, IOP subsequently increased several months later. Filtering surgery was performed in Boston on both eyes 17 years ago. Multiple prior brain MRIS revealed no abnormal findings. Visual acuity: OD-hand motion at 3 inches with correction spectacles; OS-20/30. Lid margins Slit-lamp еxат: inflammation in both eyes; conjunctiva without injection; normal tear break-up, did not stain with fluorescein; cornea clear and smooth; anterior chamber deep and quiet; lenses-clear in both eyes; were without iris round without neovascularization or Other ocular history includes severe myopia since childhood, history of dry eyes, and history of contact abnormality; no mass/nodules; filtering bleb is visible at 11 o'clock meridian. lens wear. Intraocular pressure: OD-14 mm Hg; OS-20 mm Hg. PMH Childhood asthma that resolved at puberty Depression as a consequence of chronic open-angle glaucoma and worsening of vision after completion Vitreous examination: Clear in both eyes. Disks: OD-the disc appeared whitish, fully cupped and showed marked pallor; cup-to-disk (C/D) ratio =
Transcribed Image Text:Glaucoma of his PhD program S/P ultrasonic renal lithotripsy secondary to nephrolithiasis associated with acetazolamide use S/P tonsillectomy as a child Chief Complaint FH "My left eye is foggy, and I get blurred vision and Father, mother, and sister have glaucoma. Father headaches." has HTN. HPI SH Lee Angeles is a pleasant 44-year-old man with a history of advanced open-angle glaucoma who presents to his ophthalmologist with complaints of fogging and distortion of vision in the left eye lasting 6-12 hours. This occasionally progresses to tunnel vision, with chronic sensitivity to fluorescent lights and throbbing band-like squeezing headaches lasting for hours. He also complains of periodic distortion in the left eye for the past 3 months, PhD in molecular biology from Harvard. Single. No history of smoking. Drank four cans of beer per day for 3 years during postgraduate study. Currently drinks two to three cans of beer/wk. ROS Negative except for occasional episodes of erectile dysfunction sometimes associated with central area visual Meds blurring. Despite his condition, he continues to maintain self-independence. He often drives from Los Angeles to his weekend home in Palm Springs. Betoptic 0.5% in both eyes BID lopidine 0.5% in left eye TID Trusopt 2% in left eye TID FML 0.1% in both eyes TID Bion Tears in both eyes BID Nifedipine 10 mg po TID Trental 400 mg po TID Paxil 20 mg po once daily He was in his usual state of health until he had a skydiving accident 19 years ago and fractured his thoracic spine at the level of T9-10. During that hospitalization, he complained of blurred vision. Ophthalmology consult was sought, and he was ultimately diagnosed with advanced open-angle glaucoma. He was managed by a general ophthalmologist for several years, who prescribed Timoptic 0.5% in both eyes BID, Propine 0.1% in both eyes BID, and Ocusert Pilo-40 in right eye and Ocusert Pilo-20 in left eye once every week. He was Also performs eye massage on both eyes QID Past medications include pilocarpine 4%, Timoptic 0.5%, Propine, Diamox sequels 500 mg, and Pred- Forte 1% All NKDA subsequently referred to a glaucoma specialist because of worsening of his condition. He had undergone laser trabeculoplasty in both eyes prior to his referral. Physical Examination VS ВР 120/82, Р 70, R 18, T 36.8°C The glaucoma specialist examined the patient, and a complete work-up was done on the initial visit. Bilateral laser trabeculoplasty was performed 18 years ago with an initial decrease in IOP; however, IOP subsequently increased several months later. Filtering surgery was performed in Boston on both eyes 17 years ago. Multiple prior brain MRIS revealed no abnormal findings. Visual acuity: OD-hand motion at 3 inches with correction spectacles; OS-20/30. Lid margins Slit-lamp еxат: inflammation in both eyes; conjunctiva without injection; normal tear break-up, did not stain with fluorescein; cornea clear and smooth; anterior chamber deep and quiet; lenses-clear in both eyes; were without iris round without neovascularization or Other ocular history includes severe myopia since childhood, history of dry eyes, and history of contact abnormality; no mass/nodules; filtering bleb is visible at 11 o'clock meridian. lens wear. Intraocular pressure: OD-14 mm Hg; OS-20 mm Hg. PMH Childhood asthma that resolved at puberty Depression as a consequence of chronic open-angle glaucoma and worsening of vision after completion Vitreous examination: Clear in both eyes. Disks: OD-the disc appeared whitish, fully cupped and showed marked pallor; cup-to-disk (C/D) ratio =
1.0; OS-C/D ratio = 0.99 with only a narrow rim present (normal C/D ratio = < 0.33). Color vision: OD-unable to see; OS-WNL. Visual fields: OD-unable to see the Amsler grid; can only see hand motion at 3 inches away; OS- several paracentral scotomata with the Amsler grid; 20/30. Diurnal curve of IOP revealed pressures between 10 mm Hg and 21 mm Hg. CV RRR without MRG; carotid pulses are brisk and equal bilaterally without bruits Neuro Smell and corneal sensation are intact bilaterally. Facial symmetry, tone, and sensation are intact bilateral Cranial nerves VIII through XII were intact. Gait was intact. Finger-to-nose and rapid alternating movement tests were normal. Reflexes were symmetric and normal. Sensation was intact and symmetric to pinprick, proprioception, and light touch. Motor strength of all extremities was 5/5. Labs Na 138 mEq/L K 3.7 mEq/L CI 99 mEq/L CO2 25 mEq/L BUN 10 mg/dL SCr 0.9 mg/dL FBG 105 mg/dL Assessment 1. High myopia with advanced chronic juvenile open-angle glaucoma 2. No evidence of macular edema 3. No cataracts 4. S/P filtering procedure in both eyes 5. Depression associated with chronic open-angle glaucoma Plan Increase eye massage to 8 times/day Follow-up in 6 weeks Repeat filtering surgery/trabeculectomy with mitomycin C to further lower IOP Switch nifedipine to nimodipine for better CNS/ophthalmic absorption to increase blood flow Counsel with neuro-ophthalmologist, retina ophthalmologist, and Neurologist
Transcribed Image Text:1.0; OS-C/D ratio = 0.99 with only a narrow rim present (normal C/D ratio = < 0.33). Color vision: OD-unable to see; OS-WNL. Visual fields: OD-unable to see the Amsler grid; can only see hand motion at 3 inches away; OS- several paracentral scotomata with the Amsler grid; 20/30. Diurnal curve of IOP revealed pressures between 10 mm Hg and 21 mm Hg. CV RRR without MRG; carotid pulses are brisk and equal bilaterally without bruits Neuro Smell and corneal sensation are intact bilaterally. Facial symmetry, tone, and sensation are intact bilateral Cranial nerves VIII through XII were intact. Gait was intact. Finger-to-nose and rapid alternating movement tests were normal. Reflexes were symmetric and normal. Sensation was intact and symmetric to pinprick, proprioception, and light touch. Motor strength of all extremities was 5/5. Labs Na 138 mEq/L K 3.7 mEq/L CI 99 mEq/L CO2 25 mEq/L BUN 10 mg/dL SCr 0.9 mg/dL FBG 105 mg/dL Assessment 1. High myopia with advanced chronic juvenile open-angle glaucoma 2. No evidence of macular edema 3. No cataracts 4. S/P filtering procedure in both eyes 5. Depression associated with chronic open-angle glaucoma Plan Increase eye massage to 8 times/day Follow-up in 6 weeks Repeat filtering surgery/trabeculectomy with mitomycin C to further lower IOP Switch nifedipine to nimodipine for better CNS/ophthalmic absorption to increase blood flow Counsel with neuro-ophthalmologist, retina ophthalmologist, and Neurologist
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