Transcript Pharmacology and the Nursing Process, 4th ed. Lilley/Harrington

Chapter 58
Otic Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Ear Disorders
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Bacterial and fungal infections
Inflammatory disorders that cause pain
Earwax accumulation
External ear
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Physical trauma
Dermatitis
Middle ear
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Otitis media
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Ear Disorders (cont’d)
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Otitis media: middle ear infection
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Most often afflicts children and follows an upper
respiratory tract infection
In adults, usually results from foreign objects or water
sports
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Ear Disorders (cont’d)
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Otitis media: middle ear infection (cont’d)
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Symptoms include pain, fever, malaise, pressure,
sensation of fullness in the ears, hearing loss
If untreated, tinnitus, nausea, vertigo, mastoiditis may
occur
Hearing deficits and hearing loss may result if prompt
therapy is not started
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Classroom Response Question
A 2-year-old is seen in the pediatrician’s office with
a bacterial middle ear infection. Which medication
does the nurse anticipate being prescribed for the
child?
A.
B.
C.
D.
amoxicillin
Cortic
carbamide peroxide (Debrox)
Acetasol HC
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Otic Drugs for External and Middle
Ear Disorders
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Antibiotics
Antifungals
Antiinflammatories
Local analgesics
Local anesthetics
Corticosteroids
Earwax emulsifiers
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Antibacterial and Antifungal
Otic Drugs
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Topical formulations applied to the external ear
Often combined with steroids for
antiinflammatory, antipruritic, and antiallergic drug
effects
Middle ear infections generally require
systemically administered antibiotics
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Antibacterial and Antifungal
Otic Drugs (cont’d)
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Antibiotics
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neomycin and polymyxin B plus hydrocortisone
combination (Cortisporin Otic)
 Others containing ciprofloxacin
 ofloxacin
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Antifungals
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Cortic (combination of antifungal drugs and
hydrocortisone)
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Earwax Emulsifiers
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carbamide peroxide (Debrox)
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Combined with other drugs, such as glycerin, to loosen
and help remove cerumen
Ear canal irrigation with water may be needed
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Classroom Response Question
When teaching an adult patient about eardrops,
which statement will the nurse include?
A. “Hold your ear down and back to instill the drops.”
B. “If you feel dizzy after instilling the ear drops, stand
up and walk around the room.”
C. “Warm the ear drops up for 30 seconds in the
microwave before using them.”
D. “Lie on the opposite side of that of your affected
ear for about 5 minutes after instilling the drug.”
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Nursing Implications
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Assess baseline hearing or auditory status
Evaluate patient’s symptoms
Assess drug and food allergies
Assess for contraindications
Keep in mind that perforated eardrum(s) may be
a contraindication to these drugs
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Ciprofloxacin and ofloxacin can be used with
perforated eardrums.
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Nursing Implications (cont’d)
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If necessary or if ordered, remove cerumen by
irrigation before instilling eardrops
Cleanse outer ear thoroughly
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Nursing Implications (cont’d)
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Warm eardrops to approximately body
temperature before instillation
Allow refrigerated solutions to warm to room
temperature
Keep in mind that cold eardrops may cause
vomiting and dizziness
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Classroom Response Question
While administering medications, the nurse finds a
patient’s eardrops in the medication refrigerator. If
the nurse gives the eardrops immediately, what
response might the patient have?
A.
B.
C.
D.
No unusual response
Immediate relief of ear discomfort
A vestibular-type reaction
Increased ear pain
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Nursing Implications (cont’d)
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When administering eardrops to adults
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Hold the pinna up and back
When administering eardrops to children younger
than 3 years
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Hold the pinna down and back
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Nursing Implications (cont’d)
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Allow time for eardrops to flow down into the ear
canal
Have patients lie on the side opposite to the side
of the affected ear for about 5 minutes after
instilling eardrops
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Nursing Implications (cont’d)
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A small cotton ball may be gently inserted into the
ear canal to keep the drug in, but do not force the
cotton into the ear canal
Gently massage the tragus of the ear to
encourage flow of medication
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Classroom Response Question
Gentle massage of the tragus area of the ear after
administering eardrops results in
A. decreased absorption of the medication.
B. softening of the cerumen in the ear canal.
C. increased coverage of the medication in the ear
canal.
D. reduced pain in the ear.
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