okay class so we have made it to chapter 60 and we're going to be talking about drug therapy for disorders of the ear learning objectives we need to recognize the theology pathophysiology and clinical manifestations of both acuto titis externa and necrotising otitis externa we're going to identify the Prototype and describe the action used adverse effects Contra indications and nursing implications for topical medications used to treat otitis externa as as well as systemic medications that are used uh to treat necrotising otitis externa um we're going to um also uh talk about the systemic medications used to treat otitis media and also the combination therapy or adant uh drugs that are used to treat um otitis externa and otitis media and we need to implement the nursing process in the care of patients with otitis external or otitis media okay so we have a few key terms and um it's just one slide just this necroing otitis externa it's invasive self tissue infection of the external auditorial canal and the skull it's also called malignant external otitis otalgia it's ear pain or ear ache otic will be related to the ear otitis externa it's inflammation of the external ear and it will occur as a my allergic dermatitis or as severe cellulitis we also have otitis media which is inflammation of the middle ear and attera which is going to be discharged from the ear either clear or purulent any type of discharge following perforation of the tanic membrane or the eard drum okay guys so atitis externa will be um also known as swimmer's ear and the causes for these will include moisture in the your Canal it could be caused uh by allergic reactions or trauma of the a canal maybe from itching or scratching let's say you just have an allergic reaction or just allergies and and then you use an item to to scratch and because it's itching and you there is trauma that could lead to um infection it will provoke pain it could uh have uh dis charge either watery or purulent and it's mainly moisture um in the air Canal um that's part of like the name known as swimmer's ear and many times when um you go to the pool and some water gets trapped there um it could cause the infection so uh you could have some hearing losss and these could develop if I'm treated to necrotizing no titis exter turn out this one's going to involve um the skull and the soft tissue um so it is important that otitis gets treated because otitis um necrotising otitis is actually uh a very serious infection it could be fatal also known as malignant or titis now atitis media it's more common in children than in adults and what happens is that the pathogens um enter the middle ear and then produce the infection so um it could develop from an upper respiratory uh congestion uh inflammation or also an allergic reaction and as mentioned before bacteria may enter the middle ear uh from contaminated secretions coming from the nasal fings or also uh because of perforation of the tanic membrane the symptoms are going to include uh pain and diminish uh hearing now the drug therapy for these um conditions for otitis externa and otitis media for otitis externa it's mainly the use of topical agents um sometimes they'll um prescribe drops uh to help with um the infection and many times it also helps with a pain now if um more tissue is involved or if we have a combination of otitis externa and otitis media then um they may give uh a systemic then we may get a a a prescription for a systemic uh drug uh when there is more involvement um also if um the infection extends to the external ear like the the P the P or the Pina then oral anti-infective agents are used for titis media we need systemic drugs um oral amoxicilin is the drug of choice and for those who are allergic to penicillin then we can probably use a sefalosporin so think about um amoxicilin as a penicillin uh sefalosporin could be sephos Solin and there well there's others as well and we're going to see right now okay so for um the prototypes we have the neomin polycin be hydrocortisone so the hydrocortisone is going to help with the inflammation and we have this combination drug uh for acute external otitis media this is going to be in the form of drops then we also have the fluoroquinolone and the Prototype will be cicin we had already heard about this drug before and this is this will be the drug of choice for necrotising otitis externa and antibacterial agents we had already mentioned amoxicillin is a prototype for acuto titis media um so the adverse effects we already know it will be hypers sensitivity to the drug we have already mentioned that penicillins have a um a high rate of um hypers sensitivity and then um some GI effects it will mess up with the stomach um and also the development of Sou infections other infections on top of the the one treating we um also have a juven medications and it's mainly to help with the fever and the pain that are related to the infection so um they're uh giving us the Sal salic slates and the Prototype is aspirin but guys remember with kids we wouldn't choose aspirin as the choice of treatment for pain and fever because um the of the ray disease or the ray syndrome so please keep that into account um even for adults I rarely see aspirin used for pain and and fever and I'm going to confess that you may see it with like the older gener like older gener Generations like I know my grandma she loves aspirin um she lives in Mexico and they have these combination of uh caffeine an aspirin or some sometimes also just the aspirin and a lot of people use that as as a choice for the treatment of pain here in the US I've seen more uh the ibuprofen the proxin the leave um the acetaminophen uh being used to help with fever and pain so remember just with children no aspirin okay um and also the ibuprofen will depend on the age of the child for adults maybe a combination of both of ibuprofen and acetaminophen will help uh break the the fever um but um the ibuprofen just by itself will take care of the inflammation the fever and the pain now if the patient has um hyper sensitivity to aspirin then ibuprofen would probably not be a good choice um if the patient has any problems with their GI uh if they have ulcers if they have gastritis then probably aspirin or ibuprofen is not the best choice either remember that those mess up with a prostaglandins and uh the prandin produce a protective um mechanis they have a protective mechanism in the stomach so by taking Nets um we are actually lowering that mechanism so if there is also no lever damage then maybe add acetaminophen would be um the choice but if we have patients with lever problems then acetaminophen it it needs to be um probably not the choice or we need to be very careful with that okay because remember acetaminophen it's going to have more adverse effects to the liver um and induce hpat toxicity if it's not taken correctly or um if we take more than needed or more than actually the limit for the day okay so guidelines for our patients take take the entire course of the anti-infective agents and we have learned that one right by now you guys should already know finish the course of the treatment unless right they develop a ratch and anaphylactic reaction of okay that's severe they need to stop it like right away um and call the doctor or seek uh emergency care if it's severe um uh mainly drink it with a full glass of water when they take the antibiotics um they they can take take um other medications to help with the pain and the fever and we just mentioned those do not put anything in the ear sometimes the itching could be so severe that um they want to scratch maybe sometimes use even like the the coton tipped um oh my God I forgot the name of those that we shouldn't actually be inserting in the ear but they're very uh the Q-tips they're very common also use ear plugs when swimming um and then um dry the ear carefully following bathing or swimming and those are just patient guidelines that we should be teaching them even if there is no infection in order to prevent the recurrence of infections or even just prevent ear infections just um they need to cover their ears when when swimming nursing implications preventing interactions okay that's part of like what we need to um ask our patients if they're taking any other medications if they're taking any other um any her supplements um we need to teach them also how to administer the medications for the ear if it is the ear right if they're oral um when to take it if they miss a dose and it's very close to the next dose then they need to just follow with the next dose if they miss the dose and it's been always it's been only like an hour uh that they have missed it and the next one is not until like six seven hours more then they need to take it right away as soon as like they notice that they have missed it now if the as I mentioned before if the next dose is closer then they just need to take the next dose um assessing for therapeutic effects what is that they should see okay um I know that they're going to be taking um agents to help them with the pain and the inflammation but also the anti-inflam the antibiotic is going to have that anti-inflamm effect also because it's already it's killing the bacteria it's taking care of the bacteria it's decreasing the infection so they should start feeling better overall um adverse effects is it uh giving you a rash um we need to make them aware that it might upset their stomach and they need to know that okay so it's not taking it by surprise um and that's mainly for the systemic uh or the oral medications now for the drug they should know that they might uh burn and they might um also sting they could cause autotoxicity so they need to be very careful as well um and make sure that they um they know that that could happen um notify the doctor if they they start feeling um um adverse effects that are more than um well I shouldn't say more than beable because they actually should know exactly like when to call the doctor for example if they um have hearing loss with a drops then that's that's a reason um to call uh the doctor now for um as I mentioned before for the oral antibiotics common effects with um moxilin will be um upset stomach sore throat well nsia vom vomiting abdominal pain diarrhea now uh as mentioned before if they develop um an a a rash severe itching they need to stop it they need to stop and call the doctor right away now we also have uh the treatment for um the malignant otitis that one's going to include a a stronger antibiotic and that's that will be cypro uh fline that's the choice for the the treatment of um um the necrotising or titis and for children that's mainly for adults guys and for children will be the sexine okay um so we need to just um make sure that we teach our patients on what to expect of course therapeutic effects will be um starting to feel better right like the the resolving of the issue of the infection now the adverse effects um are mainly going to have to do with nausea vomiting um abdominal discomfort some dizziness and Mild headache could happen as well um if they have an allergic uh reaction then they need to uh stop the medication let the doctor know and also photosensitivity could also have happen when taking CYO uh the cypro flusin um now if the patients have sensitivity to cypro fline then they cannot take this drug or any other fluoroquinolone and we need to make sure that we uh review the in the potential interactions such as herbs and foods that are going to interact with uh cypro now these medication uh will most likely be given IV remember this is a severe uh condition so if given IV then um we need to assess for signs and symptoms of hypers sensitivity and if the patients are taking an oral form of the medication again I mentioned GI upset um now important teaching for cypro flusin do not take it within two hours of eating any dairy products any calcium Phi juices any an acid sink or iron okay if it is given through an interal interal feeding an interal or a feeding tube we need to um stop any feedings for one to two hours prior to and after the administration of cyprox ofine okay because the drug absorption will be decreased now therapeutic effects we're going to be assessing for decreased pain um and also decrease secretions it is important that we pay attention to the renal function and any signs and symptoms of hyper sensitivity now box uh 60.2 guys has uh the patient teaching guidelines for cypro or cicin and make sure that you um check those out I'm just going to mention some I already talked about the calcium fortified juices uh and acid sink iron um something that they need to report is tendon pain okay um also they need to be well hydrated do not operate any uh heavy machinery or anything do not drive if they're having diziness or the light um or or the light sensitivity or Li headedness okay so mainly um that's it for our nursing implications um I think that some of these drugs are already familiar to you guys um so please just um have your cards ready for uh cypro fline for um amoxicilin and also for the combination of like the drops the neyin uh poly U mic and hydrocortisone uh combination