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Ophthalmic anti-inflammatories and anti-infectives: Nursing Pharmacology

Notes

Notes

OPHTHALMIC ANTI-INFLAMMATORIES
DRUG NAME
diclofenac, flurbiprofen, ketorolac (Acular), nepafenac (Nevanac)
dexamethasone (Maxidex),  prednisolone (Pred Forte)
emedastine, epinastine
cromolyn, nedocromil (Alocril)
CLASS
Ophthalmic NSAIDs
Ophthalmic corticosteroids
Ophthalmic antihistamines
Ophthalmic mast cell stabilizers
MECHANISM OF ACTION
Decrease the number of inflammatory cells and inhibit inflammatory mediator molecules (e.g., histamines, prostaglandins)
INDICATIONS
  • Allergic conjunctivitis
  • Non-infectious uveitis
  • Postoperative eye inflammation
ROUTE(S) OF ADMINISTRATION
  • TOP
SIDE EFFECTS
  • Headache
  • Increased intraocular pressure
  • Thinning of the cornea
  • Delayed corneal healing
  • Stinging or burning sensation
  • Cataracts (prolonged use)
CONTRA-INDICATIONS AND CAUTIONS
  • None
OPHTHALMIC ANTI-INFECTIVES
DRUG NAME
ciprofloxacin (Ciloxan), erythromycin, gentamicin, (Gentak), levofloxacin, sulfacetamide (Bleph-10), tobramycin (Tobrex), tetracycline (Sumycin, Actisite, Achromycin V)

natamycin (Natacyn)
trifluridine
CLASS
Ophthalmic antibiotics
Ophthalmic antifungals
Ophthalmic antivirals
MECHANISM OF ACTION
Kill or stop growth of bacteria
Kill or stop growth of fungi
Kill or inhibit spread of viruses
INDICATIONS
  • Infectious conjunctivitis
  • Infectious uveitis
  • Infectious blepharitis
  • Infectious keratitis
  • Infectious endophthalmitis
  • Hordeolum (stye)
  • Corneal ulceration
ROUTE(S) OF ADMINISTRATION
  • TOP
SIDE EFFECTS
  • Local skin or eye irritation
  • Non-infectious conjunctivitis
  • Superinfection by resistant organisms
CONTRAINDICATIONS AND CAUTIONS
  • None
NURSING CONSIDERATIONS:
OPHTHALMIC ANTI-INFLAMMATORIES AND ANTI-INFECTIVES
ASSESSMENT AND MONITORING
Ophthalmic anti-inflammatories and anti-infectives
  • Assess for ophthalmic symptoms; e.g., redness, decreased visual acuity, discomfort
  • Review ophthalmic exam results and intraocular pressure test results
  • Monitor for side effects
  • Evaluate the therapeutic response: decreased eye inflammation, resolution of infection
CLIENT EDUCATION
Ophthalmic anti-inflammatories and anti-infectives
  • May experience burning and stinging during application
    • Rest in a dim and quiet environment; applying a warm or cool compress can promote comfort
  • Blurry vision
    • Environmental modifications to prevent falls or injuries
  • Self-administration of the medication
    • Wash hands before and after administration
    • Lie down or sit up with head tilted back
    • Look upward and gently pull down on the lower eyelid to expose the conjunctival sac
    • Administer the prescribed number of drops or amount of ointment
      • Keep applicator tip clean
    • After administration: close eyes for about three minutes
      • For drops: gently press on the inside corner of the closed eye; decreases systemic absorption
      • For multiple eye drops: wait at least five minutes between each administration
      • After administration: blot excess liquid or ointment with a clean tissue
  • Report worsening condition or if their symptoms don’t resolve
Transcript

Commonly used ophthalmic medications can be broadly divided into two categories: anti-inflammatories and anti-infectives. Ophthalmic anti-inflammatories are a group of medications that are used to treat inflammatory eye conditions, such as allergic conjunctivitis, non-infectious uveitis, and to treat eye inflammation after an ophthalmic procedure.

In contrast, ophthalmic anti-infectives are used to treat infectious eye conditions caused by bacteria, fungi, or viruses. These conditions include infectious conjunctivitis, uveitis, blepharitis, keratitis, and endophthalmitis.

A hordeolum or stye, which is a common bacterial infection of the sebaceous glands of the eyelids, is also treated with ophthalmic anti-infectives. Finally, ophthalmic anti-infectives can also be used in clients with corneal ulceration to prevent infection.

Okay, starting with ophthalmic anti-inflammatories, they can be broadly classified into five groups: NSAIDs, which include diclofenac, flurbiprofen, ketorolac, and nepafenac; as well as corticosteroids, which include dexamethasone and prednisolone; antihistamines, such as emedastine and epinastine; and mast cell stabilizers, including cromolyn and nedocromil.

Finally, a combination of antihistamines and mast cell stabilizers can be used, such as azelastine, epinastine, ketotifen, and olopatadine.

These medications are applied topically in the form of eye drops or ointments. Once applied, they control the eye inflammation by decreasing the number of inflammatory cells, and inhibiting the production and effects of inflammatory mediator molecules, such as histamines or prostaglandins.

Unfortunately, ophthalmic anti-inflammatories can cause side effects, such as headaches, increased intraocular pressure, thinning of the cornea, and a delay in corneal healing. In addition, clients may experience a stinging or burning sensation when the medication is applied.

Finally, prolonged use of these medications has also been associated with the development of cataracts. Luckily, there are no known contraindications for the use of ophthalmic anti-inflammatory medications.

Next are ophthalmic anti-infectives, which can be broken down into three categories: antibiotics, which include ciprofloxacin, erythromycin, gentamicin, levofloxacin, sulfacetamide, tobramycin, and tetracycline; as well as antifungals, such as natamycin; and antivirals, like trifluridine.

These medications are also applied topically in the form of eye drops, or ointments, and they act by respectively killing or stopping the growth of bacteria, fungi, or viruses.

Now, side effects of ophthalmic anti-inflammatories include local skin or eye irritation, which can cause blurred vision or a stinging or burning sensation. Also, ophthalmic anti-inflammatories can increase the risk of non-infectious conjunctivitis or even a superinfection by organisms resistant to these medications. Once again, there are no significant contraindications for ophthalmic anti-infective medications.

Alright, when your client is prescribed an ophthalmic anti-inflammatory or anti-infective, first assess for any ophthalmic symptoms, including redness, discomfort, or decreased visual acuity. Then, be sure to review the results of the most recent ophthalmic exam and intraocular pressure test.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Medical-Surgical Nursing" Elsevier Health Sciences (2016)
  4. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  5. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  6. "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)