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PYRAMID POINTS
CHAPTER 64:
OPHTHALMIC AND OTIC
MEDICATIONS
PYRAMID POINTS
I. Ophthalmic Medication Administration

Guidelines administering eye medications
• Wash hands and don gloves
• If both eye drops and eye ointment are scheduled,
•
•
•
•
administer the drops first
Separate instillation by 3 to 5 minutes if two medications
are scheduled
Place medication in lower conjunctival sac
Apply gentle pressure to nasolacrimal duct for
30 seconds to 1 minute following administration of drops
If possible, administer ointment at bedtime
ADULT HEALTH:
Ophthalmic and Otic Medications
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II. Mydriatic, Cycloplegic, and Anticholinergic
Medications


Description
• Dilate pupils and relax muscles; contraindicated in glaucoma
Side effects and toxicities
• Tachycardia
• Photophobia
• Conjunctivitis
• Elevated blood pressure
• Atropine toxicity: dry mouth, blurred vision, tachycardia, urinary
retention

Interventions
• Monitor for side effects and toxic effects
• Instruct client that a burning sensation may occur on instillation
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
III. Anti-infective Eye Medications



Description
• Kill or inhibit growth of bacteria, fungi, or viruses
Side effects
• Superinfection
• Global irritation
Interventions
• Advise client to contact the physician if improvement
does not occur
ADULT HEALTH:
Ophthalmic and Otic Medications
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IV. Anti-inflammatory Eye Medications



Description
• Control inflammation of conjunctiva, cornea, and lids
Side effects
• Cataracts
• Increased intraocular pressure
• Impaired healing
Interventions
• Advise client to contact the physician if improvement
does not occur
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
V. Topical Anesthetics for the Eye



Description
• Produce corneal anesthesia
Side effects
• Stinging and burning of the eye
• Temporary loss of corneal reflex
Interventions
• Corneal epithelium needs to be protected
• Provide eye patch until corneal reflex returns
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
VI. Eye Lubricants

Description
• Used for keratitis, during anesthesia, with disorder that
results in unconsciousness or decreased blinking


Side effects
• Burning on instillation
Interventions
• Inform conscious client that burning may occur on
instillation
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
VII. Miotics



Description
• Constrict the pupil
• Reduce intraocular pressure
Side effects
• Headache
• Eye pain
• Decreased vision in poor light
Toxicity
• Syncopy
• Bradycardia
• Hypotension
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
continued …

Interventions
• Assess risk for injury
• Monitor for side effects and toxic effects
• Instruct client to take medication exactly as prescribed
and not to stop medication because intraocular pressure
will increase
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
VIII. Ocusert System

Description
• Eye disk with a time-release dose of pilocarpine
• Disk is replaced every 7 days
• Drawbacks include sudden leakage of pilocarpine, migration of
the disk over the cornea, and unnoticed loss of system

Interventions
• Assess client’s ability to insert disk
• Inform client that temporary stinging is expected but to notify
the physician if blurred vision or brow pain occurs
• Instruct client to check for the presence of the disk in the
morning and at bedtime
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
IX. -Adrenergic Blocking Eye Medications

Description
• Reduce intraocular pressure and decrease aqueous
humor production
• Contraindicated in client with asthma or chronic
obstructive pulmonary disease

Side effects
• Ocular irritation
• Bradycardia
• Hypotension
• Bronchospasm
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
continued …

Interventions
• Monitor apical pulse rate and blood pressure
• Monitor for shortness of breath; contact physician if
shortness of breath occurs
• Instruct client to change positions slowly because of the
risk of orthostatic hypotension
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
X. Carbonic Anhydrase Inhibitors

Description
• Decrease aqueous humor formation and intraocular
pressure
• Contraindicated in client allergic to sulfonamides and
used with caution in the client with severe renal or liver
disease

Side effects
• Paresthesias
• Polyuria
• Hypokalemia
• Photosensitivity
• Drowsiness
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
continued …

Interventions
• Assess risk for injury
• Monitor intake and output
• Assess visual acuity
• Monitor for paresthesias and signs of hypokalemia
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
XI. Osmotic Medications

Description
• Lower intraocular pressure and are used in emergency
treatment of acute closed-angle glaucoma
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
Side effects
• Headache
• Gastrointestinal disturbances
• Disorientation
Interventions
• Monitor for side effects
• Assess for risk of injury
• Assist with monitoring effectiveness of medication
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
XII. Otic Medication Administration

Instillation of ear drops
• In adult, pull pinna up and back
• For infants and children younger than 3 years of age, pull
lobe down and back
• Tilt head in the opposite direction of affected ear and
apply drops

Irrigation of ear
• Warm irrigating solution to 98 F
• Avoid irrigation if perforation of eardrum is suspected
• Irrigate gently and direct solution toward wall of ear
canal, not toward eardrum
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
XIII. Anti-infective Ear Medications
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

Description
• Kill or inhibit growth of bacteria
Side effects
• Overgrowth of nonsusceptible organisms
Interventions
• Monitor for signs of superimposed infection
• Instruct client to keep ear canals dry
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
XIV. Antihistamines and Decongestants

Description
• Used for acute otitis media
• Reduce tissue hyperemia and edema to open obstructed
eustachian tubes
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
Side effects
• Drowsiness
• Dry mucous membrane
Interventions
• Instruct client to avoid hazardous activities if drowsiness occurs
• Instruct client to increase fluid intake or suck on hard candy to
alleviate dry mouth
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
XV. Local Anesthetics
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

Description
• Used for pain associated with ear infections
Side effects
• Irritation
• Allergic reaction
Interventions
• Monitor for irritation or allergic reaction
• Monitor for pain relief
ADULT HEALTH:
Ophthalmic and Otic Medications
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PYRAMID POINTS
XVI. Ceruminolytic Medications
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

Description
• Emulsify and loosen cerumen deposits
Side effects
• Irritation
• Redness or swelling of ear canal
Interventions
• Perform ear irrigation 30 minutes after instillation to
remove cerumen
• Inform client to notify physician if redness or swelling of
ear canal occurs
ADULT HEALTH:
Ophthalmic and Otic Medications
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A -adrenergic blocking agent has been prescribed for the client
with glaucoma. The nurse monitoring this client for side effects
of the medication would place highest priority on noting which of
the following parameters?
1.
2.
3.
4.
Respiratory rate
Oxygen saturation
Pulse rate
Blood glucose level
ADULT HEALTH:
Ophthalmic and Otic Medications
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