Which systemic effects should be monitored when using multiple ocular hypotensive medications?

• A. Systemic hypotension or bradycardia.
• B. Increased systemic blood pressure.
• C. Hyperglycemia.
• D. Respiratory alkalosis.

Answer: (A)

Systemic absorption of topical ocular medications can occur, so using more than one eye drop increases the chance that some medicine enters the bloodstream and affects body systems. The most important systemic effects to monitor are systemic hypotension and bradycardia, especially with nonselective beta-blockers like timolol. These drugs can slow the heart rate and lower blood pressure, and adding another drop with similar systemic potential can amplify those effects. Watch for symptoms such as dizziness, fainting, or fatigue, and check heart rate and blood pressure, particularly in patients with cardiovascular disease, bradycardia, or those taking other heart-rate– or blood-pressure–lowering drugs. While these issues are the main concerns, the other options—rising blood pressure, hyperglycemia, or respiratory alkalosis—are not typical or primary concerns with standard topical ocular hypotensive regimens.