Table 21 Drug Information Sources

Printed References

Drug Facts and Comparisons Physicians' Desk Reference FDC Reports The Merck Index

Martindale: The Complete Drug Reference Drug Induced Ocular Side Effects Drug Interactions

Other ophthalmic literature (texts, journals, etc)

Internet References

www.rxlist.com www.medicineonline.com

http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=

Search.Search_Drug_Name http://www.medsafe.govt.nz/Profs/Datasheet/datasheet.htm http://www.drugs.com/

http://www.rxmed.com/b.main/b2.pharmaceutical/b2.prescribe.html

http://www.bnf.org

http://emc.medicines.org.uk/

http://www.fda.gov/cder/consumerinfo/default.htm

http://www.medscape.com/druginfo

http://www.pslgroup.com/newdrugs.htm

http://www.centerwatch.com/patient/drugs/druglist.html

http://www.rphworld.com

(Adapted from Clinical Optometric Pharmacology and Therapeutics. See Bibliography for publishers, etc^

situation may not improve. This is especially true in ophthalmic practice. It is usually up to the patient to instill medication himself. Compliance may be difficult due to apprehension, lack of dexterity, or confusion over instructions (not to mention forgetfulness, expense, or a number of other factors). The number of patients who comply exactly with a given set of instructions is estimated between 25% and 50% and may be lower. Therefore, every effort must be made to reduce the reasons for noncompliance.

There are many ways a patient may not comply. Medications may not be put in often enough, or they may be used too often in hopes of getting a greater effect. Medication may not be stored properly or may not be shaken when required. In addition, when more than one medication is thrown into the mix or multiple conditions are being treated concurrently, problems with compliance become more likely.

Education is the key. It starts with providing the patient with a basic understanding of his or her condition and its likely course. A patient with primary open-angle glaucoma, for example, must be told that this is a chronic condition that is controlled over a lifetime (not cured) and, therefore, drops must be used regularly every day. Patients must also be informed what the medications are specifically to be used for so that they are not used in a haphazard or harmful way. Normal side effects, such as stinging or bitter taste, must be explained so that when they occur, the patient is not alarmed.

Multiple drops at one time is not advisable. The conjunctival sac can hold no more than a single drop. Multiple drops will only increase unwanted side effects. The extra drops spill down the cheek, wasting drops and burdening the patient with the expense of additional prescriptions.

For medications to be effective, they must be given time to absorb. A minimum of 5 minutes (min) is required between drops if multiple drops are used. Ointments or gel preparations should always be administered last so as not to interfere with the absorption of other drugs. If this rule is not followed, the therapeutic effects may be lessened.

All patients should be given verbal and written instructions on the proper administration of eye drops and ointments. Cases have been reported where patients actually drank their eye drops. Proper education provided by the eyecare staff will greatly improve compliance, directly impacting successful treatment and patient satisfaction.

What the Patient Needs to Know

• Always check the label and expiration date of the medication before using.

• Applying more than 1 drop in the eye during a single application gives no additional benefit, and the waste can be costly.

• Allow a minimum of 5 min between drops if using more than one type of medication.

• Always use ointments or gels last.

• To instill eye

drops:

1.

Tilt head back and look at ceiling.

2.

Gently pull eyelid down and away from eyeball.

3.

Instill 1 drop into exposed sac.

4.

Gently close eyes for 1 min.

• To instill eye

ointment:

1.

Gently grasp lower lid and pull away from eyeball.

2.

Apply a small amount of ointment (%" ribbon) into exposed sac.

3.

Gently close eyes. - OR -

1.

Apply small amount of ointment to clean fingertip.

2.

Gently pull down lower lid with opposite hand.

3.

Apply ointment directly onto exposed sac.

4.

Gently close eyes.

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