MSN Exam for Glaucoma

Questions

1. Amid a busy shift, Nurse Evelyn is tending to her new patient, Mr. Jensen, who presents with an inflamed, distressing red eye. She mentally sifts through potential causes, considering various ailments that could be responsible. What condition does not typically manifest as a painful red eye?

A. A viral attack from Herpes simplex.
B. The onset of closed angle glaucoma.
C. The irritation of conjunctivitis.
D. The progression of open angle glaucoma.

2. Nurse James is preparing medication for Ms. Parker, who has been diagnosed with glaucoma. His role includes knowing the effects of different classes of medications. In this case, he has to identify which drugs help promote the outflow of aqueous humor, a crucial aspect in managing glaucoma. Which drugs serve this purpose?

A. Timolol
B. The combination of pilocarpine and epinephrine.
C. Epinephrine alone.
D. Pilocarpine by itself.

3. While Nurse Mia administers treatment to Mr. Green, a patient with glaucoma, she considers the mechanisms of various medications. Her task is to identify the medication that minimizes intraocular pressure by decreasing the production of aqueous humor. Which one serves this purpose?

A. Epinephrine
B. Dorzolamide
C. Latanoprost
D. Pilocarpine

4. Nurse Ethan is having a conversation with a newly diagnosed open angle glaucoma patient, Mrs. Taylor. To help her understand her treatment options, Ethan explains the first-line drug class typically used for this condition, unless contraindications exist. Which class of drugs is he referring to?

A. Alpha agonists
B. ß blockers
C. Carbonic anhydrase inhibitors
D. Prostaglandins

5. In the midst of a busy day, Nurse Clara is preparing to administer dorzolamide to her patient with glaucoma. While she prepares, she reflects on what class of drug dorzolamide belongs to. How should dorzolamide be categorized?

A. As an orally administered carbonic anhydrase inhibitor.
B. As a topically applied carbonic anhydrase inhibitor.
C. As a type of prostaglandin.
D. As none of the options.

6. Nurse Olivia is discussing medication options with her patient, Mr. Black, who was recently diagnosed with glaucoma. Their conversation turns to pilocarpine, and Olivia intends to provide accurate information about this drug. Which statement about pilocarpine is correct?

A. Pilocarpine acts as a sympathomimetic drug.
B. Pilocarpine lowers the production of aqueous humor.
C. Pilocarpine can be utilized in managing both open angle and closed angle glaucoma.
D. Pilocarpine is the cornerstone of glaucoma treatment.

7. Nurse Amelia is revisiting her notes on various glaucoma medications. One point of interest is identifying a medication with well-established neuroprotective properties. Which drug fits this description?

A. Timolol
B. Brimonidine
C. Latanoprost
D. None of the options.

8. Nurse Daniel is sharing information about glaucoma with a support group. His current topic is the various mechanisms by which medications can manage this condition. One point of discussion is identifying the class of drugs that enhances uveoscleral outflow of aqueous humor. Which class of drugs is known to do this?

A. Carbonic anhydrase inhibitors
B. Prostaglandins
C. Alpha agonists
D. ß blockers

9. Nurse Rebecca is leading an educational session on glaucoma for her fellow healthcare professionals. Her objective is to identify the primary characteristic of this disease. What is the fundamental feature of glaucoma?

A. Increased intraocular pressure.
B. The presence of optic neuropathy.
C. A painful eye.
D. Diminished vision.

10. While managing Mrs. Smith’s glaucoma case, Nurse Thomas is considering potential medication combinations to augment treatment effectiveness. He needs to identify the pair that is not typically suitable as an adjunctive treatment. Which combination should he avoid?

A. Dorzolamide and timolol
B. Pilocarpine and betaxolol
C. Timolol and latanoprost
D. Brimonidine and betaxolol

11. As Nurse Lucas explains the side effects of oral carbonic anhydrase inhibitors to his patient, Mrs. Brown, who has been prescribed one for her glaucoma, he is keen to ensure she is well informed. Which side effects are associated with these medications?

A. A tingling sensation in the extremities.
B. A feeling of fatigue.
C. Episodes of nausea and vomiting.
D. All of the mentioned side effects.

12. Nurse Emma is evaluating a patient who has been referred to the clinic due to ocular hypertension. As she goes over the typical characteristics of this condition, she tries to identify which feature does not belong. Which is not a feature of ocular hypertension?

A. Normal optic discs.
B. A closed angle.
C. Normal visual fields.
D. Increased intraocular pressure.

13. While discussing the management of glaucoma with her patient, Mr. Anderson, Nurse Amelia mentions the potential of combining different classes of medications for enhanced treatment efficacy. She seeks to identify which class of drugs can be effectively combined with blockers. Which option fits the bill?

A. Miotics
B. Topical carbonic anhydrase inhibitors
C. Prostaglandins
D. Any of the choices.

14. Nurse Adrian attends to a 70-year-old woman who has a lengthy history of steroid-treated asthma. She’s come to the clinic complaining of vision decline. On examination, Adrian discovers posterior capsular opacities and an intraocular pressure of 28 mmHg. He contemplates on the most appropriate medication to recommend for her condition. Which one should it be?

A. Timolol
B. Latanoprost
C. Pilocarpine
D. None of the options.

15. During a health awareness seminar, Nurse Hannah is educating the attendees on glaucoma. Part of her presentation is highlighting the risk factors associated with this eye condition. What are some of these risk factors?

A. Having a family history of glaucoma.
B. Suffering from cardiovascular diseases.
C. Having hypothyroidism.
D. All of the choices.

Answers and Rationales

1. Correct answer:

D. The progression of open angle glaucoma. Open-angle glaucoma, also known as chronic or primary glaucoma, is a progressive condition that usually does not manifest as a painful red eye. It is often asymptomatic in the early stages and is characterized by a slow and gradual increase in intraocular pressure, leading to optic nerve damage and, if untreated, vision loss. However, because it develops so slowly, patients often do not notice a change in vision until the disease has significantly progressed.

This is akin to a river slowly eroding its banks over time. Just like you might not notice the gradual changes day by day, similarly, open angle glaucoma slowly affects your vision without you noticing any immediate signs or symptoms.

Incorrect answer options:

A. A viral attack from Herpes simplex. Herpes simplex eye infections can cause a painful red eye, often accompanied by other symptoms such as blisters, sores on the eyelids, and light sensitivity.

B. The onset of closed angle glaucoma. Acute closed-angle glaucoma typically presents as a very painful red eye. This condition occurs when the iris bulges forward to suddenly block the drainage angle formed by the cornea and the iris, causing a rapid increase in intraocular pressure.

C. The irritation of conjunctivitis. Conjunctivitis, commonly known as pink eye, often presents with a reddish or pinkish color in the eye. It is typically caused by an infection or an allergic reaction, leading to inflammation of the conjunctiva, the clear tissue covering the white part of the eye and the inside of the eyelids. It can cause discomfort or irritation, but is typically not characterized by severe pain.

2. Correct Answer:

B. The combination of pilocarpine and epinephrine. Indeed, you are right. Both pilocarpine and epinephrine have roles in promoting the outflow of aqueous humor. Pilocarpine, a miotic agent, works by constricting the ciliary muscle, which opens up the trabecular meshwork and facilitates the outflow of aqueous humor.

Epinephrine, an adrenergic agonist, traditionally has been thought to decrease the production of aqueous humor. However, recent research suggests that it can also increase uveoscleral outflow, another pathway for the drainage of aqueous humor. This secondary pathway becomes significant especially in conditions where the primary pathway (trabecular outflow) is compromised, such as in glaucoma.

Think of this combination as a team of workers unclogging a pipe (eye). Pilocarpine is the worker inside the pipe physically removing the blockage (opening trabecular meshwork), while epinephrine is the worker outside managing the flow of water (increasing uveoscleral outflow), ensuring that no further blockage occurs.

Incorrect answer options:

A. Timolol. Timolol, a non-selective beta-blocker, reduces the production of aqueous humor, but it does not promote the outflow of aqueous humor.

C. Epinephrine alone. While epinephrine can increase the uveoscleral outflow, its primary function in the eye is considered to be the reduction of aqueous humor production.

D. Pilocarpine by itself. Pilocarpine promotes outflow through the trabecular meshwork but doesn’t affect the uveoscleral pathway, where epinephrine can have a role.

3. Correct answer:

B. Dorzolamide. Dorzolamide is a type of medication called a carbonic anhydrase inhibitor. It works by decreasing the production of aqueous humor in the eye, thereby reducing intraocular pressure. This is essential in the management of glaucoma, where high intraocular pressure can lead to damage to the optic nerve and potential vision loss.

Consider dorzolamide as a tap regulator in your home’s water system (the eye). By controlling how much water (aqueous humor) comes out of the tap, it ensures that the pressure in the pipes (intraocular pressure) doesn’t get too high.

Incorrect answer options:

A. Epinephrine. Epinephrine, an adrenergic agonist, is thought to decrease the production of aqueous humor. However, its primary function in the eye is to increase the outflow of aqueous humor via the uveoscleral pathway.

C. Latanoprost. Latanoprost, a prostaglandin analogue, works mainly by increasing the outflow of aqueous humor through the uveoscleral pathway. It doesn’t primarily decrease the production of aqueous humor.

D. Pilocarpine. Pilocarpine is a miotic agent that reduces intraocular pressure by increasing the outflow of aqueous humor through the trabecular meshwork, not by decreasing its production.

4. Correct answer:

D. Prostaglandins. Prostaglandins, such as latanoprost, are typically the first-line treatment for open-angle glaucoma unless contraindications exist. These drugs primarily work by enhancing the outflow of aqueous humor via the uveoscleral pathway, effectively reducing intraocular pressure. They are generally well tolerated and have a once-daily dosing schedule, which can improve patient adherence.

To give an analogy, think of prostaglandins as a skilled crowd controller at a concert venue (eye). When the crowd (aqueous humor) becomes too dense (increased intraocular pressure), the controller (prostaglandins) opens up an additional exit (uveoscleral pathway) to let the crowd flow out smoothly and prevent overcrowding (high intraocular pressure).

Incorrect answer options:

A. Alpha agonists. Alpha agonists like apraclonidine and brimonidine are generally used as second-line treatment for open-angle glaucoma. These drugs decrease aqueous humor production and increase outflow.

B. ß blockers. Beta blockers, such as timolol, decrease the production of aqueous humor but are often considered second-line therapy due to systemic side effects in patients with respiratory or cardiac conditions.

C. Carbonic anhydrase inhibitors. Carbonic anhydrase inhibitors like dorzolamide and acetazolamide reduce the production of aqueous humor. They are typically reserved for short-term use or when other treatments are ineffective or contraindicated due to potential side effects.

5. Correct Answer:

B. As a topically applied carbonic anhydrase inhibitor. Dorzolamide is a carbonic anhydrase inhibitor that is applied topically (as eye drops) in the management of glaucoma. It decreases the production of aqueous humor in the eye, helping to reduce intraocular pressure.

Consider it like a valve in a water tank that can be tightened to reduce the flow of water (aqueous humor), thus keeping the pressure (intraocular pressure) within the tank (eye) from getting too high.

Incorrect answer options:

A. As an orally administered carbonic anhydrase inhibitor. This is incorrect because dorzolamide is administered topically, not orally. There are carbonic anhydrase inhibitors that are taken orally, like acetazolamide, but dorzolamide is not one of them.

C. As a type of prostaglandin. Dorzolamide is not a prostaglandin. Prostaglandin analogues, such as latanoprost, are used in glaucoma treatment to increase the outflow of aqueous humor, but they work through a different mechanism than dorzolamide.

D. As none of the options. This is incorrect because dorzolamide is indeed a topically applied carbonic anhydrase inhibitor.

6. Correct answer:

C. Pilocarpine can be utilized in managing both open angle and closed angle glaucoma. Pilocarpine is a medication that is classified as a direct-acting muscarinic cholinergic agonist. In simpler terms, this drug works by mimicking the neurotransmitter acetylcholine, leading to increased stimulation of the muscarinic receptors in the eye. The end result of this is twofold: firstly, the ciliary muscle contracts, leading to an increase in the outflow of aqueous humor from the eye and reducing intraocular pressure; secondly, the iris sphincter muscle also contracts, leading to miosis (constriction of the pupil). This latter action can help open up the angle in cases of acute angle-closure glaucoma, hence pilocarpine can indeed be utilized in both open angle and closed angle glaucoma.

Incorrect answer options:

A. Pilocarpine acts as a sympathomimetic drug. This statement is incorrect because pilocarpine is a parasympathomimetic (or cholinergic) drug. Sympathomimetic drugs mimic the effects of substances produced by the sympathetic nervous system, like adrenaline (epinephrine), which typically cause pupil dilation and increased heart rate among other effects. Pilocarpine, on the other hand, mimics acetylcholine, leading to pupil constriction and decreased heart rate.

B. Pilocarpine lowers the production of aqueous humor. This is incorrect. Pilocarpine primarily functions by increasing the outflow of the aqueous humor, not decreasing its production. Drugs like beta-blockers or carbonic anhydrase inhibitors are used to decrease aqueous humor production.

D. Pilocarpine is the cornerstone of glaucoma treatment. This is not entirely accurate. While pilocarpine is used in glaucoma treatment, the cornerstone of glaucoma management typically begins with prostaglandin analogs, such as latanoprost, or beta-blockers, like timolol, due to their efficacy and side effect profile. Pilocarpine can cause side effects like blurred vision or headaches, so it’s usually reserved for cases where other drugs can’t be used, or as an additional therapy.

7. Correct answer:

B. Brimonidine. Brimonidine is an alpha-2 adrenergic agonist that decreases intraocular pressure by reducing aqueous humor production and increasing uveoscleral outflow. Additionally, it has demonstrated neuroprotective properties, potentially slowing optic nerve damage in glaucoma. This may protect retinal cells from the damaging effects of high intraocular pressure, inflammation, and other factors contributing to the progression of glaucoma.

Imagine the eye as a sink with the tap turned on (aqueous humor production) and the drain (uveoscleral outflow). If the drain is blocked or the tap is too open, the sink will overflow (increased intraocular pressure). Brimonidine helps turn down the tap and unclog the drain. It also acts as a safeguard, helping to protect the plumbing (optic nerve) from damage.

Incorrect answer options:

A. Timolol. Timolol is a non-selective beta-blocker used to lower intraocular pressure in glaucoma by reducing the production of aqueous humor. However, it does not possess the neuroprotective properties that brimonidine has.

C. Latanoprost. Latanoprost is a prostaglandin analog that reduces intraocular pressure by increasing the outflow of aqueous humor. Although it’s effective in reducing pressure, it also lacks the neuroprotective attributes seen with brimonidine.

D. None of the options. This option is incorrect as Brimonidine has well-established neuroprotective properties.

8. Correct answer:

B. Prostaglandins. Prostaglandins, such as latanoprost, bimatoprost, and travoprost, are a class of drugs that help manage glaucoma primarily by enhancing the uveoscleral outflow of aqueous humor. This mechanism lowers intraocular pressure, which is the main risk factor for the progression of glaucoma.

A practical analogy for this is a river dam. If the water level gets too high (high intraocular pressure), the pressure on the dam increases, and it could eventually break, causing damage (in this case, damage to the optic nerve). Prostaglandins are like opening a spillway or secondary channel in the dam, allowing excess water to escape and lowering the water level, thus relieving the pressure on the dam.

Incorrect answer options:

A. Carbonic anhydrase inhibitors. Carbonic anhydrase inhibitors like acetazolamide and dorzolamide work by reducing the production of aqueous humor, but they do not enhance uveoscleral outflow.

C. Alpha agonists. Alpha agonists such as brimonidine decrease intraocular pressure by reducing aqueous humor production and slightly increasing uveoscleral outflow, but they are not as effective in increasing uveoscleral outflow as prostaglandins.

D. ß blockers. Beta blockers, like timolol and betaxolol, decrease intraocular pressure by reducing the production of aqueous humor, not by enhancing uveoscleral outflow.

9. Correct answer:

A. Increased intraocular pressure. Glaucoma is a group of eye conditions that damage the optic nerve, which is crucial for good vision. The primary characteristic of this disease is increased intraocular pressure (IOP). The eye produces a fluid called aqueous humor, which flows out of the eye through a mesh-like channel. In individuals with glaucoma, this channel becomes blocked, causing fluid to build up and consequently increasing pressure in the eye. Over time, this elevated pressure can damage the optic nerve, leading to vision loss.

This is akin to an over-inflated balloon – when the pressure inside the balloon (or the eye, in this case) exceeds a certain limit, it can cause damage.

Incorrect answer options:

B. The presence of optic neuropathy. Optic neuropathy, which is damage to the optic nerve, is not the primary feature of glaucoma, but rather a consequence of the increased intraocular pressure. The optic nerve carries visual information from the eye to the brain, and damage to this nerve from the elevated pressure in the eye results in vision loss. However, it’s crucial to note that optic neuropathy can occur from other causes as well, not just glaucoma.

C. A painful eye. While severe eye pain can occur in an acute glaucoma attack, most types of glaucoma do not cause pain. Primary open-angle glaucoma, the most common form of glaucoma, progresses slowly and is often painless. Patients may not notice symptoms until the disease has progressed significantly. This is why glaucoma is often referred to as the “silent thief of sight.”

D. Diminished vision. Diminished vision or loss of vision is a symptom of advanced glaucoma. However, it is not the fundamental feature of the disease, but rather an unfortunate consequence of prolonged increased intraocular pressure and the subsequent optic nerve damage. Much like optic neuropathy, diminished vision can have numerous other causes apart from glaucoma.

Vision loss in glaucoma is a progressive symptom. This condition usually begins by affecting peripheral (side) vision before it impacts central vision. A person with advanced glaucoma might see clearly when looking straight ahead but may not notice objects in their peripheral vision – much like looking through a tube or tunnel, hence the term “tunnel vision.” Eventually, if left untreated, glaucoma can lead to total blindness.

10. Correct answer:

B. Pilocarpine and betaxolol. Pilocarpine and betaxolol are both used in the treatment of glaucoma, but they are not typically used together as adjunctive therapy. This is mainly because they have different mechanisms of action that may not necessarily enhance each other’s therapeutic effects.

Pilocarpine is a direct-acting cholinergic agonist (parasympathomimetic). It works by constricting the pupil (miosis) and contracting the ciliary muscle, which opens the trabecular meshwork and increases the outflow of aqueous humor, thereby lowering intraocular pressure.

Betaxolol, on the other hand, is a selective beta-1 adrenergic antagonist (beta-blocker). It reduces intraocular pressure by decreasing the production of aqueous humor, not by improving its outflow. Unlike non-selective beta-blockers, betaxolol has minimal effect on pulmonary and cardiovascular parameters, making it a safer option for patients with respiratory problems.

While both drugs reduce intraocular pressure, their mechanisms of action don’t complement each other in a way that would increase the benefit of using them together. Additionally, pilocarpine can have significant side effects such as blurred vision, nearsightedness, and headache, which might outweigh its benefits when used as an adjunct therapy with betaxolol.

Imagine a crowded room where you want to reduce the number of people. Pilocarpine is like opening a back door to let people out, while betaxolol is like limiting the number of people who can enter. Both methods reduce the crowd, but they don’t work together to do it faster. Plus, opening the back door (pilocarpine) might cause some people to trip (side effects), which could make things worse. So, it’s not always beneficial to use both at the same time.

Incorrect answer options:

A. Dorzolamide and timolol. Dorzolamide is a carbonic anhydrase inhibitor that reduces intraocular pressure by decreasing the production of aqueous humor, and timolol is a non-selective beta-blocker that also lowers intraocular pressure by reducing aqueous humor production. A combination eye drop of these two medications is commonly used for better patient compliance and more effective intraocular pressure control.

C. Timolol and latanoprost. Timolol is a non-selective beta-blocker that reduces the production of aqueous humor, and latanoprost is a prostaglandin analog that increases the outflow of aqueous humor. The complementary mechanisms of these two drugs make them an effective combination for the treatment of glaucoma.

D. Brimonidine and betaxolol. Brimonidine is an alpha-2 adrenergic agonist that both decreases the production and increases the outflow of aqueous humor, and betaxolol is a selective beta-1 adrenergic antagonist that decreases the production of aqueous humor. The combination of these two drugs can provide an effective treatment strategy for glaucoma.

11. Correct answer:

D. All of the mentioned side effects. Oral carbonic anhydrase inhibitors, such as acetazolamide and methazolamide, are medications used in the treatment of glaucoma to decrease the production of aqueous humor, thereby reducing intraocular pressure. However, they are associated with several systemic side effects due to their mechanism of action.

• A tingling sensation in the extremities. This is called paresthesia, which is a common side effect of oral carbonic anhydrase inhibitors. It’s usually described as a “pins and needles” sensation and can affect the fingers, toes, hands, and feet.
• A feeling of fatigue. These medications can cause general malaise or fatigue as a side effect. This can occur due to metabolic acidosis, a condition that happens when the body produces too much acid or when the kidneys aren’t removing enough acid from the body.
• Episodes of nausea and vomiting. Gastrointestinal disturbances, such as nausea and vomiting, are also common with the use of carbonic anhydrase inhibitors.

The side effects associated with these medications are extensive and can also include other symptoms such as loss of appetite, weight loss, depression, kidney stones, and metabolic disturbances. Therefore, while they can be useful in managing glaucoma, oral carbonic anhydrase inhibitors are typically used as a last resort, when other treatments are ineffective or contraindicated.

12. Correct answer:

B. A closed angle. Ocular hypertension refers to a condition in which the intraocular pressure (IOP) is higher than normal. This doesn’t necessarily result in vision loss or nerve damage, and in fact, it can occur even when the optic disc (the place where the optic nerve connects to the retina) looks normal, and the visual fields (the total area an individual can see without moving their eyes) remain unaffected. Thus, options (normal optic discs), (normal visual fields), and (increased intraocular pressure) are all characteristic of ocular hypertension.

The term “closed angle” refers to a type of glaucoma known as closed or narrow-angle glaucoma. In this condition, the drainage angle formed by the cornea and iris closes or narrows, leading to a rapid increase in intraocular pressure. This is different from ocular hypertension where the angle between the iris and cornea (the drainage angle) typically remains open.

Think of the eye as a sink. The intraocular pressure is like the water level in the sink, while the drainage angle is the drain itself. Ocular hypertension is like a sink with a slightly blocked drain, leading to a higher water level, but the drain (the angle) is still open. In contrast, closed-angle glaucoma is like a sink where the drain has been fully blocked or is closed, causing the water level (intraocular pressure) to rise rapidly.

Incorrect answer options:

A. Normal optic discs. This is a typical characteristic of ocular hypertension. Even though the intraocular pressure is high, the optic discs may not show any damage.

C. Normal visual fields. People with ocular hypertension often have normal visual fields. They don’t lose their peripheral vision, which typically occurs in more advanced stages of glaucoma.

D. Increased intraocular pressure. This is the defining feature of ocular hypertension. The pressure in the eye is higher than normal, but it’s not high enough or hasn’t been high for long enough to cause damage to the optic nerve.

13. Correct answer:

D. Any of the choices. Glaucoma management typically involves reducing intraocular pressure (IOP) in the eye, which can be achieved by either decreasing the production of aqueous humor or enhancing its outflow from the eye. Beta-blockers are one class of drugs used to manage glaucoma, and they work primarily by reducing the production of aqueous humor.

However, in some cases, a single class of medication may not be sufficient to achieve the desired IOP reduction. In such scenarios, drugs from different classes can be combined to improve treatment efficacy. All the options provided – miotics, topical carbonic anhydrase inhibitors, and prostaglandins – can be combined with beta-blockers for enhanced IOP control.

• Miotics, such as pilocarpine, work by constricting the pupil and opening the drainage angle to allow more fluid to flow out of the eye.
• Topical carbonic anhydrase inhibitors, like dorzolamide, decrease the production of aqueous humor, much like beta-blockers, but through a different mechanism.
• Prostaglandins, such as latanoprost, increase the outflow of aqueous humor, hence reducing IOP.

An analogy for this might be trying to manage a river’s flow. If the river (the aqueous humor) is flowing too fast, you can slow it down by reducing the amount of water entering the river (like beta-blockers or carbonic anhydrase inhibitors), opening more channels to allow water to flow out faster (like prostaglandins), or narrowing the river’s course (like miotics). Sometimes, one strategy isn’t enough, so you combine different strategies to get the desired result.

Incorrect answer options:

Miotics, Topical carbonic anhydrase inhibitors, and Prostaglandins are not incorrect per se, but rather incomplete, because they can all be combined with beta-blockers to manage glaucoma effectively. The most complete answer, in this case, is ‘Any of the choices’.

14. Correct answer:

B. Latanoprost. Latanoprost is a prostaglandin analog eye drop that is used to treat elevated intraocular pressure (IOP), a condition often seen in patients with glaucoma or ocular hypertension. It works by increasing the outflow of aqueous humor, the fluid in the eye, which lowers the intraocular pressure. This helps to prevent further optic nerve damage and the progression of vision loss. In this case, the patient’s increased IOP of 28 mmHg indicates ocular hypertension or potential glaucoma, which can be managed effectively with latanoprost. The drug is well tolerated, with a primary side effect of possible increased brown pigmentation of the iris.

Think of the eye as a sink with the faucet (aqueous humor production) turned on. If the drain (aqueous humor outflow) is blocked or working poorly, the sink can overflow (increased intraocular pressure). Latanoprost helps to unblock the drain or increase its efficacy, allowing the fluid to flow out and preventing the sink from overflowing.

Incorrect answer options:

A. Timolol is a non-selective beta-blocker eye drop also used to reduce high intraocular pressure. However, in patients with a history of asthma, as in this case, it is best avoided. Beta-blockers can cause bronchoconstriction, which can exacerbate asthma symptoms.

C. Pilocarpine is a miotic agent that can reduce intraocular pressure by enhancing aqueous humor outflow. However, it has frequent dosing and side effects such as blurry vision, nearsightedness, and potential for retinal detachment. This may not be the best choice for an elderly patient, particularly one already experiencing vision decline.

D. The option “None of the options” is incorrect because one of the listed medications, Latanoprost, is indeed suitable for the condition described in the question.

15. Correct answer:

D. All of the choices. Several factors can increase the risk of developing glaucoma, and these include the ones mentioned in all the answer options.

• Having a family history of glaucoma: There is a genetic component to glaucoma, and having a close relative with the condition increases the risk. It’s as though if your family has a history of flooding in their houses (glaucoma), your house (your eyes) might also be at risk of similar flooding.
• Suffering from cardiovascular diseases: Diseases that affect the cardiovascular system can also increase the risk of glaucoma. Blood flow and pressure play important roles in the health of the optic nerve, and any condition that compromises vascular health can potentially lead to glaucoma. To give an analogy, if there’s an issue with the main water pump (the heart), it might affect the water supply (blood supply) to certain parts of the city (your body), potentially leading to problems.
• Having hypothyroidism: This condition has been associated with an increased risk of glaucoma, although the exact mechanism isn’t entirely understood. One theory suggests that decreased metabolic activity in the eye’s tissues caused by hypothyroidism could impair the eye’s ability to regulate intraocular pressure effectively.

Incorrect answer options:

None. As explained above, all of the answer choices are known risk factors for glaucoma, making all of the choices the correct answer.