NAPLEX Question of the Week: An Eye for an Eye

This week's question focuses on a very specific drug and dosage form.
NAPLEX Question of the Week: An Eye for an Eye
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AW, a 61-year-old female, presents to your pharmacy with a new prescription for Xalatan 0.005% solution. AW has a few questions about how to administer and to store the new medication. You would like to review her medication list before answering her questions.

PMH: Recently diagnosed open-angle glaucoma, Dry eyes, HFrEF

Medication List:

New Rx: Xalatan 0.005% 1 gtt. to right eye every day in the evening

Entresto 97/103 mg PO BID

Empagliflozin 10 mg PO once daily

Coreg 3.125 mg PO BID

Aldactone 25 mg PO once daily

Cyclosporine 0.05% Instill 1 gtt. drop in each eye every 12 hours PRN

What would be appropriate counseling points/interventions for AW? Select all that apply.

A. Remove contact lens prior to administering Xalatan and to wait 15 minutes before placing contacts back in

B. When using other eye drops with Xalatan, wait at least 20 minutes apart

C. Once Xalatan is opened, it must be refrigerated.

D. Xalatan may cause blurred vision, burning, and eyelash changes

E. Contact provider to discuss cyclosporine use because it could be worsening AW's glaucoma

Answer with Rationale:

Glaucoma is a disease that damages the optic nerves. In people without glaucoma, the eye produces aqueous fluid that is allowed to drain through the drainage angle. If a person has glaucoma, they have an inability to drain the fluid, which causes an increase in intraocular pressure. The most common type of glaucoma is open-angle glaucoma, where their ability to drain decreases, versus closed-angle glaucoma, in which the drainage angle is blocked by the iris, 

Patients may be on 3 or 4 different eye drops, taking some in the morning and some at night. To help patients keep track of their eye drops, the caps on the bottle are color-coordinated by pharmacological class. These drugs help decrease the intraocular pressure of the eye. Here are some examples below:

Beta-Blockers: Yellow (ex Timoptic/timolol 0.5%)

Alpha agonists: Purple (ex Alphagan/brimonidine 0.1%)

Carbonic anhydrase inhibitors: Orange (ex Trusopt/dorzolamide)

Prostaglandin agonist: Teal green (Lumigan/bimatoprost 0.01%)

Answer A is correct. Removing contact lens and waiting 15 minutes before reinsertion is the correct administration technique of Xalatan and cyclosporine.

Answer B is incorrect. Patients only need to wait 5 minutes before administering other eye drops. This is to ensure the medication is properly administered.

Answer C is incorrect. Xalatan needs to be stored prior to opening in the refrigerator. After a patient opens Xalatan, it is stable for 6 weeks at room temperature.

Answer D is correct. Although many patients do not have side effects with Xalatan, these may occur and we should warn AW before she uses Xalatan so she knows what to expect.

Answer E is incorrect. Cyclosporine does not have any contraindications with patients with glaucoma. Cyclosporine is a calcineurin inhibitor that is often used in patients with glaucoma for dry eyes due to their glaucoma. 

Brands/Generics covered: Xalatan (Latanoprost), Entresto (Sacubitril/Valsartan), Jardiance (Empagliflozin), Coreg (Carvedilol), Aldactone (Spironolactone), Restasis (Cyclosporine)

NAPLEX Competencies covered:

1.2-From patients: Medication history, medical history

1.5-Pathophysiology

2.1-Mechanism of action

2.2-Brand, generic, or biosimilar names

3.3-Indication or therapeutic uses; lack of indication

3.5-Drug route of administration

3.6-Drug contraindications

3.7-Adverse drug effects

5.5-Instructions or techniques for drug administration

5.6-Storage

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