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Pharm Eye and Ear
| Question | Answer |
|---|---|
| Spaces inside the eye Anterior cavity | Anterior chamber from the cornea to iris |
| Spaces inside the eye Posterior chamber | between the iris and the lens |
| Ciliary body produces | aqueous humor |
| Aqueous humor | helps to give shape to the eye and circulates nutrients and removes waste |
| Aqueous humor | flows through pupil into anterior chamber |
| Trabecular meshwork at edges of anterior chamber | canal of Schlemm connects with venous system |
| Production of aqueous humor is | normally in balance with outlfow of aqueous humor |
| Glaucoma is | blockage of outflow of aqueous humor; IOP above 21 mm Hg; Optic nerve destroyed over time |
| With Glaucoma you loose | peripheral visual field and central visual acuity |
| With Glaucoma you are somewhat blind, kinda blind or totally blind? | Totally blind |
| What is one of the leading causes of blindness? | Gluacoma |
| Primary glaucoma you have | impaired canal of Schlemm, no precipitating cause. |
| Can Glaucoma be genetic? | Yes |
| Can Glaucoma be congenital? | yes |
| When does Glaucoma occur? | In clients over 60 years of age |
| In Secondary glaucoma it is caused by | eye trauma or disease and certain medications |
| What type of trauam or disease can cause Secondary glaucoma? | Infection, hemorrhage, tumor and cataracts |
| In Secondary glaucome it is also caused by medications. What type of meds can cause this? | Topical glucocorticoids, Antihistamines, Antidepressants and some antihypertensives |
| What are some risk factors for Glaucoma? | HNT, Migraine HA, Nearsightedness, Farsightedness,normal aging |
| What is Tonometry? | Measures intraocular pressure |
| In glaucoma how do pressures build? | gradually |
| There are three "gradual" symptoms with glaucoma what are they? | Gradual destruction of optic nerve; gradual change in visual field; gradual increase in pressure |
| What is normal range of intraocular pressure? | 12-21 mm Hg |
| What are the two types of Glaucoma? | closed angle glaucoma and Open angle glaucoma |
| Closed angle glaucoma has two other names which are? | Acute glaucoma and Narrow angle glaucoma |
| Open angle glaucoma is | chronic, simple glaucoma and is 90% of the cases |
| closed angle glaucoma | has other names, Acute and Narrow; is the uncommon form of glaucoma and is unilateral (can occur in one eye) |
| In the two types of glaucoma, closed angle and open angle which one affects older adults and ppl of Asian descent? | Closed-angle glaucoma |
| What are the signs and symptoms of closed/narrow angle glaucoma? | Caused by sudden inc in IOP, stress, impact injury, medications and is an emergent situation |
| What are the signs and symptoms of closed/narrow angle glaucoma? | intense eye pain or HA, bloodshot eyes, blurred vision, bulging iris |
| What are the signs and symptoms of Open angle glaucoma? | iris does not cover the trabecular meshwork; is the most common type; usually bilateral; IOP increases slowly and often asymptomatic |
| What are the goals of Glaucoma? | improve circulation of aqueous humor; adjust the circulation of aqueous humor, improve aqueous humor outflow; medications or surgical alternatives |
| When do they use surgery in glaucoma? | Acute cases |
| What is the name of the surgical procedure performed? | Gonioplasty; Laser iridotomy; peripheral iridectomy |
| What is Gonioplasty? | Laser burns holes in periphery of iris, causing the iris to contract thus opening the angle |
| What is laser iridotomy? | Small hole in iris allows fluid to drain better |
| What is Peripheral iridectomy? | Section of iris is removed |
| What are the goals for open angle glaucoma? | Increase outflow of aqueous humor at the canal of Schlemm and decrease formation of aqueous humor of ciliary body |
| What are the administration alerts of the medication? | Remove contact lens before instillation and keep out for 15 min; Avoid touching the eye or eyelashes with any part of the dropper to avoid contamination; wait 5 min before instillation of additional eye drops |
| What are the groups of meds for glaucoma? | Cholinergic agonists, Sympathomimetics, Prostaglandins, Beta-adrenergic blockers, Alpha2 - adrenergic agonists, Carbonic anhydrase inhibitors, Osmotic diuretics |
| Acetylcholine (Ach) | Nicotinic receptor works on skeletal muscle; smooth muscle and glands |
| Acetylcholine (Ach) | Muscarinic receptor works on Smooth muscle, glands, decreases heart rate, decreases strength of heart contraction |
| What is the Physiology of acetylcholine | synthesized in the presynaptic neuron, then stored in vesicles; Acetylcholinesterase (AchE) destroys/erases Ach; agonist encourage something to happen |
| What do Miotics (cholinergic agonists) do? | Change the tradbecular meshwork to allow greater outflow of fluid which decreases IOP; |
| What are Miotics direct acting cholinergic agonists drugs? | carbochol (Isopto Carbachol) pilocarpine HCL (Isopto Carpine) |
| What does Miotics indirect-acting cholinergic agonist do? | inhibit cholinesterase activity demecarium bromide (Humorsol) |
| Side effects of Cholinergic agonists are | stinging, burning, eye pain; altered vision, HA; sweating, muscle weakness, v |
| When do they use these medications in glaucoma patients? (cholinergic agonists) | In open agnle glaucoma not responding to other drug therapies |
| What is the antidote for toxicity in choliergic agaonist? | pralidoxime chloride, (Z-PAM) |
| What effect will a cholinergic agonist have on the size of the pupil? | Miotic, constriction |
| Sympathomimetic drugs for glaucoma are | nonselective and activate the sympathetic nervous system (fight or flight) |
| Prototype drug is? | dipivefrin (Propine) |
| dipivefrin (Propine)does? | converts to epinephrine in the eye; produces dilation of the eye (mydriasis); inc outflow of aqueous humor; reduces IOP |
| if epinephrine reaches system circulation what also happens? | increases blood pressure and pressure |
| Prostaglandin-inhibiting agents actions are? | decreasing aqueous humor production and increase outflow |
| Adverse effections of Prostaglandin-inhibiting agents actions are? | May change the pigmentation of the eye; ppl w light color eyes may becomes more brown |
| Prototype: latanoprost (Xalatan)actions are? | increased outflow of aqueous humor; reaches peak effect in 12 hours |
| latanoprost (Xalatan)actions side effects are? | Tearing; conjuctival edema; dryness, burning, itching; sensation of foreign body in the eye; photophobia; orther visual disturbances |
| When do you administer latanoprost (Xalatan)? | HS |
| Beta blocking drugs are | drug of choice for open angle glaucoma, chronic/simple |
| What are the actions of beta blocking drugs on glaucoma? | decrease production of aqueous humor thus decreasing IOP; rare ocular side effects; rare systemic effects - bronchospasm, bradycardia, hypotension |
| What are some examples of beta blockers? | betaxolol (Betaoptic), carteolol (Ocupres), levobunolol (Betagen), metipranolol (OptePranolol), timolol (Timoptic) |
| What type of side effects do Alpha2-adrenergic agonist have? | minimal cardiovascular and pumonary side effects |
| How are carbonic anhydrase inhibitors taken? | topical or po |
| carbonic anhydrase inhibitors ... | reduce production of aqueous humor |
| When do you use carbonic anhydrase inhibitors ? | when beta blockers are not effective |
| What type of glaucoma is carbonic anhydrase most effective? | open angle glaucoma |
| What are examples of carbonic anhydrase? | acetazolamide (Diamox) taken po is a diuretic that works on HTN as well; brinzolamide (Azopt); dorzolamide (Trusopt) |
| What are the action of carbonic anhdrase inhibitors? | diuretic; decreases production of aqueous humor |
| What are the precautions of carbonic anhydrase inhibitor? | contains sulfur, may cause severe allergic reaction; may cause electrolyte imbalance |
| Osmotic diuretics are used during? | eye surgery to decrease production of aqueous humor and is administered topical or po; & emergent treatment of acute/ closed angle glaucoma |
| Side effects of Osmotic diuretics ? | HA, tremor, dizziness, dry mouth, electrolyte imbalance |
| Example of osmotic diuretic? | glycerin anhydrous (Ophthalgan)and Manitol (IVP) |
| Which of the following increase the outflow of aqueous humor? Sympathomimetics, beta blockers, osmotic diurects, carbonic anhydrase inhibitors? | Sumpathomimetics |
| What are the nursing considerations for glaucoma? | monitor pts condition; |
| Prior to giving meds for glaucoma what should the nurse do? | general health history; drug history for interactions; cardiovascular and respiratory system - heart block, CHF, COPD may not be able to take drug that act in the ANS; baseline blood pressure and pulse |
| What are the contraindications? | Pregnancy and lactation; factors that may affect compliance such as financial resources; dexterity, dosing schedule |
| Patient education administration technique is | wash hands; avoid touching tip of container w hands, eye and lashes; admin into conjuctival sac, apply pressure over lacrimal sac for one min to prevent systemic absorption |
| Patient education in glaucoma | inc risk for falls r/t reduced visual fields & following admin of meds; visual diff may worsen or be blurry just after installation; removed contacts and wait 15 min b4 reinserting; report poss of pregnancy |
| What side effects should the patient report? | eye irritation, burning, stinging; itching, sensation of foreign body in eye; photophobia, visual disturbances |
| Drugs used for eye exams | provide relief for minor eye conditions |
| Examples of drugs used for eye exams are | Cycloplegic drugs Mydriactic drugs Fluorescein sodium |
| Cycloplegic drugs actions are | paralyze the ciliary muscles prevent lens from moving during exam |
| Example of cycloplegic drug is | atropine (Isopto Atropine) |
| Side effects from cycloplegic drug is | severely blurred vision loss of near vision |
| Mydriatic drugs actions are | dilate the pupil to allow examination of the retina |
| Example of a mydriatic drug is | tropicamide (Mydriacyl) |
| Side effects of mydriatic drugs are | intense photophobia |
| Fluorescein sodium is used for | diagnosing lesion on the surface of the eye temporarily stains the tears yellow so that lesions are easier to observe during slit lamp exam |
| Minor irritation and injury there are broad range of classes of drugs used such as | antimicrobials; glucocorticoids; local anesthetics; Nsaids |
| Minor irritation and injury lubricants are | lanolin alcohol (Lacri-lube) ointment - methylcellulose (Methulose)they are water soluble |
| Admin of eye ointment | pull lower lid down to form a pouch apply oint from inner to outer part of eye have pt blink to distribute instruct pt 2 avoid taks requiring clear vision |
| Otic preparations treat | infections inflammation ear wax buildup |
| External otitis is aka | swimmer's ear |
| External otitis is associated with | water exposure and can be very painful |
| How do you treat external otitis? | otic drops - ABX, STEROIDS, PAIN MEDS sometimes may need systemic ABX |
| eXAMPLES OF OTIC PREPARATIONS ARE | acetic acid & hydrocortisone benzocaine & antipyrine ciprofloxacin hydrochloride & hydrocortisone polymixin B, neomycin & hydrocortisone |
| Otitis media is | inflammation of middle ear |
| Otitis media is associated with ? | upper respiratory infections |
| What location of an ear infection is the most difficult to treat? | Inner ear (Otitis media) |
| How do you treat Otis media? | systemic ANB comfort meds for pain |
| Treatment for otitis | Amoxicillin first line of defense - assess pt for allergy to penicillin; Trimethoprim/sulfamethoxazole (TMP-SMZ), Bactrim is next choice - assess for sulfa allergy, maintain adequate U.O. to prevent crystalluria |
| Mark has an inf of the external ear. Treated w polymixin B, neomycin and hydrocortisone(Cortisporin)The steroid should relieve all his symptoms EXCEPT? | Pain |
| Why was the polymixinB prescribed? | This is an ABX and used to treat the infection |
| Mastoiditis is | inflammation of the mastoid sinus |
| if mastoiditis goes untreated | client could have hearing loss brain abscess |
| What is the treatment for mastoiditis? | ABX BASIC TREAMENT TRIAL PERIOD |
| Surgery for mastoiditis is called | mastoidectomy or meatoplasty |
| What types of ear wax are there? | wet and dry |
| What could change the nature of the wax? | age |
| Can ear wax cause problems with hearing? | Yes, narrows ear canal and interferes with hearing and can cause pain in some people |
| What is another term for ear wax? | cerumen |
| How do you manage wax buildup? | mineral oil and cerumen softeners (Debrox (OTC brand) Lavage/irrigation w tepid water and asepto syringe |
| What are your nursing considerations? | monitor patient's condition before admin otic preparations assess - baseline hearing/auditory status; symptoms and current medical conditions; hypersensitivities |
| Patient drug education | warm ear drops to body temperature Lie down while instilling ear drops to avoid dizziness - remain lying on side w affected ear up for 5 min after admin, massage area around ear gently after admin |
| Patient drug education | do not touch dropper to ear > age 3 hold pinna up and back during instillation < age 3 years hold pinna down and back |
Created by:
kgion
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