eye ointments lecture 3 pharm.txt

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tracey
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11975
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eye ointments lecture 3 pharm.txt
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2010-03-25 22:37:31
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Lecture # 2 Eye Ointments
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Eye Ointments
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  1. Ophthalmological Pharmacology
    • How should you Instill Ophthalmalogic Medications?
    • Wash hands
    • Remove eye glasses or contacts if present
    • Do not touch dropper tip or let it touch patient or any other surface
    • Tilt head back or lay patient supine
    • Pull down lower eyelid to make a pouch
    • Hold the dropper directly over the eye and instill the prescribed number of drops
    • Close eye and place one finger at the corner of the eye near the nose and apply gentle pressure for a minute – the goal is to block the lacrimal duct
    • Instruct patient (able to follow instructions) not to blink or rub eye
    • Do not rinse the dropper
    • Replace the dropper cap after each use
    • If using another kind of eye medication wait at least five minutes before applying any other medications
    • Caveat: use eye drops before eye ointments to allow the eye drops to enter the eye
  2. When writing a presciption what should you consider?
    Write to instill in both eyes because will probably transfer to other eye?
  3. When applying ointment, how much should you tell parents to instill?
    Instill ½ inch ribbon
  4. What is the difference b/w ointment and drops?
    Ointments stay better but it is more difficult to see so consider this when prescribing.
  5. What are the common medications utilized for eye exams and surgery?
    Phenylephrine, cyclopentanate, tropicamide
  6. What is Phenylephrine (Ophthalmic) used for?
    Alpha-adrenergic for eye exams or surgery – sypathetic medication
  7. What does phenylephrine do to the eyes?
    Mydriasis and cycloplegia
  8. How is phenylephrine instilled?
    • 1 drop OU using 2.5%
    • Apply pressure to lacrimal sac during and for 2 minutes after instillation to minimize systemic absorption
    • Effects seen 5-10 minutes with recovery in 1 hour
  9. What are the side effects of phenylephrine?
    AE: ↑resp problems with BPD. Do not use with beta-blockers
  10. What does Tropicamide (Ophthalmic) and Cyclopentolate (Ophthalmic)
    • do?
    • Anticholinergics – parasympathetics- slows things down
  11. How does the eye drops cause Mydriasis and cycloplegia.
    • Paralyzes the muscles and changes the shape of the lens
    • Affects accomadation
  12. How is tropicamide instilled?
    • 1-2 drops OU using 0.5% or less
    • Apply pressure to lacrimal sac during and for 2 minutes after instillation to minimize systemic absorption
    • Effects seen 30-60 minutes with recovery in 6-24 hours
  13. What are the side effects of tropicamide
    AE: anticholinergic including delayed gastric emptying (? Hold feeds)
  14. Why are eye ointments applied after birth?
    Prophylaxis against gonococcal ophthalmia neonatorum is mandatory for all neonates (AAP perinatal guidelines)
  15. What is used for birth prophylaxis eye ointment?
    • 1-2 cm ribbon of ointment
    • Tetracycline 1% or erythromycin 0.5%
    • Or solution of providone-iodine 2.5% (this is rarely used)
    • Wipe away excess solution after 1 minute
  16. What are S/S of conjunctivitis?
    • S/S- redness, swelling, purulent discharge lasting 48 hours after initial eye drops
    • For infants less than 4 weeks of age
  17. What is the management for conjunctivitis
    • Send culture
    • Treat the bacteria with antibiotics
  18. What are common causes of eye infections?
    • Birth - GC
    • Childhood - Strep pneumoniae and Haemophilus influenzae
  19. What are the common ophthalmic antibiotics?
    • Aminoglycosides - gentamicin, neomycin, tobramycin
    • Tetracycline – DO NOT give <8 d/t teeth discoloration
    • Fluroquinolones $$ - ciprofloxacin, levofloxacin, ofloxacin, gatifloxacin, moxifloxacin
    • Sulfa - sulfacetamide
    • Natamycin (fungal)
    • Combination products - bacitracin, neomycin sulfate, and/or polymyxin B sulfate, tobramycin, and dexamethasone; Polytrim, Maxitrol, Tobradex
  20. How should the opthalmic antibiotics be instilled?
    1-2 gtts or ½ inch ribbon ointment QID x 7 d
  21. What are the most commonly used opthalmic antibiotics
    Gent and tobradex are used quite often

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