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Naplex > Common Conditions of the Eyes & Ears > Flashcards

Common Conditions of the Eyes & Ears Flashcards

1
Q

T/F: Eye drops can be used in the ear but never use ear drops in the eyes.

A

TRUE

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2
Q
  • AD: __
  • AS: __
  • AU: __
    ~~~

~~~

  • OD: __
  • OS: __
  • OU: __

Fill in the blanks

Eyes and ears abbreviations

A

1) EAR
* AD: Right ear

  • AS: Left ear
  • AU: Each ear

2) EYE
* OD: Right eye

  • OS: Left eye
  • OU: Each eye
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3
Q

Solutions: 1 drop = __ mL

Suspensions: __

Ointments: apply to the conjunctival sac or over lid margins. ointments can make vision __.

Gels: with cap on, invert and __ once to get the medication into the tip before instilling into the eye.

Fill in the blanks

A

Solutions: 1 drop = 0.05 mL

Suspensions: Shake well

Ointments: apply to the conjunctival sac or over lid margins. Ointments can make vision blurry.

Gels: with cap on, invert and shake once to get the medication into the tip before instilling into the eye

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4
Q

What is glaucoma and how it’s diagnosed?

A
  • Glaucoma is a disease of the eye that results in damage to the optic nerve and loss of the visual field.
  • The vision straight and the peripheral vision measured by the visual field test.
  • In most cases, intraocular pressure (IOP) is above the normal range of 12 -22 mmHg. The goal of treatment is to reduce IOP.
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5
Q

List the drugs that can increase IOP

A
  • Anticholinergics ( e.g., oxybutynin, tolterodine, benztropine, trihexyphenidyl, TCAs)
  • Cough, cold and motion sickness medications (e.g., antihistamines, scopolamine)
  • Chronic steroids, especially eye drops such as prednisolone (Pred Forte)
  • Topiramate (Topamax)
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6
Q

What are two main forms of galucoma?

A

Open-angle glaucoma
* Most common type

  • Often presents without symptoms
  • Treatment: eye drops or surgery

Closed-angle glaucoma
* Sharp, sudden increase in IOP due to blockage

  • Usually presents with eye pain, headaches and decreased vision
  • Treatment: medical emergency that is treated surgically
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7
Q

Drug treatments for glaucoma

A

Treatments decrease IOP by targetting the aqueous humor (fluid in the eye) in two main ways:

  1. Prostaglandin (PG) analogs - intitial Tx, most effective at decreasing IOP (30%), used once daily.
  2. Opthalmic BBs (e.g., timolol) - preferable if the pressure is high in one eye only.
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8
Q

What are glaucoma treatment goals?

A

Decrease IOP:
1. Reduce aqueous humor production (make less fluid)
* BBs, like timolol
3. Increase aqueous humor outflow (move fluid out)
* Protaglandin analogs, like latanoprost

  1. Or, do both: often achieved with add-on treatment
    * Alpha-2 agonists, like brimonidine
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9
Q

Prostaglandin analogs - MOA, brand/generic, admistration, warnings, SEs, storage

A

MOA: increase aqueous humor outflow

Brand/generic: apply 1 drop QHS
* Bimaprost (Lumigan)

  • Latanoprost (Xalatan, Xelpros) + netarsudil (Rocklatan)
  • Travoprost (Travatan Z)
  • Tafluprost (Zioptan)
  • Latanoprostene bunod (Vyzulta)
  • Bimaprost (Latisse) - indicated for eyelash hypotrichosis to increase eyelash growth; do not use with prostaglandin analogs indicated for glaucoma

Warnings:
* Ocular effects - darkening of the iris, eyelashes; eyelash length and number can increase

Side Effects:
* Blurred vision

  • Stinging
  • Increased pigmentation of the iris/eyelashes
  • Eyelash growth

Storage:
* Latanoprost, latanoprostene and tafluprost should be stored in the refrigerator before opening

  • Once opened, store at room temperature
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10
Q

BBs - MOA, administration, brand/generic, SEs

A

MOA: reduce aqueous humor production

Administration:
* Timolol - apply 1 drop daily or BID

  • Timoptic-XE Timollol GFS (gels) - daily
  • Gels: shake once before use; wait 10 minutes after administering other eye drops before inserting gel

Brand/generic:
* Timolol 0.25% and 0.5% (Timoptic, Timoptic-XE, Istalol, Timolol GFS, Betimol, Timoptic Ocudose); + dorzolamide (Cosopt, Cosopt PF), + brimonidine (Combigan)

  • Betaxolol (Betoptic S)
  • Carteolol
  • Levobunolol (Betagan)

Side Effects:
* Burning

  • Stinging
  • Bradycardia/fatigue
  • Bronchospasm

All are non-slective BBs except betaxolol; Betaxolol is less like to cause pulmonary adverse effects in patients with chronic lung disease (asthma/COPD)

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11
Q

Cholinergics (Miotics)
Carbonic Anhydrase Inhibitors
Adrenergic Alpha-2 Agonists
Rho Kinase Inhibitors

A

Cholinergics (Miotics): increase aqueous humor outflow
* Carbachol (Miostat), Pilocarpine (Isopto Carpine)

  • SEs: pupil constriction

Carbonic Anhydrase Inhibitors: reduce aqueous humor production
* Dorzolamide (Trusopt) + timolol (Cosopt, Cosopt PF), Brinzolamide (Azopt) + brimonidine (Simbrinza), Acetazolamide (oral, injection), Methazolamide (oral, injection)

  • Warnings: sulfonamide allergy
  • Acetazolamide - Tx of acute mountain (altitude) sickness

Adrenergic Alpha-2 Agonists: increase aqueous humor outflow, reduce aqueous humor production

  • Brimonidine (Alphagan P); + timolol (Combigan), + brinzolamide (Simbrinxa), Apraclonidine (lopidine)
  • Brimonidine (Lumify) (OTC) is indicated for ocular redness

Rho Kinase Inhibitors: increase aqueous humor outflow

  • Netarsudil (Rhopressa) + latanoprost (Rocklatan)
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12
Q

Conjunctivitis, AKA __ can be due to a __, __, __ or ocular irritant. Mostly occur in __ __ and are highly contagious.

Fill in the blanks

A
  • Pink eye
  • Virus
  • Bacteria
  • Allergen
  • Young children
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13
Q

How do you prevent the spread of conjunctivits?

A
  • Avoid touching eyes
  • Use proper hand hygiene and wash hands thoroughly and frequently
  • Change towels and washcloths daily
  • Discard eye cosmetics, particularly mascara
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14
Q

Treatment of conjunctivitis by type

Viral, bacterial and allergic

A

Viral - Adenovirus
* No topical Tx; infection runs its course over several days to three weeks

Bacterial - Staphyloccoccus aureus, Neisseria gonorrhoeae (most severe cases) or Chlamydia (most severe cases)

  • Moxifloxacin (Vigamox)
  • Neomycin/Polymixin B/ Dexamethasone (Maxitrol)
  • Ofloxacin (Ocuflox)
  • Trimethoprim/Polymyxin B (Polytrim)
  • Azithromycin (AzaSite) - store in the refrigerator, stable for 14 days at room temperature

Allergic - Common allergens
* Mast cell stabilizers: Cromolyn, lodoxamide (Alomide), nedocromil (Alocril)

  • Antihistamines: Azelastine, olopatadine (Pataday), cetirizine (Zerviate), Epinastine (Elestat)
  • Antihistamine/Mast cell stabilizer: Ketoifen (Alaway, Zatidor), alcaftadine (Lastacaft)
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15
Q

What is blepharitis and its treatment?

A
  • Belpharitis is an eyelid inflammation most commonly involves the eyelid margins
  • Apply a warm compress over the eye for a few minutes to loosen the crusty deposits, then use a warm, moist washcloth (water + a few drops of baby shampoo) to wipe away the debris
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16
Q

Inflammation of eyes can be reduced with a __ compress and either an __ eye drop (if mild) or a __ eye drop (if severe)

Other ocular conditions - symptom-based opthalmic Tx

A
  • Cold
  • NSAID
  • Steroid
17
Q

Why do most eye drops burn?

A

Benzalkonium chloride (BAK) is a preservative added to eye drop bottles to prevent the growth of microorganisms and contamination;
* Preservatives are toxic to bacteria and are irritating to sensitive tissues in the eyes, which leads to burning/stinging after administration

  * Some drugs found in eye drops can also cause irritation * Contact lenses trap the drug and preservatives against the surface of the eye, making irritation worse

   * Lenses should be removed before using eye drops and wait 15 minutes after administration before reinserting
   * This is especially important with drops containing BAK as these can damage the eyes when used with contacts * Some eye drops have preservative-free formulations for those unable to tolerate the side effects

  * Example: Cosopt PF  (the PF stands for preservative-free)
18
Q

Examples of treatments for symptom-based opthalmic conditions

Inflammation, dryness, chronic dry eye disease, redness

A

Inflammation
* Steroids - Prednisolone (Pred Forte, Pred Mild)

  • NSAIDS - Ketorolac (Acular)
  • Steroids should be used short-term due to risk of increased IOP

Dryness
* Refresh (OTC)

  • Systane (OTC)
  • Often referred to as Artificial tears

Chronic Dry Eye Disease
* Cyclosporine Emulsion Eye Drops (Restasis)

Redness
* Naphazoline (Clear Eyes Redness Relief) (OTC)

  • Naphazoline/Pheniramine (Naphcon A, Visine A) (OTC)
  • Tetrahydrozoline (Visine) (OTC)
19
Q

List the common drugs known to cause vision changes or damage

  • Retinal changes/retinopathy
  • Optic neuropathy
  • Intraoperative floppy iris syndrome (IFIS)
  • Color discrimination
  • Vision loss/abnormal vision
A

Retinal changes/retinopathy
* Chloroquine

  • Hydroxychloroquine

Optic neuropathy
* Amiodarone (+corneal deposits)

  • Ethambutol
  • Linezolid

Intraoperative floppy iris syndrome (IFIS); causes difficulty in cataract surgery

  • Alpha-blockers (e.g., tamsulosin)

Color discrimination
* Digoxin (with toxicity) - yellow/green vision

  • PDE-5 inhibitors (e.g., sildenafil) - greenish tinge around objects
  • Voriconazole - color vision changes

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 - visusal field defects
  • Vigabatrin - permanent vision loss (high risk)
  • Voricinazole - abnormal vision, photophobia
20
Q

Tinnitus causes ringing, roaring or __ sounds and is caused by drug __ (e.g., __ ).

Fill in the blanks

A
  • Buzzing
  • Toxicity
  • Salicylates
21
Q

Which antibiotic ear drops are used for treatment of otitis externa?

A
  • Ciprofloxcin and dexamethasone (Ciprodex)
22
Q

How does ear wax (cerumen) blockage occurs and how is it treated?

A
  • It occurs when wax (cerumen) accumulates in the ear or becomes too hard to wash away naturally
  • It is removed in a medical office
  • If the condition is chronic, ear wax removal medication [carbamide peroxide (Debrox), triethanolamine] can be used every 4-8 weeks as a preventive measure
23
Q

What are key counseling points for all eye drops?

A
  • Can cause stinging/burning (except for preservative-free)
  • Wait 5 minutes in between two drops of the same medication
  • Apply gels last. Wait 10 minutes after the last eye drop before use
  • Wait 5-10 minutes in between drops of two different medications
  • Remove contact lenses prior to using eye drops. Wit 15 minutes to reinsert
24
Q

What are key counseling points for prostaglandin analogs?

A
  • Darkening of the iris and an increase in eyelash growth can accur
  • Do not use with bimaprost (Latisse). Latisse can reduce the effectiveness of other prostaglandins

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