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no more than six references
CASE STUDY (Total 20 marks)
Adapted from p 1120 6th Ed. Bullock & Manias
Ms PB is a 81-year-old widow living at home independently. Her ongoing health problems are:
chronic asthma, hypertension, peripheral oedema and angina pectoris, but she is managing them well using a combination of drugs and sensible lifestyle. The drugs she is taking for her condition are:
• for asthma – the inhaled corticosteroid beclomethasone (daily); the inhaled asthma prophylactic sodium cromoglycate (daily); the inhaled β2 agonist salbutamol (as required)
• for hypertension – the thiazide diuretic hydrochlorothiazide (daily); the α-antagonist prazosin (daily)
• for angina pectoris – the peripheral vasodilator glyceryl trinitrate (as required)
Over the past few years her intraocular pressure has been rising and she has recently been diagnosed with open-angle glaucoma. She is prescribed the β-blocker betaxolol, the prostaglandin analogue latanoprost, and the muscarinic agonist pilocarpine, and has just had them delivered by her local pharmacy. You watch her instil the drops and offer her encouragement and advice about the correct use of these drugs. Within a couple of months of starting therapy her intraocular pressure is rechecked and found to be reduced.
Answer the following questions:
1. By which route would the β-blocker, the prostaglandin analogue and muscarinic agonist be administered in the treatment of TH’s glaucoma? Why? (2 marks)
2. Explain how each of the drug groups used to treat her glaucoma relieve the high intraocular pressure. You must cover the pharmacological mechanisms. (6 marks)
3. How can systemic absorption of these drugs be minimised? (2 marks)
4. What are the common local adverse reactions associated with topical administration of eye drops? (2 marks)
5. Given PB’s pre-existing health problems, are there likely to be any precautions associated with her prescribed glaucoma therapy? (2 marks)
6. Are there any potential drug interactions between her existing therapy and her glaucoma therapy worth noting? (2 marks)
7. What changes to eye structures are associated with prostaglandin analogue therapy? Are these changes harmful to the eye? (2 marks)
8. What advice would you give her regarding the adverse effects she might expect when using the β-blocker and the muscarinic agonist? (2 marks)
Use your text book and other references to answer these questions.