Contraindications for topical beta blockers Beta blockers

 Suppress conduction through the atrioventricular (AV) node; therefore, topical beta 

blockers are contraindicated in patients with bradycardia or advanced AV block.

 Do not use in patients with compromised ventricular dysfunction, cardiogenic shock, or 

with systolic congestive HF

 D/c at first sign of cardiac failure

 Contraindicated with hypotension

 Use with caution: poorly controlled DM and hyperthyroidism

 Surgical patients should be monitored closely for cardiac failure

o Withdraw before surgery 2 days prior

 Contraindicated with Raynaud’s disease or PVD, CVD

 Preg cat C: fetal anomalies and fetotoxicity in animal studies

Prophylaxis for opthalmia neonatorum

 Common patient group: infants younger than 1 month who presents with conjunctivitis 

should have Gram's stain, antigen detection tests, and cultures of the eye discharge to 

rule out gonococcal, chlamydial, or HSV origin. 

 Chlamydia is the most common cause of neonatal conjunctivitis 

 Gonococcal conjunctivitis is the most serious cause of ophthalmia neonatorum owing to 

concerns about the bacteria causing blindness

 Prophylaxis: Administration of antibiotic eye medication within 1 hour of delivery

 Erythromycin ointment 0.5% (0.25 to 0.5-inch ribbon in each eye)

 Chlamydial conjunctivitis is not prevented by prophylactic use of erythromycin at birth 

therefore any mucopurulent eye discharge in the first few weeks of life should be 

evaluated for chlamydia. 

Glaucoma: Treatment, dosing, and patient education:

 IOP damages the optic nerve 

 Leading cause of blindness worldwide 

 6-8 times more likely in African Americans than Caucations

 Antiglaucoma medications are prescribed by ophthalmologists. Dosage is determined by 

the clinical condition of the patient.

Treatment and dosing

 Current medical therapies are aimed at 

o decreasing the production of aqueous humor at the ciliary body and 

o Increasing the outflow of this fluid from the angle structures

 Requires evaluation and treatment by an ophthalmologist

o FNPs need to be aware of the medications prescribed, drug interactions, and 

ADRs

 Antiglaucoma agents are prescribed by ophthalmologists and dosage is determined by 

the clinical condition of the patient

 Four categories: Beta Blockers, adrenergic agonists, miotics, and carbonic anhydrase 

(CA) inhibitors

o Beta Blockers:

 Betaxolol, carteolol, metipranolol, levobunolol, timolol

o Adrenergic Agonists

 Apraclonidine, brimonidine 

o Miotics

 Carbachol, pilocarpine, echothiophate

o Carbonic Anhydrase Inhibitors

 Acetazoleamide, brinzolamide, dorzolamide, methazolamide

Patient education

 The patient should be instructed to administer the medication exactly as the 

ophthalmologist has prescribed

 Abruptly stopping the medication can increase adverse effects.

 The patient should have been instructed by the ophthalmologist regarding the adverse 

effects of the medication. 

o Reinforcement may be necessary. If the patient is experiencing adverse effects 

from the medication, the primary care provider can facilitate a referral back to 

the ophthalmologist.

Allergic or Vernal conjunctivitis: Treatment, dosing, and patient education

 Occurs in response to a variety of allergens

 Vernal conjunctivitis refers to conjunctivitis that occurs primarily in the spring, usually 

because of an allergen. 

 The mast cell stabilizers (lodoxamide, cromolyn sodium) may be used to treat vernal 

conjunctivitis and may be used safely for up to 3 months.

Treatment and Dosing

 Ketotifen (H1 blocker) for allergic conjunctivitis and ocular pruritus.

o The dose used in adults and children over age 3 is 1 drop in the affected eye every 

8 to 12 hours

 Levocabastine (H1 blocker): allergic conjunctivitis and ocular pruritis

o 1 drop in the affected eye 4 times a day.

 Mast Cell Stabilizers: 

o Cromolyn sodium (1-2 gtt, 4-6 times/day)

o Pemirolast (Alamast), 1-2 gtts QID

o Nedocromil (Alocril), 1-2 gtts in each eye bid at regular intervals

 Antihistamines

o Antazoline-naphazoline (Vasocon-A), 1-3 gtts Q3-4 hours

o Azelastine (Optivar) 1 gtt each eye bid

o Epinastine (Elestat) 1 gtt each eye bid

o Emedastine (Emadine) 1 gtt QID

 OTC products

o Combine a decongestant with an antihistamine 

o Products that combine antazoline and naphazoline (Vasocon-A) or 

o Naphazoline and pheniramine (Opcon-A, Naphcon-A) 1-2 gtt q3-4 hrs