Pharm 4.4 Medications Affecting the Eye, Ear, and Nose

Medications Affecting the Eye, Ear, and Nose

Objective 4.4

  • Discussion of medications that impact the eyes, ears, and nose, particularly regarding conditions such as infections and inflammatory disorders.

Disorders and Treatments

Bacterial and Fungal Infections

  • Treatment options for these infections include:

    • Antibacterial medications (antibiotics)

    • Antifungal medications

    • Local analgesics and anaesthetics

    • Anti-inflammatories

    • Corticosteroids

    • Wax emulsifiers

Inflammatory Disorders & Pain Management

  • Various conditions can lead to inflammation and pain, such as:

    • Earwax accumulation

    • Physical trauma

    • Dermatitis, seborrhea, and psoriasis

Ear Disorders

  • Otitis Externa: Infection of the external ear.

  • Otitis Media: Infection of the middle ear.

    • Affects: Most commonly affects children, often following an upper respiratory infection; in adults, typically due to water sports or foreign objects.

    • Symptoms: Pain, fever, malaise, pressure in ears, sensation of fullness, impaired hearing.

    • Complications if untreated: May lead to tinnitus, nausea, vertigo, mastoiditis. Potential for hearing deficits and hearing loss if therapy is delayed.

Otic Drugs for External and Middle Ear Disorders

  • Administration: Topical formulations applied to the external ear; often combined with steroids for anti-inflammatory effects.

  • Middle Ear Infections: Typically require systemically administered antibiotics.

  • Types of Otic Drugs:

    • Antibacterial Drugs:

    • Neomycin and polymyxin B plus hydrocortisone (AK-Spor HC Otic®).

    • Ciprofloxacin hydrochloride (0.3% Ciprodex®).

    • Clioquinol (1% Locacorten Vioform®).

    • Antifungal Drugs:

    • Clioquinol (ear drops).

    • Earwax Emulsifiers:

    • Carbamide peroxide (Murine Ear Wax Removal System Otic®); often combined with glycerin.

Nursing Implications

  • Assessment:

    • Evaluate patient’s baseline hearing and symptoms.

    • Assess for drug and food allergies, and contraindications (e.g., perforated eardrum).

  • Medication Administration:

    • Remove cerumen by irrigation if necessary before ear drops application.

    • Cleanse the outer ear prior to administration.

    • Ensure ear drops are at room temperature; cold drops may cause discomfort (vomiting, dizziness).

    • Instillation Technique:

    • For adults: Hold the pinna up and back.

    • For children < 3 years: Hold the pinna down and back.

    • Allow drops to flow down into the ear canal and have patients lie on the opposite side for 5 minutes post-administration.

    • A small cotton ball may be inserted (not forced) into the canal.

    • Gentle massage of the tragus to encourage flow of medication.

Drugs That Affect the Eye

  • Mydriatics: Drugs that dilate the pupil.

  • Miotics: Drugs that constrict the pupil.

  • Cycloplegics: Drugs that paralyze the ciliary body, also have mydriatic properties.

Drug Classes and Effects on Pupil Size

  • Antiglaucoma Drugs:

    • Mimic the parasympathetic neurotransmitter acetylcholine.

    • Also known as miotics or cholinergics, lead to pupillary constriction (miosis) and reduced intraocular pressure (IOP).

  • Sympathomimetics:

    • Mimic sympathetic neurotransmitters, increasing pupil size (mydriasis), enhancing aqueous humor outflow.

Indications for Cholinergic Drugs

  • Used for conditions like:

    • Open-angle glaucoma

    • Closed-angle glaucoma

    • Ocular surgery

    • Strabismus

    • Ophthalmological examinations.

ß-Adrenergic Blockers

  • Drugs:

    • Betaxolol hydrochloride (Betoptic®)

    • Levobunolol hydrochloride (Betagan®)

    • Timolol maleate (Betimol, Timoptic®).

  • Mechanism: Reduce IOP by decreasing aqueous humor formation and increasing outflow.

  • No effects on pupil size, accommodation, or night vision.

Prostaglandin Agonists

  • Newer class for glaucoma:

    • Medications include:

    • Latanoprost (Xalacom®, Xalatan®)

    • Travoprost (Travatan Z®)

    • Bimatoprost (Lumigan®).

  • Mechanism: Increase uveoscleral outflow, allow for single daily dosing due to prolonged effects lasting 20-24 hours.

Ocular Antimicrobial Drugs

  • Types include antibacterials, antivirals, and antifungals.

  • Examples:

    • Macrolides: Erythromycin for STI prevention in newborns.

    • Quinolones:

    • Ciprofloxacin (Ciloxan®)

    • Gatifloxacin (Zymar®)

    • Moxifloxacin hydrochloride (Vigamox®)

    • Ofloxacin (Ocuflox®).

  • Aminoglycosides:

    • Gentamicin (Diogent®, Gentak®)

    • Tobramycin (Tobrex®).

Ocular Anti-inflammatory Drugs

  • Nonsteroidal anti-inflammatory drugs (NSAIDs):

    • Kelorolac tromethamine (Acular®), Flurbiprofen sodium (Ocufen®), Diclofenac sodium (Voltaren®, Ophtha®).

  • Corticosteroids:

    • Examples include:

    • Dexamethasone (AK Dex®, Doidex®, Dioptrol®, Maxidex®)

    • Fluorometholone (Flarex®, FML®)

    • Loteprednol etabonate (Alrex®, Lotemax®)

    • Prednisolone acetate (Diopred®)

    • Rimexolone (Vexol®).

  • Uses include prevention of postoperative inflammation and treating allergic conjunctivitis symptoms.

Nursing Implications for Ocular Medications

  • Assess patient history and vital signs.

  • Follow specific medication administration guidelines:

    • Avoid touching the eye with dropper/container tip.

    • Apply ointments as a thin layer in conjunctival sac.

    • Have the patient look up for drops administration into conjunctival sac.

    • Apply pressure to the inner canthus to reduce systemic absorption.

  • If multiple eye medications are ordered, clarify the administration order and intervals.

  • Instruct patients on contact lens care during therapy.

Treatment of the Common Cold

  • Combines antihistamines, decongestants, antitussives, and expectorants.

  • Note that symptomatic treatment is not curative; it does not eliminate the pathogen.

Supplements and Herbal Products

  • Commonly discussed supplements: Vitamin C, Echinacea, Goldenseal.

Histamine and Antihistamines

  • Histamine: Major inflammatory mediator in allergic disorders, linked with conditions like urticaria, anaphylaxis, and allergic rhinitis.

    • H1-Anagonists (Blockers):

    • Examples:

    • Chlorpheniramine, Fexofenadine (Allegra®), Loratadine (Claritin®), Cetirizine (Reactine®), Desloratadine (Aerius®), Diphenhydramine (Benadryl®).

    • Properties include antihistaminic, anticholinergic, and sedative effects.

Indications for Antihistamines

  • Used for managing:

    • Nasal allergies

    • Seasonal/Perennial allergic rhinitis

    • Allergic reactions, motion sickness, vertigo, sleep disorders

  • Used to relieve common cold symptoms but does not cure.

  • Traditional Antihistamines: Diphenhydramine, Brompheniramine.

  • Nonsedating Antihistamines: Loratadine, Cetirizine, Fexofenadine.

Nasal Congestion and Decongestants

  • Symptoms: Excessive nasal secretions, inflamed and swollen nasal mucosa; typically caused by allergies or upper respiratory infections.

Types of Decongestants

  • Adrenergics: Largest group, sympathomimetics.

  • Anticholinergics: Less commonly used.

  • Corticosteroids: Topical, intranasal steroids.

Oral Decongestants

  • Example: Pseudoephedrine.

  • Benefits: Prolonged effects, minimal rebound congestion.

Topical Nasal Decongestants

  • Examples include ephedrine, oxymetazoline, phenylephrine, tetrahydrozoline.

  • Drawbacks: Sustained use can lead to rebound congestion.

Nasal Steroids

  • Provide anti-inflammatory effects to decrease inflammation and congestion associated with various conditions, including rhinitis and allergic reactions.