OPHTHALMIC AND OTIC MEDICATIONS

From Herlihy, B. & Maebius, N. (2000) From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.

From Herlihy, B. & Maebius, N. (2000) From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B. Saunders.

PYRAMID POINTS Actions, side effects, contraindications, and nursing considerations when administering eye and ear medications Procedure for administering eye and ear drops Procedure for irrigation of an ear Client education regarding prescribed medications

ADMINISTERING OPHTHALMIC MEDICATIONS Place prescribed dose of eye medication in the lower conjunctival sac, never directly onto the cornea Avoid touching any part of the eye with the dropper or applicator Administer drops or liquid preparations before ointments Administer glucocorticoid preparations before other medications When two or more eye medications are to be administered, wait at least 3 minutes between medications

ADMINISTERING OPHTHALMIC MEDICATIONS To prevent overflow of medication into the nasal and pharyngeal passages, thus reducing systemic absorption, occlude the nasolacrimal duct with one finger for 1 to 2 minutes after instilling the medication Monitor the pulse of the client receiving an ophthalmic beta-blocker and instruct the client to do the same; if the pulse is below 50 to 60 beats per minute (adult), withhold the next dose of eye medication and notify the physician

ADMINISTERING OPHTHALMIC MEDICATIONS CLIENT INSTRUCTIONS How to instill medication correctly; supervise instillation until the client can do it safely Avoid driving or operating hazardous equipment if vision is blurred Wear sunglasses and avoid bright lights if photophobia occurs Administer a missed dose of the eye medication as soon as remembered, unless the next dose is scheduled to be administered in 1 to 2 hours

ADMINISTERING OPHTHALMIC MEDICATIONS CLIENT INSTRUCTIONS Report the development of any eye irritation Inform the client using eye gel to store the gel at room temperature or in the refrigerator but not to freeze it; discard unused eye gel kept at room temperature after 8 weeks

ADMINISTERING OPHTHALMIC MEDICATIONS CLIENT INSTRUCTIONS Soft contact lenses may absorb certain eye medications and that preservatives in eye medications may discolor the contact lenses In infants, inform the parents that atropine sulfate eye drops may contribute to abdominal distention; the parents should keep a record of the bowel movements of the infant

MYDRIATIC, CYCLOPLEGIC, AND ANTICHOLINERGIC MEDICATIONS DESCRIPTION Mydriatics and cycloplegics dilate the pupils (mydriasis) and relax the ciliary muscles (cycloplegia) Anticholinergics block responses of the sphincter muscle in the ciliary body, producing mydriasis and cycloplegia Used preoperatively or for eye examinations to produce mydriasis

MYDRIATIC, CYCLOPLEGIC, AND ANTICHOLINERGIC MEDICATIONS DESCRIPTION Contraindicated in clients with glaucoma because of the risk of increased intraocular pressure Mydriatics are contraindicated in cardiac dysrhythmias and cerebral atherosclerosis and should be used with caution in the elderly and in clients with prostatic hypertrophy, diabetes mellitus, or parkinsonism

MYDRIATIC, CYCLOPLEGIC, AND ANTICHOLINERGIC MEDICATIONS SIDE EFFECTS Tachycardia Photophobia Conjunctivitis Dermatitis

MYDRIATIC, CYCLOPLEGIC, AND ANTICHOLINERGIC MEDICATIONS ATROPINE TOXICITY Dry mouth Blurred vision Photophobia Tachycardia Fever Urinary retention Constipation Headache, brow pain

MYDRIATIC, CYCLOPLEGIC, AND ANTICHOLINERGIC MEDICATIONS SYSTEMIC REACTIONS OF ANTICHOLINERGICS Dry mouth and skin Fever Thirst Confusion Hyperactivity

MYDRIATIC, CYCLOPLEGIC AND ANTICHOLINERGIC MEDICATIONS IMPLEMENTATION Monitor for allergic response Assess for risk of injury Assess for constipation and urinary retention Instruct the client that a burning sensation may occur on instillation

MYDRIATIC, CYCLOPLEGIC, AND ANTICHOLINERGIC MEDICATIONS IMPLEMENTATION Instruct the client not to drive or operate machinery for 24 hours after instillation of the medication unless otherwise directed by the physician Instruct the client to wear sunglasses until the effects of the medication wear off Instruct the client to notify the physician if blurring of vision, loss of sight, difficulty breathing, sweating, or flushing occurs Instruct the client to report eye pain to the physician

ANTIINFECTIVE EYE MEDICATIONS DESCRIPTION Kill or inhibit the growth of bacteria, fungi, and viruses SIDE EFFECTS Superinfection Global irritation

ANTIINFLAMMATORY EYE MEDICATIONS DESCRIPTION Control inflammation, thereby reducing vision loss and scarring Used for uveitis, allergic conditions, and inflammation of the conjunctiva, cornea, and lids SIDE EFFECTS Cataracts Increased intraocular pressure Impaired healing Mask the signs and symptoms of infection

ANTIINFECTIVE AND ANTIINFLAMMATORY EYE MEDICATIONS IMPLEMENTATION Assess for risk of injury Instruct the client how to apply the eye medication Instruct the client to continue treatment as prescribed Instruct the client to wash hands thoroughly and frequently Advise the client to notify the physician if improvement does not occur

TOPICAL ANESTHETICS DESCRIPTION Produce corneal anesthesia Used for anesthesia for eye examinations, surgery, or to remove foreign bodies from the eye SIDE EFFECTS Temporary stinging or burning of the eye Temporary loss of corneal reflex

TOPICAL ANESTHETICS IMPLEMENTATION Assess for risk of injury Note that the medications should not be given to the client for home use and are not to be self-administered by the client Note that the blink reflex is temporarily lost and that the corneal epithelium needs to be protected Provide an eye patch to protect the eye from injury until the corneal reflex returns

EYE LUBRICANTS DESCRIPTION Replace tears or add moisture to the eyes Moisten contact lenses or an artificial eye Protect the eyes during surgery or diagnostic procedures Used for keratitis, during anesthesia, or in a disorder that results in unconsciousness or decreased blinking

EYE LUBRICANTS SIDE EFFECTS Burning on instillation Discomfort or pain on instillation IMPLEMENTATION Inform the client that burning may occur on instillation Be alert to allergic responses to the preservatives in the lubricants

MIOTICS DESCRIPTION Reduce intraocular pressure Used for chronic open-angle glaucoma or acute and chronic closed-angle glaucoma Used to achieve miosis during eye surgery Contraindicated in clients with retinal detachment, adhesions between the iris and lens, or in inflammatory diseases

MIOTICS SIDE EFFECTS Myopia Headache Eye pain Decreased vision in poor light Local irritation

MIOTICS SYSTEMIC EFFECTS Flushing Diaphoresis GI upset and diarrhea Frequent urination Increased salivation Muscle weakness Respiratory difficulty

MIOTICS TOXICITY Vertigo and syncope Bradycardia Hypotension Cardiac dysrhythmias Tremors Seizures

MIOTICS IMPLEMENTATION Assess vital signs Assess for risk of injury Assess the client for the degree of diminished vision Monitor for side effects and toxic effects Monitor for postural hypotension and instruct the client to change positions slowly

MIOTICS IMPLEMENTATION Assess breath sounds for rales and rhonchi because miotic cholinergic medications can cause bronchospasms and increased bronchial secretions Maintain oral hygiene because of the increase in salivation Have atropine sulfate available as an antidote for pilocarpine Instruct the client or family regarding the correct administration of eye medications

MIOTICS IMPLEMENTATION Instruct the client not to stop the medication suddenly Instruct the client to avoid activities such as driving while vision is impaired Instruct clients with glaucoma to read labels on over-the-counter medications and to avoid atropine-like medications because atropine will increase intraocular pressure

OCUSERT SYSTEM DESCRIPTION Ocusert is a thin eye wafer (disk) impregnated with time-release pilocarpine It is placed in the upper or lower cul-de-sac of the eye The pilocarpine is released over 1 week The disk is replaced every 7 days Drawbacks of its use include sudden leakage of pilocarpine, migration of the system over the cornea, and unnoticed loss of the system

OCUSERT SYSTEM From Jeglleon El. Ocular Therapeutics. Nursing Clinic of North America 16 (3): 456, 1981.

OCUSERT SYSTEM IMPLEMENTATION Assess the client’s ability to insert the medication disk Store the medication in the refrigerator Instruct the client to discard damaged or contaminated disks

OCUSERT SYSTEM IMPLEMENTATION Inform the client that temporary stinging is expected but to notify the physician if blurred vision or brow pain occurs Instruct the client to check for the presence of the disk in the conjunctival sac daily at bedtime and upon arising Since vision may change in the first few hours after the eye system is inserted, instruct the client to replace the disk at bedtime

BETA-ADRENERGIC BLOCKING EYE MEDICATIONS DESCRIPTION Reduce intraocular pressure Used to treat chronic open-angle glaucoma Contraindicated in the client with asthma because systemic absorption can cause increased airway resistance Used with caution in the client receiving oral beta-blockers

BETA-ADRENERGIC BLOCKING EYE MEDICATIONS SIDE EFFECTS Ocular irritation Visual disturbances Bradycardia Hypotension Bronchospasm

BETA-ADRENERGIC BLOCKING EYE MEDICATIONS IMPLEMENTATION Monitor vital signs, especially blood pressure and pulse before administering medication If the pulse is 60 or below or if the systolic blood pressure is below 90 mm Hg (adult), withhold the medication and contact the physician Monitor for shortness of breath Assess for risk of injury

BETA-ADRENERGIC BLOCKING EYE MEDICATIONS IMPLEMENTATION Monitor I&O Instruct the client to notify the physician if shortness of breath occurs Instruct the client not to discontinue the medication abruptly Instruct the client to change positions slowly to avoid orthostatic hypotension Instruct the client to avoid hazardous activities Instruct the client to avoid over-the-counter medications without the physician’s approval

CARBONIC ANHYDRASE INHIBITORS DESCRIPTION Interfere with the production of carbonic acid, which leads to decreased aqueous humor formation and decreased intraocular pressure Used for long-term treatment of open-angle glaucoma Contraindicated in the client allergic to sulfonamides

CARBONIC ANHYDRASE INHIBITORS SIDE EFFECTS Appetite loss and gastrointestinal upset Paresthesias in the fingers, toes, and face Polyuria Hypokalemia Renal calculi Photosensitivity Lethargy and drowsiness Depression

CARBONIC ANHYDRASE INHIBITORS IMPLEMENTATION Monitor vital signs Assess visual acuity and the risk of injury Monitor I&O and weight Maintain oral hygiene and increase fluid intake unless contraindicated Monitor electrolytes for hypokalemia

CARBONIC ANHYDRASE INHIBITORS IMPLEMENTATION Advise the client to avoid prolonged exposure to sunlight Encourage the use of artificial tears for dry eyes Instruct the client not to discontinue the medication abruptly Instruct the client to avoid hazardous activities while vision is impaired

OSMOTIC MEDICATIONS DESCRIPTION Lower intraocular pressure Used in emergency treatment of acute closed-angle glaucoma Used preoperatively and postoperatively to decrease vitreous humor volume

OSMOTIC MEDICATIONS SIDE EFFECTS Headache Nausea, vomiting, diarrhea Disorientation Electrolyte imbalances

OSMOTIC MEDICATIONS IMPLEMENTATION Assess vital signs Assess visual acuity and the risk of injury Monitor I&O and weight Monitor for electrolyte imbalances Increase fluid intake unless contraindicated Monitor for changes in level of orientation

OTIC MEDICATION ADMINISTRATION ADMINISTERING DROPS In an adult, pull the pinna up and back to straighten the external canal to instill ear drops Pull the pinna down and back for infants and children younger than 3 years of age; up and back for older children

OTIC MEDICATION ADMINISTRATION IRRIGATION OF THE EAR Irrigation of the ear needs to be prescribed by the physician Ensure that there is direct visualization of the tympanic membrane Warm irrigating solution to 100° F because solutions that are not close to the client’s body temperature will cause ear injury, nausea, and vertigo

OTIC MEDICATION ADMINISTRATION IRRIGATION OF THE EAR Irrigation must be done gently to avoid damage to the eardrum When irrigating, do not direct irrigation solution directly toward the eardrum If a perforation of the eardrum is suspected, irrigation is not done

ANTIINFECTIVE EAR MEDICATIONS DESCRIPTION Kill or inhibit the growth of bacteria Used for otitis media or otitis externa Contraindicated if a prior hypersensitivity exists SIDE EFFECT Overgrowth of nonsusceptible organisms

ANTIINFECTIVE EAR MEDICATIONS IMPLEMENTATION Monitor vital signs Assess for allergies Assess for ear pain Monitor for nephrotoxicity Instruct the client to report dizziness, fatigue, fever, or sore throat, which may be indicative of a superimposed infection Instruct the client to complete the entire course of the medication Instruct the client to keep ear canals dry

ANTIHISTAMINES AND DECONGESTANTS DESCRIPTION Produce vasoconstriction Stimulate the receptors of the respiratory mucosa Reduce respiratory tissue hyperemia and edema to open obstructed eustachian tubes Used for acute otitis media

ANTIHISTAMINES AND DECONGESTANTS SIDE EFFECTS Drowsiness Blurred vision Dry mucous membranes

ANTIHISTAMINES AND DECONGESTANTS IMPLEMENTATION Inform the client that drowsiness, blurred vision, and a dry mouth may occur Instruct the client to increase fluid intake unless contraindicated and to suck on hard candy to alleviate a dry mouth Instruct the client to avoid hazardous activities if drowsiness occurs

LOCAL EAR ANESTHETICS DESCRIPTION Block nerve conduction at or near the application site to control pain Used for pain associated with ear infections SIDE EFFECTS Allergic reaction Irritation IMPLEMENTATION Monitor for effectiveness if used for pain relief Assess for irritation or allergic reaction

CERUMINOLYTIC MEDICATIONS DESCRIPTION Emulsify and loosen cerumen deposits Used to loosen and remove impacted wax from the ear canal SIDE EFFECTS Irritation Redness or swelling of the ear canal

CERUMINOLYTIC MEDICATIONS IMPLEMENTATION Instruct the client not to use drops more often than prescribed Moisten a cotton plug with medication before insertion Keep the container tightly closed and away from moisture Avoid touching the ear with the dropper

CERUMINOLYTIC MEDICATIONS IMPLEMENTATION Thirty minutes after instillation, gently irrigate the ear as prescribed with warm water using a soft rubber bulb ear syringe Irrigation may be done with hydrogen peroxide solution as prescribed, to flush cerumen deposits out of the ear canal For a chronic cerumen impaction, 1 to 2 drops of mineral oil will soften the wax Instruct the client to notify physician if redness, pain, or swelling persists