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Nursing pharmacology: Agents used in the Eye

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What is Mydriatic agents?
Agents that dilate the pupil.
List four purposes of Mydriatic agents use:
1. facilitate thorough examination of the eye
2. relieve inflammation associated with Uveitis and keratitis.
3. break or prevent formation of adhesions between the iris and the lens.
4. Prepare a client for ocular surgery.
What are the two major classes of Mydriatic agents?
1. Sympathomimetic Mydriatics
2. Anticolinergic Mydriatics
Provide example of Sympathomimetic Mydriatics.
i. alpha-adrenergic agonist properties ( Phenylephrine 2.5% and 10% solutions) : used for eye examination.
ii. epinephrine HCl 0.5-2%: used for treatment of narrow-angle glaucoma.
iii. epinephrine HCl 0.1% and Phenylephrine 0.125%: used as opthalmic decongestants for symptomatic relief of minor eye irritations.
Effects of Sympathomimetic Mydriatics
1. produce pupillary dilation
2. increase the outflow of aqueous humor
3. causes vasoconstriction,
4. relax the Ciliary muscle,
5. decrease the formation of aqueous humor.
What are some of the instructions that should be noted for patient receiving Sympathomimetic Mydriatics drugs?
1. Vision may be affected temporarily after administration
2. wear sunglasses because of light sensitivity.
3. Activities such as driving should be avoided after administration.
Provide example of Anticolinergic Mydriatics
atropine sulfate
Mechanism(s) of Anticolinergic Mydriatics
Blocks the response of the sphincter muscle of the iris and the muscle of the ciliary body to cholinergic stimulation. These agents produce:
- dilation of the pupil (mydriasis)
- interfere with the ability of the eye to focus properly (paralysis of accommodation or cycloplegia)
instructions that should be noted for patient receiving Anticolinergic Mydriatics
1. If administered for prolonged periods, systemic effects such as blurred vision, dry mouth, fever, and Urinary retention may occur
2. Do not use if you have glaucoma.
3. Vision may be affected temporarily after administration
4. wear sunglasses because of light sensitivity.
5. Activities such as driving should be avoided after administration.
Usage of Anticolinergic Mydriatics
1. determination & proper corrective lens to be use.
2. relief of inflammation associated with uveitis and keratitis
List the three classes of ophthalmic anti-infective agents.
1. Antibiotic
2. Antifungal Agents
3. Antiviral Agents
Example of Antibiotic Agents
bacitracin, gentamicin, sulfacetamide
Example of Antifungal Agents
natamycin (Natacyn)
Example of Antiviral Agents
idoxuridine (Herplex), Vidarabine (Vira-A), trifluridine (Viroptic)
Usage of Antiseptics Agents
1. use Primarily as ocular irrigants.
2. remove accumulated mucus from the eye
3. treat irritations and minor infections of the eyelids.
Usage of Local Anesthetic Agent
1. used in procedures where a topical ophthalmic anesthetic is required (e.g., tonometry, gonioscopy, removal of foreign objects.
2. Blinking reflex is temporarily eliminated.
List two purposes for which corticosteroid ophthalmic preparation may be used.
1. Relieving pain and discomfort that may accompany ocular infection, trauma, and allergic disorder (anti-inflammatory action)
2. Used to inhibit scar formation after ocular surgery.
contraindication of Corticosteroids
- contraindicated in the presence of most fungal and viral infections.
- only for short period usage.
- prolonged used may resulting glaucoma, damage to the structure of the eye including the optic nerve, cataract formation, and increase susceptibility to infection.
- Clients should have frequent eye examination and closely monitored for increase in intraocular pressure.
Give an example of when not to use or use with Caution an anti-inflammatory ophthalmic drug.
All NSAIDs may cause hypersensitivity reactions in clients who have a history of hypersensitivity to aspirin or other NSAIDs.
Give an example of when not to use or use with Caution Suprofen (Profenal)
should not be used in clients with epithelial herpes simplex keratitis.
Give an example of when not to use or use with Caution Ketorolac tromethamine
Ketorolac tromethamine should not be used in clients wearing soft contact lenses.
Describe the usual method of applying fluorescein sodium.
Topical application is generally performed by instilling a fluorescein sodium moistened with sterile water, to the eye.
List four types of clients who may require an eye patch following administration of medications to the eye.
1. Children and individuals not fully conscious who may rub or irritate the eye.
2. client who may received local anesthetics and who temporary have no blinking reflexes.
3. clients with sensitivity to light (photosensitivity)
4. Client with a considerable amount of drainage from eye.
List some of the adverse reactions to watch for in Pt. using ophthalmic drugs:
Beta-adrenergic blocking agents
Beta-adrenergic blocking agents
1. it has he ability to absorb into systemic circulation and interfere with the therapy cf clients with bronchial asthma and CHF.
2. May also cause ocular irritation.
List some of the adverse reactions to watch for in Pt. using ophthalmic drugs:
Direct-acting Miotic
Direct-acting Miotic
systemic effects such as flushing, sweating, gastric distress, diarrhea and headache.
List some of the adverse reactions to watch for in Pt. using ophthalmic drugs:
Cholinesterase Inhibitors
Cholinesterase Inhibitors
Adverse effects are:
1. stinging
2. burning
3. lacrimation
4. lens opacities
5. ocular inflammation.
List some of the adverse reactions to watch for in Pt. using ophthalmic drugs:
Carbonic Anhydrase Inhibitor
Carbonic Anhydrase Inhibitor
i. derivative of sulfonamide antibiotics
ii. any person known to be sensitive to these agents should be carefully observed for
1. fever
2. rash
3. hemolytic anemia
4. edema.
List some of the adverse reactions to watch for in Pt. using ophthalmic drugs:
Osmotic diuretics
Osmotic diuretics
cause headaches, nausea and vomiting, plus phlebitis and thrombosis at site of injection

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