CC of Eyes and Ears Flashcards
What is special condition applicable to eye drops but not ear drops?
The eyes are more sensitive than the ears. Eye drops can be used in the ear, but never use ear drops in the eyes
Why can’t ear drops be used in the eyes?
The ear drops may not have an appropriate pH, may not be isotonic and may not be sterile
What is the meaning of the abbreviation AD?
Right ear
What is the meaning of the abbreviation AS?
Left ear
What is the meaning of the abbreviation AU?
Each ear
What is the meaning of the abbreviation OD?
Right eye
What is the meaning of the abbreviation OS?
Left eye
What is the meaning of the abbreviation OU?
Each eye
For eye and ear solutions, how many mL/s is one drop?
1 drop = 0.05 mL
What is a counseling point of eye and ear suspensions?
Shake well
What is a counseling point of ointments?
Apply to the conjunctival sac or over lid margins (for blepharitis). Ointments can make vision blurry. Do not use with contact lenses
What is a counseling point of eye and ear gels?
With cap on, invert and shake once to get the medication into the tip before instilling into the eye
What is glaucoma?
Glaucoma is a disease of the eye that results in damage to the optic nerve and loss of the visual field. In most cases, the intraocular pressure is above the normal range
What is normal range of intraocular pressure?
12 -22 mmHg
What are some drugs that can increase IOP?
Anticholinergics, cough, cold and motion sickness medications, chronic steroids, topiramate
What is the goal of treatment of glaucoma?
To reduce IOP
What are the two main forms of glaucoma?
Open-angle glaucoma and angle-closure or closed-angle glaucoma
How does open-angle glaucoma present?
Open-angle glaucoma often presents without symptoms and is treated without symptoms and is treated with eye drops or surgery
How does closed-angle glaucoma present?
Closed-angle glaucoma is a sharp, sudden increase in IOP due to blockage. This type of glaucoma usually presents with eye pain, headaches and decreased vision and is a medical emergency that is treated surgically
How do glaucoma treatments decrease IOP?
Glaucoma treatments decrease IOP by targeting the aqueous humor (fluid in the eye) either by reducing aqueous humor production (make less fluid) or increase aqueous humor outflow (move fluid out)
What is commonly used for initial treatment of glaucoma?
Prostaglandin (PG) analogs are used commonly as initial treatment. PG analogs are the most effective drugs at decreasing IOP (about 30%); they are safe and used once daily
What is another common class of drugs that can treat glaucoma?
Ophthalmic beta-blockers decrease IOP by about 22%
When is a beta-blocker preferred for the treatment of glaucoma over PG analogs?
A beta-blocker is preferable if the pressure is high in one eye only because the darkening of the iris and eyelash thickening seen with PG analogs is not desirable in only one eye
What is key in adequate treatment of glaucoma?
Adequate treatment requires good eye drop technique and a high level of adherence. Counseling on proper administration technique and the importance of adherence is critical
Which medications can increase aqueous humor outflow?
Prostaglandin analogs, cholinergics, adrenergic alpha-2 agonists, rho kinase inhibitors
Which medications reduce aqueous humor production?
Beta-blockers, carbonic anhydrase inhibitors, adrenergic alpha-2 agonist
What are some examples of prostaglandin analogs?
Bimatoprost, Latanoprost, Travoprost
What are some warnings of prostaglandin analogs?
Ocular effects: darkening of the iris, eyelid skin and eyelashes; eyelash length and number can increase; contamination of multiple-dose ophthalmic solutions can cause bacterial keratitis
What are some side effects of prostaglandin analogs?
Blurred vision, stinging, increased pigmentation of the iris/eyelashes, eyelash growth/thickening, foreign body sensation
What are some notes about Travatan Z and Xelpros?
They do not contain BAK (a different preservative is used); can be used in patients with a past reaction to BAK or dry eye
What are some notes about Zioptan?
Zioptan comes as 10 single-use, preservative-fre containers in foil pouch; discard each container after use
What are some notes about Latanoprost, latanoprostene bunod and tafluprost?
They should be stored in the refrigerator before opening; once opened, store at room temperature
What are some examples of beta-blockers?
Timolol, Cosopt
What are some contraindications of beta-blockers?
Sinus bradycardia; heart block > 1st degree (except in patients with a pacemaker); cardiogenic shock; uncompensated cardiac failure bronchospastic disease
What are some side effects of beta-blockers?
Burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents, itching of the eyes or eyelids, changes in vision, increased light sensitivity
What are some notes about the beta-blockers?
All are non-selective beta-blockers except betaxolol, so betaxolol is less likely to cause pulmonary adverse effects in patients with chronic lung disease. Some products contain sulfites, which can cause allergic reactions
What are some notes about Cosopt PF?
Cosopt PF is packaged in single-use containers
What are some examples of cholinergics?
Carbachol and Pilocarpine
What are some side effects of cholinergics?
Poor vision at night (due to pupil constriction), corneal clouding, burning (transient), hypotension, bronchospasm, abdominal cramps/GI distress
What are some notes of cholinergics?
Use with caution in patients with a history of retinal detachment or corneal abrasion
What are some examples of carbonic anhydrase inhibitors?
Dorzolamide, Brinzolamide, Acetazolamide, Methazolamide
What are some warnings of carbonic anhydrase inhibitors?
Sulfonamide allergy: caution due to risk of systemic exposure and cross reactivity (especially with oral formulations)
What are some side effects of the carbonic anhydrase inhibitors eye drops?
Burning, blurred vision, blepharitis, dry eye
What are some side effects of oral carbonic anhydrase inhibitors?
CNS effects (ataxia, confusion), photosensitivity/skin rash (including risk of SJS and TEN), anorexia, nausea, risk of hematological risk
What are some notes about Acetazolamide?
Acetazolamide is used infrequently for glaucoma; it is used for the prevention and treatment of acute mountain (altitude) sickness
What are some examples of adrenergic alpha-2 agonists?
Brimonidine and Apraclonidine
What are some warnings about adrenergic alpha-2 agonists?
CNS depression: caution with heavy machinery, driving
What are some side effects of adrenergic alpha-2 agonists?
Sedation, dry mouth, dry nose
What are some examples of Rho Kinase inhibitors?
Rhopressa, Rocklatan
What are some side effects of rho kinase inhibitors?
Burning/eye pain, corneal disease, conjunctival hemorrhage and conjunctival hyperemia (excess blood vessels)
What are some notes about Rho kinase inhibitors?
Store in the refrigerator before opening; once opened, store at room temperature for < 6 weeks
What is conjunctivitis?
Conjunctivitis, also known as “pink eye,” occurs in one or both eyes
What are symptoms of conjunctivitis?
Symptoms include swelling, itching, burning and redness of the conjunctiva, the protective membrane that lines the eyelids and covers the white part of the eye (the sclera)
What are potential causes of conjunctivitis?
Conjunctivitis can be due to virus, bacteria, an allergen or some type of ocular irritant, such as chemical or contact lenses
To prevent the spread of viral and bacterial conjunctivitis, what should patients be instructed to do?
- Avoid touching their eyes
- Use proper hand hygiene and wash their hands thoroughly and frequently
- Change towels and washcloths daily, and do not share towels with others
- Discard eye cosmetics, particularly mascara
How do you treat chemical conjunctivitis?
The irritant should be flushed out of the eyes with saline, and inflammation can be reduced with an NSAID or steroid eye drop. If contact lenses caused the irritation, they should not be used until the condition clears
What are the typical causes of viral conjunctivitis?
Adenovirus (most common), other viruses
*Most infections are mild, but some can be severe (e.g. caused by zoster virus or HIV)
What is the treatment of viral conjunctivitis?
No topical treatment for common viral conjunctivitis; the infection runs its course over several days to three weeks
What are some causes of bacterial conjunctivitis?
Staphylococcus aureus, streptococcus pneumoniae, haemophilus influenzae, moraxella catarrhalis
More severe cases caused by Neisseria gonorrhoeae or Chlamydia, which requires systemic treatment
What are some treatments of bacterial conjunctivitis?
Moxifloxacin, neomycin/polymyxin /dexamethasone, ofloxacin, trimethoprim/polymyxin B, azasite, besivance, ciloxan, eryhthromycin, gentak, neo-polycin, tobrex, tobradex, bleph-10
What are some causes of allergic conjunctivitis?
Common allergens include pollen, dust mites, animal dander, molds
What are some treatments of allergy conjunctivitis?
- Mast cell stabilizers: Cromonlyn, Alomide, Alocril
- Antihistamines: Azelastine, Patadaty, Cetirizine, Epinastine
- Antihistamine/mast cell stabilizer: Zaditor, Lastacaft
What is blepharitis?
Blepharitis (eyelid inflammation) most commonly involves the eyelid margins (where the eyelashes come out of the skin)
What are symptoms of blepharitis?
The primary symptoms are inflamed, irritated and itchy eyelids
What is the preferred treatment of belpharitis?
The preferred treatment includes application of a warm compress over the eye for a few minutes to loosen the crusty deposits, then use of a warm, moist washcloth (water plus a few drops fo baby shampoo) to wipe away the debris
Why do most eye drops burn?
- Preservatives are toxic to bacteria and are irritating to the sensitive tissues in the eyes which leads to burning/stinging after administration
- Contact lenses trap the drug and preservatives against the surface of the eye, making the irritation worse
- Some eye drops have preservative-free formulations for those unable to tolerate the side effects
What are some common ophthalmic symptoms?
Inflammation, dry eye and eye redness
How can inflammation of the eye be treated?
Inflammation can be reduced with a cold compress and either an NSAID eye drop (f mild) or a steroid eye drop (if severe)
What are some examples of steroid eye drops?
Prednisolone, Dexamethasone, Flourometholone, Loterprednolq
What are some usage notes of steroid eye drops?
Steroid eye drops should be used short-term due to risk of increased IOP
What are some examples of NSAID eye drops?
Ketorolac, Illevro, Bromfenac, Diclofenac
What are examples of treatments for eye dryness?
Refresh, Systance, Liquifilm Tears
What are some usage notes about the treatment of eye dryness?
- Often referred to as artificial tears
- Contain common lubricants (mineral oil, glycerin, propylene glycol, dextran, hypromellose
- Administered multiple times daily, as needed
What are some examples of treatment for chronic dry eye disease?
Restasis, Xiidra, Eysuvis
What are some usage notes about Restasis?
Restasis is indicated for keratoconjunctivitis sicca (severe, chronic dry eye syndrome)
What are some examples of treatment of eye redness?
Naphazoline, Naphcon A, Visine A, Tetrahydrozoline, Brimonidine
What are examples of medications that can cause retinal changes/retinopathy?
Chloroquine, hydroxychloroquine
What are some examples of medications that can cause optic neuropathy?
Amiodarone, Ethambutol, Linezolid
What are some medications that can cause IFIS?
Alpha-blockers
What are some medications that can cause color discrimination?
- Digoxin (with toxicity): yellow/green vision
- PDE-5 inhibitors: greenish tinge around objects
- Voriconazole: color vision changes
What are some medications that can cause vision loss/abnormal vision?
- Digoxin (with toxicity): blurriness, halos
- PDE-5 inhibitors: vision loss in one or both eyes (can be permanent)
- Isotretinoin: decreased night vision (can be permanent), dry eyes, irritation
- Topiramate: visual field defects
- Vigabatrin: permanent vision loss (high risk)
- Voriconazole: abnormal vision, photophobia
What are some common conditions treated in the ear?
Pain, such as from an outer ear infection (otitis externa) and ear wax impaction
Describe tinnitus
Tinnitus (ringing, roaring or buzzing sounds) is caused by drug toxicity (e.g. salicylates), noise exposure or it can be idiopathic
What is the treatment for outer ear infections?
Ear drops with antibiotics can be used for outer ear infections
How can ear pain be treated?
Pain can be treated with systemic analgesics
What are some counseling points during treatment of otitis externa?
During treatment, patients should stay out of the water, avoid flying due to the pressure changes and avoid the use of headphones and earplugs
What are a few antibiotic eardrops?
Ciprodex, Cipro HC, Cortisportin-TC
When does ear blockage occur?
Ear blockage occurs when wax (cerumen) accumulates in the ear or becomes too hard to wash away naturally. It is removed in a medical office
What is the treatment for chronic, ear blockage?
If the condition is chronic, ear wax removal medication (Debrox) can be used every 4-8 hours as a preventative measure
What are some counseling points of Debrox?
Instruct the patient to tilt the head sideways and instill 5-10 drops twice daily for up to 4 days
What are some counseling points for all eye drops?
- Can cause stinging/burning (except for preservative-free)
- Wait five minutes in between two drops of the same medication
- Wait 5-10 minutes in between drops of two different medications
- Apply gels last. Wait 10 minutes after the last eye drop before use
- Remove contact lenses prior to using eye drops. Wait 15 minutes to reinsert
What are some counseling points of prostaglandin analogs?
- Darkening of the iris and an increase in eyelash growth can occur
- Do not use with bimatoprost because it can reduce the effectiveness of other prostaglandins
