CHAPTER 41 MCKENRY OVERVIEW OF THE EYE Miotics have action similar to those of acetylcholine by acting on receptor sites in the

e sphincter muscle. Cycloplegia-can affect accommodation Sclera Cornea Abraded corneas Iris-pupillary constriction and dilation Miotics and mydriasis Accommodations-lens, cataracts develop on the lens Canal of schlemm Retina responsible for vision Blinking Conjunctiva-lines anterior part of the sclera and the inner surfaces of the eyelid Pupillary constriction Pupillary dilation CHAPTER 42: OPHTHALMIC DRUGS Pilocarpine-ocular inserts Toxicity can cause heachace, salivation, sweating, diarrhea, asthmatic attacks, low BP Adrenergic agonists-ophthalmic drugs that can cause systemic absorption with clients who have cardiovascular disease, namely elevated blood pressure and tachycardia Glaucoma-Increased intraocular pressure, can cause blindness Epinephrine solutions causes vasoconstriction of capillaries, thereby making it a useful treatment for a topical hemorrhage Nurse should first assess client for tachycardia Levocabastine-used as a topical antihistamine for allergic conjunctivitis Chymotrypsin (catarase) B adrenergic blocking ophthalmic agents cause burning and stinging 5% sodium chloride used for corneal edema which may occur after cataract extraction Atropine-anticholinergic used for mydriasis Chloramphenicol solution may cause signs of infection Maintaining sterility of eye solutions Erythromycin eye drops Check solutions for color and exp. Date Triple antibiotic ointment, watch for hypersensitivity Corticosteroids for the eye Cardioselective blocking agent (Betaxolol) Allergic reactions (wheezing) Xalatan-used to treated open angle glaucoma

May cause brown pigmentation in the iris Ocular hypertension must be treated by eye drops rather than oral medications Carboptic affects light adaptation, could affect safety Pilocarpine may take from 10 to 30 minutes to work Artificial tears should be used 3 to 4 times a day Fluorcyte Voltaren Normal saline used for irrigation

CHAPTER 43 OVERVIEW OF THE EAR Inner ear Eustachian tube Middle ear disorders Tympanic membrane perforation Tympanic membrane Ossicles Cochlea Vestibular apparatus Hematoma Otitis media-pain and fever Hydrocortisone and antibiotics Ototoxic drugs (aminoglycosides) Risk for injury How to warm ear drops Instilling eardrops in a child, in an adult Tinnitus and hearing loss can occur with cochlea damage After instilling ear drops, the patient should lie on the unaffected side with the bad ear facing upward. Earwax Ethacrynic acid-irreversible CHAPTER 45: OVERVIEW OF THE ENDOCRINE SYSTEM OXYTOCIN THYROID HORMONE HYPOPARATHYROIDISM AND TETANY ADMINISTER CALCIUM ADRENAL INSUFFICIENCY CAN LEAD TO HYPERKALEMIA MYXEDEMA GOITER ANTIDIURETIC HORMONE HYPOTHRYOIDISM

ALDOSTERONE GLUCAGON GLYCOGEN CRETINISM EXOPHTHALMUS

CHAPTER 46: DRUG AFFECTING THE PITUITARY PROTROPIN GIVING PROTROPIN DO NOT ADMINISTER PROTOPIN WITH HYDROCORTISONE DESMOPRESSIN-nocturnal enuresis Vasopressin Protropin can be used for muscle wasting syndrome Protropin given three times a week sub-q for growth failure, child evaluated in 3 to 6 months for adjustment Pegvisomant (Somavert) Humatrope-growth hormone. Contraindications- sensitivity to benzyl alcohol, a client who is 17 years or older due to epiphyseal closure May cause pain at injection site Protropin should be administered at bedtime for best results Client should have thryoid studies and bone age determination studies routinely done. Sandostatin- used in clients with acromegaly who have not responded to other therapies. Can be used to treat symptoms associated with carcinoid tumors (flushing, diarrhea), control bleeding related to esophageal varices, control diarrhea in AIDS patients (not FDA approved) Sandstatin contraindications Client with gallbladder disease or has a history of gallstones Sandstatin causes a decreaste in gallbladder motility Vasopressin-used to treat esophageal varices and diabetes insipidus. Can also be used for cardiac asystole. Serious side effects of vasopressin are: chest pain, MI, allergic reaction, urinary difficulties, coma seizures. Desmopressin (DDAVP)-may cause water intoxication CHAPTER 47 DRUGS AFFECTING THE PARATHYROID AND THYROID GLANDS Goal of thyroid drug therapy-regain a normal physical and emotional state Underdosing of thyroid supplements will cause ataxia, headaches, drowsiness, and tiredness Drug interactions with thyroid replacements include anticoagulants, cholestyramine, sympathomimetics Thyroid hormone concentration is regulated by the anterior pituitary gland and the thyroid feedback mechanism.

 Hypothalamus produces thyroid-releasing hormone and the anterior pituitary produces thyroid stimulating hormone Lugols iodine solution given for thyroid disorders, but instruct the client not to eat foods high in iodine Iodine 131 Overdose of thyroid replacement drugs-imbalance nutrition, less than body requirements, disturbed sleep pattern, anxiety Hyperparathyroidism-must increase excretion of calcium. May need Lasix. Plicamycin-used for hypercalcemia and testicular cancer. Calcitonin is used of osteoporosis. Adverse effects-nasally, epistaxis, headache, muscle and back pain; parenteral flushing and tingling sensations, epigastric distress, pain and swelling at injection site Didronel-can cause bone pain, nausea, diarrhea, and hypersensitivity. Zometa can cause renal dysfunction (most serious side effect) Patient should be well hydrated. Med should be administered over 15 minutes Sensipar-used to decrease parathyroid hormone secretion N&V most frequent side effect Fosamax-must be able to sit or stand for 30 minutes after ingestion. Administer 30 minutes before a meal with a full glass of water Bone density measurement should be taken for the client on Actonel. Synthroid-cause nervousness Signs and symptoms of hypothyroidism Take synthroid at the same time every day, usually in the morning to help prevent insomnia Synthroid may cause alopecia Administer iodine through a straw if liquid Iodine 131 used 7-14 days before surgery to decrease the size of the thyroid gland Drink iodine through a straw Thyrotoxicosis-drug of choice is propylthiouracil (PTU) CHAPTER 48: DRUGS AFFECTING THE ADRENAL CORTEX Plasma cortisol levels Glucocorticoids affected by sleep wake cycle Glucocorticoids are antiinflammatory, help to maintain blood pressure, helps in metabolism, has eosinopenic properties Glucocorticoids do not interfere with pain meds. Glucocorticoids are used with caution in clients with hypertension Check weight ASA and alcohol should not be used with corticoids, can cause gastric irritation Cushings syndrome- drug used cytadren, do not give to a child with chicken pox Mineralcorticoids- reabsorp sodium in the renal distal tubules (aldosterone)

 Florinef-diet should be low in sodium. Adverse effects: persistent headaches, hypertension, dizziness, edema, numbness in lower extremities, weight gain anaphylaxis. Cytadren-do not give to children exposed to chicken pox Aldosterone-affects metabolism Florinef-causes potassium to be excreted. Adverse effects of corticosteroids: insomnia, nervousness, increased appetite, GI upset, dizziness, glucose intolerance, seizure, mood changes, hallucinations, osteoporosis, fat redistribution, pancreatitis, hepatitis, growth suppression, muscle wasting Solucortef- should be schedule according to secretion of corticosteroid levels in the body: two thirds of the dose in the morning and one third in the evening. Client should be weaned from steroid use. Removing the client from steroids too fast may cause lethargy, hypoglycemia, depression, nausea, anorexia. Tapering of steroids should be about every 4 days to avoid addisonian crisis Could be done slower if the client is not in the hospital; such as reduce by 2.5mg every 10 days. Monitor weight every day, same time, same amount of clothes on. Weight gain could indicate fluid retention. Solu-Medrol can cause hyperglycemia, diabetics should be cautioned about the side effect. P.O. corticosteroids can be administered with milk or food in order to decrease GI upset. Sodium restriction may be needed to reduce water retention Instruct client to report any signs of infection