Pharmacology Sensory

Chapter 58: Ophthalmic Drugs

 

Ophthalmic Agents with Nursing Implications

 

Drug Group	Drug Examples	Nursing Implications
β-Adrenergic blocker	timolol	Use nasolacrimal pressure to prevent possible systemic absorption (as with all other topical ophthalmic solutions or ointments); monitor for bradycardia, heart block, and wheezing.
Osmotic drugs	glycerin, mannitol, urea	Glycerin should be used with extreme caution; flavor with lemon or lime juice over cracked ice; monitor for signs of cerebral dehydration.
		Mannitol may result in digitalis toxicity when given concurrently; if crystallized, may dissolve in warm water; adequate hydration is important (up to 200 mL/day).
		Urea, if given at a rate 4 mL/min, may result in hemolysis and cerebral vasomotor symptoms; monitor fluid volume status closely; preparation and administration vary; read instructions carefully.
Mydriatics and cycloplegics	atropine, cyclopentolate	With atropine, monitor for adverse effects such as irregular pulse, confusion, dry mouth, and fever; causes blurred vision and photosensitivity, so sunglasses should be worn outside until effect is gone.
		With cyclopentolate, use with caution and give as ordered; same nursing management as with atropine.
Sympathomimetics	epinephrine, hydroxyamphetamine, phenylephrine, tetrahydrozoline	Monitor for serious adverse effects that may occur if systemically absorbed, such as tachycardia and elevated BP.
		With corticosteroid agents, report blurred vision or visual disturbances, eye pain, ptosis (lid drooping), or enlarged pupils.
		Prophylactic use is potentially dangerous and is not recommended. This may cause local reactions such as redness, itching, edema, and dermatitis.
Antimicrobials/ antiinflammatories		Follow instructions for instillation.
Antibacterials	chloramphenicol, erythromycin, gentamicin, neomycin, sulfonamides, tetracycline, tobramycin	With chloramphenicol, monitor fever, sore throat, and unusual bleeding, and any drop in complete blood count.
		With erythromycin, make sure to administer as ordered and apply only a thin ointment strip.
		Gentamicin and similar agents should be given as ordered.
		With neomycin combination agents and tetracycline, be sure to follow instructions.
		Cleanse eye with use of sulfonamide agents such as sulfacetamide and sulfisoxazole because they will be inhibited by purulent drainage or exudate; discard any darkened solution; may cause mild pain on instillation.
Antifungals Antivirals	natamycin, idoxuridine, trifluridine, vidarabine,	May cause irritation of the eye.
		Notify physician if the patient complains of blurred vision, eye irritation, visual changes or disturbances, or photosensitivity if not present before therapy; apply as ordered and, if an ointment, apply only a thin strip; always instill drops and ointments into the conjunctival sac.
Antiseptics	silver nitrate	Used for gonococcal infections and may inactivate bacitracin if used concurrently; leave in contact with sac for at least 3 seconds; irrigation afterward is not recommended.
Topical anesthetics	proparacaine tetracaine	Not recommended for long-term use because they could lead to possible irreversible eye damage; eye should be patched until injury healed; CNS excitation and subsequent depression are potential systemic adverse effects if absorbed.
Artificial tears	Lacrisert (Lacri-Lube, Duratears, and HypoTears are ointment forms)	Instill as directed.
Antiallergics	cromolyn sodium	Ocusert forms given daily.
Enzyme preparations	chymotrypsin	Instill as ordered; therapeutic effects in 4 weeks if given regularly.
		May result in postoperative glaucoma for about 1 week, which can be reversed with parasympathomimetics.
Hyperosmolar preparations	sodium chloride ointment	Apply as ordered.
Nonsteroidal antiinflammatories	diclofenac, flurbiprofen, ketorolac, suprofen	Use only as prescribed; solutions preferred for eye infections because ointments often decrease healing.
Ophthalmic surgery aids	sodium hyaluronate	Used to protect the eye from damage and to be given exactly as ordered.
Prostaglandin preparations	latanoprost	Instill as ordered; lowers IOP for 20–24 hr with single dose; well tolerated; patients with hazel-colored eyes may experience permanent iris color change to brown, but this is not harmful to the patient.

 

BP, Blood pressure; CBC, complete blood count; CNS, central nervous system; GI, gastrointestinal; IOP, intraocular pressure.