pharm eyes and ears Flashcards
uvea
Choroid, iris, ciliary body = uvea
Mydriatics (apraclonidine) (my big app and pupil)
Dilate the pupil
Miotics (acetylcholine, pilocarpine)
Constrict the pupil
Cycloplegics (atropine, cyclopentolate) (cyclyopse is paralyzed)
Paralyze the ciliary body (so we can look inside the eye)
Have mydriatic (dilation) properties
Cycloplegia: paralysis of accommodation
Cholinergic Drugs cause
pupil constriction (miosis)
sympathomimetics
reduces the rate of aqueous humor production
sympathomimetics - adverse rare (think sympathetic)
Hypertension Tachycardia Extrasystoles Headache Faintness
Ocular Antibacterial Drugs
erythromycin, azithromycin
NSAIDs ex. (NSAIDs are my bro)
bromfenac (xibrom)
topical opthalmic anesthetics - long or short term use?
short-term use only
Glaucoma (eye aquarium)
Inhibition of the normal flow and drainage of aqueous humor
types of glaucoma (this is a dangerous angle)
Angle-closure glaucoma (medical emergency)
Open-angle glaucoma
Angle-closure glaucoma helps with (cross the angle)
cross eyes
sympathomimetics open or close pupil? (fight or flight)
Stimulate the dilator muscle to contract Result is increased pupil size (mydriasis)
sympathomemtics - Stimulate the dilator muscle to contract Result is increased pupil size (mydriasis) selective and non-selective - use caution with (sympathy for the beta is no good)
pts who are already taking beta blockers
beta blockers - do what? (alpha and beta part the seas)
reduce IOP (intraocular pressure) by reducing aquous humor formation and increasing aqeuous humor outflow
beta blockers - side effects (betas burn the COPD’ers)
burning, blurred vision, pain, photophobia, LIMITED - bronchospasm - be careful with ashtma pts.
carbonic anhydrase (ana reduces water)
reduces aqueous humor formation in the eye. treats both types of glaucoma.
osmotic diuretics
Create ocular hypotension by producing an osmotic gradient
Water is forced from the aqueous
osmotic diuretics - Glycerin (glycerin is sugar, so diabetics beware)
Glycerin usually tried first. Can cause hyperglycemia - careful w/ diabetics
Prostaglandin Agonists last how long? (prostie just once a day)
Most drugs allow for single daily dosing because effects last 20 to 24 hours - advantage over other drugs
Which antiglaucoma drug works by increasing the outflow of aqueous humor between the uvea and sclera as well as via the usual exit through the trabecular meshwork? (prostie uvea)
Prostaglandins
Prostaglandins do what? (latisse is a prostie)
change eye color
Macrolides for eye infections - ex. (glide in myocins)
erythromycin, azithromycin
erythromycin (eerie gonhorrhea)
used for prevention of Neisseria
gonorrhoeae eye infections in newborns or neonatal conjunctivitis caused by Chlamydia trachomatis
antibacterial - Polypeptides (bac to poly)
bacitracin (AK-Tracin), polymyxin B
red glass eye (red fungus)
fungal infection
viral eye infections - easy or hard to treat?
most difficult to treat. may need implant in eye. CMV.
NSAIDs
bromfenac (Xibrom)
steroids do what? (no scars for roids)
quickly. only use short term. they will prevent scarring.
Which statement about use of corticosteroids for ocular inflammation does the nurse identify as being true? (a cutie steroid)
They are used during the acute phase of the injury process to prevent fibrosis and scarring, which result in visual impairment.
Topical Ophthalmic Anesthetics - ex (caines for anesthetics)
Anesthetics are short term only! main ex. is tetracaine.
Ophthalmic Diagnostic Drugs
Cycloplegic mydratics - open pupil. Ophthalmic dye - to highlight part of eye.
Used for seasonal allergy symptoms
mast cell stablizers and Decongestants.
A patient receiving tetrahydrozoline asks how the drug works. The best response by the nurse will include that the drug works by (tetris constricts my eyes)
promoting vasoconstriction of blood vessels in and around the eye.
Ophthalmic Lubricants
cyclosporine) Restasis® - it’s an immunosuppressant and treats dry eye. It can be used together with artificial tears, if the drugs are given 15 minutes apart
if you give 2 different eye drops at the same time,
space out at least 15 min bc the eye can only absorb so much.
eye drop application
Apply ointments as a thin layer in the conjunctival sac - one corner to the other
When administering eyedrops to a patient, the nurse places the drop
into the lower conjunctival sac.
When applying eyedrops
have the patient look up to the ceiling, and place the drop in the conjunctival sac
Pressure may be applied to the inner canthus for at least 1 minute to reduce systemic absorption of the drug
If the patient wears contact lenses
check to see if they should be removed during therapy with eye medications
A 60-year-old male with a history of benign prostatic hypertrophy and hypertension is seen in the Emergency Department because he was trimming his shrubs and got something in his right eye. He complains of a pain rating of 8 on a scale of 1 to 10 in the right eye. Which medication does the nurse anticipate administering via eyedrop to help control the patient’s pain?
tetracaine
After administering an ophthalmic anesthetic drug, which adverse effects does the nurse anticipate as possibly developing in the patient? (Select all that apply.)
all can occur -
A. Stinging
B. Burning
C. Redness
D. Lacrimation
E. Blurred vision
The ophthamologist tells the patient that she is going to place a dye onto the patient’s eye to help identify the location of the foreign object. Which drug does the nurse anticipate the ophthamologist will use? (fluorescent dye)
fluorescein (AK-Fluor®)
A foreign particle is removed from the patient’s eye. He tells the nurse that he previously forgot to mention that he takes eyedrops for glaucoma. He can’t remember the name of the drug, but he knows the eyedrop bottle has a purple lid. The nurse identifies a purple lid as most likely containing which type of antiglaucoma drug? (purple rain has sympathy)
B. Sympathomimetics
A 2-year-old is seen in the pediatrician’s office with a bacterial middle ear infection. Which medication does the nurse anticipate being prescribed for the child?
amoxicillin
anti-fungal for middle ear (cortney is a fungus)
Cortic
When teaching an adult patient about eardrops, which statement will the nurse include?
Lie on the opposite side of that of your affected ear for about 5 minutes after instilling the drug
what can be used with a perforated eardrum? (flock of seagulls in my perforated ear)
Ciprofloxacin and ofloxacin can be used with perforated eardrums.
Warm eardrops to approximately
body temperature before instillation. cold can cause dizziness and vomiting.
While administering medications, the nurse finds a patient’s eardrops in the medication refrigerator. If the nurse gives the eardrops immediately, what response might the patient have?
A vestibular-type reaction
When administering eardrops to children younger than 3 year
Hold the pinna down and back
Gentle massage of the tragus area of the ear after administering eardrops results in
increased coverage of the medication in the ear canal.
cholinergic drugs - side effects
Most limited to local effects
If sufficient amounts enter the bloodstream, systemic effect may occur (most likely with indirect-acting)
Hypotension, bradycardia, or tachycardia
Headache, nausea, vomiting, diarrhea, abdominal
cramps, asthma attacks Others
Sympathomimetics: Indications (sympathy for open glaucoma)
Chronic, open-angle glaucoma (to reduce IOP) Reduction of perioperative IOP
Reduction of ocular hypertension
beta blockers (beta stops all humor)
Do not affect pupil size, accommodation, or night vision. Reducing aqueous humor formation Increasing aqueous humor outflow
beta blockers for
Reduction of elevated IOP Chronic open-angle glaucoma Ocular hypertension
Treatment of some forms of angle-closure glaucoma
Administration of systemic beta blockers with high doses of ophthalmic beta blockers may result
t in additive effects
Carbonic Anhydrase Inhibitors - ex (Ana dolamide)
brinzolamide (Azopt®) dorzolamide (Trusopt®)
Carbonic Anhydrase Inhibitors - oral forms side effects (Ana makes me drowsy)
Oral forms can produce systemic effects Drowsiness, confusion
Transient myopia, tinnitus
Anorexia, vomiting, diarrhea
Several others
prostaglandins - ex (it’s in the name)
latanoprost (Xalatan®) travoprost (Travatan-Z®) bimatoprost (Lumigan®)
prostaglandins - mechanism of action (prosties increase outflow)
Reduce IOP by increasing the outflow of aqueous fluid
Increase uveoscleral outflow of fluid
Used in the treatment of glaucoma
Most drugs allow for single daily dosing because of effects lasting for 20 to 24 hours
Use of ophthalmic antibiotics with corticosteroids may make it more
difficult to rid the eye of infection
Ocular Antiviral Drugs - adverse effects - (anti- viral ain’t anti-glaucoma)
trifluridine (Viroptic®,1% ophthalmic drops)
Used for ocular infections (keratitis and
keratoconjunctivitis) caused by types 1 and 2 of the
herpes simplex virus
Applied topically as drops
Significant adverse effects include secondary
glaucoma, corneal punctate defects, uveitis, and stromal edema (edema in the tough, fibrous, transparent portion of the cornea known as the stroma)
occular anti-inflammatory
Act on various parts of the arachidonic acid metabolic pathway
Reduce the production of various inflammatory mediators
As a result, pain, erythema, and other inflammatory processes are reduced
fluorescein (AK-Fluor®) - uses
Diagnostic dye used to identify corneal defects and to locate foreign objects in the eye
Used in fitting hard contact lenses
Various defects are highlighted in either bright greeen
or yellow-orange, and foreign objects have a green halo around them
external ear
Physical trauma
Dermatitis
middle ear
Otitis media
Otitis media: middle ear infection
Most often afflicts children and follows an upper
respiratory tract infection
In adults, usually results from foreign objects or water sports
cholenergic drugs - If sufficient amounts enter the bloodstream,
systemic effect may occur (most likely with indirect-acting)
cholergic = increases outflow, Sympathomimetics = Reduce the rate of aqueous humor production
IOP is reduced
beta blockers do both = Reducing aqueous humor formation
and Increasing aqueous humor outflow
beta blockers can treat
open glaucoma and some forms of closed glaucoma
ana treats both
open and closed glaucoma and Preoperatively to reduce intraocular pressure
Carbonic Anhydrase Inhibitors - adverse effects
Oral forms can produce systemic effects Drowsiness, confusion
Transient myopia, tinnitus
Anorexia, vomiting, diarrhea
Several others
osmotic diuretics - which is tried first?
Glycerin usually tried first. Mannitol used if glycerin is unsuccessful
osmotics used for what type of glaucoma?
acute, and
Before and after ocular surgery to reduce IOP
trifluridine (Viroptic®,1% ophthalmic drops)
Used for ocular infections (keratitis and
keratoconjunctivitis) caused by types 1 and 2 of the
herpes simplex virus
trifluridine (Viroptic®,1% ophthalmic drops) = adverse effects
Significant adverse effects include secondary
glaucoma, corneal punctate defects, uveitis, and stromal edema (edema in the tough, fibrous, transparent portion of the cornea known as the stroma)
NSAIDs - ocular anti-inflammatory
bromfenac (xibrom)
Pressure may be applied to the inner canthus for at least
1 minute to reduce systemic absorption of the drug
