Administering Medications

1. Administering Medications Chapter 8 Drugs for the Eye and Ear

2. Learning OutcomesAfter studying this chapter, you should be able to • Describe the major disorders of the eye and ear • Describe how medications are usually administered to the eyes and ears. • Recognize the types or classes of medications that treat disorders of the eye and ear, and briefly explain their therapeutic effect and how they work • Discuss why antibiotics are useful in childhood ear infections, and why they are not always prescribed

3. The Eye

4. Disorders of the Eye • Glaucoma • Cataracts • Eye Infections • Removal of Objects in the Eye • Eye Allergies • Eye exams (not a disorder, but drugs used…)

5. Glaucoma • Caused by increased intraocular pressure • This is because the fluid that is in the eye (aqueous humor) builds up too high. It’s either made in excess, or can’t escape as it should. • The increased pressure damages the optic nerve and vision. • Leads to blindness if untreated

6. For a patient with glaucoma, this is how their vision is affected.

7. Glaucoma Drugs • Drug therapy for treating glaucoma decreases intraocular pressure and reduces damage to the optic nerve by: • increasing aqueous humor outflow • miotics • decreasing aqueous humor production • carbonic anhydrase inhibitors • beta-adrenergic blocking agents • Glaucoma drugs are usually gels, ointments, drops, etc. used for local effect. • If patient takes drops and ointments, drops should be applied first.

8. Cataracts • An opacity that appears within the crystalline lens and may affect one or both eyes • Treatment of choice is surgery although before the surgery, patients can take eye drop medicines to dilate the pupil and help them see better. • mydriatics • cycloplegic agents

9. Cataract Surgery Post-operative Care • Postoperatively, topical antibiotics and anti-inflammatory drugs are used. • These drugs are often eye drops, and can prevent complications (infection, swelling, etc.)

10. Eye Infections • Conjunctivitis—bacterial, viral or chlamydial infection of the conjunctiva • Blepharitis—bacterial infection of the eyelids • Hordeolum—a “sty,” infection of the sebaceous glands (blocked sebaceous duct) • Drugs for infection • tobramycin (Tobrex) • Polymyxin B, bacitracin, neomycin (Neosporin Ophthalmic) Usually drops or ointments

11. Blepharitis—infection of eyelids Conjunctivitis—infection of conjunctiva (whites of the eyes) Hordeolum—blocked sebaceous duct on eyelid

12. Removal of Objects in the Eye • Local anesthesia needed to facilitate removal of the object • Drugs to remove objects • Topical anesthesia—drops or ointments—are most common. Sometimes, an injection of local anesthesia to numb the entire area around the eye is needed. • Often the “-caine” medications (e.g. lidocaine, proparacaine, etc.). It is essential that the preparation is preservative free and labeled “sterile, for ophthalmic use.”

13. Eye Allergies • Eyedrops or gels can relieve symptoms • Antihistamines—alleviate redness and swelling, relatively fast acting • epinastine hydrochloride (Elestat) • Mast cell stabilizers—alleviate redness and swelling, longer lasting than anti-histamines • olopatadine (Patanol) • Decongestants—clear up redness by vasoconstriction • tetrahydrozoline (Visine) • NSAIDs—relieve itching and inflammation • ketorolac tromethamine (Acular) NSAID = non-steroidal anti-inflammatory agent

14. Eye Exams • Eye exams require dilatation of the pupil • Mydriatics are used for this • Given in form of eyedrops

15. The Ear

16. Disorders of the Ear • External Otitis • Cerumen • Childhood Ear Infections

17. Ear Drops • Note that many ear medications are given in the form of drops • These should be administered at room temperature (not cold) to avoid dizziness and for comfort of the patient • To prevent contamination of the contents of the bottle, avoid touching the tip of the dropper to the auricle

18. External Otitis • Inflammation of outer ear; often called “swimmer’s ear” caused by bacteria or fungus • Drug therapy is in form of drops • Topical antibiotics for bacteria • polymyxin B, colistin, neomycin (Cortisporin Otic) • Chloramphenicol (Chloromycetin Otic) • Antifungals like nystatin for fungal infections

19. Cerumen • As people age, ear wax becomes drier, harder, and can’t be easily removed. • Treatment: • irrigation of ear canal • lubricating drops in ear canal to soften ear wax for removal

20. What About Childhood Ear Infections? • Often in children, viral colds can cause bacterial ear infections • Cold virus causes the nasal passages and mucous membranes to swell • Natural bacteria in nose could travel up through child’s immature Eustachian tube into middle ear space and grow there—bacterial infection • BUT, it could be that the pain is just from trapped fluid in the middle ear, with no bacterial growth at all

21. What About Childhood Ear Infections? • New research is suggesting that 80% of uncomplicated ear infections will resolve within 4 to 7 days without antibiotics. • If ear pain is from uninfected fluid build-up, antibiotics wouldn’t help at all. • But if bacterial infection is present, antibiotics would help (but it may have cleared up on its own, too). • If antibiotics are only prescribed when necessary, potential for antibiotic resistance can be minimized.

22. Personal Experience… • In the past few months, my (Melinda, not Ann) kids have both had mild ear infections. • Both children were prescribed antibiotics. • What could have been done to determine if antibiotics were really needed? • A “culture and sensitivity test” could have been done to see if bacteria were present, and what antibiotic would work best.