Pharmacy Practice

Lecture (3)
Prof. Yahya El-Emam
• Ophthalmic preparations :
• How to use eye drops:
1) Wash hands.
2) As appropriate , remove exudate from the
eyelid and eyelashes using sterile saline
solution. Always use separate cotton ball for
each wiping motion. Start at the inner
canthus and wipe outward.
3) With one hand , gently pull lower eyelid
down.
4) Holding dropper above eye , drop medicine
inside lower lid while looking up; don't touch
dropper to eye or fingers.
5) Release lower lid . Try to keep eye open and
do not blink for at least 30 seconds.
6) After instilling the drops, apply gentle
pressure, using a cotton ball ,to the inner
corner of the eyelid on the bone for
approximately 1-2 minutes.
• This prevents the medication from entering
the canal where it would be absorbed in the
vascular mucosa of the nose and produce
systemic effects.
• It also ensures an adequate concentration of
medication in the eye.
• Never use eye drops that have changed color,
become cloudy or contain particles.
• If you have more than one bottle of the same
kind of drops open only one bottle at a time.
• If you are using more than one kind at the
same time, wait several minutes before use of
other drops.
• It may be helpful in use of the medicine to
practice use by positioning yourself in front of
the mirror.
• How to use ophthalmic ointments:
1) Wash hands.
2) With one hand, gently pull lower eyelid
down.
3) While looking up, squeeze a small amount of
ointment (about ¼ to ½ inch ) inside lower
lid.
* Be careful not to touch tip of the tube to eye ,
eyelid ,fingers...etc.
4) Close eye gently and roll eyeball in all
directions while eye is closed. Temporary
blurring may occur.
5) The closed eyelid may be rubbed very gently
by a finger to distribute the drug throughout
the formix.
6) Replace cap on tube.
• When opening ointment tube for the first time
squeeze out the first ¼ inch of ointment and
discard as it may be too dry.
• Never touch tip to any surface.
• If you have more than one tube of the same
ointment open only one at a time.
• If you are using more than one kind at the
same time, wait about 10 minutes before use
of other ointment.
• To improve follow of ointment , hold tube in
hand several minutes to warm before use.
• It may be helpful in use of the medicine to
practice use by positioning yourself in front of
the mirror.
• Inhalations:
• It is essential that the patient is taught the
technique of using the inhaler if the treatment is to
be effective.
1) Remove the cover from the mouthpiece and
Shake the inhaler vigorously.
* Many patients forget, or are unaware of, the need
to shake the container. This should be emphasized
when counseling patient on inhaler technique.
2) Breathe out slowly.
3) Place inhaler in the mouth and close the lips
around the mouthpiece.
4) Breathe in deeply and press the canister
firmly.
5) Hold breath for 10 seconds or as long as
patient can comfortably manage.
6) Breathe out normally.
7) Check your Technique in front of a mirror. If
you see a fine mist check actions 3 and 4 .
8) If another dose has to be taken at least one
minute should elapse before repeating the
exercise.
*Unfortunately, some patients find these
devices difficult to use and because of poor
technique many patients do not get the
expected response.
• There are several reasons for patients problems.
These include:
1) Patients may not be able to synchronize
breathing in and firing the aerosol.
2) Some patients have difficulty pressing hard
enough to fine the aerosol.
3) The inhaled drug does not travel in a straight
line which results in desposition of the drug
droplets in the mouth and pharynx.
• The breath in, therefore, must be slow, as this
will reduce the impaction of particles in the
mouth and pharynx.
4) The breath must be held at the end of the
inspiration period to allow the particles to
deposit on the site of action.
5) When the propellant hits the back of the
throat it causes the " cold Freon effect". This
interrupts breathing in some patients and
renders this type of inhaler device useless in
these cases.
* Inhalers are unsuitable for use by children
under 5 years of age.
• For these reasons much work has gone into
developing devices which will overcome the
various problems.
• The Haleraid:
• This is a simple device which fits over certain
makes of pressurized aerosols. Instead of
firing aerosol by pressing down on the canister
with the forefinger, the Haleraid is gently
squeezed using the whole hand.
• It is useful for certain elderly or arthritic patients
who have difficulty pressing the canister.
• The spacer inhaler:
• It is a standard pressurized inhaler with an
elongated mouthpiece. The benefit of this device
is that the delivered dose of drug and propellant
is more diffuse when it arrives at the mouth and
the "cold Freon effect" is considerably reduced.
• However, they are slightly awkward to
manipulate for some patients, particularly the
elderly and those with arthritic hands.
• Nebulizers :
• Nebulizers are devices that transform liquid
medicine into mist. The mist is inspired to
treat respiratory disorders.
• There are two kinds of nebulizers (Ultrasonic
and Compressor).
• Compressor nebulizers use air to transform the
liquid medication into mist, while ultrasonic
nebulizers use vibration to turn the medication
into mist.
• How to use a nebulizer:
1) Wash hands and keep them clean.
2) Make sure the nebulizer is clean.
3) Open the cup and place the medication inside
the cup and close it.
4) Turn the nebulizer on and make sure mist is
coming out of the mouthpiece or mask.
5) a) If you are using a mouthpiece, hold the
mouthpiece with your mouth and gently bite
on it. Gently breathe in and out using your
mouth. keep holding the nebulizer cup in an
upright position.
5) b) If you are using a mask, place The mask
over mouth and nose. keep holding the
nebulizer cup in an upright position.
6) If the nebulizer starts to sputter, that means
most of the medication is gone. Tapping the
nebulizer cup can help the remaining
medicine to drop to where it can be turned
into mist.
7) Clean and dry the nebulizer after use.
• Make sure the nebulizer is completely dry
before storing it in a cool and dry place.
* A typical treatment lasts about 10 to 15
minutes.