Ch 75: Glaucoma, Ophthalmics, and Otics Flashcards
AU, AD, AS
a for aural. d for dextra (right). s for sinistra (left). AU is for each ear.
OU, OD, OS
o for optic. d for dextra (right). s for sinistra (left). OU is each eye.
gel form counseling
invert and shake once to get med into tip before putting in eye
soln counseling
1 gtt = 0.05 ml
susp counseling
shake well
ointment counseling
make vision blurry, do not use with contact
glaucoma, tx, goal
open angle more common, treat with surgery or eye drops. narrow angle is med emergency d/t blockage increases IOP. tx is 1st line prostaglandin analogs most effective or BB. goal: reduce intraocular pressure
drugs that inc IOP
antiACh, cough/cold/motion sickness meds, chronic steroids (esp eye drops), topiramate.
common causes of persistently high IOP
poor eye drop technique and poor adherence
Prostaglandin analogs - examples, MOA, warnings, ADRs, notes
latanoprost (Xalatan) + timolol (Xalacom), travoprost (Travatan Z), bimatoprost (Lumigan). warnings: darkening of iris, eyelash length and number can inc. ADRs: blurred vision, stinging, inc pigmentation of iris/eyelashes, eyelash growth/thickening. store unopened Xalatan in fridge.
beta blockers - examples, MOA, ADRs, avoid in
timolol (timoptic) + brimonidine (combigan)/ + dorzolamide (cosopt)/ + latanoprost (xalacom). betaxolol is only selective BB. ADRs: slight burning, stinging. MOA: reduce aqueous humor production. avoid in asthma, COPD, chronic bronchtisi, emphysema, or adv cardiac disease since nonselective.
cholinergics (miotics) - examples, MOA
carbachol (miostat), pilocarpine (pilopine). inc aqueous outflow.
carbonic anhydrase inhibitors - examples, warning
dorzolamide (trusopt) + timolol (cosopt), acetazolamide (diamox) PO. warnings: sulfonamide allergy. acetazolamide PO used more for acute mountain (altitude) sickness. cosopt is single use containers.
adrenergic alpha 2 agonists - examples, warnings, MOA
brimonidine (alphagan P) + timolol (combigan). MOA: inc aqueous outflow, reduce aqueous humor production. warnings: CNS depression. ADRs: sedation, burning/stinging/itchy eyes, dry mouth, dry nose.
tell pts with viral and bacterial conjunctivitis:
highly contagious, prevent spread of infection by not touching eyes, wash hands, change towel and washcloth daily - do not share, discard eye cosmetics (esp mascara)
minor chemical conjunctivitis
remove contacts, flush eye with saline, cold compress, reduce inflammation with NSAID (mild disease) or steroid (moderate disease) eye drop. if dangerous chemical or unknown –> visit ED
blepharitis, tx
inflamed, irritated, itchy eyelids. acute short term condition. involves where eyelid meets eyelash. tx: warm compress for few min then warm moist washcloth to wipe away debris (couple drops of baby shampoo)
agents known to cause vision changes or damage
alpha blockers, amiodarone, digoxin, chloroquine, ethambutol, ezogabine, hydroxychloroquine, isotretinoin, linezolid, pde5is, tamoxifen, voriconazole
tinnitis tx
none that is effective
otitis externa
treat pain with ibu or apap/etc. treat infection with abx ear drops: cipro + hydrocortisone (Cipro HC), cipro + dexamethasone (Ciprodex), or neomycin + colistin + hydrocortisone + thonzonium (Cortisporin TC)
cerumen removal tx
carbamide peroxide (debrox) pr triethanolamine (cerumenex) q4-8wks as ppx if chronic impaction prob. 5-10 drops BID for up to 4 days.
ear drop counseling
shake or roll for 1-2 min if cold to warm it d/t dizziness if cold drops admin. tilt head, pull ear up and back for adults (down and back for children <3 YO), admin and stay for 5 min, do not touch dropper to any surface, wipe with clean tissue.
viral conjunctivitis cause, tx
usually adenovirus commonly, no topical tx available. runs course from several days to 2-3 wks
allergic conjunctivitis cause, tx
pollen, dust mites, animal dander, molds. antiHAs like azelastine (optivar) or olopatadine (patanol). mast cell stabilizers like cromolyn, etc.
