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Chapter 49
Drugs for
Eye and Ear Disorders
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
1
Anatomy of the Eye
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Drugs for Eye Disorders
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Diagnostic stains
Topical anesthetics
Antiinfectives
Antiinflammatories
Decongestants
Lubricants
Immunosuppressants
Antiglaucoma agents
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Diagnostic Stains
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Fluorescein sodium, rose bengal, lissamine
green
Frequently used to locate lesions or foreign
objects, evaluate dry eye, and evaluate eye
changes from poorly fitting contact lenses
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Topical Anesthetics
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Proparacaine HCl (Ophthaine, Ophthetic)
Tetracaine HCl (Pontocaine)
Corneal anesthesia is achieved within 1
minute and generally lasts about 15 minutes.
Ophthalmic anesthetics are not to be selfadministered by the patient.
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Antiinfectives
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Frequently used for eye infections
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Conjunctivitis: inflammation of the delicate
membrane covering the eye and inner eyelids
Blepharitis
Chalazion
Bacterial and fungal endophthalmitis
Hordeolum
Infectious keratitis
Infectious uveitis
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Antiinflammatories
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NSAIDs
Corticosteroids
Emedastine (Emadine), epinastine (Elestat),
and levocabastine (Livostin)
Cromolyn (Crolom), nedrocromil ophthalmic
(Alocril), and pemirolast (Alamast)
Azelastine (Optivar), epinastine, ketotifen
(Zaditor), and olopatadine (Patanol)
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Decongestants
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Ophthalmic decongestants: vasoconstrictors
that narrow blood vessels of the eye
Phenylephrine (Neo-Synephrine Ophthalmic),
naphazoline (Clear Eyes), tetrahydrolazine
(Opti-Clear), and oxymetazoline (Ocuclear)
Systemic absorption
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Lubricants
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Replace tears to alleviate discomfort
associated with eye dryness
Isopto Tears, Tearisol, Ultra Tears, Tears
Naturale, Tears Plus, Lens Mate, and LacriLube
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Immunosuppressants
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Cyclosporine ophthalmic emulsion (Restasis)
suppresses the immune response that leads
to inflammation, allowing tear production to
resume.
Ophthalmic corticosteroids: prednisolone
(Pred Forte), dexamethasone (Decadron),
loteprednol (Lotemax), rimexolone (Vexol),
and fluorometholone (FML)
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10
Antiglaucoma Agents
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Prostaglandin analogues
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Decrease IOP by improving trabecular outflow and
by increasing the uveoscleral pathway, which is an
alternate pathway of aqueous humor outflow
Bimatroprost (Lumigan), latanoprost (Xalatan),
tafluprost (Zioptan), and travoprost (Travatan)
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Prostaglandin Analogues
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Side effects
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Change the color of the iris by increasing brown
pigmentation
Darkening of the eyelids
Hypertrichosis
Blurred vision, redness of the conjunctiva, and
itching or stinging of the eye
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Cholinergic Agents
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Miosis: Constriction of the pupil and
contraction of the ciliary muscle
Cholinergic agonists: direct-acting
cholinergics
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Pilocarpine (Isopto Carpine)
Cholinesterase inhibitors: indirect-acting
cholinergics
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Echothiophate (Phospholine Iodide)
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Beta-Adrenergic Blockers
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Beta-adrenergic blockers decrease IOP by
decreasing the production of aqueous humor.
Betaxolol (Betoptic), carteolol (Cartrol),
levobetaxolol (Betaxon), levobunolol
(Betagan), metipranolol (OptiPranolol), and
timolol (Timoptic)
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Beta-Adrenergic Blockers (cont.)
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Side effects
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Eye discomfort, miosis, difficulty with night vision
Systemic absorption: slows the heart rate, which
can worsen bradycardia, AV heart block, and
heart failure
Prevent adequate bronchodilation in patients who
have asthma and other obstructive pulmonary
diseases
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Alpha-Adrenergic Agonists
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Decrease IOP by decreasing production and
improving outflow of aqueous humor
Apraclonidine (Iopidine), brimonidine
(Alphagan), epinephrine, and dipivefrin
(Propine)
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Alpha-Adrenergic Agonists (cont.)
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Side effects
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Burning, stinging, blurred vision, and headache
Adverse cardiovascular effects: tachycardia and
hypertension
Patients with narrow-angle glaucoma should not
take epinephrine and dipivefrin because dilation of
the pupil may allow the iris to block outflow of
aqueous humor, triggering acute closed-angle
glaucoma.
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Carbonic Anhydrase Inhibitors
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Decrease IOP by decreasing the production
of aqueous humor
Topical carbonic anhydrase inhibitors:
brinzolamide (Azopt) and dorzolamide
(Trusopt)
Systemic carbonic anhydrase inhibitors:
acetazolamide (Diamox) and methazolamide
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Carbonic Anhydrase Inhibitors (cont.)
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Side effects
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Systemic forms
• Lethargy, drowsiness, headache, seizures, paresthesias,
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mental status changes
Nausea, vomiting, diarrhea, altered taste, anorexia
Polyuria, increased thirst, fluid and electrolyte
disturbances
Hyperuricemia, gout attacks
Hepatic encepthalopathy, hepatic necrosis
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Osmotics
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Used preoperatively and postoperatively to
decrease vitreous humor volume, reducing
IOP
Emergency treatment of acute closed-angle
glaucoma
Side effects
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Headache, nausea, vomiting, and diarrhea
Mannitol and urea may cause disorientation
resulting from electrolyte imbalances especially in
older adults.
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Nursing Process: Anti-Glaucoma
Drugs
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Assessment
Nursing diagnoses
Planning
Nursing interventions
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Patient teaching
Cultural considerations
Evaluation
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Anticholinergic Mydriatics and
Cycloplegics
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Mydriatics: dilate the pupils
Cycloplegics: paralyze the muscles of
accommodation
Used in diagnostic procedures and
ophthalmic surgery
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Anticholinergic Mydriatics and
Cycloplegics (cont.)
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Side effects
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Xerophthalmia (dry eyes), photophobia (sensitivity
to light), and blurred vision
Systemic effects: Dry mouth, increased heart rate,
and constipation
Contraindicated in patients with narrow-angle
glaucoma
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Drugs for Macular Degeneration
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Dry ARMD: No effective drug. Some studies
suggest that antioxidants and zinc
supplements may have a role in preventing or
slowing progression of dry ARMD.
Wet ARMD: VEGF inhibitors (ranibizumab
[Lucentis], bevacizumab [Avastin], pegaptanib
[Macugen], and aflibercept [Eylea])
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Administration of Eyedrops and Eye
Ointments
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25
Anatomy of the Ear
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
26
Drugs for Ear Disorders
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Antiinfectives
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Use: Acute otitis media (AOM) and acute otitis
externa
Amoxicillin
Azithromycin and clarithromycin if the patient has
a severe allergy to penicillin
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27
Antiinfectives
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Side effects
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Burning or stinging
Aminoglycosides: Ototoxicity
Chloroamphenical: Bone marrow suppression
Opportunistic overgrowth of nonsusceptible
organisms
Hypersensitivity
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Nursing Process: Topical
Antiinfectives for Ear Conditions
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Assessment
Nursing diagnoses
Planning
Nursing interventions
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Patient teaching
Cultural considerations
Evaluation
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Antihistamines and Decongestants
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In 2006, a landmark Cochrane review of the
medical literature concluded that
antihistamines and decongestants were not
as effective as once assumed and that the
risks of adverse effects outweighed the
benefits.
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Ceruminolytics
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Ceruminolytics: Topical otic agents that
soften or break up the cerumen so that it can
be removed
Usually composed of mineral oil with
hydrogen peroxide
Carbamide peroxide (Auro Ear Drops,
Debrox)
Regular mineral oil
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31
Administration of Eardrops
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Administration of eardrops
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32
Practice Question #1
The nurse is teaching a patient with glaucoma.
Which herbal product should the nurse include
as not recommended for patients with
glaucoma?
A.
B.
C.
D.
Garlic
St. John’s wort
Goldenseal
Valerian
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Practice Question #2
The nurse is showing the parent of a 2-year-old
child how to administer eardrops. Which are
correct statements? (Select all that apply.)
A.
B.
C.
D.
E.
Pull down on auricle.
Pull up on the auricle.
Position child’s head with affected ear up.
Position child’s head with affected ear down.
Warm the eardrop in the microwave prior to
administration.
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Practice Question #3
Pilocarpine has which action on the eye?
A.
B.
C.
D.
Miosis
Mydriasis
Ciliary muscle paralysis
Pupillary dilation
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Practice Question #4
Which is the most common side
effect/adverse reaction associated with
prostaglandin analogues for the treatment of
glaucoma?
A.
B.
C.
D.
Hypokalemia
Renal calculi
Ocular hyperemia
Postural hypotension
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Practice Question #5
A child is treated four times during the
summer for external ear infections, or
“swimmer’s ear.” The nurse teaches the
family to prevent these infections by
A. refraining from any submersion in water.
B. continuing antibiotic therapy through the summer
season.
C. taking high-dose vitamin C.
D. using custom-fitted ear plugs.
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