Drugs used in Ophthalmic/ENT Disorders

www.remixeducation.in
 Objectives

By the completion of this section the learners will be able to:

• Review ocular structure that influence drug therapy

• Discuss different categories of drugs used in E ENT disorders

• Review the proper methods of instilling the EEN drops

• Utilize nursing process while taking care of clients using drugs related to EENT disorders.

• Calculate drug dosage calculations accurately.

www.remixeducation.in
 Ocular Structure

• The eye is broadly divided into two compartments called the anterior (front of the
eye) and posterior (back of the eye) segment
• The anterior segment of the eye consists of the cornea, conjunctiva, iris, ciliary body
and the lens.
• The posterior segment of the eye refers to the posterior two‐thirds of the eye,
including the anterior hyaloid membrane and all the structures behind it such as the
vitreous, retina, choroid and optic nerve.

www.remixeducation.in
 Pharmacotherapy in Ophthalmic Diseases

• Ocular administration of drug is primarily associated with the need to treat

ophthalmic diseases.
• The common eye diseases are cataract, glaucoma and uveitis, with cataract
(accounting for 51% blindness), infections e.g. conjunctivitis etc.
• Eye is the most easily accessible site for topical administration of a medication.
• Ideal ophthalmic drug delivery must be able to sustain the drug release and to
remain in the vicinity of front of the eye for prolong period of time.

www.remixeducation.in
 Pharmacotherapy in Ophthalmic Diseases

• Local applications do pose some disadvantages.

• Topically administered drugs often display limited bioavailability (< 5%) due to many
physical and biochemical barriers including
– pre‐corneal tear film,
– the structure and biophysiological properties of the cornea,
– the limited volume that can be accommodated by the cul‐de‐sac, the lacrimal
drainage system,
– reflex tearing and
– the aqueous outflow within the eye.

www.remixeducation.in
 Factors Affecting Intraocular Bioavailability

• Inflow & outflow of lacrimal fluids.

• Efficient naso-lacrimal drainage.

• Interaction of drug with lacrimal fluid.

• Dilution with tears.

• Blinking of the eyes (increase tears formation)

• Corneal barriers (closely packed corneal epithelium)

• Blood–retinal barrier (BRB)

www.remixeducation.in
 Barriers in Ocular Absorption

Precorneal Constraints Corneal constraints

It include – • Cornea as rate limiting barrier
• Solution drainage • Anatomy of cornea
• Lacrimation – Outer Epithelium (lipophilic),
• Tear dilution – Middle Stroma (hydrophilic),
• Tear turnover – Inner Endothelium (lipophilic)
• Conjunctival absorption

www.remixeducation.in
 Cont.…

• Therefore, intra vitreous (i.v.t.) injections are required to administer drugs directly to
the posterior segment to achieve high doses.

• Although repeated administration of i.v.t. injections, poses potential complications

including endophthalmitis, retinal detachment, traumatic cataract, intraocular
hemorrhage and ocular infections

www.remixeducation.in
 Examples of drugs used in eye diseases

• Anti-infectives – e.g. antibacterials, antifungals, antivirals

• Anti-inflammatories – e.g. corticosteroids,
• Antihistamines
• Mydriatics & cycloplegics –e.g. atropine – dilate pupil & paralyze ciliary muscle to
facilitate examination of interior of the eye
• Antiglaucoma agents –reduce IOP e.g. beta-blockers
• Miotics – e.g. pilocarpine –constrict pupil & contract ciliary muscle
• Anesthetics – e.g. topical & surgical procedures

www.remixeducation.in
 Drugs used to Treat Eye Infection

• Superficial bacterial, fungal, and viral infection can occur in the:

– Eye
– Eyelid and surrounding structures
– Cornea
– Conjunctiva
– Lacrimal duct

www.remixeducation.in
 Drugs used to Treat Eye Infection

• Treated topically or systemically with:

– Antibiotic drugs for bacterial infections

– Antifungal for fungal infections

– Antiviral for viral infections

www.remixeducation.in
 Drugs used to Treat Eye Infection

Topical antibiotics for bacterial eye infections

• Disrupt the cell wall of bacteria or inhibits protein synthesis
• Not effective against viral infections
• Example are:
• Azithromycin
• Bacitracin
• Ciprofloxacin
• Erythromycin
• Chloramphenicol
• Gentamicin
• Ofloxacin
• Tobramycin
www.remixeducation.in
 Drugs used to Treat Eye Infection

Topical antifungal drugs for fungal eye infections

– Natamycin (Natacyn)
Topical antiviral drugs for viral eye infections
• Trifluridine (viroptic )
– Affective against viruses
– Herpes Simplex Virus, type 1 and type 2
• Ganciclovir (Vitrasert)
– Administered as an implant that is placed with in the eyes in vitreous humor so
that the drug will come in contact with retina
– Also use topically to cytomegalovirus retinitis

www.remixeducation.in
 Drug used to Treat Eye Inflammation

• Inflammation of the eye may be due to:

– Injury

– Trauma

– Contact with chemicals

– Allergies

– Infections

www.remixeducation.in
 Drug used to Treat Eye Inflammation

• Anti inflammatory drugs treat inflammation in the following areas of the eye:

– Eyelid

– Cornea

– Conjunctiva

– Lacrimal duct

www.remixeducation.in
 Drug used to Treat Eye Inflammation
Corticosteroid drugs
• Used topically to treat inflammation
• Suppress the immune system’s local response local inflammatory response
• Drugs that are commonly used are:
– Dexamethasone (Maxidex)
– Difluprednate (Durezol)
– Fluromatholone (Flarex)
– Loteprednol (Lotepred Forte)
– Prednisolone (Pred Forte)
– Remexolone (Vexol)

www.remixeducation.in
 Drug used to Treat Eye Inflammation
Corticosteroid drugs
• Following anti-inflammatory drugs are administered with in eye into the vitreous humor
uveitis

– Dexamethasone (oxudex) is an implant

– Fluocinolone (Retisert) is an implant

– Triamcinolone (Trivaris) is injected as a solution

• Note

• uveitis : inflammation in the tissue of middle layer of the eye wall (uvea)

www.remixeducation.in
 Drug used to Treat Eye Inflammation
NSAIDS
• Non-steroidal anti-inflammatory drugs treat pain and inflammation after cataract or
LASIK surgery on the eye.
• Following NSAIDs are commonly used
– Diclofenac
– Ketorolac
– Nepafenac
– Bromofenac
• NSAIDs has 3 types of effects
– Anti-inflammatory
– Analgesic
– Antipyretic (COX-2)
• Inhibits the cyclooxygenase pathway www.remixeducation.in
 Newer NSAIDS

• Nepafenac 0.1% and Bromofenac 0.09%are topical, nonsteroidal anti-inflammatory,

recently introduced

• Nepafenac is a prodrug, converted by ocular tissue hydrolases to amfenac, which

inhibits the action of prostaglandin H synthase(cyclooxygenase)

www.remixeducation.in
 Mydriatics & Cycloplegics

• Mydriatics are the drugs which dilate the pupil and cycloplegics are agents which
causes paralysis of ciliary muscles
• Mydriatics are of two types
1. Adrenergic agonist
– Adrenaline
– Phenylephrine
2. Cholinergic antagonists
– Tropicamide
– Atropine
– Scopolamine

www.remixeducation.in
 Drugs used To Treat Allergy Symptoms

• Human eye has about 50 million mast cells, which contains

preformed chemical mediators (histamines)
• Eye allergy occur from the same reason as other parts of the body
• Foreign substances enter the body, antibodies attach to the antigen, forming an
antigen-antibody complex
• Antigen-antibody can be destroyed, in the process histamine released from mast cells
– Cause vasodilation of blood vessels
– Tissue become swollen, inflamed and red
– Irritates tissues causing pain and itching

www.remixeducation.in
 Anti-histamine Drugs for Eye Allergy

• These drugs block histamine receptors, hence inhibits effects of histamine

• Following are commonly used anti-histamine drugs
• Alcaftadine (H1 receptors antagonist)
• Azelastine eye drop (Anti-histaminic effects)
• Emedastine eye drop (H1 receptors antagonist)
• Epinastine eye drop (highly selective H1 receptors antagonist)
• Ketotifen eye drops (anti-histamine & mast cell stabilizer)
• Olopatadine eye drop (H1 receptors antagonist & mast cell stabilizer)

www.remixeducation.in
 Mast Cell Stabilizers for Eye Allergy

• Mast cell stabilizers as anti-histamine drugs, prevent the cell membrane of the mast
cells in the eye from releasing histamines
• Commonly used drugs are:
– Bapotastine eye drop (non-sedating mast cell stabilizer)
– Cromolyn eye drop (mast cell stabilizer & also prevent release of leukotriene)
– Lodoxamide eye drop (mast cell stabilizer)
– Nedocromil eye drop(non- selective mast cell stabilizer)
– Pemirolast eye drop (mast cell stabilizer)

www.remixeducation.in
 Decongestants Drugs for Eye Allergy

• Decongestant drugs constrict blood vessels in the conjunctiva to reduce redness

• Commonly used decongestants are
– Naphazoline
– Oxymetazoline
– Phenylephrine
– Tetrahydrozoline

www.remixeducation.in
 Combination Anti-histamine & Decongestant Eye Drugs

• Combine an anti-histamine drug with a decongestant drug

• Opcon A
– Naphazoline plus Pheniramine
• Visine-A
– Pheniramine plus Tetrahydrozoline

www.remixeducation.in
 Drugs used to Treat Dry Eye Syndrome

• Xerophthalmia is caused by an insufficient production of tears because of eye

inflammation or because of old age
• Also a side effects of certain drugs
• Treated with OTC lubricant Drugs (artificial tears) or prescription drugs
• Commonly used drugs are
– Carboxymethylcellulose: OTC artificial tears gel
– Cyclosporine: decrease T cells that cause inflammation, producing more tears
– Hydoxypropyl cellulose: dissolving insert to stabilize tear film and keep it in place
through out the day

www.remixeducation.in
 Drugs used for Glaucoma

• Increased intraocular pressure that, if left untreated, can lead to blindness

• Drugs acts either by:

– Decreasing the amount of aqueous humor circulating in the anterior and

posterior chambers of eye

– Decreasing intraocular pressure

www.remixeducation.in
 Drugs used for Glaucoma
• Glaucoma drugs act either by:
– Constricting the pupil (miosis) to open the angle of contact
between the iris and trabecular meshwork
• Allows aqueous humor to flow freely
• Beta blockers drugs used to treat glaucoma: it block beta
receptors in the eye
• Decrease the production of aqueous humor to decrease IOP
• Has no effects on pupil size so does not cause blurred vision
• Beta blockers drugs used for glaucoma includes:
– Betaxolol
– Cartelol
– Levobunolol
– Metipranolol
www.remixeducation.in
– Timolol
 Drugs used for Glaucoma
Alpha Receptor Agonists

• These drugs stimulates alpha-2 receptors in the eye

• Decrease the production of aqueous humor

• Increase outflow of aqueous humor

• Commonly used drugs are

– Apraclonidine

– Brimonidine

www.remixeducation.in
 Drugs used for Glaucoma
Prostaglandin F Agonists

• Stimulate prostaglandins F receptors

• Increase the outflow of aqueous humor and decrease the IOP

• Examples:

– Bimatoprost

– Latanoprost

– Tafluprost

– Travoprost.
Note: :Bimatoprost : hair growth (eye lashes)
www.remixeducation.in
 Drugs used for Glaucoma
Carbonic Anhydrase Inhibitors
• Inhibits enzyme carbonic anhydrase present in epithelium of ciliary body
• Prevents the bicarbonate and sodium influx and decreases aqueous formation
• Useful in short term treatment of acute glaucoma
• Onset of action within 1 hour and maximum effect in 4 hours
• Given orally
– Acetazolamide
• Dorzolamide & Brinzolamide are topical Carbonic Anhydrase Inhibitors

www.remixeducation.in
 Miotic drugs for Glaucoma

• First drugs drug developed to treat glaucoma

• Have the same action as acetylcholine
– Causes the pupil to constrict
– Increases the outflow of aqueous humor
– Lowers the IOP
• Miotic drugs includes
– Carbachol
– Pilocarpine

www.remixeducation.in
 Cholinesterase Inhibitors Drugs for Glaucoma

• This class of drugs inhibits enzyme cholinesterase that normally destroys

acetylcholine

• Hence acetylcholine available for long period of time, and cause pupil to constrict

• Echothiophate iodide is example of this class.

www.remixeducation.in
 Combination Drugs for Glaucoma

• Following is a common combination drugs

• Cosopt is combination of Dorzolamide 2% (carbonic anhydrase inhibitors) & Timolol

0.5% (beta-blocker drug)

• Brimonidine 0.2% and Timolol 0.5%

• Latanoprost 0.005% and Timolol 0.5%

• Travaprost 0.004% and Timolol 0.5%

• Bimatoprost 0.03% and Timolol 0.5%

www.remixeducation.in
 Anesthetic Ophthalmic Drugs

• Used in the eye to facilitate eye examination and for short surgical procedures such
as foreign body removal or suture removal

• Drugs in this class are

– Lidocaine

– Proparacaine

– Tetracaine

www.remixeducation.in
Ear Nose Throat Drugs

www.remixeducation.in
 ENT Drugs

• ENT drugs can be divided into the following categories

– Decongestants
– Antihistamines
– Mast Cell Stabilizer Drugs
– Corticosteroids
– Nasal steroid preparations
– Antibiotics
– Anti-fungal/anti-yeast drugs
– Antitussives
– Expectorants
– Combination ENT Drugs
www.remixeducation.in
 Decongestant Drugs

• Act as vasoconstrictors by stimulating alpha receptors in the smooth muscle around

the blood vessels
• Reduce blood flow to edematous mucous membranes in the nose, sinuses and
pharynx
• Alleviate nasal stuffiness and sinus congestion
• Allow secretions to drain
• Commonly prescribed for colds and allergies
• Can be administered topically as nasal drops or nasal sprays or orally
• Phenylpropanolamine & Pseudoephedrine are commonly used decongestants

www.remixeducation.in
 Decongestant Drugs

Others drugs in this class are:

• Naphazoline

• Oxymetazoline

• Tetrahydrozoline

• Xylometazoline

www.remixeducation.in
 Antihistamine Drugs

• Exert their therapeutic effect by blocking histamine (H1) receptors in the nose and
throat

• Histamine released from mast cells in the tissues when an antibody-antigen complex is
created during an allergic reaction

– Causes vasodilation in which the blood vessels and mucous membranes become
swollen and red

– Irritates the tissue directly, causing pain and itching

www.remixeducation.in
 Antihistamine Drugs

• Block the action of histamine at H1 receptors to dry up secretions

• Shrink edematous mucous membranes
• Decrease itching and redness
Side effects
• 1st generation antihistamines causes drowsines, s while 2nd generation
antihistamine, do not cause drowsiness because of a different chemical structure.

www.remixeducation.in
 Antihistamine Drugs

1st generation drugs are:

• Chlorpheniramine, Cyproheptadine, Diphenhydramine, brompheniramine,
carbinoxamine, clemastine, dexchlorpheniramine, phenindamine, promethazine,
and triprolidine
2nd generation drug are:
• Azelastine, cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine and
olopatidine
• Azelastine (Astelin) is administered as a nasal spray. It is used to treat allergic
rhinitis, which is characterized by an itchy, runny, stuffy nose.
• Loratadine (Claritin) is used to treat allergy symptoms in the eyes and nose

www.remixeducation.in
In Depth First-generation antihistamine drugs, such as
diphenhydramine (Benadryl), are nonselective in that they bind to
both central histamine (H1) receptors in the brain as well as
peripheral H1 receptors in body tissues. This drug action in the brain
results in drowsiness and impaired performance while driving or
operating machinery.
In Depth Second-generation antihistamine drugs, such as cetirizine
(Zyrtec) and loratadine (Claritan), only bind to peripheral H1
receptors in the body tissues; this blocks the action of histamine and
relieves the symptoms of redness, inflammation, and itching
associated with allergies – without producing drowsiness.

www.remixeducation.in
Continue
In depth Hydroxyzine (Vistaril) is also a first-generation
antihistamine. However, it is not used to treat allergies.
Instead,its typical side effect of drowsiness and dry mouth are
used as therapeutic effects when Vistaril is given as a
preoperative medication to calm the patient and decrease oral
secretions prior to intubation during surgery.

www.remixeducation.in
Did You Know? Antihistamines are not effective in treating bacteria or
viruses that cause the common cold. Although symptoms of allergies
and colds are similar, no release of histamine occurs with the common
cold. Nevertheless, drug companies combine antihistamine drugs and
decongestant drugs in over-the-counter cold remedies because
antihistamine drugs have a drying effect on the mucous membranes
that is helpful during a cold.
Figure 19-2 Figure 19-3. It is one of the newer antihistamine drugs and
does not cause drowsiness. It is advertised in television commercials
as helping patients be “Claritin clear,” that is, free of the fogginess or
drowsiness associated with older antihistamine drugs.

www.remixeducation.in
 Mast Cell Stabilizer Drugs

• Stabilize the cell membranes of mast cells in the tissues of the nose.

• Prevent them from releasing histamine during the immune response to an antigen.

• Prevents edema of the nasal mucous membranes and sneezing in patients with
allergic rhinitis,

• Commonly used drug is cromolyn (Nasalcrom)

www.remixeducation.in
 Corticosteroid Drugs

• Act by inhibiting the body’s immune system

• Decrease inflammation and edema of the mucous membranes
• Have no decongestant or antihistamine effect
• Are not used to treat the common cold
• Corticosteroid drugs are administered intranasally to treat allergic and nonallergic
rhinitis
• Drugs in this class includes beclomethasone, budesonide (Rhinocort), flunisolide,
fluticasone, mometasone, triamcinolone

www.remixeducation.in
 Cont.….

• Budesonide is a prescription corticosteroid drug that is sprayed into the nose to

treat allergy symptoms.
• Mometasone (Nasonex) is a corticosteroid drug that is given intranasally to treat
allergy symptoms in the nose.
• Triamcinolone (Kenalog ) applied topically as a paste to treat mouth ulcers
inflammation
• Dexamethasone applied topically as a solution in the external ear canal o decrease
inflammation associated with allergies or infections

www.remixeducation.in
 Antibiotics

• Antibiotics are prescribed for colds caused by bacterial infections, particularly

streptococci that causes strep throat
• Antibiotic ofloxacin (Floxin Otic) applied topically as a solution to the external ear
canal to treat bacterial infections, swimmer’s ear, external otitis, infections of the
tympanic membrane (otitis media)
• Sulfonamide drugs such as sulfadiazine & sulfisoxazole are a type of anti-infective
drug that inhibits the growth of bacteria and given orally to treat an infected
tympanic membrane (otitis media)

www.remixeducation.in
Common cold not effective in because it is usually caused by a virus
although they may be prescribed to prevent subsequent superimposed
bacterial infections from developing, this practice is not recommended
Did You Know? Most people contract two or more colds per year. There
are over 120 different viruses, and most colds are caused by viruses. The
common cold is considered the single most expensive illness in the
United States in terms of time lost from work and school. No drug is
currently available to treat viral common colds; available drugs merely
provide temporary relief of various symptoms until the cold has run its
course

www.remixeducation.in
 Anti-yeast/anti-fungal Drugs

• Yeasts are organisms that are closely related to fungi grow easily in the warm, moist,
dark environments of the mouth especially true in patients whose immune systems
are compromised by disease

• Candida albicans yeast infections of the mouth are also known as oral
candidiasis(thrush)

• Topical anti-yeast drugs such as clotrimazole and nystatin are used to treat oral
candidiasis in the mouth

www.remixeducation.in
Drug Alert! Topical antiyeast drugs used to treat oral
candidiasis (thrush) are administered in several unique ways.
(1) An infect with oral candidiasis is given an oral suspension
of the drug. The entire dose is placed in an unattached
nipple, and the infant sucks on the nipple until the dose is
gone.
Drug Alert! The drug is not mixed with milk or formula in a
bottle because the infant may not drink the entire bottle and
would not get the full dose of medicine. Also, the drug should
not be diluted with milk or formula because it needs to
adhere to the mucous membranes of the oral cavity in order
to be effective.

www.remixeducation.in
Drug Alert! (2) An adult with oral candidiasis is told to “swish and
swallow” the oral suspension. The swishing action helps to coat all
areas of the oral cavity, and swallowing ensures that the medication
coats the pharynx and esophagus, which can also be infected.
Drug Alert! (3) Alternatively, an adult can suck on a troche that contains
the antiyeast drug. A troche is an oblong tablet that dissolves in the
mouth like a lozenge. Pastille is another name for a troche. Pastille is a
French word that means little lump of bread.

www.remixeducation.in
 Antitussive Drugs

• Decrease coughing by suppressing the cough center in the brain and by anesthetizing
stretch receptors in the respiratory tract
• Main purpose is to control dry, nonproductive coughs
• Not prescribed to treat productive coughs because it is important for the patient to
cough the sputum up
• Benzonatate and dextromethorphan drug commonly seen in combination drugs used to
treat coughs and colds
• Some antitussive drugs contain codeine a narcotic drug
• Codeine hydrocodone are used to treat severe, nonproductive coughs

www.remixeducation.in
 Expectorant Drugs

• Expectorant Drugs increases volume and decreases viscosity of respiratory

secretions

• E.g. Guaifenesin is used to treat productive coughs that create amounts of sputum
that must be expelled from the lungs

www.remixeducation.in
 Combination ENT Drugs

These combination drugs contain an antihistamine drug and a decongestant drug and
antitussive drug
• Allegra-D (fexofenadine, pseudoephedrine)
• Clarinex-D (desloratadine, pseudoephedrine)
• Phenergan VC (promethazine, phenylephrine)
• Rondec (chlorpheniramine, phenylephrine)
• Zyrtec-D (cetirizine, pseudoephedrine)
• Rondec-DM chlorpheniramine (an antihistamine), phenylephrine (decongestant
drug), dextromethrophan (antitussive drug)

www.remixeducation.in
Note
Drugs Alert! Prescription cough syrups that contain a
controlled substance are very effective in treating severe
coughing, but they also contain a narcotic drug that can be
addicting. These narcotic antitussive drugs include codeine (a
Schedule IV drug), dihydrocodone (a Schedule III drug),
hydrocodone (a schedule III drug), and hydromorphone (a
Schedule II drug).
Drug Alert! Schedule drugs cause euphoria (an exaggerated
sense of well-being and happiness) and slowed muscle
movements. The Drug Enforcement Agency (DEA) reports that
these prescription cough syrups are available to addicts whose
drug of abuse is cough syrup from some online pharmacies
that do not verify prescriptions sent to them.
www.remixeducation.in
Continue
Drug Alert! The Website for Partnership for a Drug-Free
America notes that the nonnarcotic antitussive drug
dextromethorphan is also being abused by 1 out of every 10
teenagers. It causes distortions in color and sound,
disorientation, hallucinations, and an out-of-body
experience in addition to dizziness, nausea and vomiting,
loss of motor control, and a rapid heart rate. Because it is an
over-the-counter drug, it is commonly available.

www.remixeducation.in
Continue
Combinations Prescription ENT Drugs These combination
prescription drugs contain a decongestant drug (phenylephrine,
pseudoephedrine) and an expectorant drug (guaifenesin) to
relieve edema and nasal dripping and treat a productive cough
Entex Guaifenex PSE
Figure 19-7 Prescription bottle of Guaifenex PSE. This
combination prescription drug contains a decongestant and an
expectorant drug to help expel sputum produced from the
throat and lungs.
Combination Prescription ENT Drugs These Rx drugs contain an
antibiotic ciprofloxacin neomycin polymyxin B a corticosteroid
dexamethasone hydrocortisone used topically in the ear treat
infections of the external ear (otitis externa) tympanic
www.remixeducation.in
membrane (otitis media)
Continue
Combination Prescription ENT Drugs Ciprodex (ciprofloxacin,
dexamethasone) Cipro HC Otic (ciprofloxacin,
hydrocortisone) Coly-Mycin S Otic (hydrocortisone,
neomycin) Cortisporin Otic (hydrocortisone, neomycin,
polymyxin B) Octicair (hydrocortisone, neomycin, polymyxin
B) Otosporin (hydrocortisone, neomycin, polymyxin B)
Pediotic (hydrocortisone, neomycin, polymyxin B)
Combination Over-the-Counter ENT Drugs Hundreds of OTC
combination drugs, with common brand names Claritin-D
Dimetapp Drixoral Entex Excedrin Mucinex Pediacare
Polaramine Primatene Robitussin Rondec Sudafed Theraflu
Triaminic Tylenol

www.remixeducation.in
Continue
Combination Over-the-Counter ENT Drugs Hundreds of OTC
combination drugs contain various combinations of analgesic
drugs (acetaminophen, ibuprofen, naproxen) decongestant
drugs (ephedrine, phenylphedrine, pseudophedrine)
antihistamine drugs (brompheniramine, cetirizine,
chlorpheniramine, clemastine, dexchlorpheniramine,
diphenhydramine, fexofenadine, loratadine, phenyltoloxamine,
triprolidine) and expectorant drugs (guaofenesin)

www.remixeducation.in
 Installation of eye drops
1. Wash your hands & do not touch the dropper opening.
2. Look upward.
3. Pull the lower eyelid down to make a ‘gutter.
4. Bring the dropper as close to the gutter as possible without
touching it or the eye.
5. Apply the prescribed amount of drops in the gutter.
6. Close the eye for about two minutes. Do not shut the eye
too tight.
7. If more than one kind of eye-drop is used wait at least five
minutes before applying the next drops.
8. Eye-drops may cause a burning feeling but this should not
last for more than a few minutes. If it does last longer
consult a doctor or pharmacist. www.remixeducation.in
 Installation of Eye Drops into The Eye of a Minor

1. Let the child lie back with head straight.

2. The child's eyes should be closed.

3. Drip the amount of drops prescribed into the corner of the eye.

4. Keep the head straight.

5. Remove excess fluid.

www.remixeducation.in
 Installation of Eye Ointment

1. Wash your hands.

2. Do not touch anything with the tip of the tube.
3. Tilt the head backwards a little.
4. Take the tube in one hand, and pull down the lower eyelid with the other hand, to
make a gutter.
5. Bring the tip of the tube as close to the gutter as possible.
6. Apply the amount of ointment prescribed.
7. Close the eye for two minutes.
8. Remove excess ointment with a tissue.
9. Clean the tip of the tube with another tissue.

www.remixeducation.in
 Installation of Ear Drops

• Warm the ear-drops by keeping them in the hand or the armpit for several minutes. Do
not use hot water tap, no temperature control!
• Tilt head sideways or lie on one side with the ear upward.
• Gently pull the lobe to expose the ear canal.
• Apply the amount of drops prescribed.
• Wait five minutes before turning to the other ear.
• Use cotton wool to close the ear canal after applying the drops ONLY if the
manufacturer explicitly recommends this.
• Ear-drops should not burn or sting longer than a few minutes.

www.remixeducation.in
 Installation of Nose Drops

• Blow the nose.

• Sit down and tilt head backward strongly or lie down with a pillow under the
shoulders; keep head straight.
• Insert the dropper one centimeter into the nostril
• Apply the amount of drops prescribed and remove the dropper.
• Immediately afterward tilt head forward strongly (head between knees).
• Sit up after a few seconds, the drops will then drip into the pharynx.
• Repeat the procedure for the other nostril, if necessary.
• Rinse the dropper with boiled water.

www.remixeducation.in
 Installation of Nasal Spray

• Blow the nose.

• Sit with the head slightly tiled forward.
• Shake the spray & insert the tip in one nostril.
• Close the other nostril and mouth.
• Spray by squeezing the vial and sniff slowly.
• Remove the tip from the nose and bend the head forward strongly (head between
the knees).
• Sit up after a few seconds; the spray will drip down the pharynx.
• Breathe through the mouth.
• Repeat the procedure for the other nostril, if necessary.
• Rinse the tip with boiled water.
www.remixeducation.in
 Nursing consideration
• Obtain a complete health history including allergies, drug
history, and possible drug interactions
• Monitor the client for specific contraindications for the
prescribed drug.
• Remove contact lenses before administering eye solutions.
• Blow the nose before applying nasal drugs
• Administer ophthalmic and ENT drugs using proper technique.
• Monitor for ocular and reaction to the drug such as
conjunctivitis
• Monitor response of the dugs
• Encourage compliance with treatment regimen.
• Educate the patients regarding self use of drops and ointment
www.remixeducation.in
 References

• Snell RS, Lemp MA; Clinical Anatomy of the Eye (2nd ed.), 1998, chapter 6. Blackwell Science
• Hall & Colman's Diseases of the Ear, Nose and Throat (15th ed.); Burton M, Leighton S, Robson A,
Russell J. Churchill Livingstone, 2001
• Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott
Williams & Wilkins.
• Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
• Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing care.
• Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing.
Philadelphia: JB Lippincott.

www.remixeducation.in
Thank you
www.remixeducation.in