Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is pilocarpine. This scenario describes a paradoxical increase in intraocular pressure, likely due to the accidental use of pilocarpine eye drops. In patients with open-angle glaucoma who are on long-term prostaglandin analogs (like latanoprost), the sudden use of pilocarpine can cause a paradoxical increase in intraocular pressure. This is due to the anterior movement of the lens-iris diaphragm, which can temporarily block the trabecular meshwork.

Timolol and latanoprost are the patient's regular medications and typically lower intraocular pressure. Brimonidine, an alpha-2 agonist, also lowers intraocular pressure and would not cause this effect. Cyclopentolate, a cycloplegic agent, can potentially increase intraocular pressure in patients predisposed to angle-closure glaucoma, but it's less likely to cause such a dramatic increase in a patient with open-angle glaucoma.

This question highlights the importance of understanding drug interactions and paradoxical effects in glaucoma management. Emergency nurses should be aware that seemingly appropriate glaucoma medications can sometimes have unexpected effects, especially when patient medication regimens are altered or mixed up.