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PDAT1 > 7 - Eye & Ear > Flashcards

7 - Eye & Ear Flashcards

1
Q

Debrox

Dose / Indication / Ingredient + strength

A

Carbamide Peroxide 6.5%

prepared in anhydrous glycerol

5-10 drops BID

for 3-4 days if needed

>12 y/o

indicated for IMPACTED EARWAX

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2
Q

Visine

(Tetrahydrozoline HCL / oxymetazoline HCL / naphazoline HCL / pheniramine maleate)

Dose / Indication

A

Opthalmic DECONGESTANT / ANTIHISTAMINE

1-2 Drops < QID

Third line therapy for Allergic Conjungtivitis

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3
Q

Systane

(PEG 400 / propylene glycol)

Dose / Indication

A

Artificial Tears

1-2 Drops

First line therapy for Allergic Conjunctivitis

Also treatment for Dry Eye Syndrome

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4
Q

NonPharmacologic Treatment

of Water-Clogged Ears

A
  • Tilt affected ear DOWNWARD
    • manipulate the auricle gently
  • Blow Dryer
    • on LOW HEAT & SPEED
      • ​(NOT DIRECTLY INTO EAR)
  • ​​One-Time use of WATER-ABSORBING EAR PLUGS
    • ​remove after 10 min
    • for use for patients >16 y/o
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5
Q

Ocular Irrigants

A

Cleanse ocular tissues of unwanted debris

while still maintaining MOISTURE

Chemical Burn / Loose Foreign Object

Specifically balanced pH & Osmolality

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6
Q

EX-ST for self treatment

of OTIC DISORDERS

A
  • SUDDEN hearing loss
  • Signs of infection
  • Sharp / severe PAIN
  • Bleeding or signs of trauma
    • ​presence of ruptured tympanic membrane
  • <12 y/o
  • Ear surgery within 6 weeks
  • Tympanostomy tubes present
  • Hypersensitivity to recommended angents
  • Incapable of following proper instructions
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7
Q

Purpose of Earwax

(Cerumen)

A

Lubricates ear canal

Traps debris

WATERPROOF BARRIER

Antimicrobial properties = Contains lysosimes / ACIDIC pH

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8
Q

Key Points for

OTIC DISORDERS

A

Know EX-ST

Limit self-treatment to minor symptoms

Contact PCP if symptoms persist or worsen >4 days

Provide instructions on proper use / effective products

Proper ear hygiene & importance of earwax

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9
Q

Treatments that we DO NOT RECOMMEND

for Impacted Earwax

A
  • Docusate
    • ​conflicting data
  • Hydrogen Peroxide 3%
    • ​contains WATER –> ear infection possible
  • Olive Oil
    • ​delay seeking proper treatment
  • Ear Candles
    • ​INEFFECTIVE –> ear injury / burns
  • Garlic Oil / Willow Bark / Chamomilla
    • ​lacking data on efficacy / safety
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10
Q

S/Sx + Goals

Allergic Conjuctivitis

A

RED eyes + Watery discharge

Remove / Avoid ALLERGEN

Limit or reduce the severity of allergic rxn

symptomatic relief

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11
Q

S/Sx of

IMPACTED EARWAX

A

MOST common cause of temporary hear loss

  • Feeling of fullness/pressure
  • GRADUAL HEARING LOSS
  • Dull Pain
  • Vertigo / Tinnitus
  • Chronic Cough
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12
Q

Debrox

Carbamide Peroxide 6.5%

ADR / CI-P / Consult

A
  • DNU if h/o of perforation of eardrum or prior ear surgery*
  • discharge / drainage / SEVERE ear pain*
  • AIDS / DM*

Mild Tingling + CRACKLING NOISES are normal

DNU for more than <4 days

avoid eye contact

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13
Q

S/Sx of

WATER-CLOGGED EARS

A

NOT THE SAME AS SWIMMER’S EAR

  • Feeling of wetness / fullness
  • GRADUAL HEARING LOSS
  • Ear exposed to excessive moisture
    • Trappped moisture –>
      • –> itching / pain / inflammation / infection
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14
Q

Zaditor

KETOTIFEN FUMARATE

Dose / Indication

A

Opthalmic Antihistamine / Mast Cell Stabilizer

0.035% Ketotifen

1 Drop BID q8-12hrs

2nd line therapy for Allergic Conjunctivitis

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15
Q

EX-ST for Self-Treatment of

Ocular Disorders

A
  • Eye PAIN
  • Blurred vision, not associated with ointment/drops
  • Light sensistivity
  • History of contact lens wear
  • Blunt trauma to eye
  • Chemical exposure to eye
  • HEAT - eye exposure ( excluding sun exposure )
  • Lack of response to therapy
    • ​in >72hours
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16
Q

Adult vs Child

Ear Canal

A

Adult = S-Shaped canal

Eutachian tube lengthens DOWNWARD (towards mouth/nose)

Child = normal

  • SHORTER / STRAIGHTER*
  • FLATTER ear canal*
17
Q

What goes first, Solutions or Suspensions?

And how long do you wait?

A

Solutions FIRST > suspensions

wait 5 minutes between drops

shake SUSPENSIONS well

18
Q

ADR / CIs

Opthalmic Antihistamine / Mast Cell Stabilizer

Ketotifen Fumarate (Zaditor)

A

Can cause Burning / Stinging / Discomfort

can cause Pupil DILATION

esp w/ light-colored irises & contact wearers

CI in ppl w/ risk for angle closure glaucoma

19
Q

Flowsheet of Impacted Earwax

A
  1. Complaint of consistant earwax excess / impact
  2. Obtain medical/medication history​​
    1. ​intended use / previous use / length&history of use
  3. Any EX-ST?
    1. yes –> SEE MD
  4. If no, Ask if using IMPROPER removal methods / unapproved meds
    1. yes –> S/Sx of infection –> SEE MD
  5. If no, use Carbamide Peroxide
    1. if treatment didnt work –> SEE MD
  6. Counsel on proper ear hygiene
20
Q

Opthalmic DECONGESTANTS

Visine Redness Relief

A

Treatment for Allergic Conjuctivitis

  • A-adrenergic agonist -> constriction -> reduced redness
  • Can cause eye dryness
    • and REBOUND CONGESTION, limit use to 72 hours
      • oxymetazoline/PE > naphazoline/tetrahydrozoline
  • Contraindicated in angle closure glaucoma
  • Use in caution in:
    • HTN / DM
    • CVD / Arteriosclerosis
    • HYPEthyroidism
21
Q

Risk factors for Dry Eye Syndrome

A

Female!

Older Age!

Postmenopausal estrogen therapy

Medications :

Antihistamines / Antidepressants / Decongestants

Diuretics / Beta Blockers

22
Q

Steps to Instill

Eye OINTMENT

A
  1. Wash hands
  2. Tilt head back
    1. grasp lower outer lid below lashes,
    2. pull down form pocket
  3. Place ointment tube over eye, look up
    1. place 1/4in to 1/2in of ointment into LOWER EYELID pocket
      1. using a sweeping motion
  4. Close eye for 1-2 minutes
  5. Vision may be temporarily blurred
    1. ​prefer to use ointment at night
23
Q

Visine - Decongestant/AH

(Tetrahydrozoline HCL / oxymetazoline HCL / naphazoline HCL / pheniramine maleate)

ADR / CI+P / Consult

A

MILD STINGING

Limit use to <72 hours, Rebound Congestion

>6y/o, remove contact lenses

  • Contraindicated in angle closure glaucoma
  • Use in caution in:
    • HTN / DM
    • CVD / Arteriosclerosis
    • HYPERthyroidism
24
Q

Steps to Instill

EYE DROPS

A
  1. WASH HANDS
  2. Tilt head back
  3. Grasp lower eyelid below lash line, pull away to make pouch
  4. Place dropper over eye by looking directly at it
  5. Before applying drop, LOOK UP
  6. Release eyelid after drop is applied
  7. Use finger to put pressure over tear duct
  8. Wait 5 min b4 instilling next drop
25
Q

Pharmacologic Treatment for

Dry Eye Syndrome

A

Artificial Tears

Stabilize tear film / reduce tear evaporation / lubricate occular surface

Non-Medicated Ointments

INCREASE retention time in eye / enhance tear film integrity

Topical Cyclosporine

RX only, long term benefit nclear

26
Q

Drops or ointments first

and how long do you wait?

A

DROPS FIRST >> ointments

wait 10 MINUTES between products

27
Q

Non-pharmacologic Treatment

for Dry Eye Syndrome

A

AVOID- dry/dusty places + prolonged computer use

Use humidifiers + Eye Protection outdoors

Elmininate offending medications

Reposition work station away from air vents

28
Q

Refresh

(carboxymethhylcellulose sodium, glycerin, mineral oil, petrolatum, povidone, polysorb80)

Dose / Indication

A

NON-MEDICATED OINTMENT

Use as often as needed

used for Dry-Eye Treatment

29
Q

Opthalmic Antihistamines

A

Treatment for Allergic Conjunctivitis

More effective when taken w/ Opthalmic Decongestant

  • Histamine1 receptor antagonist
    • Pheniramine maleate & Antazoline phosphate
30
Q
  • SUDDEN hearing loss
  • Signs of infection
  • Sharp / severe PAIN
  • Bleeding or signs of trauma
    • ​presence of ruptured tympanic membrane
  • <12 y/o
  • Ear surgery within 6 weeks
  • Tympanostomy tubes present
  • Hypersensitivity to recommended angents
  • Incapable of following proper instructions
A

EX-ST for self treatment

of OTIC DISORDERS

31
Q
  • Eye PAIN
  • Blurred vision, not associated with ointment/drops
  • Light sensistivity
  • History of contact lens wear
  • Blunt trauma to eye
  • Chemical exposure to eye
  • HEAT - eye exposure ( excluding sun exposure )
  • Lack of response to therapy
    • ​in >72hours
A

EX-ST for Self-Treatment of

Ocular Disorders

32
Q

Non-pharmacologic Treatment

Allergic Conjuctivitis

A

Remove / Avoid offending ALLERGEN

Apply Cold Compress TID/QID

Use air conditioning

Use / replace air filters

33
Q

S/Sx of Dry Eye Syndrome

A

White / mildly Red eye

Sands / Gritty feeling

Chronic & Incurable

34
Q

Pharmacologic Treatment for

WATER-CLOGGED EARS

A
  • Isopropyl Alcohol 95% in anhydrous glycerin 5%
    • ​ONLY agent FDA approved as ear-drying age
    • glycerin prevents over drying in ear canal
    • may sting or burn
      • 50-50 mix of Acetic Acid 5% & Isopropyl Alcohol 95%
    • ​DO NOT use apple cider vinegar
    • may sting or burn
35
Q

Steps on how to use an

EAR DROP

A
  1. Wash Hands
  2. Warm ear drops to body temp (hold in PALM of hand)
    1. shake if indicated
  3. Tilt head on side or lie down, with ear up
  4. Position dropper tip NEAR the ear canal
  5. To open ear canal:
    1. pull ear BACK & UPward
  6. Place proper dose/drops into the ear canal opening
  7. You may gently press flap over ear canal oepening
    1. to force out air bubbbles / push drops down the canal.
  8. Stay in same position ~3 minutes
    1. depends on product
  9. Gently wipe away excess medication off the outside of ear
36
Q

Opthalmic Antihistamine / Mast Cell Stabilizer

Ketotifen Fumarate (Zaditor)

A

Treatment for Allergic Conjuctivitis

Last up to 12 hours

  • POTENT Histamine 1 receptor antagonist
    • Inhibits mast cell degrauluation
      • –> stops release of inflammatory mediators
    • Inhibits eosinophils
      • ​**–> stops release of **late-phase mediators​
37
Q

ORDER OF USE

Pharmacologic Treatment options

for Allergic Conjuctivitis​

A

FIRST USE: Artificial Tears

Second = Opthalmic Antihistamine / Mast cell stabilizer

THIRD, USE BOTH:

Opthalmic Decongestant

Opthalmic Antihistamine

38
Q

Pharmacologic Treatment of

IMPACTED EARWAX

A

DEBROX

Carbamide Peroxide 6.5% in anhydrous glycerin

  • Hydrogen peroxide + moisture
    • slow release of O2 –> effervescent (bubbles)
  • Urea debirdes tissue
  • Glycerin softens earway

PDAT1 (27 decks)

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