Chapter 5: Eye and Ear Disorders Flashcards
typical disorders of the ear canal
otitis media
otitis externa
inflammatory conditions
cerumen impaction
Class of drug used to treat ear inflammation
corticosteroids
class of drugs used in treatment of ear pain
topical antipyrine and benzocaine
drug classes used to treat cerumen impaction
emulsifiers and emolients
agents used in treatment of pruritis of the ear
emolients such as: glycerin, mineral oil, and olive oil
Is substitution of ototopical antibiotics reccommended?
Why or why not?
No because different preparations can differ in pH, viscosity, and presence of steroids
Advantage of ototopical cipro
better activity against gram- bacilli
advantage of ototopical ofloxacin
longer half-life and higher serum levels
appropriate for aerobic gram-bacilli (staph, strep)
What ABT would you use for urethritis if you suspected Chlamydia was present?
ofloxacin
what is an acceptable substitution for a solution of ofloxacin and why
a suspension of ciprofloxacin
has low pH and high viscosity
same chemical classification
drug therapy for otitis externa
analgesic and antibiotic
otic anti-infectives:
mild acids and alcohols
make the environment inhospitable for pathogens to reproduce
causes drying of cellular infective agents
topical, antibacterial, and antifungal effects
otic anti-infectives:
Fluoroquinolones
broad coverage and affect psudomonas species
otic anti-infectives:
corticosteroids
aid in reducing inflammation and patient symptoms
gives better access for topical medicines
Implications of OTC neomycin topical antibiotics
associated with severe ototoxicity (especially with perforated tympanic membrane)
can cause contact dermatitis
mechanism of action:
topical otic anti-infectives
work as either bacteriostatic or bacteriacidal
Are topical anti-infectives absorbed
Not unless skin is broken
rest of pharmicokinetics is unknown
Examples of otic anti-infectives
Ofloxacin (Floxin)
Neomycin (Myciguent)
Ciprofloxacin-hydrocortisone (Cipro HC otic)
Dosage/administration for topical otic anti-infectives
preparations with and without steroids
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Proper installation of ear drops
Adults
pull ear lobe up and back
poper installation of ear drops
children
pull ear lobe down and back
clinical uses for otic acid-alcohol solutions
superficial infections of external auditory canal
examples of otic acid-alcohols
acetic acid/aluminum acetate (Domeboro Otic)
isopropyl alcohol/propylene glycol (Ear Sol)
Antipyrine
otic analgesic
also has anti-inflammatory effects because it affects prostaglandin system
Benzocaine
otic analgesic
blocks nerve sodium channels
What if otitis externa does not clear after 1 week of treatment
obtain cultures to guide further treatment
What should you do if a patient has 2 or more ear infections in a 6 month period
further eval for cholesysteatoma, foreign body, or tumor
Analgesics that can cause ototoxicity
ASA and NSAIDs
antibiotics that can cause ototoxicity
Aminoglycosides
clarithromycin
erythromycin
vancomycin
neomycin
antineoplastics that can cause ototoxicity
cisplatin
mechlorethamine
Loop diuretics that can cause ototoxicity
bumetanide
ethacrynic acid
furosemide
dosage/administration of acid-alcohol solutions
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two combination otic analgesics commonly used today
acetic acid and benzocaine/antipyrine/glycerin (Auralgan Otic)
benzocaine/antipyrine/propylen glycol (Tympagesic)
dosage/administration of otic analgesics
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purpose of cerumenolytics
soften and remove ear wax
classifications of cerumenolytics
water based
oil based
nonwater/nonoil based
examples of cerumenolytics
carbamide peroxide 6.5% (Debrox)
triethanolamine polypeptide oleate (Cerumenex drops)
what is used for “swimmer’s ear”
isopropyl alcohol and glycerin
What happens if triethanolamine polypeptide drops are left in the ear longer than 30 minutes
inflammation occurs
cerumenolytics:
patient education
may hear bubling with Debrox d/t action of releasing O2 from cerumen
using carbamide peroxide longer than 4 days can damage tympanic membrane
common eye infections
conjunctivitis
blepharitis
hordeolum
What should be monitored when patient
is being treated for eye disorder
effectiveness of treatment
intraocular pressure
consideration for infants and children being treated for eye disorders
erythromycin ointment has good coverage and is easier to administer than drops
classes of opthalmic anesthetics
tetracaine (Pontocaine)
proparacaine (Ophthaine, Ophthetic)
What can result from improper use of opthalmic anesthetics
deep corneal infiltrates
ulceration
perforation
mechanism of action:
opthalmic anesthetics
agents penetrate to sensory nerve endings in corneal tissue
(tetracaine, proparacaine)
locally stabilize and block initiation and conduction of nerve impulses by decreasing neuronal membrane’s sensitivity to sodium ions
doasge/administration of opthalmic anesthetics
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acute conjunctivitis is usually caused by
virus
(pink eye)
how can you recognized hepres infections of the eyes
severity
vesicular nature
corneal involvement or nerve distribution
patient population
cases to refer to opthalmologist
herpes infections of the eyes
deeper infection of the globe or eye socket is suspected
what do contact lenses place at risk for
fungal infections
treatment of allergic conjunctivitis
antihistamines
NSAIDs
leukotriene inhibitors
corticosteroids
best way to treat viral eye infections
saline drops
warm compresses
and time
most common organisms that cause bacterial conjunctivitis
staphylococcus aureus
streptococcus pneumoniae
haemophilus influenzae
opthalmic anti-infectives mechanism of action
bacteriostatic or bacteriocidal
most commonly used opthalmic anti-infectives
tobramycin (Tobrex)
sulfacetamide (Sulamyd, Bleph-10)
sulfacetamide/prednisolone (Blephamide)
fluoroquinolones (Cipro drops)
opthalmic anti-infectives
contraindications
tobramycin should not be used if systemic aminoglycosides are being used because it could affect serum levels and lead to toxicity
Which opthalmic anti-infective may cause transient blurry vision
bacitracin
patent education :
sulfacetamide solution
when it turns dark it has lost its potency and should be discarded
opthalmic mast cell stabilizers mechanism of action
inhibit degranulation of mast cells after exposure to an antigen
clinical uses of mast cell stabilizers
allergic conjunctivitis and keratitis
examples of opthalmic mast cell stabilizers
Nedcromil (Alocril)
Cromolyn (Opticrom)
Lodoxamide (Alomide)
dosage/administration of mast cell stabilizers
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opthalmic antihistamines mechanism of action
blocks the effects of histamine released during allergic reactions and blunts its symptoms
clinical use of opthalmic antihistamines
relief of itching associated with seasonal allergies and allergic conjunctivitis
examples of opthalmic antihistamines
azelastine (Optivar)
epinastine (Elestat)
antazoline (Vasocon)
amedastine (Emadine)
ketotofen (Zaditor)
levocabastine (Livostin)
olopatadine (Patanol)
opthalmic antihistamines and contact lenses
dont wear while using them
wait 15 minutes before re-applying them
replace them if eye is red
opthalmic vasoconstrictors mechanism of action
weak sympathomimetic agents that constrict
blood vessels in conjunctiva
clinical use for opthalmic vasoconstrictors
relief of eye redness caused by irritants or allergies
opthalmin vasoconstrictors contraindications
narrow angle glaucoma
examples of opthalmic vasoconstricotrs
oxymetazoline (Afrin)
tetrahydrozine (Visine)
dosage/administration of opthalmic vasoconstrictors
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dosage/administration of opthalmic antihistamines
page 73
opthalmic vasoconstricotrs interactions
increased pressor effects with MAOIs
cyclosporin (Restasis)
polycyclic polypeptide that inhibits interleukin 2
clinical uses of Restasis
prevents organ rejection after transplant surgery
opthalmic preparation to prevent rejection of corneal implant
opthalmic lubricants actions
contain agents that provide hydration. maintain moisture, and protect eye
can be viscous or non-viscous
clincal uses of opthalmic lubricants
supplement natural tears for dry eyes or to wash away irritants
viscosity enhancers
(promotes increased contact time of an opthalmic agent with an ocular surface)
secondary corneal edema
Types of agents used to treat glaucoma
direct and indirect acting miotics
topical prostaglandin agonists
carbonic anhydrase inhibitors
sympathomimetic agents
alpha-2 adrenergic agonists
beta blockers
opthalmic osmotics
Miotics mechanism of action
contracts the iris sphincter muscle, resulting in miosis
(pupillary constriction)
Examples of direct acting miotics
carbachol (Isopto Carbachol)
examples of indirect-acting miotics
echothiophate (Phospholine)
How do miotics decrease intra-ocular pressure
- when the pupil constricts, it also constricts the ciliary muscles attached to the trabecular mesh work
- This opens the canal of Schlemm which increases the outflow of aqueous humor
- which decreases IOP
dosage/administration of miotics
page 77
clinical uses of miotics
glaucoma
Sjogren’s syndrome
Miotics adverse reactions
abdominal cramps, diarrhea, watery mouth, excessive sweating, urinary incontinence, muscle weakness
Miotics contraindications
active inflammation of the eye
Patient education on miotics
it will impair adjustment to changes in light
topical prostaglandin agonists mechanism of action
stabilized, synthetic analogues of prostaglandin that increase outflow of intraocular aqueous humor to lower IOP
(acts on RF prostaglandin receptor)
examples of topical prostaglandin agonsits
latanoprost(Xalatan)
bimatoprost (Lumigan)
travoprost (Travatan)
unoprostone (Recula)
clinical use of topical prostaglandin agonists
open-angle glaucoma
dosage/administration of topical prostaglandin agonists
page 78
absorption of topical prostaglandin agonists
- through cornea ad hydrolyzed into active compound:
- Latanoprost and bimatoprost
- not absorbed but active on the cornea:
- travoprost and unoprostone
distribution of topical prostaglandin agonists
- bimatoprost: 80% protein bound
- lataoprost: 4h in aqeous humor and 1 hour in plasma
- travoprost: 1 hour in plasma then rapidly eliminated
- unoprostone: not reported
metabolism of topical prostaglandin agonists
- latanoprost: hydrolyzed in liver
- bimatoprost: oxidated in liver
- travoprost and unoprostone: hydrolyzed by esterases in the cornea
excretion of topical prostaglandin agonists
- latanoprost and bimatoprost: urine
- travoprost and roprostone: urine (rapid and undetectable in an hour)
half-life of topical prostaglandin agonists
- latanoprost: 45 minutes
- bimatoprost: about 45 minutes
- travoprost: 45 minutes
- unoprostone: unreported
topical prostaglandin agonist adverse reactions
sensation of foreign body in the eye
permanent discoloration of iris with brown pigment
eyelash changes
conjunctival hyperuremia
topical prostaglandin agonist contraindications
pregnancy category C
not for children
pulmonary diseases
carbonic anhydrase inhibitors
(CAIs)
not first-line therapy
used as diuretics
topical CAIs
brinzolamide (Azopt)
dorzolamide (Trusopt)
oral CAIs
Diamox
Neptazane
page 78
CAI pharmacookinetics
page 78
CAI adverse reactions
- DERM: rash, alopecia, STEVENS-JOHNSON SYNDROME
- GI: anorexia, bitter or altered sense of tast with dorzolamide and brinzolamide
- GU: kidney stones
- HEME: blood dyscrasias, bone marrow supression
- META: metabolic acidosis
- MISC: weakness and myalgia, groin/leg pain, malaise, fatigue
- NEURO: depression, headache, nervousness, numbness/tingling
CAI interactions:
acetazolamide and methimazole
sulfa derivatives so interacts with salicylates, phenytoin, quinidine, and cyclosporine
contraindications to sympathomimetic agents
- hypersensitivities
- cerebrovascular insufficiencies
- cardiovascular disease
- DM
- hyperthyroidism
- parkinson’s
- HTN
interactions for alpha-2 agnosits
use with MAOIs can cause HTN crisis
most common agent to treat open-angle glaucoma
beta blocker eye drops
contraindications for opthalmic beta blockers
glaucoma who also have bradycardia, AV block, or HF
DM because it intereferes with glycolysis
hyperthyroidism
Raynaud’s or any other peripheral vascular disorder
Opthalmic osmotics mechanism of action
makes osmotic pressure of glomerular filtrate hypertonic allowing water and electrolytes to be passively pulled out of cellular and interstitial spaces
excess fluid is excreted in urine
clinical use for opthalmic osmotics
interupt acute attack og glaucoma or hypertensive crisis
extremely high IOP
cerebral edema
example of opthalmic osmotic
mannitol
Mannitol adverse reactions
- EENT: blurry vision, rhinitis
- CV: transient volume expansion, chest pain, edema, tachycardia
- GI: N/V, thirst
- GU: renal failure
- META: dehydration, hyperkalemia, hypernatremia, hypokalemia, hyponatremia
- MISC: phlebitis at injection site
- NEURO: confusion, headache
Mannitol interactions
hypokaleia can potentiate digoxin toxicity
Mannitol contraindications
cardiac impairement, sever liver dysfunction, dehydration, intracranial bleeding, kidney impairement
administration of mannitol
infuse over 30 minutes to reduce IOP
pupillary constricters mechanism of action
paralyze accomodation reflex (cytoplegia)
used for eye exams (to examine retina)
contraindication for pupillary constrictors and why
closed-angel glaucoma
iris dilation occludes outflow of aqueous humor and increases IOP
examples of pupillary constrictors
cyclopentolate (Cyclogyl)
tropicamide (Mydral)
pregnancy, geriatric, and pediatric considerations
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