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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
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When writing a presciption what should you consider?
Write to instill in both eyes because will probably transfer to other eye?
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When applying ointment, how much should you tell parents to instill?
Instill ½ inch ribbon
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What is the difference b/w ointment and drops?
Ointments stay better but it is more difficult to see so consider this when prescribing.
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What are the common medications utilized for eye exams and surgery?
Phenylephrine, cyclopentanate, tropicamide
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What is Phenylephrine (Ophthalmic) used for?
Alpha-adrenergic for eye exams or surgery – sypathetic medication
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What does phenylephrine do to the eyes?
Mydriasis and cycloplegia
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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
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What are the side effects of phenylephrine?
AE: ↑resp problems with BPD. Do not use with beta-blockers
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What does Tropicamide (Ophthalmic) and Cyclopentolate (Ophthalmic)
- do?
- Anticholinergics – parasympathetics- slows things down
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How does the eye drops cause Mydriasis and cycloplegia.
- Paralyzes the muscles and changes the shape of the lens
- Affects accomadation
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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
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What are the side effects of tropicamide
AE: anticholinergic including delayed gastric emptying (? Hold feeds)
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Why are eye ointments applied after birth?
Prophylaxis against gonococcal ophthalmia neonatorum is mandatory for all neonates (AAP perinatal guidelines)
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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
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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
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What is the management for conjunctivitis
- Send culture
- Treat the bacteria with antibiotics
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What are common causes of eye infections?
- Birth - GC
- Childhood - Strep pneumoniae and Haemophilus influenzae
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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
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How should the opthalmic antibiotics be instilled?
1-2 gtts or ½ inch ribbon ointment QID x 7 d
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What are the most commonly used opthalmic antibiotics
Gent and tobradex are used quite often
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