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NAPLEX 2024 > 38. Common Conditions of the Eyes and Ears > Flashcards

38. Common Conditions of the Eyes and Ears Flashcards

1
Q

Med abbreviation: AD

A

Right ear

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2
Q

Med abbreviation: AS

A

Left ear

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3
Q

Med abbreviation: AU

A

Each ear

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4
Q

Med abbreviation: OD

A

Right eye

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5
Q

Med abbreviation: OS

A

Left eye

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6
Q

Med abbreviation: OU

A

Each eye

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7
Q

Eye/ear Solutions: 1 drop = ___ mL

A

0.05mL

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8
Q

What is a counseling point for eye/ear ointments?

A

Apply to conjunctival sac or over lid margins (for blepharitis)
Can make vision blurry, do not use with contacts

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9
Q

What is a counseling point for ewye gels?

A

With cap on, invert and shake once to get med into tip before instilling into eye

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10
Q

Glaucoma is a disease of the eye that results in ____

A

damage to optic nerve and loss of visual field (i.e., the vision straight ahead and peripheral vision, measured by visual field test)

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11
Q

In most cases, intraocular pressure (IOP) is above the normal range of ____ in glaucoma

A

12-22 mmHg

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12
Q

Goal of treatment for glaucoma is ___

A

to reduce IOP

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13
Q

What are the 2 different types of glaucoma?

A

Open-angle glaucoma (most common) - without symptoms and treated with eye drops or surgery
Closed-angle glaucoma - sharp sudden increase in IOP d/t blockage, presents with eye pain, HA, and decreased vision. Considered med emergency that is treated surgically

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14
Q

Drugs that can increase IOP

A

anticholinergics (e.g. antihistamines, oxybutynin, tolterodine, benztropine, scopolamine, trihexyphenidyl, TCA)
Decongestant (e.g. pseudoephedrine)
Chronic steroids , esp eye drops such as prednisolone (Pred Forte)
Topiramate (Topamax)

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15
Q

Glaucoma treatments decrease IOP by targeting ____ in 2 main ways: ____, ___, or both

A

the aqueous humor (fluid in the eye)
Reduce aqueous humor production (make less fluid) - beta-blockers (timolol), carbonic anhydrase inhibitors (drozolamide)
Increase aqueous humor outflow (move fluid out) - prostaglandin analogs (lantaoprost)
Both - often with add-on, alpha-2 agonists (brimonidine)

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16
Q

What glaucoma med is most effective at decreasing IOP (~30%)?

A

Prostaglandin analogs (used 1 drop once daily)

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17
Q

Which glaucoma med is preferred if the pressure is high in only one eye?

A

Beta-blockers (b/c darkening of iris and eyelash thickening seen with prostaglandin analogs is not desirable in only one eye (uneven))

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18
Q

How do prostaglandin analogs work for glaucoma?

A

Increase aqueous humor outflow

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19
Q

Examples of prostaglandin analogs used in glaucoma

A

Bimatoprost (Lumigan)
Latanoprost (Xalatan, Xelpros)
travoprost (Travatan Z)

Note: Bimatoprost (Latisse) inidcated for eyelash hypotrichosis (inadequate growth of eyelashes), do NOT use with prostaglandin analogs indicated for glaucoma

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20
Q

Warnings with prostaglandin analogs used in glaucoma

A

Darkening of iris, eyelid skin, and eyelashes
Eyelash growth/thickening

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21
Q

Side effects with prostaglandin analogs used in glaucoma

A

Blurred vision, stinging, increased pigmentation or iris/eyelashes, eyelash growth/thickening

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22
Q

Lantanoprost, latanoprostene bunod, tafluprost storage notes

A

Refrigerator BEFORE opening, store at room temp after opening

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23
Q

How do beta-blockers work for glaucoma?

A

Reduce aqueous humor production

24
Q

Timolol 0.25%, 0.5% (Timoptic, Timoptic-XE, Istalol) dosing and administration notes

A

1 drop daily or BID
Timoptic-XE, Timolol GFS (gels): daily

Gels: shake once before use; wait 10 min after administering other eye drops before inserting gel

25
Q

Side effects of timolol

A

Burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching or eyes/eyelids, changes in vision, increased light sensitivity

26
Q

Beta-blockers used in glaucoma are all non-selective except ____ which is less likely to cause pulmonary adverse effects in pts with asthma/COPD

A

betaxolol

27
Q

In timolol/dorzolamide (Cosopt PF), what does PF stand for?

A

Preservative free

28
Q

How do cholinergics (Carbachol (Miostat), piloarpine (Isopto Carpine)) work for glaucoma?

A

Increase aqueous humor outflow

29
Q

Side effects of cholinergics (Carbachol (Miostat), piloarpine (Isopto Carpine)) used in glaucoma

A

Poor vision at night d/t pupil constriction
Others: corneal clouding, burning (transient), hypotension, bronchospasm, abd cramps/GI upset

30
Q

How do carbonic anhydrase inhibitors work for glaucoma?

A

Reduce aqueous humor production

31
Q

-zolamide (carbonic anhydrase inhibitors used for glaucoma) = caution with ____ allergy

A

sulfonamide

32
Q

Which carbonic anhydrase inhibitor is used infrequently for glaucoma; it is used for prevention and treatment of acute mountain (altitude) sickness?

A

Acetazolamide

33
Q

Examples of carbonic anhydrase inhibitors

A

Dorzolamide (Trusopt)
Brinzolamide (Azopt)
Acetazolamide - oral, injection
Methazolamide - oral

34
Q

How do Adrenergic Alpha-2 agonist work for glaucoma?

A

increase aqueous humor outflow, reduce aqeuous humor production

35
Q

Examples of Adrenergic Alpha-2 agonist

A

Brimonidine (Alphagan P)
Apraclonidine (Iopidine)

36
Q

counseling points to prevent spread of conjunctivitis (“pink eye”)

A

Avoid touching eyes
Use proper hand hygiene and wash hands thoroughly and frequently
Change towels and washcloths daily - do not share wit others
Discard eye cosmetics esp mascara

37
Q

Conjunctivitis (“pink eye”) can be d/t ___

A

virus, bacteria, allergen, or some type of ocular irritant such as chemical or contact lenses

38
Q

Viral conjunctivits causes and treatment

A

Adenovirus (most common)
No topical treatment, will last days to 3 weeks

39
Q

Bacterial conjunctivitis causes and treatment

A

S. aureus (others: strep pneumoniae, H. influenzae, Moraxella catarrhalis)
Most severe cases caused by Neisseria gonorrhoeae or Chlamydia - requires systemic treatment

Moxifloxacin (Vigamox)
Neomycin/Polymyxin B/Dexmethasone (Maxitrol)
Ofloxacin (Ocuflox)
Trimethorpim/Polymyxin B (Polytrim)
Azithromcyin (AzaSite) - store in fridge, stable for 14 days at room temp

Others: besifloxacin (Besivance), ciprofloxacin (Ciloxan), erythromycin, gentamicin (Gentak), neomycin/bacitracin/polymyxin B (Neo-Polycin), tobramycin (Tobrex), tobramycin/bdexamethasone (TobraDex), Sulfacetamide (Bleph-10)

40
Q

Allergic conjunctivitis causes and treatment

A

Common allergens - pollen, dust mites, animal dander, molds

Mast cell stabilizers: cromolyn, lodoxamide (Alomide), nedocromil (Alocril)
Antihistamines: azelastine, olopatadine (Pataday) OTC, cetirizine (Zerviate), epinastine
Antihistamine/Mast Cell Stabilizer: Ketotifen (Alaway, Zaditor) OTC, alcaftadine (Lastacaft)

Note: prednisolone/steroid eye drops often used acutely for severe reaction but not long term d/t risk of increased IOP

41
Q

What is blepharitis?

A

eyelid inflammation, most commonly involves eyelid margins (Where eyelashes come out of skin)

42
Q

How to treat blepharitis?

A

warm moist washcloth for compress

43
Q

Symptom-based ophthalmic treatments: inflammation of the eye

A

cold compress and either an NSAID eye drop (if mild, ketorolac (Acular)) or steroid eye drop (if severe, Predniosolone (Pred Forte, Pred Mild))

44
Q

Why do most eye drops burn?

A

Preservatives (common one is benzalkonum chloride BAK) or actual drug in the eyedrops

Contact lenses trap drug and preservatives against the surface of the eye, making irritation worse - lenses should be removed before using eye drops and wait 15min after admin before reinserting (esp with drops containing preservative BAK, can damage eyes when used with contacts)

PF formulations for pts who cannot tolerate side effects

45
Q

Symptom-based ophthalmic treatments: Dryness

A

Refresh (OTC)
Systane (OTC)

aka artificial tears

46
Q

Symptom-based ophthalmic treatments: Chronic Dry Eye disease

A

Cyclosporine Emulsion eye drops (Restasis) - indicated for keratoconjunctivitis sicca (severe, chronic dry eye syndrome)

Others: lifitegrast (Xiidra), loteprednol (Eysuvis), Varencicline nasal spray (Tyrvaya)

47
Q

Symptom-based ophthalmic treatments: Redness

A

Naphazoline (Clear Eyes Redness Relief) (OTC)
Naphazoline/Pheniramine (Naphcon A, Visine A) (OTC)
Tetrahydrozoline (Visine) (OTC)
Brimonidine (Lumify) (OTC)

48
Q

Common drugs known to cause retinal changes/retinopathy

A

Chloroquine, hydroxychloroquine

49
Q

Common drugs known to cause optic neuropathy

A

Amiodarone (plus corneal deposits)
Ethambutol
Linezolid

50
Q

Common drugs known to cause intraoperative floppy iris syndrome (IFIS); causes difficulty in cataract surgery

A

Alpha-blockers (e.g. tamsulosin)

51
Q

Common drugs known to cause color discrimination

A

Digoxin (with tox) = yellow/green vision
PDE-5i (e.g. sildenafil) - greenish tinge around objects
Voriconazole - color vision changes

52
Q

What can be used for ear wax (cerumen) blockage?

A

Irrigation with carbamide peroxide (Debrox)
Others: water, saline solution, mineral oil, hydrogen peroxide
Use should be limited to 3-5 days with f/u after this time

53
Q

Common drugs known to cause vision loss/abnormal vision

A

Digoxin (with tox) - blurriness, halos
PDE-5i - vision loss (one or both eyes; can be permanent
Isotretinoin - decrease night vision (can be permanent), dryness, irritation
Topiramate - visual field defects
Vigabatrin - permanent vision loss (high risk)
Voriconazole - abnormal vision, photophobia

54
Q

Mild cases of otitis externa (swimmer’s ear) can be treated with ear drops containing ____

A

acetic acid and glucocorticoid (VoSol HC)

55
Q

Mod-severe cases of otitis externa (swimmer’s ear) can be treated with abx such as ___

A

ciprofloxacin and dexamethasone (Ciprodex)

Others: ciprofloxacin and hydrocortisone (Cipro HC), noemycin, colistin, hydrocortisone, and thonzonium (Cortisporin-TC)

NAPLEX 2024 (74 decks)

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