ENT and Ophthalmology Pharmacology

Question 1

what is first line for a person with mild-to-moderate symptoms of allergic rhinitis? Give an example

Answer 1

intranasal antihistamine e.g. azelastine

Question 2

what is second-line for mild-to-moderate allergic rhinitis? give 2 examples

Answer 2

non-sedating oral antihistamine e.g. cetirizine, loratidine

Question 3

if antihistamines are contraindicated or not tolerated, what can be used in allergic rhinitis?

Answer 3

intranasal chromone such as sodium cromoglicate.

Question 4

when should an intranasal corticosteroid be used for allergic rhinitis?

Answer 4

for moderate-to-severe persistent symptoms or when initial drug treatment is ineffective

Question 5

name two examples of intranasal cotricosteroids

Answer 5

beclometasone, fluticasone, mometasone furoate.

Question 6

how do people with vertigo explain their dizziness?

Answer 6

as if the room is spinning around them

Question 7

what can be used to rapidly relieve severe nausea or vomiting associated with vertigo and what class of drug is this?

Answer 7

buccal prochlorperazine or IM injection of prochlorperazine or cyclizine.
Prochlorperazien is a phenothiazine and cyclizine is an antihistamine

Question 8

what can be used to alleviate less severe nausea, vomiting and vertigo?

Answer 8

short course of oral prochlorperazine (a phenothiazine) or antihistamines sucha s cinnarizine, cyclizine or promethazine teoclate.

Question 9

what is the name of the repositioning manoeuvre that can be used to help alleviate symptoms of BPPV?

Answer 9

Epley manoeuvre

Question 10

what are the 4 classic symptoms of Meniere’s disease?

Answer 10

• episodes of vertigo
• tinnitus
• fluctuating sensorineural hearing loss
• aural fullness

Question 11

above what intraocular pressure does someone need to be offered treatment?

Answer 11

> /=24mmHg

Question 12

what is first line treatment for people with suspected chronic open angle glaucoma? Give an example

Answer 12

PGA e.g. latanoprost, travoprost

Question 13

if a PGA has not been enough to lower IOP in chronic open angle glaucoma, what drugs from other classes of drugs could you offer? (4)

Answer 13

beta-blockers, CA inhibitors, sympathomimetics,

miotics

Question 14

give two examples of topical beta-blockers used in the eye

Answer 14

betaxolol

timolol

Question 15

give an example of a topical sympathomimetic

Answer 15

brimonidine

Question 16

give 3 exampels of carbonic anhydrase inhibitors

Answer 16

acetazolamide,
brinzolamide,
dorzolamide

Question 17

give an example of miotic drugs used in the eye for chronic open angle glaucoma

Answer 17

pilocarpine

Question 18

what should you do if you suspect acute angle closure glaucoma?

Answer 18

admit immediately for specialist ophthalmology assessment and treatment

Question 19

if immediate admission is not possible for acute angle closure glaucoma, what treatment can you start in primary care?

Answer 19

lay person flat to help relieve some pressure on teh angle.
give pilocarpine eye drops
give acetazolamide 500mg orally
analgesia and anti-emetic if required.

Question 20

give four examples of antimuscarinic drugs that can be used to dilate the pupil for fundoscopy

Answer 20

atropine, cyclopentolate, homatropine, tropicamide

Question 21

which is the best antimuscarinic to use for fundoscopy if you just need a window of about 3hrs to work with?

Answer 21

tropicamide

Question 22

homatropine and atropine dilate the pupil for 3-7 days respectively. when might you want to use this?

Answer 22

to prevent adhesions in anterior uveitis

Question 23

what drug might you give alongside an antimuscarinic to produce pupil dilatation for procedues such as cataract operations?

Answer 23

sympathomimetic e.g. phenylephrine.

Question 24

name two topical corticosteriods that can be used for treating uveitis or scleritis

Answer 24

dexamethasone, prednisolone

Question 25

topical corticosteroids can exacerbate what optic conditions?

Answer 25

glaucoma and viral dentritic ulcers

Question 26

what can prolonged use of corticosteroids lead to?

Answer 26

thinning of sclera or cornea, or formation of a ‘steroid cataract’

Question 27

name two topical antihistamines that can be used in the eye for allergic conjunctivitis?

Answer 27

antazoline or levocabastine

Question 28

name 5 broad spectrum antibacterial agents that can be used topically for e.g. blephariitis, conjunctivitis

Answer 28

gentamicin, chloramphenicol, ciprofloxacin, fusidic acid, neomycin

Question 29

name an antiviral that can be used topically for dendritic corneal ulcers cuased by herpes simplex infection

Answer 29

aciclovir

Question 30

which topical local anaesthetics might you use to provide surface anaesthesia for tonometry?

Answer 30

oxybuprocaine or lidocaine

Question 31

for minor surgical procedures, such as cataract removal, what topical local anaesthetic might you use

Answer 31

tetracaine - may be combined with injection of small amount of lidocaine into the anterior chamber.