antibiotics

antibiotic corticosteroid combos

miscellaneous

ofloxacin-otic (Floxin Otic)

neomycin and hydrocorticosne

ciprofloxacin and hydrocortisone

neomycin, polymyxin and hydrocortisone

Otic miscellaneous preparations, often combinations and usually contain:

• benzocaine to relieve pain
• phenylephrine for vasoconstriction/decongenstion
• hydrocortisone for antiinflam and antipruritis effects
• glycerin as an emollient and solvent
• antipyrine for analgesia
• acetic acic, boric acid, benzoalkonium, aluminusm, bensethonium for antibacterial and antifungal actions
• carbamide peroxide to remove cerumen by softening and breaking up

Pain

infection and inflammation

removal of cerumen

If pt has INNER ear infection, systemic antibiotics indicated

• Topically generally don’t enter system to produce advrxns
• prolonged use of antibiotic preps. can cause SUPERINFECTION (bacterial or fungal)
• Local reactions can occur like irritation, itching, burning

Do not use cerumen removers if drainage/discharge, pain, irritation, eardrum perforation or after ear surgery

pregnancy and lactation – categories unknown

Store safely from children and pets, dangerous if injested

Ofloxin preg cat C, used if benefits outweigh risk to fetus

Examine ear and document

Check withPCPbefore giving drops to pt with perf. eardrum

Examine for signs of sensitivity like irritation, local redness

PEDIATRIC – infant may pull, grab or tug at ears – can be a sign of ear pain. Behavior may change, cry, or have fever.

• Straighten ear canal (age 3 and above) pull cartilage up and back
• PEDIATRIC - for children under 3, pull ear down and back
• Have pt stay in position 5 minutes

• Wash hands before instilling
• warm solution if cold
• do not touch dropper to ear or touch dropper
• do not use OTC drops unless approved
• Temp feeling of fullness or hearing loss
• notify if no improvement
• Do not use Cerumex (or similar if drainage, pain, or irritation); do not use for more than 4 days, if dizziness occurs, contactPCP

promotes eye health, vision, night vision, blod flow to eye; no known adverse reactions

increased pressure causes atrophy of optic nerve, 2nd leading cause of blindness after cataracts

fluid normally flows through a "filtration angle" where iris and trabeculum meet forming trabecular meshwork

2 types;

a.       angle-closure glaucoma

                                                              i.      the iris blocks the trabecular meshwork, backing up fluid

                                                            ii.      often rapidly occurs, so pts seek treatment before damage done

b.      open-angle glaucoma = chronic glaucoma

                                                              i.      angle is open and normal, yet fluid not flowing through trabecular meshwork

                                                            ii.      Most common 90% of glaucoma

                                                          iii.      progresses slowly and may not be noticed until damage is done

Some people have a narrower "angle" but don't have glaucoma; they might have symtoms, however, under abnormal circumstnaces like meds, fear, pain, etc.

GOAL OF TREATMENT IS TOLOWER IOP

Adverse reaction of all opth. drugs usually low bc localized (momentary stinging or burning), though some absorbed systemically

alpha2-adrenergic agoist
sympathomimetic 
Adrenergic BLOCKERS (alpha and beta)
miotics, direct acting, and cholinesterase inhibitors
carbonic anhydrase inhibitors
prostaglandin agonists
mast cell stabilizers
NSAIDS
Corticosteroids
Antibiotics/sulfonamides
silver
antivirals
antifungals
vasoconstrictors/mydriatics

• Side effects are rare, but include
• transient local burning, headache, blurring, tearing, itching
• transient systemic fatigue, drowsiness, palpitations, nausea

·         carbonic anhydrase inhibitors EYEDROPS Actions and Uses

•  CA is an enzyme found in eye naturally
• Inhibiting it decreases production of aqueous humor
•  Open-angle glaucoma

o        latanoprost

o        travoprost

o        brimatoprost

o        unoprostone isopropyl

§         Action/Use

·         Glaucoma

·         Used for pts not responding to other treatments

·         Increases outflow of AH

o        nedocromil

o        pemirolast

o        bromfenac

o        declofenac

o        flurbiprofen

o        ketorolac

o        nepafenac

§         Action/Use

·         Inhibit prostaglandin synthesis; anti-inflam

·         pain and inflammation after eye surgery

§         Precautinos

·         bleeding tendencies

·         possible cross-sensitivity reactions in those allergic to salicylates

o        dexamethasone

o        fluorometholone

o        loteprednol

o        prednisolone

For Eyes

Corticosteroid eyesrops

o        silver nitrate

§         Action/Use

·         antibacterial

·         prevention of gonorrheal opthalmia neonatorum (not used as much now)

§         Adverse reations

·         usually well tolerated with few adv rxns

·         May cause local irritation, burning, itching, inflam, blurriness (transient)

·         With prolonged use, can cuase superinfection

o        ganciclovir

o        idoxuridine (Herplex)

o        trifluridine

o        vidarabine

o        natamycin (Natacyn)

§         Adverse reactions are rare, occasionally local irritation

·         vasoconstrictors/mydriatics EYEDROPS

o        oxymetazoline (OcuClear, Visine LR)

o        phenylephrine

o        tetrahydrozoline (Visine, Murine+)

§         Action/Use

·         Dilate pupils, constrict small vessels of eyes, decrease AH production

·         relief of redness from minor irritation

·         cycloplegic/mydriatics eyedrops

o        atropine

o        homatropine hydrobromide

§         Action/Use

·         causes mydriasis (dilation)

·         causes cyclopegia (paralysis of ciliary muscle)

·         Used for exams and inflam conditions

·         artificial tear solutions

o        benzalkonium chloride (Artificial Tears)

o        glycerine, NaCl, benzkonium chloride

Preassessment Eyedrops

·         baseline eye exam for irritation, redness, exudates, etc

·         general health hx

·         ADLs

Whil hospitalized, how often should the nurse assess the glaucoma pt for pain relief?

·         for glaucoma, assess q2hr for pain relief, can indicate increased IOP

PaOR Eyedrops

·         warm first hand few minutes

·         order must indicate for opthalamic use

·         make sure clear and not discolored

·         lower conj sac, middle

·         do not touch eye with tip as to not contaminate med

·         apply pressure to inner canthus to delay drainage into tear duct and systemic absorption (check first to make sure not contraindicated, i.e. after eye surgery)

·         if 2 diff drops, wait 5 minutes after first to allow tearing and prevent dilution of drug

·         some pts can instill own glaucoma drops at hospital, can leave at bedside with order, but still check that pt admin correctly, right time, etc

·         For pilocarpine ocular therapeutic system, replaced q 7 days, and insert at night, bc causes myopia for several hours

·         If prep for surgery, make sure to give at exact time (e.g. mydriatics, etc)

Eyedrop admin, Interventions for “Disturbed Sensory Perception: Visual rt adverse reactions or eye disease”           

·         adv rxns rare

·         but can cause blurred vision and local irritation and burning

·         usually last only several minutes

·         if lasts longer than 30 min, report

Eyedrop admin, Interventions for “Risk for Injury rt adv rxn”

·         blurred vision can lead to falls, etc

·         keep room lit at night

·         remove obstacles

·         edu to be careful

·         provide assistance if needed

Eyedrop admin, Interventions for “Acute pain rt eye disorder or adv rxn”

·         conditions can be painful like glaucoma and infectgions

·         assess glaucoma pts for relief of pain

·         pain indicator of increased IOP, and should be reported

·         with infection, if no relief of pain in 1-2 days, report

·         sometimes adv rxns are head and brow aches, usually self-limiting and rare

Eyedrop admin, Interventions for “Anxiety rt eye condition, etc”

·         can be very painful, uncomfortable and vision changes

·         concern about future effect on eyesight, assure all is being done to help, duh

General Education Eyedrops

·         how to instill

·         can cause momentary stinging, etc

·         temp blurred vision, avoid hazards until ok

·         if more than one opthalamic, wait 5-10 min for next

·         keep hands from eyes

·         do nto use OTC eyuedrops unless okayed by doc

·         some may cuase photosensitivity, sunglasses

·         notify if no relief

Education re eyedrops for glaucoma

·         may sting, esp. first few doses

·         do not use if brown or precipitates

·         do not use while wearing soft contact lenses

·         may cuase headache or browache

·         report decrase in vision and use caution

·         changes may occur in lashes

·         Iris color may change, to more brown and may be permanent

When should doc be notified if eye infection is not improving after rx drops?

·         if no improvement in 2 days, or gets worse, call doc

How to instill eyedrops (patient teaching)

·         wash hands

·         warm bottle in hands

·         cleanse eyes of secretions

·         head slightly backward and toward eye to be treated

·         lower lid down

·         lower conjuctival sac, middle

·         look up

·         do not squeeze eyes after, but shut

·         finger in inner canthus to prevent systemic absorption

·         if more than one type, wait 5-10 min

·         immediately replace cap

·         do not touch tip

q 2-4 hours if severe, even at night

There are ER tabs for less frequent dosing

Outer and middle ear - use topical

For inner ear infection - use systemic

Alzheimers blocks degradation of ACh by cholinesterase

E.g. ARICEPT

Discussed in ch 28

·         pregnancy and lactation

·         cv disease

·         diabetes (can mask symptoms of hypoglycemia)

·         hyperthyroidism (may mask symptoms)

·         bronchial asthma

·         COPD

·         sinus bradycardia

·         heart block

·         cardiac failure

·         cardiogenic shock

·         do not use in conditions where pupil constriction is not desirable like iritis

• alpha-adrenergic blocking eye drop
• Blocks alpha-adrenergic receptors on iris smooth muscle to produce MIOSIS
• used mostly to cause miosis after opth. exam induced MYDRIASIS 

betaxolol

carteolol

levobetaxolol

levobunolol

metipranolol

timolol

What type of drugs and action/use?

• beta-adrenergic blocking eye-drops
• Decreases production of AH
• Used in open-angle glaucoma

CARBACHOL and PILOCARPINE are direct cholinergics

ECHTHIOPHATE is indirect

Cause miosis

Side effects rare

Transient local burning, headache, blurring, tearing, itchin

Transient systemic fatigue, palpitations, nausea

• closed angle glaucoma bc cholinergics acually decrease AH flow (aothough they open up the canal by miosis)
• corneal abrasion
• preg/lact
• HF
• asthma
• ulcer
• hyperthyroidism
• GI spasm
• UTI
• Parkinson's (bc have to much ACh to begin with)
• renal/hep failure
• recent MI
• BP high or low

Cholinesterase inhibitor eyedrops use caution with:

• MG (bc taking systemic AChE Inhibitor, can cause crisis)
• Before and after surery
• All of above also

• additive effect of exposure to carbamate-organophosphate (pesticide)

viral infections of eye

funcal infections of eye

mycobacterial infections of eye

sulfite sensitive

pregnancy and lactation

• are usually well tolerate, can cause
• local irritation, burning, itching, infalam and blurriness
• Superinfection with prolonged use

brimonidine

type of drug

action

alpha-agoinst eyedrop

decreases AH production

Adverse reactions

alpha agoist eyedrops

rare

transiet local burning, headache, blurring, itching, tearing

transient fatigue, drowsiness, palpitations, nausea

apraclonidine

dipiverin

Increses outflow of AH

Open-angle glaucoma

aproclonidine used also for post surgical IOP

MAOIs

Epinephrine is contro in narrow-angle and aphakia (no crystalline lens of eye)

soft cotact lenses, absorp and can discolo

pregnancy and lactation

CV disease

depression

cerbral or coronary insufficiency

hypertension

diabetis

hyperthyroidism

Raynaud's phenom

rare

transient local - burning, itchin, etc

transient systemic - fatigue, drowsniess, palpitations, nausea

bleeding tendencies

possible cross-sensitivity reactions in those allergic to salicylates

brinzolamide

dorzolamide

IOP elevation, can damage nerves

loss of vision

cataracts

infection

dry eyes

ptosis

blurred vision

pain

pruritis

discharge

sulfite sensitivity, bc possibble cross sensitivity

eye infections

prolonged use can cuase IOP and optic nerve damage

Carbachol

What type of drug

Pilocarpine

What type of drug

Echthiophate iodide

What type of drug

All are choinergic eyedrops

Carbachol IS A CHOLINERGIC AGOIST (binds and excites ACh receptors)

(from wikipedia)

Pilocarpine IS A PARASYMPATHOMIMETIC - ACTS LIKE ACh

Echthiophate is and indirect AChE Inhibitor Chlolinergic

alpha2 agoist BRIMONIDINE decreases AH production and increases AH outflow

sympathomimetics increase AH outflow

alpha blocker DAPIPRAZOLE relaxes iris muscle (not ciliary)

beta blockrs decrease AH production

So, all but the alpha blocker reduce AH production and/or increase it's outflow to reduce IOP; the alpha blocker relaxes the iris.  

·         local irritation, pain, pruritus, inflammation, edema, corneal clouding

·         systemic photophobia and allergic reactions

Adverse reactions

Contraindications

Precautions

Artificial Tear Eyedrops

• Adverse reactions are rare, occasional redness or irritation
•  Only contraindication is hypersensitivity
•  No precautions or interactions reported