Eye, Ear, and Skin

Non-selective beta blocker prototype

Timolol

Timolol action

decreased IOP by decreasing production of aqueous humor

Timolol uses

• topical = Tx of open-angle glaucoma

• occasional Tx of closed-angle glaucoma in emergencies

Timolol complications

• heart block

• bradycardia

• HYPOtension

• bronchospasm

• stinging in eyes

• conjunctivitis, blurred vision, photophobia, dry eyes

Timolol contradinications/caution

• caution = asthma, heart failure

• do NOT give to pts with chronic respiratory disease, sinus bradycardia, or AV heart block!

Punctual occlusion

place pressure on lacrimal duct for 30-60 seconds after eye med administration

Timolol nursing interventions

• monitor pulse rate/rhythm

• monitor glucose in diabetic pts

Timolol interactions

• use with CCBs can increase CV and respiratory effects

• can interfere with some effects of insulin

Timolol education

• report conjunctivitis, blurred vision, photophobia and dry eyes to provider

• notify provider if HR drops to <50 BPM

• monitor BG extra carefully if diabetic

Alpha-agonist prototype

brimonidine

Brimonidine action

decreases production of aqueous humor while increasing outflow to lower IOP

Brimonidine uses

first-line Tx for long-term open-angle glaucoma

Brimonidine complications

• stinging, pursuits

• sensation of something in eye

• DILATED pupils, blurred vision, HA, dry mouth

• reddened sclera

• HYPOtension, drowsines

Brimonidine administration

take contacts out before administering and wait 15 mins before putting new ones in

Brimonidine interactions

• antihypertensive meds can intensify HYPOtension

• DO NOT GIVE MAOIS - RISK FOR HTN CRISIS

Brimonidine nursing interventions

monitor BP for hypo/hypertension

Brimonidine education

• do NOT rub eyes

• report dilated pupils, blurred vision, HA, dry mouth to provider

• caution with driving

• report dizziness/weakness IMMEDIATELY

Prostaglandin analogs prototype

Latanoprost

Latanoprost action

decreases IOP by increasing aqueous humor outflow through relaxation of ciliary muscle

Latanoprost use

first-line for pts with open-angle glaucoma and ocular HTN

Latanoprost complications

• bulging of ocular blood vessels

• PERMANENT increase in brown pigmentation of the iris, lids, and lashes

• stinging, burning, reddened conjuctiva

• blurred vision

• MIGRAINE = RARE BUT SERIOUS AE

Latanoprost education

• do NOT rub eyes

• report blurry vision to provider

• report migraines IMMEDIATELY

Antimicrobial prototypes

amoxicillin; ciprofloxacin + hydrocortisone

Antimicrobial uses

• (A) = eradication of infection in ear

• (C+H) = decreases pain, edema, and erythema in ear canal

Antimicrobial uses

• (A) = Tx of otitis media

• (C+H) = Tx of otitis externa

Antimicrobial complications

• (A) = GI upset, suprainfection

• (C+H) = dizziness, lightheadedness, tremors, restlessness, convulsions, rash

Antimicrobial administration

• warm medication before administering (cold = dizzy)

• keep pt on unaffected side for 5 mins after administration

• if using a cotton ball, remove after 15 mins

• children <3 = pull pinna down and back

• adults = pull pinna up and back

Antimicrobial contraindications/cautions

• hypersensitivity

• (A) = caution in infants <3 y/o

Antimicrobial education

• take FULL COURSE EXACTLY AS PRESCRIBED

• dry ears/canal after swimming/bathing

• avoid ear plugs/sticking objects in ear

Topical corticosteroid

hydrocortisone

Topical corticosteroid uses

• eczema

• dermatitis

• psoriasis

Topical corticosteroid key point

use lowest potency for shortest time

Topical antifungals

• miconazole

• nystatin

Topical antifungal uses

tinea infection

Topical antifungal key point

symptoms resolve after 1-2 weeks

Topical antibiotics

• mupirocin

• bacitracin

Topical antibioitc uses

impetigo

Topical antibiotic key point

monitor for allergic reaction

Acne medication

benzoyl peroxide

Acne mediation uses

acne vulgaris

Acne medication key point

pt education on skin protection/photosensitivity

Antiparasitcs

permethrin

Antiparasitic uses

scabies

Antiparasitic key point

treat close contacts/family/environment

Psoriasis agents

• calcipotriene

• biologics

Psoriasis agent uses

psoriasis

Psoriasis agent key point

immunosuppression risk

Antihistamine

diphenhydramine

Antihistamine uses

pruritis

Antihistamine key point

sedation with first-gen