Pharm exam 3: Eye, ear, & skin disorders

Major eye drug classes

Antiglaucoma drugs

Diagnostic agents

Antimicrobials

Decongestants

Lubricants

Ophthalmic Medication Safety

Verify 'ophthalmic' labeling

Typical dose: 1-2 drops

Avoid touching dropper to eye

Check concentration & expiration

Glaucoma overview

Increased intraocular pressure (IOP)

Caused by decreased aqueous humor drainage

Leads to optic nerve damage and vision loss

Types: open-angle and closed-angle

Glaucoma Drug Strategies

 Increase aqueous outflow: prostaglandin analogues, cholinergics, rho kinase inhibitors

 Decrease production: beta blockers, alpha agonists, carbonic anhydrase inhibitors

Beta blockers (timolol)

(nonselective beta blockers)

Mechanism: decrease aqueous humor production

Timolol possible systemic complications

heart block, bradycardia, hypotension, bronchospasm

Use caution in asthma, COPD, heart block

Alpha blockers (brimonidine)

Mechanism: decreases production while increasing outflow of aqueous humor to lower IOP

Brimonidine complications

Stinging discomfort, pruritus

Dilated pupils, blurred vision, HA, dry mouth

Reddened sclera

Hypotension, drowsiness

Prostaglandin Analogs (Latanoprost)

Mechanism: increase aqueous humor outflow through relaxation of ciliary muscle

Lantanoprost complications

Bulging of ocular blood vessels

Increased pigmentation

Stinging, burning, reddened conjunctiva

Blurred vision

Migraine

Diagnostic & Anesthetic Eye Drugs

Stains

-identify corneal injury or foreign body (e.g., fluorescein)

Diagnostic & Anesthetic Eye Drugs

Topical anesthetics:

proparacaine, tetracaine

Used for procedures - not self-administered

Ophthalmic Antiinfectives & Antiinflammatories treats

infections: conjunctivitis, blepharitis, keratitis

Ophthalmic Antiinfectives & Antiinflammatories drug types

antibiotics, NSAIDs, corticosteroids, cyclosporine, antihistamines

Decongestants (phenylephrine, naphazoline)

stimulate alpha receptors → ↓ redness

Contraindicated in angle-closure glaucoma

lubricants

artificial tears for dry eyes

Drugs for Ear Disorders

antimicrobials (amoxicillin; ciprofloxacin plus hydrocortisone otic drops)

Common ear disorders

acute otitis media (middle ear effusion), otitis externa (swimmer's ear)

Ear Medication Nursing Points

Children <3 yrs: pull auricle down & back
Movement of tragus or pinna can be very painful
Adults: pull auricle up & back
Complete antibiotic therapy

Drugs for Skin Disorders
Topical corticosteroids (Hydrocortisone)

For Eczema, dermatitis, psoriasis
-Use lowest potency for shortest time

Drugs for Skin Disorders
Topical antifungals (Miconazole, nystatin)

For tinea infections
-1-2 weeks after symptoms resolve

Drugs for Skin Disorders
Topical antibiotics (Mupirocin, bacitracin)

For impetigo
-Monitor for allergic reactions

Drugs for Skin Disorders
Acne medications (Benzoyl peroxide)

For Acne vulgaris
-photosensitivity

Drugs for Skin Disorders
Antivirals (Acyclovir)

For Herpes simplex
-start early

Drugs for Skin Disorders
Antiparasitics (Permethrin)

For scabies
-Treat close contacts

Drugs for Skin Disorders
Psoriasis agents (Calcipotriene, biologics)

For psoriasis
-Immunosuppression risk

Drugs for Skin Disorders
Antihistamines (diphenhydramine)

For Pruritus
-Sedation with 1st generation