Week 5 Eyes and Ears Flashcards
Opthalmic Anti-infectives Pharmacodynamics
Bacteriostatic or bactericidal
Ophthalmic Anti-infectives Phamacokinetics
•Generally penetrate only the
ocular fluid and tissues
•Minimal systemic absorption
Ophthalmic Anti-infectives Precautions and Contraindications
Hypersensitivity
Ophthalmic Anti-infectives ADR
Local infections
Superinfection with prolonged use
Ophthalmic Anti-infectives ADR - Bacitracin
may caused blurred vision
Ophthalmic Anti-infectives ADR - Sulfacetamide opthamic preperations
may cause a hypersensitivity reaction in
patients who have previously exhibited
sensitivity to sulfonamides
Ophthalmic Anti-infectives ADR - Aminoglycosides
may cause localizeed ocular toxicity
Ophthalmic Anti-infectives ADR - Fluoroquinolones
may cause a white christalline precipitate to form in the superficial portion of the cornea
Sulfacetamide ophtamic preparations are incompatiable with
silver preperations
Ophthalmic Anti-infectives: Patient
Education
Administration
Instruct on preventing contamination
Instruct on how to instill drops or ointment
• ADRs
Lifestyle management Handwashing No sharing of towels Avoiding use of eye makeup. Clearing purulent discharge with wet cotton ball or washcloth.
Glaucoma
Gradual loss of peripheral vision • Increased intraocular pressure • Leading cause of preventable blindness • Treated by ophthalmologist
Antiglaucoma Agents
Pharmacology • Beta blockers, adrenergic agonists • Miotics • Carbonic anhydrase inhibitors • Sympathomimetics • Prostaglandin agonist: latanoprost (xalatan) • Rho kinase inhibitor (metarsudil)
Mast cell stabilizers - use
conjunctivitis
mast cell stabilizes decrease
Limit hypersensitivity reactions
by inhibiting the degranulation of
sensitized mast cells.
mast cell stabilizer examples
•iodoxamide (Alomide), cromolyn
sodium (Crolom)
•Vernal conjunctivitis
Ocular anihistamines decrease what and are used to treat what
puritis
conjunctivitis
Ocular antihistamines work by blocking
H1 receptors
Ocular mast cell stabilizer and antihistamine side effects
Transient burning and stinging
Ocular antihistamine examples
•levocabastine (Livostin), antazoline (Vasocon-A, Antazoline-V), ketotifen (Zaditor), pheniramine (Naphcon-A), emedastine (Emadine) •Allergic conjunctivitis
Ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) work by inhibiting
prostaglandin biosynthesis
Ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) pharmacodynamics
- Analgesic, antipyretic, and anti-inflammatory activities
* Exert an anti-inflammatory effect
Ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) examples
Flurbiprofen (Ocufen), suprofen (Profenal), diclofenac (Voltaren
ophthalmic solution), nepafenac (Nevanac), ketorolac (Acular)
Corticosteroid ophthalmic agents have a
antiinfmalatory effect. Mechanism unknown.
Corticosteroid ophthalmic agents can
increase intraocular pressure
Ophthalmic Anti-inflammatory Drugs
Ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) and Corticosteroid ophthalmic agents
Ophthalmic Anti-inflammatory Drugs precautions and contraindications
Referral to an ophthalmologist is warranted for patients who appear to
need corticosteroid therapy.
Ophthalmic Anti-inflammatory Drugs adr
Eye discomfort or tearing may occur
Ocular H1 histamine blockers may cause headache.
Ocular Lubricants
tear like lubricants - artificial tears
ocular lubricants pharmacodynamics
Maintain ocular tonicity, buffers, and preservatives
Ocular lubricants clinical use and dosing
Dry eye
• Irritation
• Instilled 3 or 4 times/day
Ophthalmic Vasoconstrictors used for
Relief of redness caused by minor eye irratants
Ophthalmic Vasoconstrictors pharmacodynamics
sympathomimetic agents
Ophthalmic Vasoconstrictors precautions and contraindications
hypersensitivity, narrow angle glaucoma
Ophthalmic Vasoconstrictors ADR
Transient stinging and burning, temporary blurred vision, increased
intraocular pressure (IOP), rebound congestion or redness
developing with frequent or extended use
Ophthalmic Vasoconstrictors Drug interactions
Oxymetazoline or tetrahydrozoline: no interactions
• Naphazoline: tricyclic antidepressants, maprotiline
• Monoamine oxidase inhibitors
• Beta blockers
Ophthalmic Vasoconstrictors clinical use
Relief of eye redness caused by irritation or allergic conjunctivitis
• Tetrahydrozoline, oxymetazoline, naphazoline, and phenylephrine
• Patient education: avoid prolonged or excessive use
External otitis
Inflammation of the outer ear
Otitis Media and treatment
Inflammation of the inner ear
• Systemic antibiotics – such as amoxicillin
Mastoiditis and treatment
Inflammation of the mastoid sinus
• Aggressive antibiotic therapy
Cerumen impaction treatment
Earwax softeners
Otic Anti-infectives
Uses
Acute otitis externa (swimmer’s ear), chronic otitis externa,
malignant OE, prevention of swimmer’s ear
Otic Anti-infectives Pharmacodynamics
Combination products with corticosteroid and antibiotic
Hydrocortisone reduces the inflammation caused by OE.
Acid or alcohol drops
Otitis externa
painful irritation of the external auditory canal
Otic Anti-infectives Precautions and contraindications
Perforated tympanic membrane (TM)
May cause superinfection
Acid or alcohol drops
decrease inflamation adn are also antifungal and antibacterial
Malignant Otitis externa
rare, but leathal infection that invades surrounding tissues and can cause osteomyltis at the base of the skull and menigintis. Treated with antibiotics and surgical debredment.
Prevent swimmers ear
alchohol
Topical anesthetics Topical
used in the ear to treat pain
associated with otitis media.
Otic Analgesics - Local Anesthetics
antipyrine and benzocaine
(Aurpdex)
-provide pain relief
Cerumenolytics -
Carbamide peroxide (Debrox,
Dent’s Ear Wax, Murine Ear Wax
Removal)
-softens and emulsifies the wax
Otic Analgesics
make sure tympanic membrane is intact
