Transforming and Supporting Patient Care - Health Professions ...

322Chapter 13 – Profession of Optometry• Alpha-agonists may cause burning or stinging, fatigue, drowsiness,dry mouth and dry nose;• Beta blockers may cause low blood pressure, reduced pulse rateand fatigue; shortness of breath in people with a history of asthmaor respiratory disorders; additionally, they can change cardiacactivity by decreasing the amount of blood the heart pumps out,reducing the pulse rate, and slow the heart’s response rate duringrespiration;• Carbonic anhydrase inhibitors in pill form may cause tingling orloss of strength in the hands or feet, upset stomach, memoryproblems or mental fuzziness, depression, kidney stones andfrequent urination; the eye drop form of this medication isrelatively new, and studies are yet to be completed current effectsnoted including stinging, burning and other eye discomfort;• Cholinergic agents (miotic) may cause dim vision due toconstriction of the pupil;• Combined agents, which are a combination of either beta blockerand alpha-agonists or beta blocker and carbonic anhydraseinhibitors may include the symptoms of the basic drugs; sincethey are new to the market, long-term follow-up of people usingthe medications in not available;• Prostaglandin analogs may cause gradual change in eye colour,along with stinging, blurred vision, eye redness, itching andburning; these medications are new to the market, and long-termfollow-up of people who use them is not available. 35The risk of adverse events associated with the use of glaucoma drugsrequires that prescribers conduct complete physical and medical historiesto ensure persons with histories of renal disease, pulmonary edema, heartdisease, asthma and chronic obstructive pulmonary disease and liverdisease are prescribed appropriate medications, and that their response tomedications is followed carefully.The COO indicated that it had carefully reviewed the safety profiles ofglaucoma drugs, along with malpractice reports, and said that with theexception of the beta-blocker category, glaucoma drugs have anoutstanding safety record.Patient compliance is also a key factor in managing glaucoma:One of the most difficult problems faced by glaucoma patients is that ofhaving to take medicines which may have both ocular and systemic sideeffects to control a disease which is usually painless and has nosymptoms. Understanding the necessity for the medication often helpsto reduce the severity of a side effect, since it is often magnified byanxiety.A side effect is any action produced by a drug beyond the intended oneof lowering IOP. Some patients have no side effects whatsoever, whileothers find them too severe to tolerate. Why a drug causes side effects35Glaucoma Research Foundation. http://www.glaucoma.org.HPRAC Critical Links January 2009