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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • List the goals of treatment for patients with primary open-angle glaucoma

  • Choose the most appropriate therapy using patient-specific data for open-angle glaucoma

  • Develop a monitoring plan for patients on specific pharmacologic regimens

  • Counsel patients about glaucoma, drug therapy options, ophthalmic administration techniques, and the importance of adherence to the prescribed regimen

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PATIENT PRESENTATION

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Chief Complaint

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"My eyes are hurting and I feel like my vision is worsening. It has been worsening over the last few months and, now that I'm in the hospital, I'd like to have my eyes examined."

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History of Present Illness

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Carrie Kindred is a 52-year-old female who was admitted to the hospital 6 days ago for suspected community-acquired pneumonia (CAP). She had complained of a progressively worsening cough with increased sputum production and a tough time catching her breath on admission. These symptoms have improved drastically and are no longer a concern for this patient. While doing the initial review of systems with the patient, the physician who admitted her to the hospital asked her about any other problems she was currently experiencing. The only other problem she described was a dull, aching pain in her eyes and a subjective feeling that she needs new glasses or contacts as her vision seems to be worsening and becoming blurrier every day. When asked about this vision loss, she claims to be less able to see things to her sides and that her peripheral vision seems to be the main aspect of her vision loss. Additionally, she has noticed that she seems to have blind spots in her visual field that were not there previously.

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Past Medical History

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HTN diagnosed at age 43

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AF diagnosed at age 47

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COPD diagnosed last year

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Insomnia, for the last 15 years

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Family History

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Father is alive and well with only medical problem being CAD. Mother passed away from breast cancer at age 74. Her mother also had a history of glaucoma and type 2 DM. Three younger siblings have no medical issues, except for her brother who has type 2 DM and HTN.

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Social History

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Works as a receptionist at a local dentist's office. Married for 30 years and lives with her husband. Has four children, aged 17, 22, 24, and 28.

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Tobacco/Alcohol/Substance Use

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Has smoked 2 ppd cigarettes for 25 years. (−) Illicit drug use. Drinks three to five glasses of wine per week (usually a glass of wine with dinner).

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Allergies/Intolerances/Adverse Drug Events

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Allergic to sulfamethoxazole/trimethoprim (anaphylaxis) and codeine (hives)

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Medications (Current)

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Metoprolol tartrate 50 mg PO twice daily

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