Family Nurse Practitioner Exam

What is a common contraindication for the use of Betimol (timolol) ophthalmic drops?

1. Astmatic patients

2. Second- or third-degree AV block

3. Overt heart failure

4. Migraine headaches

The correct answer is: Migraine headaches

Betimol (timolol) is a non-selective beta-adrenergic antagonist commonly used to lower intraocular pressure in conditions like glaucoma or ocular hypertension. A key contraindication in its use is related to cardiovascular effects, primarily due to its systemic absorption when administered as eye drops. Patients with second- or third-degree AV block or overt heart failure may experience worsening of their cardiac conditions with beta-blockers, as these medications can reduce heart rate and myocardial contractility. This physiological response raises concerns about the potential for serious heart rhythm disturbances or exacerbation of heart failure. In contrast, while migraine headaches may lead a clinician to consider the potential for beta-blocker therapy as a preventive measure, they are not a contraindication for timolol use. Some patients with a history of migraines may actually benefit from beta-blockers. Considering this, the common contraindications based on the patient's cardiovascular status clearly support the need for caution when administering timolol. Thus, the emphasis is placed on the selection of patients with underlying cardiac conditions.