Ophthalmic Drugs nursing PDF

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Examples and descriptions of ophthalmic drugs in nursing pharmacology....

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Antimicrobial Drugs 1. Aminoglycosides Drugs: gentamicin (Garamycin) and tobramycin (Tobrex) Mechanism of Action: Interfere with protein synthesis in bacterial cells, which lead to bacteria death Indications: Treat bacterial ocular infections Contraindications: Known drug allergy or previous adverse drug reaction Adverse Effects: Swollen eyelids, mydriasis, local erythema. Systemic reactions are rare due to poor topical absorption Overgrowth of nonsusceptible organisms is a possibility (Can lead to eye infections that are resistant to treatment) Interactions: Concurrent use with corticosteroids can decrease the therapeutic effects of ocular antimicrobials.   

2. Macrolide Antibiotics Drugs: erythromycin (most commonly used drug) and azithromycin Mechanism of Action: Inhibits bacterial cell wall synthesis Indications: Treats various infections Contraindications: Known drug allergy

3. Polypeptide Antibiotics Drugs: bacitracin (AK- Tracin) and polymyxin B Mechanism of Action: Inhibits protein synthesis Indications: Treats superficial infections caused by gram-positive bacteria Contraindications: Known drug allergy Adverse Effects: local and transient inflammation, burning and stinging.

4. Quinolone Antibiotics Drugs: ciprofloxacin (Ciloxan), gatifloxacin (Zymar), moxifloxacin (Vigamox), levofloxacin (Quixin), and ofloxacin (Ocuflox)

Mechanism of Action: Destroys a wide spectrum of organisms that are often very difficult to treat Indications: ciprofloxacin is used for the treatment of bacterial keratitis and conjunctivitis; treats infections caused by gram positive and negative organisms Contraindications: Known drug allergy Adverse Effects:  Formation of corneal precipitates during the treatment for bacterial keratitis.  Corneal staining and infiltrates  Systemic reactions- rare, usually taste disorders and nausea

5. Sulfonamides Drugs: sulfacetamide sodium (Bleph-10) and sulfisoxazole (Gantrisin) Mechanism of Action: Blocks the synthesis of folic acid in bacteria Indications: Treat conjunctivitis and other ocular infections. Contraindications: Known drug allergy Adverse Effects: Local irritation and stinging, photosensitivity

6. Antifungal Drugs Drugs: natamycin (Natacyn) Mechanism of Action: Detroys fungal cell eye by binding to sterols in the fungal cell membrane, disrupting protective capabilities of the cell Indications: Treats blepharitis, conjunctivitis, and keratitis caused by Candida and Aspergillus species Contraindications: Known drug allergy Adverse Effects: Burning, stinging, hives, and swelling

7. Antiviral Drugs Drugs: formivirsen (Vitravene), ganciclovir (Vitrasert), and trifluridine (Viroptic)

Mechanism of Action: Inhibits replication by blocking the synthesis of DNA Indications:  Formivirsin and ganciclovir – treats cytomegalovirus infections  Trifluridine- treats ocular infections, such as keratitis and keratoconjunctivitis, caused by types 1 and 2 of HSV (herpes simplex virus) Adverse Effects: Secondary glaucoma, corneal punctate defects, uveitis, and stromal edema (edema in the stoma of the eye).

The adverse effects for all the antimicrobial drugs are local and transient inflammation, burning, stinging, urticaria, dermatitis, angioedema, and drug hypersensitivity. Any topical drugs used can cause a superinfection in the eye. If given in large doses, systemic side effects can occur, but it is unlikely. The drug interactions of antimicrobial drugs are limited due to the localized effects of the drugs. Concurrent use of corticosteroids with antimicrobial drugs can lead to decreased therapeutic effects of the antimicrobial drugs. Nursing implications: Make sure you assess the eye and skin surrounding eye carefully. Assess for allergies before administration of these drugs. Document any redness, swelling, pain excessive tearing, drainage/ discharge from the eye, or decreased visual acuity.

Anti-Inflammatory Drugs 1. Corticosteroids Drugs:       

dexamethasone (Decadron) fluocinonide (Retisert) fluorometholone (Fluor-Op) loteprednol (Lotemax) medrysone (HMS) prednisolone (Pred Forte) rimexolone (Vexol)

Mechanism of Action: Reduce the production of inflammatory mediators, which reduces pain, erythema, and other inflammatory processes Indications: 

Used to provide relief of ophthalmic inflammatory conditions

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Used to treat corneal, conjunctival, and scleral injuries from burns (chemical, thermal, and radiation) or penetration from foreign bodies Used to prevent fibrosis and scarring, which can cause visual impairment Used prophylactically before and after eye surgeries Dexamethasone – treats inflammation of the eye, eyelids, conjunctiva, and cornea; can treat uveitis, iridocyclitis, allergic conditions, burns, and in the removal of foreign bodies

Contraindications: Known allergies, minor abrasions or wounds Adverse Effects: Transient burning or stinging on application. Extended use can lead to cataracts, increased intraocular pressure, and optic nerve damage. Larger doses can lead to systemic effects. Interactions: Concurrent use of corticosteroids with antimicrobial drugs can lead to decreased therapeutic effects of the antimicrobial drugs.

2. Nonsteroidal Anti-inflammatory Drugs (NSAIDS) Drugs: bromfenac (Xibrom), diclofenac (Voltaren), flurbiprofen (Ocufen), ketorolac (Acular) Mechanism of Action: Reduce the production of inflammatory mediators, which reduces pain, erythema, and other inflammatory processes Indications:    

Used to treat corneal, conjunctival, and scleral injuries from burns (chemical, thermal, and radiation) or penetration from foreign bodies Used to prevent fibrosis and scarring, which can cause visual impairment Used to treat symptomatic treatment of seasonal allergic conjunctivitis Used prophylactically before and after eye surgeries

Contraindications: Known drug allergy, minor abrasions and wounds Adverse Effects: Transient burning or stinging on application. Extended use can lead to cataracts, increased intraocular pressure, and optic nerve damage. Larger doses can lead to systemic effects. Interactions: Concurrent use of corticosteroids with antimicrobial drugs can lead to decreased therapeutic effects of the antimicrobial drugs.

Topical Anesthetics Drugs: proparacaine (Alcaine) and tetracaine. Mechanism of Action: Stabilizes the membranes of nerves causing decreased ion movement entering and exiting the nerve ending. This blocks the stimulation of sending signals of pain to the brain. Indications:

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Produce ocular anesthesia for short corneal and conjunctival procedures. Prevent pain during surgical procedures and certain painful ophthalmic examinations Short-term use

Contraindications: Known drug allergy Adverse Effects: Rare: stinging, burning, redness, lacrimation, and blurred vision Interactions: None

Diagnostic Drugs 1. Cycloplegic Mydriatics Drugs: atropine sulfate (Isopto Atropine) and cyclopentolate solution (Cyclogyl) Mechanisms of Action: Mydriasis and paralyzes the ciliary muscle, inhibiting accommodation Indications:  Assist in eye exams  Atropine sulfate is used to treat uveal tract inflammatory states Contraindications: known drug allergy Adverse Effects: burning, stinging, redness, blurred vision Interactions: none 2. Ophthalmic Drugs Drugs: fluorescein (AK- Fluor) Mechanism of Action: Detects defects in the eye by highlighting areas bright-green or yelloworange; foreign objects have a green halo around them Indications:  Used to identify corneal defects and to locate foreign objects in the eye.  Used in fitting hard contact lenses Contraindications: Known drug allergy Adverse Effects: Burning, stinging, redness, blurred vision Interactions: None

Antiallergic Drugs 1. Antihistamines Drugs: olopatadine (Patanol), azelastine (Optivar), emedastine (Emadine), ketotifen (Zaditor), and epinastine (Elestat) Mechanism of Action: Competes at the receptor sites for histamine, which produces symptoms such as itching and tearing. Indications: Treats symptoms of allergic conjunctivitis (seasonal and nonseasonal) Contraindications: Drug allergy and closed angle glaucoma Adverse Effects: Burning, stinging, redness, blurred vision

Interactions: None 2. Mast Cell Stabilizers Drugs: cromolyn sodium (Crolom), pemirolast (Alamast), nedocromil (Alocril), and lodoxamide (Alomide) Mechanism of Action: Inhibits the release of inflammation-producing mediators from mast cells Indications: Treats vernal keratoconjunctivitis (springtime inflammation of the cornea and conjunctiva) Contraindications: Known allergy and closed angle glaucoma Adverse Effects: Burning, stinging, redness, blurred vision Interactions: None 3. Decongestants Drugs: tetrahydrozoline, phenylephrine (Neo-Synephrine), oxymetazoline (Visine LR), and naphazoline (Clear Eyes) Mechanism of Action: Promotes vasoconstriction of blood vessels in and around the eye Indications: Used for patients with redness, burning, or minor irritants of the eye Contraindications: Known allergy and closed angle glaucoma Adverse Effects: Redness, watery eyes, blurred vision, stinging Interactions: None 4. Lubricants and Moisturizers Drugs: Artificial tears (Moisture Drops, Murine, Nu-Tears, Akwa Tears, and Tears Plus) Mechanism of Action: Adjust pH, control microbial infections, and extend ocular activity Indications: Used for patients with dry and/or irritated eyes. Contraindications: Known allergy Adverse Effects: Redness, watery eyes, blurred vision, stinging Interactions: Restasis can be used in adjunct with artificial tears if the drug is given 15 minutes apart...