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Timolol Maleate &

Pilocarpine HCL

BY: Alexis Roberts, Breanna


Jarmin, Jinny Tran, and
Cameron Yee
Therapeutic Uses

● Open- angle glaucoma


● Ocular hypertension

What is Glaucoma?

- Damage of optic nerve


- Fluid does not drain properly
- Clogged drain
- Extra fluid in eye increases pressure
- Result: vision loss and blindness
Brand Names
Timolol Maleate Pilocarpine HCL
● Isopto Carpine
● Betimol
● Ocu-Carpine
● Istalol
● Ocusert Pilo
● Timoptic Ocudose
● Pilocar
● Timoptic Ocumeter
● Pilopine-HS
● Timoptic-XE Ocumeter

DOSAGE FORMS: DOSAGE FORMS:


- Solution - Solution
- Gel Forming Solution - Gel/ Jelly
Pharmacological Action
Timolol Maleate Pilocarpine HCL

Classification: Classification:

- Pharmacologic: Beta Blocker - Pharmacologic: Miotic

Mechanism of Action: Mechanism of Action:

- Decrease production of - Increases drainage of


intraocular fluid Intraocular fluid
Pharmacodynamics
Timolol Maleate: Pilocarpine HCL:

-When applied topically to the eye, it has the -When applied topically to the eye, as a
action of reducing high, or normal single dose it may cause miosis, spasm of
intraocular pressure. This occurs whether or accommodation, and may cause a rise in
not it is associated with glaucoma. intraocular pressure followed by a more
persistent fall.
Side / Adverse Effects
Timolol Maleate: Pilocarpine HCl:
Most common, Life threatening Most common

CNS: fatigue, weakness, dizziness, mental GI: nausea, vomiting, dyspepsia, dysphagia.
status changes GU: urinary frequency.
CV: ARRHYTHMIAS, BRADYCARDIA, HF, Derm: flushing, sweating.
PULMONARY EDEMA, orthostatic
hypotension, peripheral vasoconstriction.
GU: erectile dysfunction,
Misc: ANAPHYLAXIS(rare)

Black Box Warning: Avoid abrupt cessation


Medication Interaction
Timolol Maleate: Pilocarpine HCL:

-May increase myocardial depression: -Decreased effectiveness of pilocarpine:


General anesthesia, IV phenytoin, and Anticholinergics
Verapamil
-Increased cholinergic effects: Concurrent
-Increased bradycardia: Digoxin use of bethanechol or ophthalmic cholinergics

-Increased hypotension: Other -Increased risk of adverse cardiovascular


antihypertensives, alcohol, or nitrates reactions (conduction disturbances): Beta
blockers
-Alter the effectiveness of: Thyroid
medications, insulins, antidiabetics,
bronchodilators, dopamine
Pharmacokinetics

Timolol Maleate: Pilocarpine HCL:


● Absorption: well ● Absorption: well absorbed
absorbed ● Metabolism/ Excretion:
● Metabolism/ Excretion: metabolites are excreted in
Liver urine
Client Education
Timolol
● Instruct patient on proper use to avoid infections
● Advise patient not use any other eye medication unless unless prescribed
● Caution patient about driving as timolol can cause blurred vision
● Teach patient, family, and caregivers how to check and monitor pulse /BP for any significant changes
● Patients w/ diabetes should closely monitor blood glucose
● Instruct patient to inform HCP with any history/current conditions

Pilocar
● Instruct patient on proper use to avoid infections
● Use caution while night driving or performing hazardous tasks in poor light
● With glaucoma, must adhere to prescribed regimen to prevent blindness; long-term therapy may be
required
● Refrigerate gel. Discard solution after expiration date.
Lab test considerations:
Timolol Maleate:

● May cause increase BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels
● May cause increase in ANA titers
● May cause increase in blood glucose levels

Pilocarpine:

● Urinalysis
Nursing Administration

Timolol/Pilocarpine (Eye Drop Solution)

1. Tilt head back → Pull eyelid down and drop


2. Press finger to inner eye corner (near tear duct)
3. Make sure the tip DOES NOT touch eye surface/other surfaces

Pilocarpine (Gel Ointment)

1. Tilt head forward → Pull eyelid down → Put ointment on lower eyelid pocket
2. Blink until evenly distributed along the eye
3. Do NOT touch tip to surface of eye or other areas
Nursing Administration Video: Eye Ointment
Evaluation of Medication
Effectiveness
● Check for any signs of side effects noted
○ Specific signs of allergies around eye:
■ Itchiness
■ Swelling
■ Redness
● Continue appointments with HCP for assessments
Case Study: Timolol Maleate

https://www.hindawi.com/journals/cricc/2015/714919/
Questions

1. Match the mechanisms of actions:

Timolol Maleate ____ A. Decreases production of


intraocular fluid
Pilocarpine HCL ____ B. Increases excretion of
Intraocular fluid
Questions

2. What is a major adverse effect of Timolol?

a. Cyanosis
b. Abdominal Cramping
c. Alteration in HR
d. Hair Loss
Questions

3.) Which drug when taken with Timolol may increase risk of myocardial depression?

a.) General Anesthesia


b.) Tylenol
c.) Alcohol
d.) Digoxin
Questions

4. Which is the most important safety precaution to inform patients


about for both Timolol and Pilocarpine?

a. These medications can affect their ability to drive safely


b. Advise wearing sunglasses due to light-sensitivity
c. Avoid wearing contacts
References
About Medication

DrugBankCA. (2005, January 13). Timolol. Retrieved March 02, 2018, from https://www.drugbank.ca/drugs/DB00373

MayoClinic. (2017, March 01). Timolol (Ophthalmic Route) Description and Brand Names. Retrieved March 02, 2018, from
https://www.mayoclinic.org/drugs-supplements/timolol-ophthalmic-route/description/drg-20071111

MayoClinic. (2017, March 01). Pilocarpine (Ophthalmic Route) Description and Brand Names. Retrieved March 02, 2018, from
https://www.mayoclinic.org/drugs-supplements/pilocarpine-ophthalmic-route/description/drg-20065516

MedlinePlus. (2018, January 25). Pilocarpine Ophthalmic. Retrieved March 02, 2018, from https://medlineplus.gov/druginfo/meds/a682874.html

About Glaucoma:

AAO. (2018, January 05). What Is Glaucoma? Retrieved March 02, 2018, from https://www.aao.org/eye-health/diseases/what-is-glaucoma

Glaucoma. (2016, July 19). Medication Guide. Retrieved March 02, 2018, from https://www.glaucoma.org/treatment/medication-guide.php

About Case Study Article:

Rana, M. A., Mady, A. F., Rehman, B. A., etc. (2015, August 06). From Eye Drops to ICU, a Case Report of Three Side Effects of Ophthalmic Timolol Maleate in the Same Patient.
Retrieved March 02, 2018, from https://www.hindawi.com/journals/cricc/2015/714919/
References Continued

Video:

Medicine Manage. (2014, September 03). Medicine Management - How to Administer Eye Ointment. Retrieved March 13, 2018, from
https://www.youtube.com/watch?v=ANSnYgasAuo

About side effects and medication interactions:

Davis' Drug Guide. (2015). Pilocarpine. Retrieved March 12, 2018, from https://davisplus.fadavis.com/3976/meddeck/pdf/pilocarpine.pdf

Davis' Drug Guide. (2015). Timolol. Retrieved March 12, 2018, from
https://davisplus.fadavis.com/3976/meddeck/pdf/timolol.pdf

Epocrates (n.d.). Retrieved March 13, 2018, from https://online.epocrates.com/u/10b294/timolol/Black+Box+Warnings

About Pharmacodynamics:

Davis' Drug Guide. (2015). Pilocarpine. Retrieved March 12, 2018, from https://davisplus.fadavis.com/3976/meddeck/pdf/pilocarpine.pdf
Group Work

● Cameron Yee: Therapeutic uses, brand names, pharmacologic


classification and mechanism of action.
● Alexis Roberts: Pharmacodynamics, side effects, and medication
interactions.
● Breanna Jarmin: Pharmacokinetics, client education, lab test
considerations and a question at the end
● Jinny Tran: Nursing Administration, Effectiveness Evaluation,
Case Study, and Question