1. Drugs for Eye and Ear Disorders
Chapter 49
Drugs for
Eye and Ear Disorders
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2. Anatomy of the Eye
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3. Drugs for Eye Disorders
Diagnostic stains
Topical anesthetics 
Antiinfectives
Antiinflammatories
Decongestants
Lubricants
Immunosuppressants
Antiglaucoma agents
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4. Diagnostic Stains 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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5. Topical Anesthetics 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 self-administered by the patient.
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6. Antiinfectives Frequently used for eye infections
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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7. Antiinflammatories 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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8. Decongestants
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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9. Lubricants
Replace tears to alleviate discomfort associated with eye dryness
Isopto Tears, Tearisol, Ultra Tears, Tears Naturale, Tears Plus, Lens Mate, and Lacri-Lube
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10. Immunosuppressants
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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11. Antiglaucoma Agents Prostaglandin analogues
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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12. Prostaglandin Analogues
Side effects
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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13. Cholinergic Agents
Miosis: Constriction of the pupil and contraction of the ciliary muscle
Cholinergic agonists: direct-acting cholinergics
Pilocarpine (Isopto Carpine)
Cholinesterase inhibitors: indirect-acting cholinergics
Echothiophate (Phospholine Iodide)
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14. Beta-Adrenergic Blockers
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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15. Beta-Adrenergic Blockers (cont.)
Side effects
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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16. Alpha-Adrenergic Agonists
Decrease IOP by decreasing production and improving outflow of aqueous humor
Apraclonidine (Iopidine), brimonidine (Alphagan), epinephrine, and dipivefrin (Propine)
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17. Alpha-Adrenergic Agonists (cont.)
Side effects
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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18. Carbonic Anhydrase Inhibitors
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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19. Carbonic Anhydrase Inhibitors (cont.)
Side effects
Systemic forms
Lethargy, drowsiness, headache, seizures, paresthesias, 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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20. Osmotics
Used preoperatively and postoperatively to decrease vitreous humor volume, reducing IOP
Emergency treatment of acute closed-angle glaucoma
Side effects
Headache, nausea, vomiting, and diarrhea
Mannitol and urea may cause disorientation resulting from electrolyte imbalances especially in older adults.
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21. Nursing Process: Anti-Glaucoma Drugs
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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22. Anticholinergic Mydriatics and Cycloplegics
Mydriatics: dilate the pupils
Cycloplegics: paralyze the muscles of accommodation
Used in diagnostic procedures and ophthalmic surgery
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23. Anticholinergic Mydriatics and Cycloplegics (cont.)
Side effects
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
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24. Drugs for Macular Degeneration
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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25. Administration of Eyedrops and Eye Ointments
Refer to Chapter 13.
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26. Anatomy of the Ear
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27. Drugs for Ear Disorders
Antiinfectives
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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28. Antiinfectives Side effects Burning or stinging
Aminoglycosides: Ototoxicity
Chloroamphenical: Bone marrow suppression
Opportunistic overgrowth of nonsusceptible organisms
Hypersensitivity
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29. Nursing Process: Topical Antiinfectives for Ear Conditions
Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation
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30. Antihistamines and Decongestants
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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31. Ceruminolytics
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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32. Administration of Eardrops
Refer to Chapter 13.
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33. 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?
Garlic
St. John’s wort
Goldenseal
Valerian
Answer: C
Rationale: Bitter orange, blood root, celandine, coffee, corkwood, ephedra, goldenseal, and
Jimsonweed should be avoided in patients with glaucoma.
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34. 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.)
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.
Answer: A, C
Rationale: The child should sit up with head tilted slightly toward unaffected side. This position straightens the external ear canal for better visualization. The nurse or parent should pull down and back on the auricle for a child younger than 3 years of age.
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35. Practice Question #3 Pilocarpine has which action on the eye? Miosis
Mydriasis
Ciliary muscle paralysis
Pupillary dilation
Answer: A
Rationale: Pilocarpine produces miosis (contraction of the pupil) and decreases IOP.
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36. Practice Question #4
Which is the most common side effect/adverse reaction associated with prostaglandin analogues for the treatment of glaucoma?
Hypokalemia
Renal calculi
Ocular hyperemia
Postural hypotension
Answer: C
Rationale: Hypokalemia and renal calculi are associated with the use of carbonic anhydrase inhibitors. Postural hypotension is associated with miotic therapy.
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37. 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
refraining from any submersion in water.
continuing antibiotic therapy through the summer season.
taking high-dose vitamin C.
using custom-fitted ear plugs.
Answer: D
Rationale: If the patient is prone to OE after swimming or showers, the nurse should advise the patient to keep water out of ears by using custom-fitted ear plugs and to use a portable hair dryer to facilitate drying. If water enters the ear, the patient can tilt the ear downward to allow water to drain out or pull the ear in different directions to enhance water drainage.
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