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MJ- Pharmacology Exam 1 > EENT: Eye infections > Flashcards

EENT: Eye infections Flashcards

1
Q
A

Differentiating features in acute conjunctivitis

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2
Q

What is the most common cause of conjunctivitis?

A

–most common is Viral (adenovirus)

Can also be allergic and bacterial

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3
Q

What is the treatment for viral conjunctivitis?

A

No abx

Cool compresses, hygiene awareness

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4
Q
  • Staphylococcus aureus- most common in adults
  • Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis- more common in children
  • Ophthalmic antibiotics
  • ***Special population—contact wearers: Pseudomonas aeruginosa***
A

Bacterial conjunctivitis

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5
Q

•Antibiotics:

–Ophthalmic: topical

  • **Macrolides- Erythromycin, azithromycin
  • **Trimethoprim-Polymyxin (Polytrim)
  • **Bacitracin-Polymyxin
  • **Bacitracin
  • **Fluroquinolones: Ofloxacin, Ciprofloxacin
A

Treatment for bacterial conjunctivitis

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6
Q

What condition is the following describing?

–Inflammation of lid margin (anterior)

–Staphlococcus aureus

  • ulcers with dry scales
A

Blepharitis

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7
Q

Treatment for Acute _____:

  • Warm compresses
  • Baby shampoo diluted
  • ***Antibiotics: erythromycin or bacitracin ophthalmic (ophth) ointment***
A

Treatment for Blepharitis

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8
Q

What condition is the following treatment for?

Treatment for Posterior:

  • oral tx with doxycycline, TCN, or azithromycin
A

Blepharitis

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9
Q

What condition is the following treatment for?

•Antivirals-

  • Topicals: trifluridine drops, ganciclovir gel, or acyclovir ointment
  • Orals: acyclovir, valacyclovir, famciclovir
A

Blepharitis from herpetic infection

If suspect herpetic infection—refer!

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10
Q

What condition?

•Eye is not involved

  • infection of the eyelid and surrounding skin anterior to the orbital septum
  • Staphylococcus aureus (including CA-MRSA), Streptococcus pneumoniae and other streptococci, and anaerobes

•Trauma or dermal infection

A

Preseptal Cellulitis (periorbital)

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11
Q
  • **Amoxicillin/Amoxicillin-clavulanate
  • **Cefpodoxime
  • **Cefdinir
A

Treatment for Preseptal Cellulits (periorbital) if MSSA**

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12
Q

Treatment for what condition?

1. **Trimethoprim-sulfamethoxazole

2. **Clindamycin

3. **Doxycycline

A

Treatment for Preseptal Cellulitis (periorbital) if CA-MRSA suspected

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13
Q

Warm compresses are a treatment for what condition?

A

Preseptal Cellulitis (periorbital) if the patient is a child- inpatient treatment

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14
Q

Which condition has the following description?

–**Ocular and medical emergency

–Suspect orbital cellulitis and consult an ophthalmologist if there is decreased ocular motility, pain with eye movements, proptosis, or decreased visual acuity.

–Presentation

–Fever; PAIN with red eye

A

Orbital cellulitis

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15
Q

Which condition has the following treatment?

***Inpatient treatment: empiric with vancomycin plus - ceftriaxone or cefotaxime***

A

Treatment for Orbital cellulitis

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16
Q

–Presents with pain, injection, photophobia, foreign body sensation

A

Corneal abrasion

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17
Q
  1. Ophthalmic antibiotics
  • Erythromycin ointment
  • Sulfacetamide 10 percent,
  • Polymixin/trimethoprim (Polytrim),
  • Ciprofloxacin (Ciloxan), or ofloxacin (Ocuflox)
  • ***Aminoglycosides (gentamicin/tobramycin) should be avoided, except in the case of contact lens-related abrasions, since they can be toxic to the epithelium***.
    • **Preparations containing steroids are contraindicated- slows epithelial healing and reduce host resistance to superinfection*
  1. Topical NSAIDs
    * Ketorolac Ophth. (unlabeled use
A

Treatment for a corneal abrasion

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18
Q

Why should you NOT use aminoglycosides?

A

Corneal abrasion

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19
Q

What do all of the following conditions have in common?

  • Corneal ulcer
  • HSV Keratitis
  • Herpes Zoster (presenting with pain despite local anesthetic, tearing, photophobia, injection, pseudodendrite)
A

All are ASAP/STAT ophthalmology referrals

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20
Q

How do you treat a corneal ulcer that presents as an infection from contact lens, foreign body, or an abrasion?

A

•**Ophthalmic Fluroquinolones**

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21
Q

The following is a treatment for which condition?

–*Topical antivirals

  • *Ganciclovir ophth gel
  • *Trifluridine ophth solution
  • *Acyclovir ophth ointment

_–*Corticosteroids ONLY by ophthalmologist*_

A

HSV Keratitis

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22
Q

What condition presents with dendritic lesion, pain, injection?

A

HSV Keratitis

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23
Q

Which condition is treated with the following:

–**Ophthalmic antivirals, and antibiotics

–**Corticosteroids-ONLY by ophthalmologist

A

Herpes Zoster

24
Q

–should be treated with inexpensive nontoxic topical antibiotics such as erythromycin ophthalmic ointment

–dose may be reduced to twice daily if there is improvement in symptoms after a few days.

A

Bacterial conjunctivitis

25
Q

•_______ is preferred over _____ for children, those with poor compliance, and those in whom it is difficult to administer eye medications

A

OINTMENT is preferred over DROPS

–This is b/c ointments blur vision for 20 minutes after the dose is administered.

26
Q
  • Patients with ________ should respond in one to two days with a decrease in discharge, redness, and irritation
  • Patients who do not respond should be referred to an ophthalmologist.
A

**bacterial conjunctivitis**

27
Q

There is no specific therapy for ________, although patients may receive symptomatic benefit from topical antihistamine/decongestants or from lubricating agents like those used for noninfectious conjunctivitis

A

**viral conjunctivitis**

28
Q

Patients with noninfectious conjunctivitis may feel better with topical lubricants that can be used as often as _____

A

Hourly

29
Q

True or false: Primary care clinicians should NOT prescribe topical glucocorticoids for acute conjunctivitis

A

True!

30
Q

True or False: Although antibiotic therapy for nonbacterial conjunctivitis is not recommended, if this is required for the patient to return to school or daycare, providers should select an inexpensive topical antibiotic such as erythromycin or sulfa

A

True

31
Q

Mechanism for Erythromycin Ophth Ointment and Azithromycin Ophth Solution

A

Inhibits RNA-dependent protein synthesis at the chain elongation step; binds to the 50S ribosomal subunit resulting in blockage of transpeptidation

32
Q

What medications have the following Adverse Events/ side effects:

Hypersensitivity, minor ocular irritation, redness

A

Erythromycin Ophth Ointment
Azithromycin Ophth Solution

33
Q

What is the mechanism of Sulfacetamide 10% Solution

A

–Interferes with bacterial growth by inhibiting bacterial folic acid synthesis through competitive antagonism of PABA

34
Q

ADEs:

–Blurred vision, burning, discomfort, dryness, edema, eye pain

–foreign body sensation

–itching

–photophobia, redness

–stinging, tearing

–Hypersensitivity

A

Fluoroquinolones (Ofloxacin, Ciprofloxacin, Moxifloxacin, Levofloxacin)

35
Q
A
36
Q

Which medication has the following ADEs?

  1. Irritation
  2. burning
  3. stinging
A

Sulfacetamide 10% Solution

37
Q
A
38
Q

Mechanism of which med:

–Binds to phospholipids, alters permeability, and damages the bacterial cytoplasmic membrane permitting leakage of intracellular constituents

–Inhibits folic acid reduction to tetrahydrofolate, and thereby inhibits microbial growth

A

Polymixin-Trimethoprim Ophth Solution

39
Q

Which medication has the following ADEs?

Burning, itching, edema, rash, redness increased, stinging, tearing

A

Polymixin-Trimethoprim Ophth Solution

40
Q

What is the mechanism of fluoroquinolones (Ofloxacin, Ciprofloxacin, Moxifloxacin, Levofloxacin)

A

•A DNA gyrase inhibitor

  • DNA gyrase is an essential bacterial enzyme that maintains the superhelical structure of DNA. DNA gyrase is required for DNA replication and transcription, DNA repair, recombination, and transposition
41
Q

What medication is the following dosage for?

•Conjunctivitis: Ophthalmic: Instill 1-2 drops in affected eye(s) every 2-4 hours for the first 2 days, then use 4 times/day for an additional 5 days.

A

Fluoroquinolones

42
Q

What is the main thing to know about dosing Flouroquinolones for corneal ulcers?

A

There are many different dosages! Look, up dosing requirements if you are going to prescribe this med for corneal ulcers

43
Q

True or false, LARGE amounts of fluoroquinolones are absorbed systemically after ophthalmic instillation

A

FALSE

Only SMALL amounts are absorbed systemically after ophthalmic instillation

44
Q

Which medications are indicated in contact wearers with an abrasion due to risk of pseudomonas infection

A

Aminoglycosides- Gentamicin, Tobramycin

45
Q

ADEs:

Burning, Irritation

A

ADEs for Aminoglycosides- Gentamicin, Tobramycin

46
Q

–Only agent with indication other than tx for postop inflammation following cataract surgery and/or laser corneal surgery.

–Treatment of allergic eye disease

A

topical NSAID for eyes- Ketorolac 0.5% Ophth solution

47
Q

–Mechanism:

Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors; has anti-inflammatory properties

A

•Ketorolac 0.5% Ophth solution (a topical NSAID for the eye)

48
Q

–ADEs: ocular inflammation, irritation, pain, ocular pressure increased, tearing

–Dose: 1 drop QID

A
49
Q

–ADEs: ocular inflammation, irritation, pain, ocular pressure increased, tearing

A

•Ketorolac 0.5% Ophth solution (topical NSAID for the eye)

50
Q

What is the dosage for Ketorolac 0.5% Ophth solution

A

1 drop QID

51
Q

–Mechanism: competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase resulting in inhibition of viral DNA synthesis

A

Antiviral: Ganciclovir 0.15% Ophth gel

52
Q

–ADEs: Ocular: Blurred vision (60%), irritation (20%)

A

Antivirals: Ganciclovir 0.15% Ophth gel

53
Q

–Mechanism: Interferes with viral replication by inhibiting thymidylate synthetase and incorporating into viral DNA in place of thymidine

A

Eye antiviral: Trifluridine 1% Ophth solution

54
Q

–ADEs: Mild local irritation of conjunctival and cornea

A

Eye antivirals: Trifluridine 1% Ophth solution

55
Q

Which med?

–Decreases inflammation by suppression of neutrophil migration, decreased production of inflammatory mediators, and reversal of increased capillary permeability; suppresses normal immune response

A

Eye corticosteroids: Hydrocortisone, Dexamethasone, Prednisolone (alone or in combination with antimicrobials)

56
Q

What is a concern for Eye corticosteroids such as Hydrocortisone, Dexamethasone, Prednisolone (alone or in combination with antimicrobials)

A

–Steroids may mask infection or enhance existing ocular infection

  • prolonged use may result in secondary bacterial or fungal superinfection due to immunosuppression.
57
Q

Which meds have the following ADEs:

  1. Burning

2. cataract formation

3. glaucoma (with optic nerve damage)

  1. perforation of globe
  2. secondary ocular infections
  3. stinging
  4. visual acuity defects
  5. visual field defects
A

Corticosteroids

MJ- Pharmacology Exam 1 (13 decks)

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