McKenna's Pharmacology for Nursing, 2e

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A P P E N D I X D  Ophthalmic agents

■ ■ Provide comfort measures to help the person tolerate drug effects (e.g. control light, administer analgesics as needed). ■ ■ Include the following information—in addition to the proper administration technique for the drug—in the teaching program for the person to improve compliance and provide safety and comfort measures as necessary : safety measures may need to be taken if blurring of vision should occur; burning and stinging may occur on administration but should pass quickly; the pupils will dilate with mydriatic agents and the eyes may become very sensitive to light (the use of sunglasses is recommended); any severe eye discomfort, palpitations, nausea or headache should be reported to the healthcare provider. Evaluation ■ ■ Monitor response to the drug (changes in pupil size, relief of pressure of glaucoma, relief of itching and tearing related to allergic reaction). ■ ■ Monitor for adverse effects (local irritation, blurring of vision, headache). ■ ■ Evaluate the effectiveness of the teaching plan (person can name adverse effects to watch for and specific measures to avoid them; the person understands the importance of the follow-up that will be needed). ■ ■ Monitor the effectiveness of comfort measures and compliance with the regimen.

FIGURE D.1  Administration of ophthalmic drops.

FIGURE D.2  Administration of ophthalmic ointment.

■■ TABLE D Ophthalmic agents (continued) Drug Usage

Special considerations

aciclovir (Zovirax Ophthalmic Ointment) apraclonidine (Iopidine)

Treatment of ocular herpes simplex

One cm into lower conjunctival sac five times daily for 14 days Monitor for the possibility of vasovagal attack; do not give to individuals with allergy to clonidine One drop into the eye as needed. Apply gentle pressure to tear duct for 1 minute following administration Antihistamine, mast cell stabiliser; dosage (≥3 years): 1 drop b.d.; rapid onset, 8-hours duration One drop b.d.; may take up to 2 weeks to see results; do not combine with beta-adrenergics Used for people who are intolerant to other IOP-lowering drugs or who have failed to achieve optimum IOP with other IOP-lowering medications -antagonist; minimal effects on cardiovascular and pulmonary systems; do not use with monoamine oxidase inhibitors; dosage: one drop t.d.s. One drop to the affected eye q 12 hours; do not use with contact lenses Selective alpha 2

To control or prevent postsurgical elevations of intraocular pressure (IOP) after argon-laser eye surgery Conditions necessitating pupil dilation and paralysis of accommodation Treatment of ocular itching associated with allergic conjunctivitis Reduction of IOP with chronic open-angle glaucoma, ocular hypertension Reduction of IOP in individuals with open-angle glaucoma or ocular hypertension Treatment of open-angle glaucoma and ocular hypertension

atropine (Atropt)

azelastine (HCl) (Eyezep)

betaxolol (Betoptic, Betoquin)

bimatoprost (Lumigan)

brimonidine tartrate (Alphagan, Alphagan P, Enidin) brimonidine with timolol (Combigan)

Treatment of IOP