Drugs for Eye & Ear Disorders Handout 3B PDF

Laoag City, Ilocos Norte DRUGS FOR THE EYE AND EAR DISORDERS Drugs designed to be applied to the eyes. CLASSIFICATIONS A. TOPICAL ANESTHETICS Used in selected aspects of a comprehensive eye examination and in a variety of ophthalmic procedures. Corneal...

Laoag City, Ilocos Norte DRUGS FOR THE EYE AND EAR DISORDERS Drugs designed to be applied to the eyes. CLASSIFICATIONS A. TOPICAL ANESTHETICS Used in selected aspects of a comprehensive eye examination and in a variety of ophthalmic procedures. Corneal anesthesia is achieved within 1 minute and generally lasts about 15 minutes. Blink reflex is temporarily lost, therefore the corneal epithelium may become dry. Examples Proparacaine HCl Tetracaine HCl (Pontocaine B. LUBRICANTS Replace tears to alleviate discomfort associated with eye dryness. Also used to moisten contact lenses and artificial eyes. These agents typically are safe, but the nurse must be alert to potential allergic reactions to preservatives in lubricants. Examples Isopto Tears Tears Plus Tearisol Lens Mate Ultra Tears Lacri-Lube Tears Naturale Pharmacology Page 1 of 8 C. ANTIGLAUCOMA AGENTS GLAUCOMA – eye condition in which optic nerve damage occurs as a result of increased intraocular pressure (IOP), which is a buildup of pressure within the eyes that occurs when there is too much aqueous humor. In glaucoma, excess fluid is prevented from draining through the trabecular structure. 2 TYPES OF GLAUCOMA 1. OPEN-ANGLE GLAUCOMA o The trabecular network becomes clogged, and as it worsens the IOP gradually increases. 2. NARROW- ANGLE GLAUCOMA/ CLOSED-ANGLE OR ANGLE-CLOSURE GLAUCOMA o The iris bows and blocks the trabecular network by narrowing or closing the angle where fluid typical exits the eye CATEGORIES OF ANTIGLAUCOMA AGENTS 1. PROSTAGLANDIN ANALOGUES Are first line drugs used primarily in the treatment of open angle glaucoma These drugs decreased IOP by improving trabecular outflow. Examples Bimatoprost (Lumigan) Latanoprost (Xalatan) Tafluprost (Zioptan) Travoprost (Travatan) Pharmacology Page 2 of 8  SIDE EFFECTS Gradual change in the color of the iris by increasing brown pigmentation Darkening of the eyelids Eyelash hypertrichosis Blurred vision Redness of the conjunctiva Itching or stinging of the eye 2. CHOLINERGIC AGENTS Cause constriction of the pupil and contraction of the ciliary muscle – resulting in widening of the trabecular meshwork to improve outflow of excess aqueous humor. Additionally, as the pupil constricts, it straightens the iris thus opening or widening the angle to relieve narrow angle glaucoma. 3. BETA ADRENERGIC BLOCKERS (OPHTHALMIC) One of the first- line drugs used in the treatment of glaucoma. Decrease IOP by decreasing the production of aqueous humor. Examples Betaxolol (Betoptic) Carteolol Levobunolol Metipranolol (OptiPranolol) Timolol (Timoptic) SIDE EFFECTS Vision problems at night Slowed heart rate Bronchoconstriction 4. ALPHA ADRENERGIC AGONISTS Decrease IOP by decreasing production and improving outflow of aqueous humor. Examples Apraclonidine (Iopidine) Brimonidine (Alphagan) Epinephrine Dipivefrin SIDE EFFECTS Burning/ stinging sensation Pharmacology Page 3 of 8  Blurred vision Headache Cardiovascular effects – tachycardia, HPN (for epinephrine and dipivefrin) 5. CARBONIC ANHYDRASE INHIBITORS Decrease IOP by decreasing the production of aqueous humor. Indicated for both open angle and acute closed-angle glaucoma They carry a greater risk of adverse effects, given only if other treatment options have been exhausted. Examples Brinzolamide (Azopt) Dorzolamide (Trusopt) Acetazolamide (Diamox) Methazolamide SIDE EFFECTS For the systemic form- CNS effects (lethargy, drowsiness, headache, seizures, paresthesias and mental status change) GI effects (n/v, diarrhea, altered taste, anorexia) Polyuria and Polydipsia Fluid and electrolyte imbalances Hyperuricemia 6. OSMOTICS Are generally used preoperatively and postoperatively to decrease vitreous humor volume, reducing IOP. These drugs are primarily used in the emergency treatment of acute closed-angle glaucoma because of their ability to rapidly reduce IOP. Examples Glycerin (Osmoglyn, Ophthalgan) Mannitol (Osmitrol) SIDE EFFECTS Headache Pharmacology Page 4 of 8  N/v Diarrhea Disorientation- as a result of fluid and electrolyte imbalances NURSING RESPONSIBILITIES (PATIENT TEACHING) a. Advise patient to never stop medication suddenly without prior approval of health care provider b. Advise patient to avoid driving or operating machinery while vision is impaired. c. Explain importance of follow ups for subsequent ophthalmologic examination and reevaluation of IOP. d. Counsel patients with glaucoma to avoid drugs with potential to increase IOP. e. It both eyedrops and eye ointment is prescribed, instruct patient to put in eyedrops first. F. If more than 1 kind of eyedrops is ordered, instruct patient to wait at least 5 minutes before instilling 2nd medication. D. ANTICHOLINERGIC MYDRIATICS AND CYCLOPLEGICS Actively block acetylcholine from attaching to cholinergic receptors resulting in both dilation of the pupils and paralysis of the muscles for accommodation by blocking the response of sphincter muscles that normally constrict the pupil. Examples Atropine sulfate (Atropisol) Cyclopentolate HCl (Cyclogyl) Homatropine hydrobromide (Isopto Homatropine) Scopolamine Hydrovromide (Isopto Hyoscine) Tropicamide (Mydriacyl Ophthalmic) ADMINISTRATION OF EYEDROPS AND OINTMENTS 1. EYE DROPS a. Wash hands b. Instruct client to lie or sit down and to look up toward the ceiling. c. Gently draw skin down below the affected eye to expose the conjuctival sac. Pharmacology Page 5 of 8  d. Administer the prescribed number of drops into the center of the sac. Do not touch eyelids or eyelashes with dropper. e. Gently press on the lacrimal duct with sterile cotton ball or tissue for 1 to 2 minutes after instillation. f. Client should keep eyes closed for 1-2 minutes following application to promote absorption. 2. EYE OINTMENTS a. Wash hands. b. Instruct client to lie or sit down and to look up toward the ceiling. c. Gently draw skin down below the affected eye to expose conjuctival sac. d. Squeeze strip of ointment (about ¼ inch)onto conjuctival sac. e. Instruct client to close eyes for 2 to 3 mins. f. Instruct client to expect blurred vision for a short time. Apply at bedtime if possible. DRUGS FOR DISORDERS OF THE EAR A. ANTIINFECTIVES ACUTE OTITIS MEDIA (AOM) Occurs most often in children. Streptococcus pneumonia is the most common pathogen Risk factors: Age younger than 2 y/o, attending day care centers, exposure to tobacco smoke and air pollution. OTITIS EXTERNA Is an infection of the external auditory canal that occurs when excess moisture and break in skin allow bacteria or fungi to invade the tissues. Pseudomonas aeroginosa and Staphyloccocus Aureus are the most common pathogens Examples of OTIC ANTIINFECTIVES Acetic Acid (Acetasol, Borofair) Chloramphenicol (Chloromycetin Otic) Ciprofloxacin (Cetraxal, Floxin Otic) Polymyxin B and neomycin Pharmacology Page 6 of 8  Laoag City, Ilocos Norte SIDE EFFECTS and ADVERSE REACTIONS Burning and stinging sensation Bone marrow suppression- chloramphenicol Opportunistic overgrowth of nonsusceptible organisms B. CERUMINOLYTICS Are topical otic agents that soften or break up cerumen so that it can be removed. Usually composed of mineral oil with hydrogen peroxide. Examples Carbamide peroxide (Auro Ear Drops, Bedrox) C. IRRIGATION Used to flush the cerumen deposits out of the ear canal. Best accomplished when there is direct visualization of the tympanic membrane. Done gently to avoid damage to the TM. Also important to warm the water to prevent nausea and vomiting. Examples Hydrogen peroxide 3% in a 1:1 solution with warm water Normal saline solution Acetic Acid mixed with a warm wate PATIENT TEACHING a. Instruct patient not to insert any foreign objects into the ear canal. b. Instruct patient to keep drug away from heat. c. Advise patient to contact health care provider before using OTC drugs to treat ear disorders. e.Encourage patient to keep follow up appointments. ADMINISTRATION OF EAR DROPS a. Wash hands. Pharmacology Page 7 of 8  Laoag City, Ilocos Norte b. Medication should be at room temperature. c. Client should sit up with head tilted slightly toward the unaffected side. Child: pull down on auricle Adult: pull up and back d. Instill prescribed number of drops. e. Take care not to contaminate dropper. f. Have client maintain position for 2 to 3 minutes. Pharmacology Page 8 of 8