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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 . . 4) Holding dropper above eye . don't touch dropper to eye or fingers. drop medicine inside lower lid while looking up. gently pull lower eyelid down.

to the inner corner of the eyelid on the bone for approximately 1-2 minutes. using a cotton ball . apply gentle pressure.5) Release lower lid . . Try to keep eye open and do not blink for at least 30 seconds. 6) After instilling the drops.

• 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.

• If you have more than one bottle of the same kind of drops open only one bottle at a time. become cloudy or contain particles.• Never use eye drops that have changed color. .

wait several minutes before use of other drops. .• If you are using more than one kind at the same time. • It may be helpful in use of the medicine to practice use by positioning yourself in front of the mirror.

.. * Be careful not to touch tip of the tube to eye .. gently pull lower eyelid down.• How to use ophthalmic ointments: 1) Wash hands. eyelid .etc. 3) While looking up. squeeze a small amount of ointment (about ¼ to ½ inch ) inside lower lid.fingers. 2) With one hand.

5) The closed eyelid may be rubbed very gently by a finger to distribute the drug throughout the formix. Temporary blurring may occur. 6) Replace cap on tube.4) Close eye gently and roll eyeball in all directions while eye is closed. .

• If you have more than one tube of the same ointment open only one at a time.• 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. .

• To improve follow of ointment . wait about 10 minutes before use of other ointment. • It may be helpful in use of the medicine to practice use by positioning yourself in front of the mirror. . hold tube in hand several minutes to warm before use.• If you are using more than one kind at the same time.

. This should be emphasized when counseling patient on inhaler technique. * Many patients forget.• Inhalations: • It is essential that the patient is taught the technique of using the inhaler if the treatment is to be effective. or are unaware of. 1) Remove the cover from the mouthpiece and Shake the inhaler vigorously. the need to shake the container.

6) Breathe out normally. 4) Breathe in deeply and press the canister firmly.2) Breathe out slowly. 5) Hold breath for 10 seconds or as long as patient can comfortably manage. . 3) Place inhaler in the mouth and close the lips around the mouthpiece.

some patients find these devices difficult to use and because of poor technique many patients do not get the expected response. *Unfortunately. 8) If another dose has to be taken at least one minute should elapse before repeating the exercise. . If you see a fine mist check actions 3 and 4 .7) Check your Technique in front of a mirror.

2) Some patients have difficulty pressing hard enough to fine the aerosol.• There are several reasons for patients problems. 3) The inhaled drug does not travel in a straight line which results in desposition of the drug droplets in the mouth and pharynx. These include: 1) Patients may not be able to synchronize breathing in and firing the aerosol. .

must be slow. . therefore. 4) The breath must be held at the end of the inspiration period to allow the particles to deposit on the site of action.• The breath in. as this will reduce the impaction of particles in the mouth and pharynx.

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. .

the Haleraid is gently squeezed using the whole hand. .• 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.

.• 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.

particularly the elderly and those with arthritic hands. they are slightly awkward to manipulate for some patients. .• However.

• Nebulizers : • Nebulizers are devices that transform liquid medicine into mist. • There are two kinds of nebulizers (Ultrasonic and Compressor). . The mist is inspired to treat respiratory disorders.

2) Make sure the nebulizer is clean. while ultrasonic nebulizers use vibration to turn the medication into mist.• Compressor nebulizers use air to transform the liquid medication into mist. 3) Open the cup and place the medication inside the cup and close it. • How to use a nebulizer: 1) Wash hands and keep them clean. .

5) a) If you are using a mouthpiece. Gently breathe in and out using your mouth. hold the mouthpiece with your mouth and gently bite on it. keep holding the nebulizer cup in an upright position.4) Turn the nebulizer on and make sure mist is coming out of the mouthpiece or mask. .

that means most of the medication is gone. place The mask over mouth and nose. keep holding the nebulizer cup in an upright position.5) b) If you are using a mask. Tapping the nebulizer cup can help the remaining medicine to drop to where it can be turned into mist. . 6) If the nebulizer starts to sputter.

. * A typical treatment lasts about 10 to 15 minutes. • Make sure the nebulizer is completely dry before storing it in a cool and dry place.7) Clean and dry the nebulizer after use.