Transcript Drugs Used to Treat Eye Disordersx

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Box 31-1 The Eye: Structures and Functions:
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Eye has 3 layers
› sclera: white of eye, outer layer
› choroid: second layer, made of blood vessels, ciliary muscle
and iris (give eye color), opening in middle of iris is pupil
 miosis: Narrowing of pupil
 mydriasis: dilation (widening) of pupil
› retina: inner layer, has receptors for vision and nerve fibers
of optic nerve
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light enters eye through cornea
light rays pass to the lens, which lies behind pupil
light then reflected to retina
light is carried to brain by optic nerve
aqueous chamber: separates cornea from lens, filled
with fluid called aqueous humor, helps keep shape
and position of cornea
vitreous humor: behind lens, gelatin-like substance
that supports retina and maintains eye’s shape
to safely give topical ophthalmic agents see ch. 12, also follow
these rules:
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do not use more than 1 drop (unless otherwise ordered) eye
can only hold a small amount of fluid
wait at least 5 mins if more than 1 drug is ordered, this
prevents:
› 2nd drug from washing away 1st
› 2nd drug from diluting the 1st drug
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apply drops before ointments
wait a few hours to apply drops after applying ointment
provide for safety after applying ointments, they may blur
vision
know standard colors for ophthalmic labels and bottle
caps:
anti-infectives: brown or tan
beta-adrenergic blocking agents: yellow, blue or both
miotics: green
mydriatics and cycloplegics: red (cycloplegics paralyze the ciliary
muscle of the eye, used for eye exams)
› non-steroidal anti-inflammatory agents: grey
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Delegation Guidelines
Drugs Used to Treat Eye Disorder:
Some drugs used to treat eye disorders are given
parenterally- by intramuscular or intravenous
injection. Because you do NOT give parenteral
dose forms, they are NOT included in this
chapter. Should a nurse delegate the
administration of such to you, you must:
- remember that parenteral dosages are often
very different from dosages other routes
-Refuse the delegation. Make sure to explain
why. Do NOT just ignore the request. Make sure
the nurse knows that you cannot give drug and
why
See Box 31-2 (p. 374) Eye disorders
Including glaucoma and cataracts
Drug therapy for glaucoma:
several drugs are used to treat glaucoma
 goals of therapy:
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› reduce intra-ocular pressure (IOP)
› prevent further blindness
Drug therapy for glaucoma:
Osmotic Agents:
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cause fluid to be drawn from outside of the vascular system into the
blood, this lowers amount of intra-ocular fluid, decreased IOP results
Assisting With the Nursing Process
Osmotic agents:
ASSESSMENT: measure vital signs, weight, intake/output, observe for
alertness and orientation to person, time and place
PLANNING: see table 31-1 for “Oral Dose Forms”
IMPLEMENTATION: see table 31-1 for “Adult Dosage”
EVALUATION: report and record:
 Thirst: changes in alertness and orientation to person, time and
place; confusion; muscle cramps; nausea: may signal dehydration or
electrolyte imbalance
 Headache: signals cerebral dehydration, person is kept in supine
position
 Edema and signs/symptoms of heart failure (ch. 21): caused by fluid
moving into blood stream
Drug therapy for glaucoma cont….
Carbonic Anhydrase Inhibitors:
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agents inhibit carbonic anhydrase, an enzyme
inhibiting the enzyme causes decreased production of aqueous humor, IOP
lowers
Assisting With the Nursing Process
Carbonic anhydrase inhibitors:
ASSESSMENT: measure vital signs, weight, intake/output, observe for alertness
and orientation to person, time and place, ask about GI signs/symptoms
PLANNING: see table 31-2 for “Oral Dose Forms”
IMPLEMENTATION: see table 31-2 for “Adult Dosage Range”, remove contact
lenses for topical dose form, do NOT give drug if person is allergic to
sulfonamide antibiotics, give oral dose forms with food/milk to lessen
stomach irritation
EVALUATION: report and record:
 Thirst: changes in alertness and orientation to person, time and place;
confusion; muscle cramps; nausea: may signal dehydration or electrolyte
imbalance
 Signs and symptoms of allergic reaction to sulfonamide antibiotics: tell nurse
at once, do not give next dose unless approved by nurse
 Confusion: provide for safety
 Drowsiness: usually mild and resolves, provide for safety
Drug therapy for glaucoma cont….
Cholinergic Agents:
produce strong contractions of the iris (miosis)
 produce muscle contractions that allow eye to adjust to distances
 drugs lower IOP in persons with glaucoma by permitting the out-flow of
aqueous humor
 they also reverse pupil dilation after eye surgery or eye exams
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Assisting With the Nursing Process
Cholinergic Agents:
ASSESSMENT: measure vital signs
PLANNING: see table 31-3 for “Topical Dose Forms”
IMPLEMENTATION: see table 31-3 for “Adult Dosage”
EVALUATION: report and record:
 problems adjusting to changes in light, problems seeing at night, blurred
vision: provide for safety
 eye irritation, eye redness, headache: usually mild and tend to resolve
 pain, discomfort: may occur in bright light
 sweating, increased saliva, abdominal discomfort, diarrhea, broncho-spasm,
tremors, hypotension, dysrhythmias, bradycardia: signal person is receiving
too much of a cholinergic agent
Drug therapy for glaucoma cont….
Cholinesterase Inhibitors:
cholinesterase is an enzyme that destroys acetylcholine
 cholinesterase inhibitors prevent the metabolism of acetylcholine within the
eye
 cholinergic activity increases, which results in decreased IOP and miosis
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Assisting With the Nursing Process
echothiophate iodide (Phospholine lodide):
ASSESSMENT: measure vital signs
PLANNING: Topical Dose Form is 0,125% solution
IMPLEMENTATION: 1 drop is instilled 1 or 2 times/day
EVALUATION: report and record:
 problems adjusting to changes in light, problems seeing at
night, blurred vision: provide for safety
 eye irritation, eye redness, headache: usually mild and resolve
 sweating, increased saliva, abdominal discomfort, diarrhea,
broncho-spasm, tremors, hypotension, dysrhythmias,
bradycardia: signal person is receiving too much of a
cholinergic agent
Drug therapy for glaucoma cont….
Adrenergic Agents:
used for eye disorders because they cause:
› pupil dilation
› increased out-flow of aqueous humor
› vaso-constriction
› relaxation of the ciliary muscle
› a decrease in formation of aqueous humor
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goals of therapy:
› dilate the pupils (mydriasis) for eye exams
› reduce IOP
› reduce redness of the eyes from irritation
Assisting With the Nursing Process
adrenergic agents:
ASSESSMENT: measure vital signs
PLANNING: see table 31-4 for “Topical Dose Forms”
IMPLEMENTATION: see table 31-4 for “Adult Dosage”
EVALUATION: report and record:
 sensitivity to bright light: sunglasses help reduce
brightness, provide for safety
 eye irritation, tearing: tend to be mild and resolve
 palpitations, tachycardia, dysrhythmias,
hypertension, faintness, trembling, sweating:
signal over-dose or excessive amounts of an
adrenergic agent
Drug therapy for glaucoma cont….
Beta-Adrenergic Blocking Agents:
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used to reduce elevated IOP
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agents are thought to reduce production of aqueous humor
Assisting With the Nursing Process
Beta-adrenergic blocking agents:
ASSESSMENT: measure vital signs
PLANNING: see table 31-5 (p. 380) for “Topical Dose Forms”
IMPLEMENTATION: see table 31-5 for “Initial Adult Dosage”
EVALUATION: report and record:
 eye irritation, tearing: tend to be mild and resolve
 bradycardia, dysrhythmias, hypotension, faintness,
broncho-spasm: dosage may need adjustment
Drug therapy for glaucoma cont….
Prostaglandin Agonists:
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reduce IOP by increasing the out-flow of aqueous humor
used to reduce IOP in persons who have not responded well to other
IOP-lowering agents
Assisting With the Nursing Process
prostaglandin agonists:
ASSESSMENT: measure vital signs
PLANNING: see table 31-6 (p. 380) for “Topical Dose Forms”
IMPLEMENTATION: see table 31-6 for “Adult Dosage Range”
EVALUATION: report and record:
 eye irritation, burning and stinging, tearing: tend to be mild
and resolve
 changes in eye color: eye color may gradually change,
amount of brown pigment in eye may gradually increase, may
take several months or years and is permanent; eyelids may
develop color changes. Eyelashes may increase in growth
Other ophthalmic Agents:
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there are many other drug classes used to treat eye
disorders:
› anti-cholinergic agents
› anti-fungal agents
› anti-viral agents
› anti-bacterial agents
› cortico-steroids
› ophthalmic anti-inflammatory agents
› antihistamines
› anti-allergic agents
› artificial tear solutions
Anti-Cholinergic Agents:
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cause relaxation of certain eye muscles, as a result pupils dilate
this allows:
› examination of interior of eye
› resting of the eye during uveitis- inflammation of the uveal tract (middle
coat of eye)
› measurement of lens strength for eyeglasses (refraction)
Assisting With the Nursing Process
anti-cholinergic agents:
ASSESSMENT: measure vital signs
PLANNING: see table 31-7 for “Topical Dose Forms”
IMPLEMENTATION: see table 31-7 (p. 381) for “Adult Dosage”
EVALUATION: report and record:
 sensitivity to bright light (dilated pupils let more light in): sunglasses
help reduce brightness, provide for safety
 eye irritation, tearing: tend to be mild and resolve
 flushing, dry skin, dry mouth, blurred vision, tachycardia,
dysrhythmias, urinary hesitancy and retention, vaso-dilation,
constipation: signal overdose or excessive administration
Anti-Fungal Agents
 used to treat fungal infections in the eye
Assisting With the Nursing Process
natamycin (Natacyn):
ASSESSMENT: ask about eye symptoms, ask about the amount
and type of visual impairment
PLANNING: topical dose form is a 5% suspension
IMPLEMENTATION: 1 drop in the eye at 1 or 2 hour intervals for the
first 3-4 days. dosage may be reduced to 1 drop every 3-4
hours, therapy is continued 14-21 days
EVALUATION: report and record:
 sensitivity to bright light (dilated pupils let more light in):
sunglasses help reduce brightness, provide for safety
 blurred vision, tearing, redness: tend to be mild and resolve,
provide for safety, remind person not to forcefully rub eyes
 eye pain: person needs medical attention
 worsening of symptoms: person need medical attention if
symptoms worsen or do not improve after several days
Anti-Viral Agents
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agents inhibit the virus from reproducing
used to treat herpes infections of the eye
Assisting With the Nursing Process
trifluridine (Viroptic)
ASSESSMENT: ask about eye symptoms, ask about the amount
and type of visual impairment
PLANNING: topical dose form is a 1% solution in 7.5mL
IMPLEMENTATION: 1 drop onto cornea of affected eye every 2
hours while awake. dosage should NOT exceed 9 drops/day,
continue for 7 more days after healing to prevent recurrence1 drop every 4 hours (at least 5 drops daily)
EVALUATION: report and record:
 visual haze, tearing, redness, burning: usually mild, tend to
resolve, provide for safety
 sensitivity to bright light (dilated pupils let more light in):
sunglasses help reduce brightness, provide for safety
 allergic reaction: person needs medical attention
Opthalmic antibiotics:
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used to treat superficial eye infections
prolonged or frequent use of topical antibiotics should be avoided
because of these risks:
hyper-sensitivity reactions
› development of resistant organisms, including fungi
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see table 38-1
Cortico-Steroids:
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used for allergic reactions of the eye
used for acute non-infectious inflammatory conditions of the eye
prolonged therapy may cause glaucoma and cataracts
see table 39-1
Ophthalmic Anti-inflammatory Agents:
the following are used before and after cataract surgery:
› flurbiprofen (Ocufen): 1 drop in eye every 30mins
beginning 2 hours before surgery, a total of 4 drops are
given
› suprofen (Profenal): 2 drops in eye 3 hours, 2 hours and
1 hour before surgery
› diclofenac(Voltaren): 1 drop in eye 4x a day
beginning 24 hours after surgery. Drug is continued for
2 weeks
 the following is used to relieve eye itching from seasonal
allergies:
› ketorolac(Acular): 1 drop in each eye 4x a day
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Antihistamines:
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used to relieve signs/symptoms associated with allergic conjunctivitis
prevent itching
for best results should be instilled before exposure to allergens
see table 31-10 pg. 384
Anti-Allergic Agents:
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inhibit the release of histamine
used to treat allergic eye disorders
cromolyn (Crolom, Opticrom): 1 or 2 drops in each eye 4-6x/day at
regular intervals
lodoxamide (Alomide): 1 or 2 drops in each affected eye 4x/day
pemirolast (Almast): 1 or 2 drops in each affected eye 4x/day
nedocromil (Alocril): 1 or 2 drops in each eye 2x/day at regular
intervals
Artificial Tear Solutions:
they are like natural eye secretions
 lubricate dry eyes
 may be used as lubricant for artificial eyes
 the dosage is 1-3 drops in each eye 3-4x/day as needed
 products include:
› Isopto Plain
› Teargen
› Tears Naturale
› Murine
› Liquifilm Tears
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