NR 565 Week 5 Chapter 26: Drugs used in treating eye &
ear disorders
Contraindications for topical beta blockers Beta blockers
Suppress conduction through the atrioventricular (AV) node; therefore, topical beta
blockers are contraindicated in patients with bradycardia or advanced AV block.
Do not use in patients with compromised ventricular dysfunction, cardiogenic shock, or
with systolic congestive HF
D/c at first sign of cardiac failure
Contraindicated with hypotension
Use with caution: poorly controlled DM and hyperthyroidism
Surgical patients should be monitored closely for cardiac failure
o Withdraw before surgery 2 days prior
Contraindicated with Raynaud’s disease or PVD, CVD
Preg cat C: fetal anomalies and fetotoxicity in animal studies
Prophylaxis for opthalmia neonatorum
Common patient group: infants younger than 1 month who presents with conjunctivitis
should have Gram's stain, antigen detection tests, and cultures of the eye discharge to
rule out gonococcal, chlamydial, or HSV origin.
Chlamydia is the most common cause of neonatal conjunctivitis
Gonococcal conjunctivitis is the most serious cause of ophthalmia neonatorum owing to
concerns about the bacteria causing blindness
Prophylaxis: Administration of antibiotic eye medication within 1 hour of delivery
Erythromycin ointment 0.5% (0.25 to 0.5-inch ribbon in each eye)
Chlamydial conjunctivitis is not prevented by prophylactic use of erythromycin at birth
therefore any mucopurulent eye discharge in the first few weeks of life should be
evaluated for chlamydia.
Glaucoma: Treatment, dosing, and patient education:
IOP damages the optic nerve
Leading cause of blindness worldwide
6-8 times more likely in African Americans than Caucations
, Antiglaucoma medications are prescribed by ophthalmologists. Dosage is determined by
the clinical condition of the patient.
Treatment and dosing
Current medical therapies are aimed at
o decreasing the production of aqueous humor at the ciliary body and
o Increasing the outflow of this fluid from the angle structures
Requires evaluation and treatment by an ophthalmologist
o FNPs need to be aware of the medications prescribed, drug interactions, and ADRs
Antiglaucoma agents are prescribed by ophthalmologists and dosage is determined by
the clinical condition of the patient
Four categories: Beta Blockers, adrenergic agonists, miotics, and carbonic anhydrase
(CA) inhibitors
o Beta Blockers:
Betaxolol, carteolol, metipranolol, levobunolol, timolol
o Adrenergic Agonists
Apraclonidine, brimonidine
o Miotics
Carbachol, pilocarpine, echothiophate
o Carbonic Anhydrase Inhibitors
Acetazoleamide, brinzolamide, dorzolamide, methazolamide
Patient education
The patient should be instructed to administer the medication exactly as the
ophthalmologist has prescribed
Abruptly stopping the medication can increase adverse effects.
The patient should have been instructed by the ophthalmologist regarding the adverse
effects of the medication.
o Reinforcement may be necessary. If the patient is experiencing adverse effects
from the medication, the primary care provider can facilitate a referral back to the
ophthalmologist.
Allergic or Vernal conjunctivitis: Treatment, dosing, and patient education
Occurs in response to a variety of allergens
Vernal conjunctivitis refers to conjunctivitis that occurs primarily in the spring, usually
because of an allergen.
The mast cell stabilizers (lodoxamide, cromolyn sodium) may be used to treat vernal
conjunctivitis and may be used safely for up to 3 months.
Treatment and Dosing
Ketotifen (H1 blocker) for allergic conjunctivitis and ocular pruritus.
o The dose used in adults and children over age 3 is 1 drop in the affected eye every
8 to 12 hours
, Levocabastine (H1 blocker): allergic conjunctivitis and ocular pruritis
o 1 drop in the affected eye 4 times a day.
Mast Cell Stabilizers:
o Cromolyn sodium (1-2 gtt, 4-6 times/day)
o Pemirolast (Alamast), 1-2 gtts QID
o Nedocromil (Alocril), 1-2 gtts in each eye bid at regular intervals
Antihistamines
o Antazoline-naphazoline (Vasocon-A), 1-3 gtts Q3-4 hours
o Azelastine (Optivar) 1 gtt each eye bid
o Epinastine (Elestat) 1 gtt each eye bid
o Emedastine (Emadine) 1 gtt QID
OTC products
o Combine a decongestant with an antihistamine
o Products that combine antazoline and naphazoline (Vasocon-A) or
o Naphazoline and pheniramine (Opcon-A, Naphcon-A) 1-2 gtt q3-4 hrs
Patient education
o Administration: use exactly as prescribed, overuse or underuse can adversely
affect outcomes
o Avoid touching the dropper to the ey or other surfaces that may contaminate the
medication
o Do not share medications
o Transient stinging and burning may occur
o If severe or prolonged contact provider
Bacterial conjunctivitis: Treatment, dosing, and pt education
Children between ages 3 months and 8 years are most likely to have staphylococcal,
streptococcal, or Haemophilus conjunctivitis.
Non-typable H. influenzae is seen more in warmer climates between May and October
o Most common in children younger than 7
S. pneumoniae is seen in colder climates and during the winter (elderly)
S. aureus shows no geographic or seasonal pattern (elderly)
Although bacterial conjunctivitis is considered a self-limited disease (unless caused by
gonorrhea), patients who receive topical antibiotic therapy have faster clinical
improvement.
Treatment and Dosing: Uncomplicated conjunctivitis treated with
o Sulfacetamide 10% solution or ointment:
1-2 gtts q2-3 hrs during the day, less often at night
ear disorders
Contraindications for topical beta blockers Beta blockers
Suppress conduction through the atrioventricular (AV) node; therefore, topical beta
blockers are contraindicated in patients with bradycardia or advanced AV block.
Do not use in patients with compromised ventricular dysfunction, cardiogenic shock, or
with systolic congestive HF
D/c at first sign of cardiac failure
Contraindicated with hypotension
Use with caution: poorly controlled DM and hyperthyroidism
Surgical patients should be monitored closely for cardiac failure
o Withdraw before surgery 2 days prior
Contraindicated with Raynaud’s disease or PVD, CVD
Preg cat C: fetal anomalies and fetotoxicity in animal studies
Prophylaxis for opthalmia neonatorum
Common patient group: infants younger than 1 month who presents with conjunctivitis
should have Gram's stain, antigen detection tests, and cultures of the eye discharge to
rule out gonococcal, chlamydial, or HSV origin.
Chlamydia is the most common cause of neonatal conjunctivitis
Gonococcal conjunctivitis is the most serious cause of ophthalmia neonatorum owing to
concerns about the bacteria causing blindness
Prophylaxis: Administration of antibiotic eye medication within 1 hour of delivery
Erythromycin ointment 0.5% (0.25 to 0.5-inch ribbon in each eye)
Chlamydial conjunctivitis is not prevented by prophylactic use of erythromycin at birth
therefore any mucopurulent eye discharge in the first few weeks of life should be
evaluated for chlamydia.
Glaucoma: Treatment, dosing, and patient education:
IOP damages the optic nerve
Leading cause of blindness worldwide
6-8 times more likely in African Americans than Caucations
, Antiglaucoma medications are prescribed by ophthalmologists. Dosage is determined by
the clinical condition of the patient.
Treatment and dosing
Current medical therapies are aimed at
o decreasing the production of aqueous humor at the ciliary body and
o Increasing the outflow of this fluid from the angle structures
Requires evaluation and treatment by an ophthalmologist
o FNPs need to be aware of the medications prescribed, drug interactions, and ADRs
Antiglaucoma agents are prescribed by ophthalmologists and dosage is determined by
the clinical condition of the patient
Four categories: Beta Blockers, adrenergic agonists, miotics, and carbonic anhydrase
(CA) inhibitors
o Beta Blockers:
Betaxolol, carteolol, metipranolol, levobunolol, timolol
o Adrenergic Agonists
Apraclonidine, brimonidine
o Miotics
Carbachol, pilocarpine, echothiophate
o Carbonic Anhydrase Inhibitors
Acetazoleamide, brinzolamide, dorzolamide, methazolamide
Patient education
The patient should be instructed to administer the medication exactly as the
ophthalmologist has prescribed
Abruptly stopping the medication can increase adverse effects.
The patient should have been instructed by the ophthalmologist regarding the adverse
effects of the medication.
o Reinforcement may be necessary. If the patient is experiencing adverse effects
from the medication, the primary care provider can facilitate a referral back to the
ophthalmologist.
Allergic or Vernal conjunctivitis: Treatment, dosing, and patient education
Occurs in response to a variety of allergens
Vernal conjunctivitis refers to conjunctivitis that occurs primarily in the spring, usually
because of an allergen.
The mast cell stabilizers (lodoxamide, cromolyn sodium) may be used to treat vernal
conjunctivitis and may be used safely for up to 3 months.
Treatment and Dosing
Ketotifen (H1 blocker) for allergic conjunctivitis and ocular pruritus.
o The dose used in adults and children over age 3 is 1 drop in the affected eye every
8 to 12 hours
, Levocabastine (H1 blocker): allergic conjunctivitis and ocular pruritis
o 1 drop in the affected eye 4 times a day.
Mast Cell Stabilizers:
o Cromolyn sodium (1-2 gtt, 4-6 times/day)
o Pemirolast (Alamast), 1-2 gtts QID
o Nedocromil (Alocril), 1-2 gtts in each eye bid at regular intervals
Antihistamines
o Antazoline-naphazoline (Vasocon-A), 1-3 gtts Q3-4 hours
o Azelastine (Optivar) 1 gtt each eye bid
o Epinastine (Elestat) 1 gtt each eye bid
o Emedastine (Emadine) 1 gtt QID
OTC products
o Combine a decongestant with an antihistamine
o Products that combine antazoline and naphazoline (Vasocon-A) or
o Naphazoline and pheniramine (Opcon-A, Naphcon-A) 1-2 gtt q3-4 hrs
Patient education
o Administration: use exactly as prescribed, overuse or underuse can adversely
affect outcomes
o Avoid touching the dropper to the ey or other surfaces that may contaminate the
medication
o Do not share medications
o Transient stinging and burning may occur
o If severe or prolonged contact provider
Bacterial conjunctivitis: Treatment, dosing, and pt education
Children between ages 3 months and 8 years are most likely to have staphylococcal,
streptococcal, or Haemophilus conjunctivitis.
Non-typable H. influenzae is seen more in warmer climates between May and October
o Most common in children younger than 7
S. pneumoniae is seen in colder climates and during the winter (elderly)
S. aureus shows no geographic or seasonal pattern (elderly)
Although bacterial conjunctivitis is considered a self-limited disease (unless caused by
gonorrhea), patients who receive topical antibiotic therapy have faster clinical
improvement.
Treatment and Dosing: Uncomplicated conjunctivitis treated with
o Sulfacetamide 10% solution or ointment:
1-2 gtts q2-3 hrs during the day, less often at night
