Chapter 38: Common Conditions of the Eyes and Ears Flashcards
T/F: Ear drops can be used in the eye, but eye drops cannot be used in the ear
FALSE - eye drops can be used in the ear, but ear drops cannot be used in the eye
(remember the eye is more sensitive than the ear, so eye products ONLY goes in the eye)
AD
Right ear (A = auris, D = dextra)
AS
Left ear (A = auris, S = sinistra)
AU
Both ears
OD
Right eye (O = oculus, D = dextra)
OS
Left eye (O = oculus, S = sinistra)
OU
Each eye
For a eye/ear solution, 1 drop = __ mL
0.05 (so, there are 20 drops per mL)
Eye ointments can make vision
blurry
For eye gels, what should the patient be counseled to do
Invert and shake ONCE to get the medication into the tip before instilling into the eye
Glaucoma is a disease of the eye that results in damage to the _____ and loss of ____
optic nerve
loss of the visual field (i.e., the vision straight ahead and peripheral vision)
In most cases, IOP is ____ (increased or decreased) in glaucoma
Increased
Which type of glaucoma is a sharp, sudden increase in IOP due to blockage & is a medical emergency that is treated surgically
Closed-angle glaucoma
Which key drugs can increase IOP
- Anticholinergics (e.g., oxybutinin, tolterodine, benztropine, trihexyphenidyl, TCAs)
- Cough, cold and motion sickness meds (e.g,. antihistamines and scopolamine)
- Chronic steroids, especially eye drops such as prednisolone (Pred Forte)
- Topiramate (Topamax)
Glaucoma treatment goal is to decrease IOP in 2 ways, which include:
- Reduce aqueous humor production (make less fluid) by using BB like timolol
- Increase aqueous humor outflow (move fluid out) using PG analogs like latanoprost
- Or do both with add-on treatment such as a-2 agonists like brimonidine
What are the most effective drugs at decreasing IOP
PG analogs (safe and used once daily)
When is a BB preferred in glaucoma
if the pressure is high in one eye only
Bimatoprost brand name
Lumigan
also Latisse to increase eyelash growth; should not be used with PG analogs indicated for glaucoma
Latanoprost brand name
Xalatan, Xelpros
PG analogs MOA
increase aqueous humor OUTFLOW
Travoprost brand name
Travatan Z
How are PG analogs dosed
1 drop QHS
PG analogs warnings
darken the iris and eyelashes, eyelash length and number can increase
PG analogs SE
blurred vision, stinging, increased pigmentation of the iris/eyelashes, growth of eyelashes
Which PG analogs should be refrigerated before opening and once opened, stored at room temp
Latanoprost, latanoprostene bunod and tafluprost
Timolol 0.25% and 0.5% brand names
Timoptic, Timoptic-XE, Istalol
Timolol 0.25% and 0.5% + dorzolamide brand name
Cosopt, Cosopt PF
How is timolol dosed
1 drop daily or BID
If using an eye gel, how long should a patient wait before administering the gel if they already used another eye drop
10 minutes
BB SE for glaucoma
Burning, stinging, bradycardia/fatigue, bronchospasm with non-selective agents
All BB used in glaucoma are non-selective except
betaxolol (less likely to cause pulmonary SE in patients with chronic lung disease)
BB MOA for glaucoma
Reduce (block) aqueous humor production
Cholinergics (miotics) can cause what side effect
pupil constriction
Dorzolamide + timolol (Cosopt) warning
Sulfonamide allergy
remember: -zolamide, caution with sulfonamide allergy
Dorzolamide + timolol (Cosopt) dosing
1 drop BID
Conjunctivitis can be due to
virus, bacteria or allergen
Which virus most commonly causes conjunctivitis
Adenovirus
What is the treatment for viral conjunctivitis
No topical treatment
Which bacteria most commonly cause conjunctivitis
Staph aureus
More severe cases caused by Neisseia gonorrhoeae or Chlamydia
Treatment for bacterial conjunctivitis
Moxifoxacin (Vigamox) Neomycin/Polymyxin B/Dexamethasone (Maxitrol) Ofloxacin (Oxyflox) Trimethoprim/Polymyxin B (Polytrim) Azithromycin (AzaSite)
Azithromycin for bacterial conjunctivitis storage & stability
store in refrigerator and stable for 14 days at RT
Treatment for allergen-induced conjunctivitis
- Mast cell stabilizers
- Antihistamines - Azelastine, olopatadine (Patanol, Pataday)
- Antihistamine/mast cell stabilizer - Ketotifen (Alaway, Zatidor)
Treatment for blepharitis (eyelid inflammation)
Apply warm compress over eye for a few min then use a warm, moist washcloth to wipe away debris
Which meds can be used to treat eye inflammation
- Steroid eye drops (severe): Prednisolone (Pred Forte, Pred Mild) – use short-term d/t risk of ↑ IOP
- NSAIDs (mild): ketorolac (Acular)
Which meds can be used for eye dryness
Refresh, Systane
often referred to as Artificial Tears
Which med can be used for chronic dry eye syndrome
Cyclosporine Emulsion Eye Drops (Restasis)
Which med can be used for eye redness
- Naphazoline (Clear Eyes Redness Relief)
- Nephazoline/pheniramine (Naphcon A, Visine A)
- Tetrahydrozoline (Visine)
What is the most common preservative in eye drops
BAK
What should a patient do if they are using an eye drop with BAK and wear contact lenses
Remove the lenses before using eye drops and wait 15 min after administration before reinserting
Common drugs that cause retinal changes/retinopathy
Chloroquine & hydroxychloroquine
Common drugs that cause optic neuropathy
Amiodarone (plus corneal deposits)
Ethambutol
Linezolid
Common drugs that cause floppy iris syndrome, which causes difficulty in cataract surgery
Alpha-blockers (e.g., doxazosin)
Common drugs that cause color discrimination
Digoxin (with toxicity) - yellow/green vision
PDE5-i - greenish tinge around objects
Voriconazole - color vision changes
Common drugs that cause vision loss/abnormal vision
Digoxin (with toxicity) - blurriness, halos
PDE5-i - vision loss in 1 or both eyes
Isotretinoin - ↓ night vision, dry eyes
Vigabatrin - permanent vision loss (high risk)
Voriconazole - abnormal vision, photophobia
Treatment for otitis externa
Cipro and dexamethasone (Ciprodex)
Ppx for cerumen blockage
carbamide peroxide (Debrox), triethanolamine
How long should a patient wait to insert another drop of the same eye medication
5 minutes
How long should a patient wait to insert a drop of a different eye medication
5-10 min
