Pharmacology - Chapter 59 - Otic Drugs

The nurse is teaching the parent of a 1-year-old patient how to instill eardrops for otitis externa. Which instructions on instillation does the nurse provide to the parent? 1 "Hold the pinna down and back." 2 "Keep the eardrops in cold place so they work better." 3 "Just put in as many drops as you can get into the ear." 4 "Put a cotton ball in to keep the medication in the ear."

1 "Hold the pinna down and back." When administering eardrops to adults, hold the pinna up and back. In children younger than 3 years, hold the pinna down and back. Administration of solutions that are too cold may cause a vestibular-type reaction with vomiting and dizziness. Store eardrops, solutions, and ointments at room temperature before instillation. Allow a period of time for adequate coverage of the ear by the medication, rather than putting as many drops as possible into the ear. A cotton ball should not be placed in the ear.

The nurse is assessing a patient who has been prescribed an antibacterial otic drug for otitis media. The nurse finds that the patient is also taking oral antibiotics for a throat infection. Which advice will the nurse give to the patient in this situation? 1 "You should take both of the drugs regularly as per the dosing regimen." 2 "You should stop taking the antibiotic for your throat infection for a time." 3 "You should start taking the otic drug only once your throat infection is treated." 4 "You need not take the otic drug, as the antibiotic will suffice for treating otitis media."

1 "You should take both of the drugs regularly as per the dosing regimen." Otic drugs are applied topically in the ear canal and thus, generally do not interact with drugs that are given orally. Therefore the nurse would tell the patient to take both medications as per the dosing regimen. If the patient stops taking oral antibiotics, the throat infection would worsen. Therefore this suggestion would not be appropriate. If the patient does not start taking the otic drug in the early stages of otitis media, the patient will develop chronic otitis media, which is a more serious condition. Otitis media is treated only with a topical antibacterial drug (otic drug). Thus the nurse would not inform the patient that the oral antibiotic will suffice for treating otitis media.

A child has a fever and otitis media. Which drug does the nurse expect to act as the first line of treatment for the child? 1 Amoxicillin 2 Ofloxacin 3 Acetasol HC 4 Carbamide peroxide

1 Amoxicillin Amoxicillin is a systemic antibiotic that acts as the first line of treatment for conditions such as fever and otitis media, and it will likely be prescribed by a health care provider to children with these issues. Systemic fluoroquinolones such as ofloxacin are not indicated in children. Acetasol HC is a commonly used combination drug to treat infections of the outer ear and ear canal. Carbamide peroxide is used to remove ear wax.

Which drug has dexamethasone as a steroidal component? 1 Ciprodex 2 Floxin Otic 3 Cipro HC Otic 4 Cortisporin Otic

1 Ciprodex Antibacterial drugs are commonly combined with steroids to treat ear disorders. Ciprodex is the drug that has dexamethasone as a steroidal component. It consists of ciprofloxacin (3 mg/mL) in combination with dexamethasone. Floxin Otic, Cipro HT Otic, and Cortisporin Otic do not contain dexamethasone as a steroidal component. Floxin Otic contains only antibiotic ofloxacin (3 mg/mL). Cipro HT Otic contains ciprofloxacin (2 mg/mL) in combination with hydrocortisone (1%). Cortisporin Otic contains neomycin (5 mg) and polymyxin B (10,000 units) in combination with hydrocortisone (1%).

A patient is being treated with otic medication. Which effect would the nurse anticipate with this treatment? 1 Improved hearing 2 Increased dizziness 3 Increase of cerumen 4 Increased head trauma

1 Improved hearing The therapeutic effects of otic drugs, as with all drugs, are gauged by evaluating whether goals and objectives have been met. Improvement in hearing may also be an anticipated therapeutic effect. Administration of cold eardrops can cause vestibular changes, such as nausea and dizziness. Earwax emulsifiers help to remove accumulated earwax from the ear canal. If the condition of the patient is untreated, it may increase the risk of head trauma.

The nurse is evaluating the effectiveness of the otic medication used for otitis externa. Which will the nurse evaluate to determine if the goals of therapy have been met? 1 Improved hearing 2 Discharge in canal 3 Redness around ear 4 Increased pain in ear

1 Improved hearing The therapeutic effects of otic drugs, as with all drugs, are gauged by evaluating whether goals and objectives have been met. Therapeutic effects of otic drugs include less pain, redness, and swelling in the ear; a reduction in fever; and resolution of any other signs and symptoms associated with the ear disorder. Improvement in hearing may also be an anticipated therapeutic effect. The other options indicate that the therapy was not effective and that further evaluation must be completed by the health care provider.

A pregnant patient is diagnosed with a perforated eardrum. The nurse can safely administer which otic solution to a pregnant client with a perforated eardrum? 1 Ofloxacin 2 Pramoxine 3 Carbamide peroxide 4 Ciprofloxacin and hydrocortisone

1 Ofloxacin The nurse would administer an otic drug to a pregnant patient only if its benefits outweigh its risks. The American Academy of Otolaryngology, American Academy of Family Physicians, and US Food and Drug Administration (FDA) do not recommend using any of the listed medications with a perforated eardrum except ofloxacin. The three remaining medications are not FDA approved to administer to a client with a perforated eardrum. Hydrocortisone may cause intense burning and irritation. All three may lead to ototoxicity or other complications if they get into the middle ear space through the perforation.

Which otic preparations are recommended for a patient who has a perforated eardrum? Select all that apply. 1 Ofloxacin 2 Neomycin 3 Polymyxin B 4 Ciprofloxacin 5 Hydrocortisone

1 Ofloxacin 4 Ciprofloxacin Ofloxacin and ciprofloxacin are recommended for the patient with a perforated eardrum. These medicines are safe for the patient with a perforated eardrum. Neomycin, polymyxin B, and hydrocortisone are contraindicated in patients with a perforated eardrum because these drugs may cause permanent damage to the ear.

The nurse observes a patient who is experiencing an allergic reaction on the surface of the ear. During assessment, the nurse finds that the patient has developed swelling due to pain and itching. Which type of drug will be administered to the patient to relieve the symptoms? 1 Steroid drugs 2 Antifungal drugs 3 Antibacterial drugs 4 Wax-emulsifying drugs

1 Steroid drugs Steroid drugs are commonly used to treat reactions like edema and allergies. When the allergic symptoms are mild, topical application of the drugs is found to be effective in treating the condition. Antifungal drugs, antibacterial drugs, and wax emulsifiers are not used to treat allergic reaction of the external ear. When the condition is mild, such complicated medications may not be necessary to manage the condition. Antifungal agents are used to treat disorders when a patient is diagnosed with fungal infection. Antibacterial agents are used to treat disorders when a patient is diagnosed with a bacterial infection. These drugs require combination with steroids for antiinflammatory action. Wax emulsifiers are the drugs used to soften ear wax.

The nursing student assesses a patient who has otitis media for whom a combination therapy of antibacterial otic drugs and steroids is prescribed. The nursing student asks the instructor why steroids are prescribed to the patient. Which response from the instructor is appropriate? 1 "The steroids are prescribed to soften the cerumen." 2 "The steroids are prescribed to reduce inflammation." 3 "The steroids are prescribed to reduce fungal infection." 4 "The steroids are prescribed to improve antibacterial effect."

2 "The steroids are prescribed to reduce inflammation." The steroids are antiinflammatory drugs prescribed in combination with antiinfective drugs for a patient who has otitis media. The steroids help reduce inflammatory symptoms such as itching. Steroids do not soften the cerumen. Steroids do not have antifungal properties and are thus not helpful in reducing fungal infection. Steroids do not have antibacterial properties; therefore steroids do not prevent bacterial infection of the ear.

The nurse is caring for a child who is experiencing severe discomfort and high fever. The health care provider diagnoses acute otitis media. Which first-line drug will be included as part of the treatment plan? 1 Ofloxacin 2 Amoxicillin 3 Ciprofloxacin 4 Carbamide peroxide

2 Amoxicillin Otitis media is a common disorder seen in infants and children. It is characterized by fever, discomfort (malaise), hearing defects, and sensation of fullness in the ears. However, it is also observed in adults, associated with bleeding of the tympanic membrane. Amoxicillin is the first-line drug for the treatment of otitis media. Thus the nurse would administer this drug to the patient. It is an antibiotic, and its action starts in 24 to 72 hours. Ofloxacin, ciprofloxacin, and carbamide peroxide are not the drugs given as first-line medication for treating otitis media. Ofloxacin and ciprofloxacin may be prescribed if the patient fails to respond to amoxicillin medication. Carbamide peroxide is the drug used to soften earwax.

A patient with otitis media is receiving ofloxacin therapy. During the follow-up visit, the patient reports severe itching in the ear pinna and has swelling around the ear. Which medication should be included in the patient's prescription to provide effective treatment? 1 Chloroxylenol 2 Dexamethasone 3 Propylene diacetate 4 Benzethonium chloride

2 Dexamethasone Dexamethasone is a corticosteroid that has antiinflammatory and antiallergic actions. Therefore including dexamethasone or an otic preparation containing corticosteroids will be beneficial for the patient. Chloroxylenol is an antiseptic antifungal medication that helps to reduce the symptoms of infection, but not itching and inflammation. Propylene diacetate is an emulsifying drug; it does not have antiallergic action. Benzethonium chloride is an antiseptic preservative that prevents degradation of medications. It does not alleviate allergic symptoms.

Which is the route of administration of glycerin, a hyperosmotic laxative? 1 Oral 2 Rectal 3 Intravenous 4 Intramuscular

2 Rectal Glycerin suppositories are given rectally. It is not given via the oral, intramuscular, or intravenous routes because the drug would damage tissue due the hyperosmotic nature of the medication. Also, not enough drug would distribute to the colon to produce laxation if given by other than the rectal route.

The nurse teaches a nursing student about earwax emulsifier. Which statement by the student indicates effective learning? 1 "Earwax emulsifier treats ear infection." 2 "Earwax emulsifier prevents fungal infection." 3 "Earwax emulsifier loosens impacted cerumen." 4 "Earwax emulsifier decreases earwax secretion."

3 "Earwax emulsifier loosens impacted cerumen." Earwax emulsifiers are products that soften and help eliminate earwax. An earwax emulsifier loosens impacted cerumen and allows it to be flushed out of the ear canal. An earwax emulsifier does not have antiinfective or antifungal properties; therefore, it is not helpful for treating ear or fungal infections. Earwax emulsifiers have little or no effect on sweat glands. Therefore they do not decrease earwax secretion.

The nurse is caring for a patient who has a middle ear infection due to exposure to contaminated water. The laboratory reports confirm fungal infection. Which is the drug of choice for treating this condition? 1 Carbamide peroxide 2 Ofloxacin solution 3 Acetic acid and hydrocortisone solution 4 Neomycin, polymyxin B sulfates, and hydrocortisone solution

3 Acetic acid and hydrocortisone solution Otitis externa is a microbial infection of the ear canal or tympanum seen mostly in adults. The condition is caused by exposure to contaminated water and results in itching and inflammation of the external ear or auditory canal. Acetic acid and hydrocortisone solution is the choice of drug for treating otitis media related to fungal infections. The drug is composed of hydrocortisone (1%), acetic acid (2%), propylene glycol diacetate (3%), sodium acetate (0.015%), and benzethonium chloride (0.02%). Acetic acid and hydrocortisone solution is effective for treating itching and pain due to otitis externa, and it promotes comfort in patients. Carbamide peroxide, ofloxacin solution, and Neomycin, polymyxin B sulfates, and hydrocortisone solution are not used for treating fungus-related otitis externa. Carbamide peroxide is an earwax emulsifier used to soften earwax. Ofloxacin solution and Neomycin, polymyxin B sulfates, and hydrocortisone solution are the drugs used for treating bacterial-related otitis externa.

In which part of the ear is the eustachian tube located? 1 Inner 2 Outer 3 Middle 4 External

3 Middle The eustachian tube is in the middle part of the ear. The middle ear also contains the tympanic cavity and three bony structures of the mastoid bone, namely the incus, stapes, and malleus. The eustachian tube is not in the inner, outer, or external part of the ear. The cochlea and semicircular canals are in the inner part of the ear. The external auditory canal is in the outer part of the ear. The pinna is part of the external ear.

In which part of the ear is the tympanic cavity located? 1 Inner 2 Outer 3 Middle 4 External

3 Middle The tympanic cavity is in the middle ear. The tympanic cavity is the space that begins with the tympanic membrane and ends with the oval window. The cochlea and semicircular canals are located in the inner part of the ear. The external auditory canal is in the outer part of the ear. The pinna is part of the external ear.

A 14-year-old patient is diagnosed with perforated tympanic membrane, otitis externa, and otitis media. Which does the nurse anticipate the health care provider will prescribe? 1 Oral antimicrobial only 2 Otic antimicrobials only 3 Otic and oral antimicrobials 4 Otic antimicrobial and otic antifungal

3 Otic and oral antimicrobials The patient will need a topical/local otic antimicrobial for the otitis externa and perforated tympanic membrane in addition to a systemic (oral) antimicrobial to treat the otitis media. Otic antifungals are the treatment of choice in otomycosis.

Which disorder can likely cause damage to the eustachian canal? 1 Psoriasis 2 Seborrhea 3 Otitis media 4 Otitis externa

3 Otitis media Otitis media is a common disorder in infants. The disease is characterized by fever and pain in the ear, and in chronic conditions, severe infection in the ear cavity. The condition commonly damages the eustachian canal because the initial stage of infection is confined to the middle ear. Psoriasis, seborrhea, and otitis externa are not conditions observed in the eustachian tube. Psoriasis and seborrhea are skin disorders that affect the external ear. Otitis externa is a common disorder of the outer ear.

The health care provider has ordered ciprofloxacin/dexamethasone otic drops for a patient with otitis externa. The nurse knows the combination medication has both antibacterial medication and topical steroid medication. Which is the purpose of the steroid in this medication? 1 Relieve pain 2 Treat infection 3 Reduce inflammation 4 Decrease the amount of earwax

3 Reduce inflammation The purpose of a steroid included in otic drops is to assist with decreasing the inflammation in the canal and the itching associated with the inflammation.

The nurse learns that a patient who has an eye infection is taking ciprofloxacin for otitis media. The patient is also prescribed ophthalmic ciprofloxacin to treat the eye infection. Which necessary precaution will the nurse take while caring for the patient? 1 The nurse stores the drugs in a single carton. 2 The nurse administers the drugs simultaneously. 3 The nurse administers the drugs with a time gap. 4 The nurse administers the drugs interchangeably.

3 The nurse administers the drugs with a time gap. The Institute for Safe Medication Practices (ISMP) has formulated several ethical practices regarding care for patients with eye and ear infections. The nurse would administer the medication to the patient with a time gap to prevent the inadvertent use of eyedrops in the ears and vice versa. The drugs should not be stored in a single carton because these drugs appear similar and can be mixed up. Formulations for otic drugs differ from those for optic drugs; patients will experience inflammation and reddening of the eye if given the wrong medication. The eyedrops should be administered via the conjunctival route, and the eardrops should be administered via the auricular route. Alternate routes of drug administration will not be effective in treating the conditions.

The nurse is teaching a group of nursing students about the anatomy of the ear. Arrange the order of structures from external to internal. 1. Cochlea 2. Eardrum 3. Ear pinna 4. Eustachian tube

3, 2, 4, 1 The structure of the ear is divided into four regions: external, outer, middle, and inner. The external auditory meatus, or the pinna, is the external projection of the ear. The middle ear is composed of the eardrum (tympanic membrane) and three bones, namely the incus (anvil), malleus (hammer), and stapes (stirrup). These structures are connected to the eustachian tube. The middle ear is followed by the inner ear, which contains the cochlea and semicircular canals.

The primary health care provider prescribes ofloxacin for a child with otitis media. The nurse is teaching the child's parent about medication administration. Which statement made by the parent indicates effective learning? 1 "I should give cool medication taken from the refrigerator." 2 "I should place the drug in a cup of hot water for 10 minutes." 3 "I should microwave the otic drug container to make it warm." 4 "I should place the medication bottle under warm running water."

4 "I should place the medication bottle under warm running water." The parent should administer ofloxacin, an otic drug, to the child at room temperature. The parent should either place the otic medication bottle outside the refrigerator 1 hour before administration or place it under running warm tap water. The parent should not administer cold otic drug to the child with otitis media because it may produce vestibular reactions, such as nausea, vomiting, and dizziness. The parent should not place the drug in a cup of hot water because there may be a chance of water entering the container, which may cause damage to the label, or the solution may get too warm to use. The nurse would instruct the parent not to microwave the drug because the high temperatures may affect the potency of the otic drug.

A parent of a young child asks what can be used to help keep the child's ears clear of wax. Which over-the-counter medication will the nurse suggest? 1 Cortic 2 Floxin 3 Ciprodex 4 Carbamide peroxide

4 Carbamide peroxide Carbamide peroxide is a commonly used earwax emulsifier. It is combined with other components (e.g., glycerin, a lubricant) that help soften and lubricate cerumen before irrigation. Carbamide peroxide slowly releases hydrogen peroxide and oxygen when exposed to moisture. The others are antifungals or antibacterial otic drugs.

A patient is complaining of excessive earwax, leading to diminished hearing ability. The nurse will expect to teach the patient to administer which medication to correct this problem? 1 Pramoxine 2 Acetic acid 3 Hydrocortisone 4 Carbamide peroxide

4 Carbamide peroxide Carbamide peroxide works to soften earwax for easy removal while providing a weak antibacterial action to prevent infection. Pramoxine, acetic acid, and hydrocortisone are not used for excessive ear wax.

The nurse is assessing a patient who has impacted cerumen. Which medicine will the nurse expect to be prescribed to the patient for removing the impacted cerumen? 1 Ofloxacin 2 Amoxicillin 3 Ciprofloxacin 4 Carbamide peroxide

4 Carbamide peroxide The patient has cerumen blockage. Carbamide peroxide is useful for the patient in this situation. Carbamide peroxide is a commonly used earwax emulsifier. Carbamide peroxide slowly releases hydrogen peroxide and oxygen when exposed to moisture. The oxygen that is released imparts a weak antibacterial action. The effervescence resulting from the interaction of moisture and oxygen emulsifies the impacted cerumen and releases it from the walls of the ear canal. Ofloxacin and ciprofloxacin are fluoroquinolone antibacterial drugs. They are used to treat bacterial infections and are not useful for removing the impacted cerumen. Amoxicillin is an antibiotic; it is not useful for removing the impacted cerumen.

Which class of drugs is used to treat pain due to infection in the auditory canal? 1 Antihistamines 2 Corticosteroids 3 Wax emulsifiers 4 Local analgesics

4 Local analgesics Pain is a common symptom for most of the otic conditions. Local analgesics are the class of drugs used to treat pain due to infection in the ear canal. Antihistamines, corticosteroids, and wax emulsifiers are not used to treat pain due to infection in the auditory canal. Antihistamines are used to treat allergic reactions. Corticosteroids are used to treat symptoms like reddening and edema. Wax emulsifiers are used to treat cerumen accumulation.

Which structure is found in the inner ear? 1 Auricle 2 Eardrum 3 Auditory canal 4 Semicircular canals

4 Semicircular canals The inner ear is composed of semicircular canals that are associated with the cochlea and supplied by several nerves. The nerves associated with the inner ear are the vestibular, facial, and cochlear nerves. The auricle, eardrum, and auditory canal are not structures of the inner ear. The auricle, or pinna, is part of the external region of the ear. The eardrum is a structure found in the middle region of the ear. The auditory canal forms the middle region of the ear.

The nurse instructs a nursing student to administer eardrops to a patient. The nursing student finds that the medication bottle has been stored in the refrigerator. Which is the appropriate action for the nursing student to follow? 1 Place the bottle in hot water for 10 minutes before administration. 2 Administer the drug immediately after taking it from the refrigerator. 3 Heat the bottle for 2 minutes in the microwave before administration. 4 Take the bottle out of the refrigerator for an hour before administration.

4 Take the bottle out of the refrigerator for an hour before administration. The nurse would remove the bottle from the refrigerator 1 hour before administering the drug so that it may warm up to room temperature. The nurse would not place the bottle in hot water because heating affects the potency of medicine. Placing the bottle in water may also damage the label of the drug, thus rendering the directions unreadable. The nurse would not administer cold eardrop medication to the patient because it can cause nausea and vomiting. The nurse would not heat the eardrops because heating affects the potency of the medication.

A patient with an upper respiratory tract infection reports fever, pain in the ear, and sensation of fullness in the ear. Which part of the ear would the nurse suspect is infected in this patient? 1 Cochlea 2 Ear canal 3 Semicircular canal 4 Tympanic membrane

4 Tympanic membrane Otitis media is an infection of the middle ear. It can be preceded by an upper respiratory tract infection that causes fever, pain in the ear, and sensation of fullness. It can also develop after trauma to the tympanic membrane. Upper respiratory tract infections do not increase the risk of infection in the cochlea, ear canal, outer ear, or structures of the inner ear, including the semicircular canal.

The nurse bases the plan of care regarding administration of eardrops on which knowledge? 1 The pinna of an adult should be held down and back. 2 Eardrops may be warmed in the microwave before administration. 3 Proper administration includes holding the pinna up and out in an infant. 4 Warming the eardrops to room temperature before administration helps reduce a vestibular-type reaction.

4 Warming the eardrops to room temperature before administration helps reduce a vestibular-type reaction. Eardrops that are administered too cold may cause vomiting and dizziness by stimulating a vestibular-type reaction. Eardrops in adults should be administered by holding the pinna up and out; in children under 3 years of age, the pinna is held down and back. The eardrops should not be warmed in the microwave because too high a temperature can destroy the effectiveness of the medication. Room air temperature is sufficient.