Methods of drug administration in ophthalmology. Injecting medications into the eye Injecting medications into the ear
Instillation of the drug into the eye (Fig. 9-9)
Equipment: pipette, sterile gauze balls, medicinal solution. I. Preparation for the procedure
Rice. 9-9. Instilling the drug into the eye:
a - equipment for the procedure; b - instillation of drops; c - closing
eye; d - blotting leaked drops
3. Help (if necessary) the patient sit or lie down.
4. Wash your hands.
5. Give the patient two balls: in the left hand - for the left eye, in the right hand - for the right.
II. Executing the procedure
6. Take the required number of drops into the pipette and take a gauze ball in your left hand.
Attention! The number of pipettes depends on the amount of drugs administered to the patient. Each drug requires a separate pipette.
7. Ask the patient to tilt his head back slightly and look up.
8. Pull back the lower eyelid with a gauze ball.
9. Place 2-3 drops into the lower conjunctival fold (do not place the pipette close to the conjunctiva).
10. Ask the patient to close his eyes.
11. Blot the leaked drops at the inner corner of the eye.
12. Repeat the same steps when instilling in the other eye.
13. Ask the patient how he is feeling.
III. End of the procedure
14. Make sure that the patient does not experience discomfort after the procedure.
15. Wash your hands.
16. Make a note about the procedure and the patient’s reaction to it in the medical record.
Note. Pipettes must be cleaned, disinfected and sterilized.
Putting ointment behind the lower eyelid from a tube (Fig. 9-10)
Equipment: sterile gauze balls, tube with medication.
I. Preparation for the procedure
1. Clarify with the patient the information about the medicine, the procedure, and obtain his consent.
II. Executing the procedure
6. Ask the patient to tilt his head back slightly.
7. Pull back the lower eyelid with a gauze ball and ask the patient to look up.
8. Squeeze the ointment out of the tube, moving it from the inner corner of the eye to the outer corner so that the ointment goes beyond the outer commissure of the eyelids. Release the lower eyelid: the patient must close his eyes.
9. Remove ointment leaking from under closed eyelids (the patient can also do this).
10. If necessary, place the ointment behind the lower eyelid of the other eye and repeat the same steps.
Rice. 9-10. Putting ointment behind the lower eyelid from a tube
III. End of the procedure
11. Help the patient find a comfortable position.
12. Make sure that the patient does not experience discomfort due to the procedure.
Note. If the patient moves independently, assist him, as the ointment may impair vision for a while.
13. Remove gloves, wash hands.
14. Make a note about the procedure and the patient’s reaction to it in the medical record.
With this method of applying the ointment, the tube must be individual for each patient.
Placing ointment behind the lower eyelid with a glass rod (Fig. 9-11)
Equipment: sterile gauze balls, glass rod, medicine.
I. Preparation for the procedure
1. Clarify with the patient the information about the medicine, the procedure, and obtain his consent.
2. Help the patient lie down or sit comfortably.
5. Give the patient a gauze ball in each hand.
II. Executing the procedure
6. Open the bottle and take a little ointment with a stick. Close the bottle.
7. Ask the patient to tilt his head back slightly, look up and pull his lower eyelid down with a cotton ball.
Rice. 9-11. Placing ointment behind the lower eyelid with a glass rod
8. Place the ointment behind the lower eyelid in the direction from the inner corner of the eye to the outer (hold the glass rod with the ointment facing down).
9. Ask the patient to close his eyes.
10. Ask the patient to remove ointment leaking from under closed eyelids or do it for him.
11. If necessary, place the ointment behind the lower eyelid of the other eye and repeat the same steps.
III. End of the procedure
12. Help the patient find a comfortable position.
13. Make sure that the patient does not experience discomfort due to the procedure and can move.
14. Wash your hands.
15. Make a note about the procedure and the patient’s reaction to it in the medical record.
19-01-2013, 00:40
Description
Most often, for the treatment of various eye diseases, medications are administered locally into the conjunctival sac in the form of eye drops or ointments.Eye drops (solutions, suspensions, sprays) and ointments (gels), ophthalmic medicinal films (OMFs) are forms of medicines specially developed for use in ophthalmology.
Their composition, in addition to the active substance that has a therapeutic effect, includes various auxiliary (inactive) components that are necessary to maintain the stability of the dosage form. However, it should be remembered that excipients can act as allergens and have a negative effect on the tissue of the eyeball and its appendages.
Preservatives are used to inhibit the growth of microflora when the drug is contaminated. All preservatives have varying degrees of toxic effects on the epithelium of the cornea and conjunctiva.
The risk of toxic effects of preservatives on eye tissue increases when instilling more than 12 drops during the day of any drug containing a preservative.
In patients with dystrophic and allergic diseases of the cornea, conjunctiva and in children, it is better to use drugs that do not contain preservatives (for example: Santen Oy, Finland, produces sodium cromoglycate solution [INN] in 0.25 ml dropper tubes intended for single use under the trade name "Lecrolin").
As preservatives the most commonly used substances are: benzalkonium chloride (0.005-0.01%), phenylethyl alcohol (0.5%), benzethonium chloride, chlorhexidine (0.005-0.01%), cetylpyridinum chloride, benzoate, chlorobutanol (0.5% ), propionate, boric acid (up to 2%), mercury preservatives - phenylmercury nitrate (acetate, borate) 0.001-0.004%, thiomersal - 0.002%.
It should be noted that in modern pharmaceuticals, mercury preservatives, boric acid and borates are used less and less. The most convenient and safe preservatives at the moment are benzalkopium chloride, chlorobutanol and chlorhexidine. Not only the range of preservatives used changes, but also their concentrations. In recent years, lower concentrations have been used. A reduction in concentration is achieved through the combined use of several preservatives.
To reduce the rate of drug removal from the conjunctival sac, viscosity-increasing agents(prolongators). For this purpose, the following substances are used: carboxymethylcellulose, dextran 70, hydroxyethylcellulose, methylcellulose, hydroxypropylmethylcellulose, gelatin, glycerin, propylene glycol, polyvinyl alcohol, povidone.
Depending on the excipients or carriers used The duration of action of 1 drop varies. The shortest effect is for aqueous solutions, longer when using solutions of viscoactive substances, the maximum is for helium solutions. For example, a single instillation of an aqueous solution of pilocarpine [INN] lasts 4-6 hours, a prolonged solution on methyl cellulose - 8 hours, a helium solution - about 12 hours.
To prevent the disintegration of the active substance included in the drug under the influence of atmospheric oxygen, use antioxidants(bisulfite, EDTA, metabisulfite, thiosulfate).
Acidity of tears a person normally ranges from 7.14 to 7.82. The ability of substances to penetrate through the cornea into the anterior chamber largely depends on the degree of their ionization, which is determined by the pH of the solution. The acidity of the solution affects not only the kinetics of the drug, but also its tolerability. If the pH of the injected solution differs significantly from the pH of the tear, the person experiences a feeling of discomfort (burning, itching, etc.). Therefore, to maintain the pH of the dosage form within 6-8, various buffer systems are used. For this purpose, the following substances are used: boric acid, borate, tetraborate, citrate, carbonate.
The ocular kinetics of drugs is influenced by tonicity of the administered drop of solution in relation to the tear. Hypotonic or isotonic drugs have better absorption. Like acidity, the tonicity of the solution affects the tolerability of the drug. A significant deviation of the osmotic pressure in the calla solution from its level in the tear will cause a feeling of discomfort (dryness or, conversely, lacrimation, etc.). To ensure that the drug is isotonic with the tear film and maintain osmotic pressure within 305 mOsm/l, various osmotic agents are used: dextran 40 and 70, dextrose, glycerin, propylene glycol.
Thus, the effectiveness of treatment depends not only on the active substance, but also on other ingredients included in the drug and determining its individual tolerance. Each company has its own drug formula. If a pronounced burning sensation occurs when the drug is instilled, it is accompanied by lacrimation and an increase in the frequency of blinking, which will lead to accelerated leaching of the drug from the tear and a decrease in its effectiveness.
The effectiveness of therapy depends on volume of the instilled drop of the drug. Studies conducted by various authors (Patton, 1977, Sugaya and Nagataki, 1978) have shown that the therapeutic effect of a 5 μl drop corresponds to 1/2 of the maximum effectiveness. The full therapeutic effect develops when using a drop whose volume ranges from 10 to 20 µl. However, increasing the drop volume to more than 20 µl does not lead to increased efficiency. Thus, the most justified drop volume is within 20 µl. Therefore, it is rational to use special dropper bottles that accurately dose the volume of the administered drop of the drug (for example, Pharmacia, Sweden, produces the drug “Xalatan” in such bottles),
When using ophthalmic dosage forms, it is possible to develop general side effects, which are associated with the reabsorption of the active substance into the systemic bloodstream through the conjunctival vessels, vessels of the iris, and nasal mucosa. The severity of systemic side effects can vary significantly depending on the individual sensitivity of the patient and his age.
For example, instillation of 1 drop of a 1% solution of atropine sulfate [INN] in children will cause not only mydriasis and cycloplegia, but can also lead to hyperthermia, tachycardia, and dry mouth.
Most eye drops and ointments are contraindicated for use while wearing soft contact lenses (SCLs) due to the risk of accumulation of both the active component and the preservatives included in the drug.
If the patient continues to use SCL, he should be warned that he must remove the contact lens before instillation of the drug and can put them on again no earlier than after 20-30 minutes. In this case, eye ointments should be used only at night during the night break from wearing contact lenses.
When prescribing two or more different types of drops, you should remember that when instilling the second drug 30 seconds after the first, its therapeutic effect is reduced by 45%. Therefore, to prevent dilution and washout of pre-administered drops, the interval between instillations should be at least 10-15 minutes. The optimal break between instillations is 30 minutes.
The doctor is obliged not only to prescribe the drug, but also to teach the patient how to use eye drops and ointments correctly, and to monitor the implementation of prescriptions.
In recent years, both in domestic and foreign literature, terms such as compliance(complace) and non-compliance(non complace) of the patient. Compliance is the patient’s compliance with all doctor’s recommendations regarding the regimen of medications, rules for their use and restrictions (nutritional and physical) associated with the disease. With some diseases, at first the person does not experience any discomfort associated with the disease. He is not bothered by pain or blurred vision. At the same time, the prescribed treatment and the need to regularly visit a doctor changes his usual routine of life. In order to increase patient compliance, the doctor needs to explain the seriousness of the disease, as well as teach the patient how to properly instill eye drops and put eye ointments behind the lower eyelid.
Rules for instilling eye drops
Rules for applying eye ointments
Rules for laying eye medicinal films
The frequency of use of eye medications varies. In case of acute infectious diseases of the eye (bacterial conjunctivitis), the frequency of instillation can reach up to 8-12 times a day; in case of chronic processes (glaucoma), the maximum regimen should not exceed 2-3 instillations per day.
Eye ointments are usually applied 1-2 times a day. It is not recommended to use eye ointment in the early postoperative period during intracavitary interventions and for penetrating wounds of the eyeball.
The general shelf life requirements for factory-made drops are 2-3 years if stored at room temperature out of direct sunlight. After opening the bottle for the first time, the period of use of the drug should not exceed 1 month.
Eye ointments have a shelf life of about 3 years on average under the same storage conditions.
In order to increase the amount of drug entering the eye, use forced instillation technique. To do this, eye drops are instilled six times with an interval of 10 minutes for an hour. The effectiveness of forced instillations corresponds to subconjunctival injection.
You can increase the penetration of the drug into the eye by placing a cotton wool soaked in the drug or a soft contact lens saturated with the drug in the conjunctival sac.
Rules for placing cotton wool with a medicinal product
Studies conducted by E. G. Rybakova (1999) revealed that the rate of sorption of drugs from solution into the SCL substance and its desorption from the CL depends on its molecular weight. Low molecular weight compounds accumulate well in both highly hydrophilic and low hydrophilic lenses. Substances with high molecular weight do not accumulate well in low-hydrophilic lenses. The rate of desorption of substances is directly dependent on the hydrophilicity of SCL. The higher it is, the faster substances are removed from the SCL. High-molecular substances are characterized by faster elimination, which is associated with the surface saturation of SCL with these drugs. E. G. Rybakova believes that the most rational is to use SCL with a moisture content of 38% and a thickness of 0.7 mm to prolong the action of low-molecular medicinal substances. The pharmacokinetic parameters of the adsorption of high molecular weight substances differ slightly from drip administration.
An example of changes in pharmacokinetic and pharmacodynamic parameters is the study of Podos S. (1972). When determining the concentration of pilocarpine in the moisture of the anterior chamber after instillation of a 1% solution and the use of SCL soaked in this solution, it was revealed that pilocarpine accumulates in the moisture of the anterior chamber in a larger volume and remains in it longer in concentrations sufficient to maintain the therapeutic effect (diagram. 1).
Diagram 1. Change in the concentration of pilocarpine in the moisture of the anterior chamber after instillation of a 1% solution and the use of SCL saturated with a 1% solution of pilocarpine (submitted by Podos S., 1972).
A study of the relationship between the hypotensive effect and the method of administration of pilocarpine showed that the maximum reduction in IOP was noted in the group of patients who used SCLs saturated with a 0.5% solution of pilocarpine (diagram 2).
Diagram 2. Dependence of the degree of IOP reduction on the method of application of a 0.5% pilocarpine solution (submitted by Podos S., 1972).
In group I, patients used a 0.5% solution of pilocarpine 3 times a day; in group II, patients used SCLs and instilled a 0.5% solution of pilocarpine (without preservative) while wearing the lenses; in group III, patients used SCLs pre-impregnated with 0. 5% pilocarpine solution for 30 minutes.
An additional route of administration is the use of periocular injections. There are subconjunctival, parabulbar and retrobulbar injections.
Rules for subconjunctival injection
Rules for parabulbar injection (1st method)
Rules for parabulbar injection (2nd method)
The rules for retrobulbar injection are the same as for parabulbar injection, however, the needle is inserted to a depth of 3-3.5 cm and is first oriented parallel to the orbital wall, and then obliquely upward behind the eyeball (Fig. 8).
Rice. 8. The position of the needle during retrobulbar injection (1 - at the beginning of the injection, 2 - final position of the needle).
Before administering the drug, pull the syringe plunger towards you to make sure that the needle is not in the vessel. If resistance to the needle moves, it is immediately pulled back. Before injection, the tip of the needle should be slightly blunted.
In special cases, medications are administered directly into the eye cavity(into the anterior chamber or into the vitreous body). The administration is carried out in an operating room during abdominal surgery or as an independent intervention. As a rule, the volume of the administered drug does not exceed 0.2-0.3 ml. The drug solution is injected into the anterior chamber through paracentesis.
Rules for intravitreal injection
When using the injection method of administering the drug, its therapeutic concentration in the eye cavity increases sharply compared to the installation route.
For the treatment of retinal and optic nerve diseases implantation of an infusion system into the sub-Tenon's space is used. This technique was developed by Nesterov A.P. and Basinsky S.N. The infusion system consists of a folded strip of collagen sponge (30x6 mm) and a silicone tube (Fig. 10, a).
Rice. 10. Method of implantation of an infusion system and sub-Tenon's space (according to Nesterov A.P., 1995).
After an incision is made in the conjunctiva and Tenon's membrane in the superior temporal segment of the eye, the collagen sponge is passed into Tenon's fissure to the posterior pole of the eyeball. The conjunctival incision is sutured with a continuous suture. The free end of the silicone tube is brought out onto the forehead and fixed with an adhesive tape (Fig. 10, b). In the postoperative period, a drug is administered through a tube. The course of treatment lasts 7-10 days, after which the tube is removed. In some cases, a silicone sponge is introduced according to the method described above, having previously soaked it with a drug. The introduction of an infusion system can be combined with direct electrical stimulation of the optic nerve. For this purpose, during the introduction of the infusion system, an electrode is inserted into this area through a special conductor, with the help of which electrical stimulation of the optic nerve is carried out. As a result of exposure to electric current, the direction of ion flow changes, which can significantly increase the penetration of drugs into the eye tissue.
For the treatment of diseases of the retina, optic nerve and orbit, long-term intracarotid administration of drugs through a catheter, introduced into the superficial temporal artery before the bifurcation of the common carotid artery. The infusion is carried out around the clock at a rate of 10-16 drops per minute for 5-7 days. This method of administration is based on the research of M. M. Krasnov, who showed that the concentration of the drug in the tissues of the eye after intravenous injection and administration into a. carotis and a. supraorbitalis increases with intra-arterial administration and is in the following proportion: 1:5:17.
Drugs can also be administered using phono- or electrophoresis.
With electrophoresis medicinal substances are introduced into the body through the intact surface of the skin or mucous membrane using direct current. The amount of injected substance is dosed by changing the size of the electrodes, the concentration of the solution, the current strength and the duration of the procedure. Substances are administered from the positive or negative electrodes (sometimes from both electrodes) depending on the charge of the drug molecule.
Electrophoresis is carried out daily; if necessary, several procedures can be performed during the day with an interval of 2-3 hours. The course of treatment includes 10-25 procedures. A second course of treatment should be carried out after 2-3 months, for children - after 1.5-2 months. Electrophoresis can be combined with phonophoresis, UHF therapy and diadynamic therapy.
Electrophoresis used for treatment inflammatory, ischemic and dystrophic processes in the tissues of the eye, hemorrhages and injuries to the organ of vision.
Electrophoresis should not be carried out in patients with neoplasms, regardless of their location, high blood pressure and a history of hypertensive crises, a tendency to thrombus formation, atherosclerosis, with severe eye hypotension or a significant increase in 13GD, intraocular foreign body, extensive ulcerative process, severe purulent discharge, increased sensitivity to direct current .
Several methods are used to administer drugs continuously.
Electrophoresis through an eye bath
Methodology: 5 ml eye bath. Through the bottom or side wall of which a carbon or platinum rod with terminals is passed, it is filled with a solution of a medicinal product heated to 28-30 ° C (antibiotic solutions are not heated). The edges of the bath are lubricated with thick Vaseline. The patient's position is sitting, head tilted back on the chair. The patient presses the tray to the edge of the eye socket, keeping the eye open. The bath is fixed with a rubber bandage. An indifferent electrode with a wet pad measuring 8x12 cm is placed on the back of the neck: the anode in the area of the upper cervical vertebrae, the cathode in the lower cervical vertebrae. The current strength is gradually increased from 0.3 mA to 0.5 (0.8) - 1.5 mA, the duration of the procedure is 3-15 minutes. During the procedure, the patient should feel a slight, uniform tingling in the area of the eyelids and eyes.
The concentrations of drugs administered using electrophoresis through a bath are indicated in Table. 1.
Table 1. Medicines used for electrophoresis through an eye bath (according to I. N. Sosin, A. G. Buyavikh, 1998)
You can administer not only simple solutions, but also mixtures of medications. When preparing a mixture, it is necessary to take into account the possibility of drug interactions and their polarity. The most commonly used mixtures are:
- a mixture of streptomycin and calcium chloride - 2.5 ml of a 2% calcium chloride solution is poured into the bath, then 0.5 ml of streptomycin is added (at the rate of 50,000 units/0.5 ml) and another 2.0 ml of calcium chloride solution is added.
- a mixture of streptomycin, calcium chloride, atropine and adrenaline: 0.5 ml of streptomycin (at the rate of 50,000 units/0.5 ml), 1.5-2.0 ml of a 0.1% atropine solution and the same amount of 2 % calcium chloride solution, last add 0.3-1.0 ml of 0.1% atropine solution.
- a mixture of atropine, adrenaline, novocaine - 2.0-2.2 ml of a 0.1% atropine solution and the same amount of a 2% novocaine solution are poured into the bath, 0.3-1.0 ml of a 0.1% atropine solution is added last.
Electrophoresis through the eyelids
Methodology: position of the patient lying on his back. Before the procedure, to enhance the effect of treatment, you can drop 1 drop of the drug into the conjunctival sac. Place 2 layers of filter paper moistened with a solution of the drug on the eyelids. A wet gauze pad (10-12 layers) of an oval shape measuring 4-5 cm is placed on top of the layer of paper. An electrode measuring 2-3 cm is inserted into the pocket of the gauze pad. The indifferent electrode is positioned in the same way as when using an eye bath. The current strength is increased from 0.5 mA to 1.5-2.0 mA - when treating one eye and to 2-4 mA - when treating both eyes at once. The duration of the procedure is from 3 to 10-15-20 minutes. The first 6-10 procedures are carried out daily, the remaining ones every other day. The course of treatment is 10-25 procedures. A repeat course can be carried out after 1-2 months.
Endonasal electrophoresis
Methodology: after rinsing the nasal cavity with water, a cotton swab 10-15 cm long, moistened with a medicinal substance, is inserted into the lower nasal passage. The ends of the turunda are placed on an oilcloth located on the upper lip and covered with a damp gauze pad measuring 1x3 cm with an electrode. The second electrode with an 8x12 cm spacer is located in the back of the head. The current strength is gradually increased from 0.3 mA to 1 mA, duration 8-15 minutes.
Endonasal electrophoresis contraindicated for rhinitis, adenoids, tendency to nosebleeds, children in puberty.
In addition to the methods described above, ophthalmology uses electrophoresis from reflex segmental zones - the collar zone and cervical sympathetic nodes.
The rate of penetration of medicinal substances into various tissues of the eye can be increased with the help of ultrasound, since under the influence of ultrasound the permeability of cell membranes and the blood-ophthalmic barrier increases, and the diffusion rate increases. For phonophoresis, drugs are used in the same concentrations as for electrophoresis through an eye bath (see Table 1).
Phonophoresis is carried out for the same eye diseases as electrophoresis.
Contraindications: hypotony of the eye, PCRD with a high risk of developing retinal detachment, history of retinal detachment, gross changes in the vitreous, recurrent intraocular hemorrhages, neoplasms of the organ of vision. Phonophoresis should not be performed in patients with severe cardiovascular, endocrine, mental and neurological diseases, with neoplasms of any location, acute infectious diseases and active tuberculosis, in the third trimester of pregnancy.
Phonophoresis technique: to carry out phonophoresis, use an eye tray-dilator. The patient's position is lying on his back. 1 drop of anesthetic is instilled into the conjunctival sac twice with an interval of 5-10 minutes. 1-3 minutes after repeated instillation, a dilator tray is inserted under the eyelids and, using a pipette with a bulb, it is filled with a warm solution of the drug in a volume of 5 ml. A tripod with an attachment is installed at a distance of 2-3 cm from the crown of the patient. The water nozzle with the vibrator is lowered into the bath, not reaching the cornea by 1 - 2 mm. Generation mode is continuous or pulsed, dose 0.2-0.4 W/cm2, procedure duration 5-7 minutes. During the procedure, the patient may feel a slight tingling and warmth. After the procedure, a 10-20% sodium sulfacyl solution is instilled. Before the procedure, the bath is treated with a 1% solution of chloramine and a 70% solution of ethyl alcohol, then washed with saline. Procedures are carried out daily or every other day. The course of treatment is 8-20 procedures. A repeat course can be carried out after 1.5-2 months.
To treat eye diseases, intramuscular and intravenous injections and infusions are used, as well as oral administration of drugs (thus, antibiotics, corticosteroids, plasma replacement solutions, vasoactive drugs, etc. are administered).
Article from the book:
Injecting medications into the ear.
Administration of drugs into the nose.
Application of powders.
Application of the patch.
The patch is a thick, sticky ointment base covered with impermeable gauze. There are fixing patches for securing bandages and medicinal ones: bactericidal, calluses, warming, contraceptive, antifungal, etc. The ointment base of medicinal plasters contains active medicinal substances.
Contraindications: intolerance to the active substance of the patch, damage to the skin.
Powders or dusting with powdered medicinal substances are used to dry the skin during diaper rash and sweating. The surface on which the powder is applied must be clean.
In the nose, drugs are used for the purpose of: influencing the nasal mucosa, ensuring nasal breathing (vasoconstrictors); immunostimulation; anti-inflammatory therapy.
Indications: as prescribed by a doctor.
Contraindications. Intolerance to the prescribed drug.
Before use, the drops must be warmed to body temperature or to room temperature (+20...+25 o C). For each patient there should be a separate sterile pipette, or an individual bottle of medication combined with a pipette, and sterile napkins. When introducing oil drops into the patient's nose, the patient should be warned that the patient will taste the drops.
When introducing the ointment into the nose, use sterile cotton swabs, separately for each nasal passage.
Drugs are used in the ear for the following purposes:
· pain relief;
· exposure to various medications;
· softening of sulfur.
Before administering the drug, you must first cleanse the external auditory canal. When instilling drops into the ear, they must be warmed to body temperature (+37...+38 o C), use a sterile pipette, and sterile beads are also required.
To put ointments into the ear, use sterile turundas, and the ointments should be at room temperature.
Purposeful administration of ophthalmic drugs:
· local effect of the drug;
measurement of intraocular pressure;
Pupil dilation for examination.
All medications and dressings must be sterile, and medications intended for ophthalmic practice are administered into the lower conjunctival sac so as not to damage the sensitive cornea; It is not recommended to use dry balls. When applying the drug, do not touch the eyelashes, eyelids, or conjunctiva.
The eye is an organ sensitive to infection and injury. For external treatment of eye diseases, eye drops are used, as well as eye ointments, which can be applied with a sterile glass rod or directly from a tube for individual use.
· Inhalation route of administration
Inhalation route of administration is the introduction of drugs into the body by inhalation (through the respiratory tract - through the mouth, nose). By inhalation, gaseous substances (nitrous oxide, oxygen), vapors of volatile liquids (ether, fluorotane), aerosols (a suspension of tiny particles of solutions of medicinal substances in the air) can be introduced into the body.
For the convenience of using drugs by inhalation, special nozzles are produced for inhalation of these drugs both through the nose and through the mouth. These attachments are included with your aerosol inhaler.
Advantages of the inhalation route of administration:
· Action directly at the site of the pathological process in the respiratory tract.
· Entry into the lesion, bypassing the liver, unchanged, which causes a high concentration of the drug substance.
Disadvantages of the inhalation route of administration:
1. In case of severely impaired bronchial obstruction, there is poor penetration of the drug directly into the pathological focus.
2. Possibility of irritation of the mucous membrane of the respiratory tract by medicinal substances.
The nurse must teach the patient how to administer medications by inhalation, since he usually performs this procedure independently.
QUESTIONS FOR SELF-CONTROL
· Routes and methods of introducing drugs into the body.
· Rules for prescribing medications.
· Rules for obtaining medicines.
· Rules for storing medicines.
· Rules for recording medicines.
· Rules for storage and accounting of narcotic drugs.
· Rules for the distribution of medicines.
· Features of external and inhalation methods of drug administration.
Literature
Main:
· Order Ministry of Health of the Russian Federation dated 12.11.97
№ 330 “On measures to improve the accounting, storage, prescribing and use of narcotic drugs” (as amended on January 9, 2001).
· Order Ministry of Health of the Russian Federation dated 08.23.99
№ 328 “On the rational prescribing of medicines, the rules for writing prescriptions for them and the procedure for their dispensing by pharmacies (organizations)” (as amended on January 9, 2001).
· Mukhina S.A., Tarnovskaya I.I. Practical guide to the subject “Fundamentals of Nursing”: textbook. – 2nd ed., corrected. And additional – M.: GEOTAR-Media 2013. 512 p.: ill.- 309-339 p.
· Lecture by the teacher.
Additional:
1. Educational and methodological manual on “Fundamentals of Nursing” for students, vol. 1.2, edited by Shpirna A.I., Moscow, VUNMC 2003
2. Internet resources: http://www.med-pravo.ru/PRICMZ/SubPric/SubR.htm#Standart
Characteristics of the methodology for performing simple medical services
Instilling eye drops
Preparation for the procedure:
3. Provide the patient with the necessary information about the drug and its side effects.
Performing the procedure:
It is convenient to sit or lay the patient with his head slightly tilted back
Pipette the required number of drops of the drug.
Ask the patient to look up
Pull back the lower eyelid with a sterile cotton swab.
Place 2-3 drops of the drug into the lower conjunctival fold, without touching the eyelashes, holding the pipette perpendicular to the lower eyelid.
Ask the patient to close his eyes.
Place the sterile ball into a container for disinfection.
Take another sterile cotton ball.
Blot any remaining drops at the inner corner of the eye.
Repeat the same steps when instilling drops into the second eye.
Make sure that the patient does not experience any discomfort after the procedure. Create a comfortable position for the patient.
End of the procedure
Throw the balls into a container with disinfectant, remove gloves, and throw into the container.
Wash and dry your hands
Putting in eye ointment
Preparation for the procedure:
1. Carefully read the doctor’s prescription: name of the drug, expiration date
2. Obtain the patient’s consent for the procedure
3. Perform hand hygiene and put on gloves.
Performing the procedure:
Squeeze the required amount of ointment from the tube into the eye tray.
Sit (lay down) the patient with his head thrown back, ask him to look up.
Take some ointment with an eye stick.
Use your thumb to pull the lower eyelid down using a sterile ball.
Apply the ointment into the lower conjunctival fornix from the inner corner of the eye to the outer.
Ask the patient to close their eyelids.
Place the ball into a container with disinfectant.
Remove excess ointment with a sterile cotton ball and perform a light circular massage through closed eyelids.
Drop the balls.
Create a comfortable position for the patient.
End of the procedure
1. Remove gloves and place them in a container with disinfectant.
2. Wash and dry your hands
Putting drops in the ear
Preparation for the procedure:
2. Obtain the patient’s consent for the procedure
4. Heat the preparation to body temperature.
5. Help the patient lie on his side. You can perform the procedure while sitting, asking the patient to tilt his head to the healthy side.
6. Perform hand hygiene and put on gloves.
Performing the procedure:
Pipette 6-8 drops of the drug.
Introduce 5-6 drops into the external auditory canal.
Press lightly on the tragus of the ear to direct the drops inward.
Place a cotton ball and do not change the position of the head for 10 minutes.
End of the procedure
1. Drop the ball into a container with a disinfectant, remove gloves, and throw it into a container with a disinfectant.
2. Wash and dry your hands.
Putting ointment in the ear
Preparation for the procedure:
1. Carefully read the doctor’s prescription: name of the drug, expiration date.
2. Obtain the patient’s consent for the procedure
3. Provide the patient with the necessary information about the drug and its side effects.
4.Help the patient lie on his side. You can perform the procedure while sitting, asking the patient to tilt his head to the healthy side.
Performing the procedure:
Dry toilet the external auditory canal.
Pour the medicine into a container, immerse the turunda in it.
Pull the auricle posteriorly and upward to straighten the external auditory canal.
Insert the turunda with the drug using a rotational movement under visual control into the external auditory canal up to the eardrum.
Leave the turunda with the medicine for a few minutes.
Remove the turunda and immerse it in a container for used material.
Make sure that the patient does not experience discomfort after the procedure.
End of the procedure
1. Drop the ball into a container with a disinfectant, remove gloves, and throw it into a container with a disinfectant.
2. Wash and dry your hands.
Putting drops into the nose
Preparation for the procedure:
1. Carefully read the doctor’s prescription: name of the drug, expiration date.
2. Obtain the patient’s consent for the procedure
3. Provide the patient with the necessary information about the drug and its side effects.
4. Perform hand hygiene and put on gloves.
5. Ask the patient to clean the nose themselves using a tissue.
Performing the procedure:
1. Sit or lay the patient down with his head slightly tilted back.
2. Pipette the required amount of the drug.
Lift the tip of the patient's nose with your left hand.
Place 3-4 drops of the drug into one nasal passage.
Press the wing of your nose against the septum and tilt your head in the same direction.
After 2 minutes, apply drops in the same sequence to the other nasal passage.
Make sure that the patient does not experience any discomfort after the procedure.
End of the procedure
2. Wash and dry your hands.
Putting ointment in the nose
Preparation for the procedure:
1. Carefully read the doctor’s prescription: name of the drug, expiration date, method of application
2. Obtain the patient’s consent for the procedure
3. Provide the patient with the necessary information about the drug and its side effects.
4. Put on a mask.
5. Perform hand hygiene and put on gloves.
Performing the procedure:
Ask the patient to empty the nasal cavities (blow his nose without straining) using tissues.
2. Sit or lay the patient down, tilting his head slightly back.
3. Apply 0.5-0.7 cm of ointment to the turundas and place them in the tray.
4. Lift the tip of the patient’s nose with your left hand
5. Insert the turunda with the drug with a rotational movement under visual control into the lower nasal passage on one side to a depth of 1.5 cm for 2-3 minutes.
6. Remove the turunda and throw it into a container for disinfection.
7. Introduce the turunda with ointment into the other half of the nose, following the same sequence.
8. Make sure that the patient does not experience discomfort after the procedure
End of the procedure
1.Remove gloves and place them in a container with disinfectant.
2. Wash and dry your hands.
Eye medications are produced in the form of the following substances: gel, ointment, soluble powders, liquid drops. Depending on this and a number of other reasons described in the article, eye medications are administered using different methods.
Classification of administration of ophthalmic drugs:
burying;
placing ointment behind the lower eyelid;
injections:
retrobulbar,
subconjunctival,
parabulbar,
V cavity ocular apple,
intramuscular And intravenous;
medicinal phonophoresis;
medicinal electrophoresis method;
oral and parenteral method of administration.
Important! Ophthalmic drugs used in ophthalmology have mainly local pharmacological effects and rarely have systemic effects on the body.
Drops And ointments
The most accessible dosage forms in ophthalmology are drops and ointments. When instilling, it is necessary to take into account the volume of the conjunctival sac, which can hold no more than 1 drop of solution or 1 cm of ointment strip.
Term actions one drops solution for the active substance is different and depends on the substance of the solution itself. So, for example, the longest action time is for a helium solution, and the shortest for an aqueous solution.
The time of one instillation is:
– aqueous solution of pilocarpine 4-6 hours,
– prolonged solution on methylcellulose – 8 hours,
– gel solution – about 12 hours.
Frequency burying:
– for acute infectious diseases of the eye 8-12 times a day,
– for chronic processes, 2-3 instillations per day.
When using several types of eye drops per day, the time interval between instillations should be 10-15 minutes to avoid dilution and washing out of the previous solution.
Side effects effects
In general, eye drops and ointments are contraindicated for use while wearing contact lenses. Local and general side effects occur when the active substance enters directly into the blood through the nasal mucosa, conjunctival vessels, and vessels of the iris, given that active drug substances penetrate into the cavity of the eyeball through the cornea.
Storage
Eye drops and ointments are produced in factories and pharmacies. Drops produced in factories contain additional substances - antiseptics and preservatives and are intended for repeated use. The shelf life of factory drops is 2 years if stored at room temperature out of direct sunlight. The period of use of the drug after the first opening of the bottle is 1 month. Eye medications produced in pharmacies do not contain any excipients, so their shelf life is 3 to 7 days. If the patient is hypersensitive to additional ingredients, dosage plastic packaging for medicines is produced, designed for a one-time administration of the drug without preservatives or preservatives.
Under the same storage conditions, eye ointments are stored for 3 years. Ointments are used by placing 1 cm strips behind the lower eyelid into the conjunctival cavity, 1-2 times a day, with rare exceptions. It is not recommended to use eye ointment for some time after intracavitary interventions.
Injections
The injection method of administering eye medications has some advantages compared to instillations:
- – 6 instillations with an interval of 10 minutes. within 1 hour corresponds to one subconjunctival injection;
- – the concentration of the active substance in the eyeball is higher than with instillations.
Anti-inflammatory, antibacterial, and vasoactive medications are administered by injection.
Methods injection introduction, readings:
- retrobulbar – with pathology of the posterior segment (chorioretinitis, neuritis, hemophthalmos).
- P subconjunctival And parabulbar injections are indicated for the treatment of diseases and injuries of the anterior part of the eye (scleritis, keratitis, iridocyclitis, peripheral uveitis)
- introduction medicinal ocular drugs directly V cavity ocular apple (into the anterior chamber or intravitreal) – determined by specialists and used in special cases
- intramuscular And intravenous injections And infusion – antibiotics, corticosteroids, plasma replacement solutions, etc.
Attention! Administration by local injection is not always indicated and requires skill.
Oral And parenteral method
At orally And parenteral administration, not all ophthalmic drugs enter the eye tissues equally, so dexamethasone easily penetrates various tissues of the eyeball, while polymyxin practically does not enter them. This is due to their ability to penetrate the blood-ophthalmic barrier, absorption, biotransformation and excretion.
Phonophoresis
A combined treatment method combining ultrasound and medication. Before the session, a medicinal substance is applied to the skin, which, using ultrasound, penetrates deep into the tissue. However, the effectiveness of the method remains controversial.
Method medicinal electrophoresis.
The therapeutic substance is applied to the electrode pads and, under the influence of an electric field, penetrates the body through the skin and affects physiological and pathological processes directly at the injection site.
Advantages method medicinal electrophoresis:
- the possibility of introducing the substance directly into areas of inflammation that are blocked as a result of disruption of local microcirculation;
- administration of small doses of the active substance;
- accumulation of the substance and creation of a depot without destroying the active substance;
- the possibility of creating a high local concentration of the active substance of the ophthalmic drug without saturating the lymph, blood and other environments of the body;
For example, a fibrinolytic agent in the form of a lyophilized powder of 5000 IU in an ampoule is diluted with distilled water and added to an eye bath for electrophoresis. The mixture is introduced from the anode. For inflammatory eye diseases, additional active ingredients are added to the mixture. For vascular diseases, it is administered separately or in a mixture with calcium chloride. In order to dilate the retinal vessels, magnetic therapy is additionally performed. In this case, the average time for resorption of a fibrin clot in the anterior chamber was 1-3 days, resorption of hemophthalmos was 7-14 days. Over the course of a month, visual acuity in such patients doubled.
Contraindications medicinal electrophoresis:
acute purulent inflammatory diseases, stage II-III heart failure, stage III hypertension, fever, severe bronchial asthma, dermatitis or disruption of the integrity of the skin at the sites where the electrodes are applied, malignant neoplasms. Contraindications for eye medications are taken into account.
Attention! All eye medications are used strictly at the discretion of the ophthalmologist.
