PHARMACOLOGY EYE AND EAR

1. Ophthalmic antibiotics

2. Ophthalmic anti-inflammatory drugs

3. Miotics

4. Mydrants

4 Groups of drugs used for eye disorders

1. Eye lotions

2. Eye drops

3. Eye ointments

4. Sub conjunctival injection and injection in the anterior chamber at operation

4 different forms of ophthalmic preparations

Ophthalmic antibiotics

Identify this group of eye drugs

• Ciprofloxacin

• Tetracycline hydrochloride

• Gentamycin

• Erythromycin

• Azithromycin

• Chloramphenicol

Ciprofloxacin 0.3%

A quinolone w/ broad spectrum of activity indicated for corneal ulcers.

Tetracycline hydrochloride

1% eye ointment indicated for conjunctival and corneal infection.

Gentamycin

• Gentacidine

• Garamycin

• An aminoglycoside that provides coverage for most gram-negative organisms causing endophtalmitis.

Erythromycin

• Indicated for chlamydial conjunctivitis

• Use w/ caution in neonates, infants, the elderly or patients w/ renal or neuromuscular disorders.

Azithromycin

• Comes in tablets, eye drops, eye ointments

• Indicated for trachoma, corneal ulcer

• W/ known side effects of corneal staining keratitis, lid oedema, lacrimation, photophobia, visual disturbances

Chloramphenicol

• Eye drops

• Indicated for infection of conjunctiva, lid and lachrymal sac

Ophthalmic anti-inflammatory drugs

• Formulated to be applied in the eyes to suppress inflammation, reducing pain.

• It is used when someone is allergic to the some substances including the environment or after surgery.

• Hydrocortisone Acetate

• Dexamethasone Eye drops

• Prednisone Eye drops

Hydrocortisone Acetate

• Comes as an eye ointment and drops

• Indicated for local sensitivity reactions in skin and eyes, and keratitis, scleritis, and iridocyclitis

• Contraindicated to herpetic keratitis, and active trachoma

Dexamethasone eye drops

• A steroid given to reduce inflammation.

• Leads to the thinning of the cornea and sclera.

• Avoid prolonged use as it may lead to steroid cataract.

Prednisone

• Indicated for local sensitivity reactions in skin and eyes, keratitis, scleritis, and iridocyclitis.

• This eye drop may aggravate infection or mask inflammatory reaction and increase intraocular pressure

• Contraindicated for herpetic keratitis, and active trachoma.

• Advise patient to have frequent tonometric examination

• Discard drug when no longer needed and do not use leftover medication

• Warn patients to call the doctor immediately if visual acuity changes and visual field diminishes.

Miotic drugs

• Acts on the sphincter muscle of the iris, either directly or indirectly constricting the pupil.

• These drugs are intended to reduce intraocular pressure by enhancing aqueous humor outflow, decrease its production, or both in the treatment of glaucoma.

• Pilocarpine hydrochloride

• Beta-adrenergic antagonists: Timolol maleate

Pilocarpine hydrochloride

• A cholinergic drug which constricts pupils by directly stimulating sphincter muscles and increase outflow of aqueous humor by ciliary muscle pull on trabecular meshwork.

• Has drug interaction w/ ophthalmic belladonna alkaloids, phenylephrine

• Contraindicated w/ acute iritis, acute inflammatory disease, secondary glaucoma, and cautiously administered to patients w/ bronchial asthma

• Warn patients that transient brow pain and myopia are common within 10-14 days.

Beta-adrenergic antagonists: Timolol maleate

• Decreases aqueous humor production and increase outflow by inhibiting sympathetic effects on ciliary processes, decreasing intraocular pressure.

Mydriatics

• Are anticholinergic preparations which block the responses of the sphincter muscle of the iris and the accommodative muscle of the ciliary body to cholinergic stimulation, producing mydriasis and cycloplegia.

• Used to dilate the pupil for eye examinations by temporarily paralyzing the iris sphincter muscle.

• Atropine

Atropine

An anti-muscarinic indicated for refraction procedure in young children and anterior uveitis.

• included drugs such as cyclopentolate

Otitis media and otitis externa

2 Common infections of the ear

Cerumen (Earwax)

Provides protection to the meatal skin and need only be removed if it causes deafness or interferes with a proper view of the eardrum.

Vegetable oil eardrops

Indicated to softened earwax.

• contraindicated to patients w/ hypersensitivity to oil

Gentamycin w/ hydrocortisone/ neomycin

• Indicated to treat bacterial and inflammatory ear conditions

• Treats eczema of the ear w/ steroids like prednisolone or bethamethasone to relieve irritation and inflammation.

Neomycin sulphate

Indicated for bacterial infection in otitis externa

• Contraindicated to perforated tympanic membrane due to the risk of ototoxicity

Chloramphenicol

Indicated for bacterial infection in otitis externa

• May produce side effects of high incidence of sensitivity to propylene glycol

Topical corticosteroids

• Anti-inflammatory preparations for the ear

• Used to treat inflammation and eczema in otitis externa and prolonged use must be avoided.

• Avoid this in the presence of untreated ear infection.

• Dexamethasone - indicated for eczematous inflammation in Otitis externa