Ch 75: Glaucoma, Ophthalmics, and Otics

Question 1

AU, AD, AS

Answer 1

a for aural. d for dextra (right). s for sinistra (left). AU is for each ear.

Question 2

OU, OD, OS

Answer 2

o for optic. d for dextra (right). s for sinistra (left). OU is each eye.

Question 3

gel form counseling

Answer 3

invert and shake once to get med into tip before putting in eye

Question 4

soln counseling

Answer 4

1 gtt = 0.05 ml

Question 5

susp counseling

Answer 5

shake well

Question 6

ointment counseling

Answer 6

make vision blurry, do not use with contact

Question 7

glaucoma, tx, goal

Answer 7

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

Question 8

drugs that inc IOP

Answer 8

antiACh, cough/cold/motion sickness meds, chronic steroids (esp eye drops), topiramate.

Question 9

common causes of persistently high IOP

Answer 9

poor eye drop technique and poor adherence

Question 10

Prostaglandin analogs - examples, MOA, warnings, ADRs, notes

Answer 10

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.

Question 11

beta blockers - examples, MOA, ADRs, avoid in

Answer 11

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.

Question 12

cholinergics (miotics) - examples, MOA

Answer 12

carbachol (miostat), pilocarpine (pilopine). inc aqueous outflow.

Question 13

carbonic anhydrase inhibitors - examples, warning

Answer 13

dorzolamide (trusopt) + timolol (cosopt), acetazolamide (diamox) PO. warnings: sulfonamide allergy. acetazolamide PO used more for acute mountain (altitude) sickness. cosopt is single use containers.

Question 14

adrenergic alpha 2 agonists - examples, warnings, MOA

Answer 14

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.

Question 15

tell pts with viral and bacterial conjunctivitis:

Answer 15

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)

Question 16

minor chemical conjunctivitis

Answer 16

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

Question 17

blepharitis, tx

Answer 17

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)

Question 18

agents known to cause vision changes or damage

Answer 18

alpha blockers, amiodarone, digoxin, chloroquine, ethambutol, ezogabine, hydroxychloroquine, isotretinoin, linezolid, pde5is, tamoxifen, voriconazole

Question 19

tinnitis tx

Answer 19

none that is effective

Question 20

otitis externa

Answer 20

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)

Question 21

cerumen removal tx

Answer 21

carbamide peroxide (debrox) pr triethanolamine (cerumenex) q4-8wks as ppx if chronic impaction prob. 5-10 drops BID for up to 4 days.

Question 22

ear drop counseling

Answer 22

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.

Question 23

viral conjunctivitis cause, tx

Answer 23

usually adenovirus commonly, no topical tx available. runs course from several days to 2-3 wks

Question 24

allergic conjunctivitis cause, tx

Answer 24

pollen, dust mites, animal dander, molds. antiHAs like azelastine (optivar) or olopatadine (patanol). mast cell stabilizers like cromolyn, etc.

Question 25

bacterial conjunctivitis cause, tx

Answer 25

s. aureus, strep pneumo, h. flu, m. cat. topical abx eye drops: azithromycin (azasite), ciprofloxacin (ciloxan), ofloxacin (ocuflox), trimethoprim/polymyxin B (Polytrim)

Question 26

eye drop counseling

Answer 26

after admin between lower eyelid and eyeball, close eye and press finger between eye and top of nose for 1 full min. if eye drop has benzalkonium Cl (preservative) and you wear contacts, remove lenses first and wait 15 min to reinsert. if more 2 drops of 1 med prescribed, wait 5 min for 2nd drop. if 2 meds, wait 5-10 min. if gel, wait 10 min before use.

Question 27

eye drop examples to reduce inflammation

Answer 27

steroids (use short term d/t inc IOP): prednisolone (pred forte). NSAIDs: ketolorac (acular, acuvail).