Exam 1 Material Flashcards
1
Q
tears
A
coat the conjunctiva and cornea
contains nutrients, enzymes, and immunoglobulins to support and protect the cornea
2
Q
POAG glaucoma
A
usually gradual until visual field loss occurs
obstructed trabecular meshwork
drainage canal blocked
3
Q
PACG
A
connected with shape of the eye
medical emergency
significant pain
quickly decrease IOP
pressure pushes iris against cornea, blocking trabecular meshwork
iris and lens stick together
4
Q
B receptor antagonists for glaucoma MOA
A
block the beta-2 adrenoceptor on the ciliary body
5
Q
B receptor antagonists for glaucoma pharm action
A
reduce aqueous production by the ciliary body (decrease inflow)
not much effect on outflow
6
Q
Nonspecific B-blocking agents for glaucoma
A
timolol
levobunolol
7
Q
relatively B1-selective agent glaucoma
A
betaxolol
8
Q
nonspecific blocker with intrinsic sympathomimetic activity for glaucoma
A
caretolol
9
Q
B receptor antagonists for glaucoma side effects
A
ocular
-sting and burning, decreased corneal sensitivity, diplopia, blurred or cloudy vision, decreased night vision, and ptosis
systemic
-cardiac: bradycardia and hypotension
-respiratory: bronchospasm in asthmatics
headache, insomnia, taste perversion, depression, impotence
10
Q
a2 agonists for glaucoma MOA
A
bind to a2 rec on the ciliary body
binds to the uveosclera
11
Q
a2 agonists for glaucoma pharm effect
A
decreases rate of aqueous humor production (decrease inflow)
some increase in uveoscleral outflow
neuroprotective
12
Q
a2 agonists for glaucoma
A
apraclonidine
brimonidine
13
Q
apraclonidine side effects
A
ocular-burning and stinging, blurred vision, foreign body sensation, ocular pruritus
systemic-hypotension, oral dryness, allergic rxns
14
Q
brimonidine side effects
A
ocular-foreign body sensation and ocular pruritus
systemic-oral dryness, dizziness, fatigue, somnolence, reduction in blood pressure and pulse
more systemic SE
15
Q
carbonic anhydrase inhibitors for glaucoma MOA
A
prevents the conversion of CO2 and water to carbonic acid
reduces availability of sodium and bicarbonate for secretion
16
Q
carbonic anhydrase inhibitors for glaucoma pharm effect
A
decreases ciliary body aqueous humor secretion (decrease inflow)
17
Q
oral carbonic anhydrase inhibitors for glaucoma
A
acetazolamide
methazolamide
18
Q
ophthalmic carbonic anhydrase inhibitors for glaucoma
A
dorzolamide
brinzolamide
19
Q
carbonic anhydrase inhibitors for glaucoma side effects
A
ocular: burning or stinging, hypersensitivity, headache, bitter, sour, or unusual taste, dry eye, foreign body sensation, and blurred vision
oral: altered taste and smell, dry mouth, excessive thirst, increased urination, systemic acidosis, and depression
20
Q
M3 agonists for glaucoma
A
carbachol
pilocarpine
21
Q
AChE inhibitor for glaucoma
A
echothiophate
22
Q
M3 agonists for glaucoma MOA
A
agonist at M3 receptor on sphincter muscle and trabecular meshwork
23
Q
M3 agonists for glaucoma pharm effect
A
contraction of the sphincter muscle and trabecular meshwork increase outflow
opens meshwork
24
Q
M3 agonists for glaucoma side effects
A
ocular: burning and stinging, painful ciliary muscle spasm->headache, blurred vision, myopia, poor vision in dim light, increased visibility of floaters and lacrimation
systemic: diarrhea, salivation, sweating, and rhinorrhea
25
AChE inhibitor for glaucoma MOA
irreversible acetylcholinesterase inhibitor
increase of acetylcholine
26
AChE inhibitor for glaucoma pharm effect
contraction of the sphincter muscle and trabecular meshwork (increase outflow)
27
AChE inhibitor for glaucoma side effects
ocular: burning and stinging, blurred vision, eye pain, lacrimation, headache, brow-ache, twitching of eyelids
systemic: diarrhea, salivation, sweating, and rhinorrhea
28
prostaglandin agonists for glaucoma
bimatoprost
latanoprost
latanoprostene bunod
travaprost
tafluprost
29
prostaglandin agonists for glaucoma MOA
agonist at the PFG2a receptor causing relaxation of the ciliary muscle
30
prostaglandin agonists for glaucoma pharm effect
reduces IOP by increasing uveoscleral and trabecular outflow of aqueous humor (increase outflow)
does NOT affect aqueous humor production
may be more effective in hazel/brown colored eyes than blue/green
31
prostaglandin agonists for glaucoma side effects
blurred vision, burning and stinging, eye pain lid edema and ocular hyperemia
increased brown pigmentation of iris and eyelids
hypertrichosis and hyperpigmentation of lashes
hair growth in other areas
few systemic side effects
32
rho kinase inhibitor for glaucoma
netarsudil
33
rho kinase inhibitor for glaucoma pharm effect
increases outflow
34
rho kinase inhibitor for glaucoma side effects
conjunctival hyperemia-vasodilation
corneal vericillate; did not change vision
instillation site pain
conjunctival hemorrhage
35
combo products for glaucoma
timolol and dorzolamide
timolol and brimonidine
brinzolamide and brimonidine
36
histamine
released from storage granules as a result of the interaction of antigen with IgE antibodies on the mast cell surface
immediate hypersensitivity and allergic rxns
37
effects of histamine release
itching and stimulates secretion from nasal mucosa
contracts smooth muscles-bronchi and gut
relaxes other smooth muscles-small blood vessels
stimulus of gastric acid secretion
edema and stimulation of sensory nerve endings
38
ophthalmic antihistamines for allergic conjunctivitis MOA
H1 inverse agonists
mast cell stabilization
39
H1 inverse agonists
reduce constitutive activity of receptor and compete with histamine binding to the receptor
40
mast cell stabilization
reduces release of mast cell mediators during an allergic response
anti-inflammatory prop, reducing cytokine secretion, decreased adhesion molecule expression, and inhibition of eosinophil infiltration
41
ophthalmic antihistamines for allergic conjunctivitis pharm action
reduce the symptoms of an allergic rxn such as edema, itch, inflammation, and watery eyes
42
ophthalmic antihistamines for allergic conjunctivitis
alcaftadine
azelastine
bepotastine
cetirizine
epinastine
ketotifen
olopatadine
43
alcaftadine
H1 antagonist and mast cell stabilization
H4 receptor antagonism
v little anticholinergic activity
little penetration into CNS
low incidence of side effects
44
azelastine
H1 antagonist and mast cell stabilization
also as nasal spray for allergic rhinitis
45
bepotastine
H1 antagonist and mast cell stabilizer
46
cetirizine
H1 antagonist
has minimal anticholinergic effects
negligible CNS penetration, but still causes drowsiness
47
epinastine
H1 antagonist and mast cell stabilization
H2 antagonist, which may reduce eyelid edema
48
ketotifen
H1 antagonist and mast cell stabilizer
49
olopatadine
H1 antagonist and mast cell stabilization
also as nasal spray
50
ophthalmic decongestants for allergic conjunctivitis MOA
adrenergic (alpha) receptor agonist
51
ophthalmic decongestants for allergic conjunctivitis pharm action
vasoconstrictors for local application to the nasal mucous membrane or the eye
reduces redness
52
a2 agonists for ophthalmic decongestants
naphazoline
oxymetazoline
tetrahydrozoline
brimonidine tartrate
53
ophthalmic antihistamine/decongestant combo for allergic conjunctivitis
naphazoline/pheniramine
54
ophthalmic mast cell stabilizers for allergic conjunctivitis pharm effect
prevents release of inflammatory and constricting mediators like histamine, leukotrienes, cytokines, and degradative enzymes from activated mast cells
prevents thee allergic event rather than alleviating symptoms
55
ophthalmic mast cell stabilizers for allergic conjunctivitis
cromolyn sodium
nedocromil
56
ophthalmic mast cell stabilizers for allergic conjunctivitis side effects
cromolyn-burning and stinging, dryness and styes
nedocromil-headache, burning/stinging, photophobia
57
glucocorticoids for allergic conjunctivitis MOA
immunosuppression to reduce inflammation
58
glucocorticoids for allergic conjunctivitis side effects
cataracts
59
glucocorticoids for allergic conjunctivitis products
fluorometholone
hydrocortisone
loteprednol
prednisolone Na+ phosphate
rimexolone
60
dry eye
aka keratoconjunctivitis sicca
onset is unpredictable but may correlate with environment (meds)
may present with or without redness of the eyes
61
risk factors for dry eye
increasing age and females
62
cyclosporine
calcineurin inhibitor class immunosuppressant
helps increase tear production
63
calcineurin inhibitor MOA
inhibits production of IL-2 needed for T cell proliferation (which reduces inflammation of eye)
64
calcineurin inhibitors for dry eye side effects
ocular burning, instillation site pain, conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging, or visual disturbances
65
loteprednol
anti-inflammatory to treat dry eye
corticosteroid
66
LFA-1 antagonist for dry eye MOA
lymphoma function-associated antigen 1 (LFA-1) antagonist
cell surface protein found on leukocytes
blocks interaction with intercellular adhesion molecule-1 (ICAM-1)
may inhibit T cell adhesion to ICAM-1 and secretion of inflammatory cytokines
67
lifitegrast
LFA-1 antagonist for dry eye
68
lifitegrast side effects
application site irritation, reduced visual acuity
69
intranasal varenicline
nicotinic acetylcholine receptor agonist
-increase production of basal tear film
typically for smoking cessation, but can also used for dry eye
70
intranasal varenicline side effects
acquired night blindness, blurred vision, retinal vascular disorder, subcapsular cataract, transient blindness, visual disturbance
71
cerumenolytics mechanisms
hydrate, soften, liquify, or disintegrate cerumen
72
three types of cerumenolytics
water based
oil based
nonwater, nonoil based
73
water based cerumenolytics
cerumenex
colace-docusate sodium
hydrogen peroxide
74
oil based cerumenolytics
olive oil
75
nonwater, nonoil based cerumenolytics
debrox-carbamide peroxide
prepared in diff solvent-glycerol
76
docusate Na
water-based cerumenolytics
surfactant which increases water entry and emulsifies
has both hydrophilic and lipophilic parts
77
carbamide peroxide
debrox
nonwater, nonoil based cerumenolytics
releases H2O2, which generates effervescing O2
effervescence breaks up ear wax
78
tooth decay causes
bacteria forms plaque on teeth and gums
bacteria also converts sugars into acids which erode enamel leading to cavities
acid drinks can also erode enamel
79
tooth decay prevention
fluoride based toothpastes or gels
non-fluoride toothpastes
mouth rinses
cavity treatments
80
fluoride based toothpastes or gels
enamel is made up of hydroxyapatite (vulnerable to acid erosion)
fluoride ions toothpastes convert hydroxyapatite into fluorapaptite which is more resistant to acid erosion
81
fluoride ions in toothpastes or gels
form fluorapatite from hydroxyapatite
enhance mineral deposition (mineralization)
but too much fluoride can cause enamel fluorosis
82
non-fluoride toothpastes
abrasives/pH modifiers/remineralizers
sodium bicarbonate
nanohydroxyapatite
calcium sodium phosphosilicate (CSPS)
amorphous calcium phosphate (ACP)
83
sodium bicarbonate
abrasive and mouth pH elevating agent
84
nanohydroxyapatite (10% nHA)
small crystals which bond to hydroxyapatite
85
calcium sodium phosphosilicate (CSPS)
bioactive glass that reacts with oral fluids to deposit crystalline hydroxycarbonate apatite (HCA)
86
amorphous calcium phosphate (ACP)
reactive salt mixture that releases Ca and PO4 ions to remineralize enamel upon contact with salvia
87
mouth rinses
for plaque/gingivitis/bad breath/tooth decay/pain management
chlorhexidine gluconate
cetylpyridinium chloride
fluoride
NaHCO3
carbamide peroxide
thymol/eucalyptol/methyl salicylate/menthol
benzocaine
88
chlorhexidine gluconate
mouth rinses
bisbiguanide salt
bind to cell wall and disrupt its integrity
89
cetylpyridinium chloride
mouth rinse
pyridinium salt
90
fluoride mouth rinse
promote remineralization and prevent caries
91
NaHCO3 mouth rinse
increase saliva pH
decrease growth of acidic bacteria
92
carbamide peroxide mouth rinse
for canker cores
93
benzocaine mouth rinse
anesthetic agent
94
thymol/eucalyptol/methyl salicylate/menthol mouth rinse
listerine
95
teeth whitening
whiteners remove stains
range from abrasives to H2O2 bleaching agents
carbamide peroxides and hydrogen peroxides
96
alpha2 agonists chem
aryl imidazolines
decrease inflow and increase outflow
clonidine
apraclonidine
brimonidine tartrate
97
SAR for alpha2 agonists
X=CH2; alpha1 receptor agonists
X=NH2; alpha2 receptor agonists
98
beta antagonists chem
aryloxypropanolamine
decrease inflow
timolol, betaxolol, levobunolol, caretolol
99
SAR of beta antagonists
aryloxypropanolamine is more potent that arylethanolamines
most have mixed B1+B2 activities
S-OH isomers are preferred
most p-aryloxypropanolamine are B1 antagonists
100
carbonic anhydrase (CA) inhibitor chem
Zn-metalloenzyme which modulates aqueous humor production through pH changes
increases pH
sulfonamides-inhibits CA to decrease inflow
acetazolamide, methazolamide, brinzolamide, dorzolamide
101
carbonic anhydrase (CA) inhibitor metabolism
undergo CYP N-deethylation to active metabolites
ionic interactions with Zn, glutamic, NH2, threonine
102
direct acting cholinergics chem
increases outflow
carbamates and esters
carbachol, pilocarpine
103
direct acting cholinergics SAR
acyloxy group for H bonding to nicotinic/muscarinic receptors (non-selective)
ionizable amine (N) group
N-methyl groups
2-C spacer btwn O and N
104
indirect acting cholinergics
organophosphate
echothiophate iodide-irreversible
105
extent of AChE inhibition depends on the FG present
phosphoryl>carbamate> ester
106
prostaglandins chem
all increase outflow via FP or PGF2a receptor activation
prodrug activation via esterase
107
prostaglandins SAR
carboxylic acids and amides are active drugs
esters are prodrugs
C-15=OH or halogens (prevents 15-OH oxidation)
108
rho kinase (ROCK) inhibitors chem
isoquinolines
netarsudil
increases outlofw
an ester prodrug
109
a1/a2 agonists decongestants chem
aryl imdiazoline
oxymetazoline, xylometazoline, tetrahydrometazoline, naphazoline
110
mast cell stabilizers chem
chromone and oxamic acid
inhibit granule histamine release from mast cells
ionized/ionizable FG
locally active
111
dual acting agents (antihistamines + mast cell stabilizing) chem
multicyclic
ionizable FGs
112
glucocorticoid steroids chem
activate the GR complex to produce proteins which in turn suppress pro-inflammatory protein
a-face away
B-face towards you
hydrocortisone, dexamethasone
113
glucocorticoid steroids SAR
anti-inflammatory activity is increased by
-double bond btwn C1 and C2
-6a-F
11B-OH
114
risk factors POAG
older age
family history of glaucoma
high IOP
use of corticosteroids
African descent
115
clinical presentation POAG
remains asymptomatic until severe with vision loss and decreased quality of life from lack of ability to perform daily activities
early intervention is essential to slow progression of disease
116
first line therapy for POAG
prostaglandins
some contain BAK preservative and some don't
once daily dosing
reduces IOP by 33%
better 24 hr IOP control
good tolerance
lower cost
117
side effects of prostaglandins
blurred vision, stinging, burning, elongation and darkening of eyelashes, induced iris darkening, periocular skin pigmentation
118
contraindications for prostaglandins
macular edema
history of herpetic keratitis
119
second line or preferred adjunctive for POAG
ophthalmic beta blockers
timolol, levobunolol, carteolol, bexatolol
reduces 20-30% may use initial monotherapy if prostaglandins CI or not tolerated
good tolerance
120
ophthalmic beta blockers side effects
stinging on application, dry eyes, blepharitis, blurred vision, decreased HR and BP, bronchospasm, cardiac effects
121
ophthalmic beta blockers precaution
asthma/COPD
bradycardia/heart block
advanced heart disease
heart failure
on PO B-blocker therapy
122
ophthalmic beta blockers product selection
adverse effect potential
-more systemic SE with non-selective agents
-rapidly absorbed into systemic circulation
individual patient response
cost
123
adjunctive therapy for POAG
alpha2-adrenergic agonists
-brimonidine
-apraclonidine
124
alpha2 agonists can also be used to
increase IOP postoperative or post-laser treatment
125
why are alpha2 agonists adjunctive
moderate IOP reduction
-10-27%
freq: every 8-12 hrs
126
alpha2 agonists side effects
lid edema, eye discomfort, foreign-object sensation, itching, dizziness, fatigue, somnolence, dry mouth, slight BP or HR reduction
127
alpha2 agonist precaution
advanced CV diseases
renal compromise
history of stroke
diabetes
taking blood pressure lowering agents, MAOIs, and TCAs
128
Last lines for POAG
topical carbonic anhydrase inhibitors
oral carbonic anhydrase inhibitors
129
why are topical carbonic anhydrase inhibitors last line
IOP reduction: 15-26%
freq: every 8-12 hr
130
topical carbonic anhydrase inhibitors side effects
burning, stinging, ocular discomfort, blurred vision, tearing
minimal systemic SEs
131
why are oral carbonic anhydrase inhibitors last line
IOP reduction: 25-40%
intolerable adverse effects: topical first, no combo of oral and topical together, often used for short-term admin to lower IOP
132
oral carbonic anhydrase inhibitors side effects
older adults do NOT tolerate CAIs as well as younger patients
A LOT of systemic SEs
systemic acidosis
133
carbonic anhydrase inhibitors precaution
sulfa allergies (cross sensitivity is v low)
sickle cell disease
pulmonary disorders
electrolyte imbalance
134
Last last line for POAG
cholinergic agonists (miotic agents)
pilocarpine
carbachol
echothiophate
135
why are cholinergic agonists last last line for POAG
poor tolerance
frequent dosing-every 6 hrs
side effects
136
cholinergic agonists (miotic agents) side effects
burning, stinging, blurred vision upon application, eyebrow ache, may precipitate acute angle-closure glaucoma
excessive sweating, nausea, vomiting, diarrhea, cramping, bronchospasm, heart block
137
rho-kinase (ROCK) inhibitor
rhopressa
-triple mechanism for lowering IOP
conjunctival hyperemia->relatively high number of discontinuation rates and adverse events
138
novel combo agent: rocklatan
prostaglandin and ROCK inhibitor
IOP reduction of 30% or greater
139
follow up on POAG
4-6 weeks after therapy initiation
every 3-4 months once target IOP are achieved
140
refrigerate before opening; once opened, store at room temp medication
latanoprost
lataoprostene bunod
tafluprost
141
refrigerate before opening; once opened, store at room temp for < 6 weeks medication
netarsudil
142
drugs that can increase IOP (POAG)
ophthalmic corticosteroid (high risk)
systemic corticosteroids
nasal/inhaled corticosteroids
ophthalmic anticholinergics
143
intolerance of medications for POAG
reduce conc (if possible)
change formulations
switch to alternative class
144
combigan
brimonidine tartrate/timolol
alpha2 agonist/B-blocker
145
cosopt
dorzolamide/timolol
CAI/B-blocker
146
simbrinza
brinzolamide/brimonidine
CAI/alpha2 agonist
147
nonpharm interventions for POAG
surgical and laser treat
148
PACG risk factors
females
older
Asian (Southeast Asian)
first degree relatives of patients
149
management of acute PACG
medical emergency->ER to avoid blindness
150
management of chronic PACG
laser surgery
151
exclusions of self-treatment for ocular disorders
eye pain, ocular trauma, chem exposure, eye exposure to heat, blurred vision, light sensitivity, signs and symptoms of eyelid infection, except stye
untreated symptoms that persist over 72 hrs
152
conjunctivitis
inflammation of the conjunctiva
most are viral
self-limiting
153
allergic conjunctivitis
pink/red/clear, itchy, watery, bilaterally
inflammatory response to allergens (pollen, animal dander, and other environmental antigens)
154
nonpharm treatment of allergic conjunctivitis
allergic avoidance
cold or warm compresses (3-4 times daily)
contacts should NOT be worn
common: pollen, mold, dust mites, pet dander
155
preferred treatment for allergic conjunctivitis
artificial tears as needed-symptomatic relief
156
after artificial tears, what do you give for allergic conjunctivitis
ophthalmic antihistamine/mast cell stabilizer/histamine type 1 antagonist
-olopatadine
-ketotifen
157
after antihistamine/mast cell stabilizers, what do you use for allergic conjunctivitis
decongestants/alpha agonists
naphazoline
oxymetazoline
tetrahydrozoline
brimonidine
158
adverse events of decongestants/alpha agonists
ocular dryness, which can exacerbate the symptoms
rebound congestion
159
decongestants/alpha agonists contraindications
pregnancy
angle-closure glaucoma
160
decongestants/alpha agonists precautions
HTN
CV disease
diabetes
161
after decongestants/alpha agonists, what do you give for allergic conjunctivitis
2nd gen oral antihistamine
if symptoms persist with topical AH/mast cell stabilizer
loratadine, fexofenadine, cetrizine
162
medical referral allergic conjunctivitis
if symptoms do NOT resolve after 72 hr of appropriate treatment
163
viral conjunctivitis
self-limiting within 1-2 weeks
does NOT require treatment
detected with high sensitivity and specificity
164
clinical presentation of viral conjunctivitis
highly contagious
pink eyes with amounts of watery discharge and crusting
presents unilateral and progresses to bilateral
165
nonpharm treatment of viral conjunctivitis
hand washing
cold compresses
avoid sharing towels or objects
multi-dose eye drops, make up and other products
contact lens use should be avoided
166
pharm treatment of viral conjunctivitis
no effective treatment
artificial tears, cold compresses, and ocular antihistamines->refer if no improvements occur within 7-10 days
AVOID topical steroids as they could worsen and prolong the infection unless corneal inflammation
167
when to refer for viral conjunctivitis
no improvements occur within 7-10 days
168
bacterial conjunctivitis
least common
transmitted btwn individuals or may result from abnormal proliferation of conjunctival bacterial flora
risk factors: dry eye, immunosuppression, or trauma
169
risk factors for bacterial conjunctivitis
dry eye, immunosuppression, or trauma
170
clinical presentation of bacterial conjunctivitis
unilateral or bilateral red eye
bilateral matting or crusting and sticking
171
when to refer for bacterial conjunctivitis
if no improvements occur within 7 days or if topical antibiotics may be indicated
172
referrals for ocular stuff should be made when
visual loss
moderate or severe pain
severe purulent discharge
photophobia
corneal inflammation
lack of response to therapy within 1 week
recurrent episodes of conjunctivitis
history herpes simplex viral eye disease
173
dry eye
aging
discomfort and visual disability
acute cases: elimination of exacerbating factors
chronic: gets worse
can use artificial tears, but need referral
174
risk factors of dry eye
older
female
175
clinical presentation of dry eye
excessive tearing
foreign body sensation->gritty feeling
itching, irritation, and soreness with or without redness
intermittent blurred vision
symptoms are often worse at the end of the day
176
treatment of blepharitis
scrub eyelids at the base of lash with a cotton swab dipped in baby shampoo, tea tree oil
apply warm compresses as necessary
177
pharm treatment of dry eye
ocular lubricants
178
ocular lubricants
drops>ointments
1-2x daily
179
ophthalmic preservatives
benzalkonium chloride (BAK)
chlorhexidine
methyparaben
propylparaben
purite
thimerosal
180
hordeolum
eyelid gland infection
tender to touch
palpable, tender, nodule present
eyelid swelling
lid redness
181
chalazion
noninfectious granuloma located near, but NOT on the eyelid
NOT tender to the touch
182
treatment of hordeolum and chalazion
warm compresses for 5-10 min 3-4x daily
stye may be treated with topical antibiotic ointment
183
referral for hordeolum and chalazion
if the nodule does NOT drain after 1 week
184
recurrent aphthous stomatitis (RAS)
canker sores
precipitated by stress and local trauma
peak onset: 10-19
185
clinical presentation of recurrent aphthous stomatitis (RAS)
sores appear on nonkeratinized mucosa
ulcers are painful, rounded, flat, or crater-like lesions
range from gray to yellow with red halo of inflamed tissue
prodome may occur 24-48 hrs prior to when the ulcers appear
may inhibit normal daily activities
self-resolves in 10-14 days
186
recurrent aphthous stomatitis (RAS) exclusions of self care
lesions > 14 days or if associated underlying pathology
frequent recurrence
symptoms of systemic illness (fever, swollen lymph nodes, malaise)
failure of prior self-care treatment
187
recurrent aphthous stomatitis (RAS) nonpharm treatment
increase nutrients
eliminate offending food
avoid spicy/acidic foods
recommend bland foods
ice every 10 min
avoid toothpastes
stress reduction
188
topical anesthetics
for recurrent aphthous stomatitis (RAS)
provide short term relief of the pain
-benzocaine
use with oral debriding agents
189
oral debriding and wound cleansing agents
for recurrent aphthous stomatitis (RAS)
carbamide peroxide
hydrogen peroxide
up to 4x daily for NO > 7->black hairy tongue
190
topical oral protectants
for recurrent aphthous stomatitis (RAS)
canker cover (menthol)
-disc placed against sore
coal and protect the area and provide relief
3-4x daily after meals, avoid drinking 30 min after
191
oral rinses
recurrent aphthous stomatitis (RAS)
helps quickly heal ulcers
-listerine
helps sooth
-saline rinses
192
systemic analgesics for recurrent aphthous stomatitis (RAS)
NSAIDs or tylenol for extra relief of pain
193
referral to PCP recurrent aphthous stomatitis (RAS)
if symptoms do not abate after 7 days with agents
lesions do not heal in 14 days
symptoms worsen
systemic infection
194
tooth hypersensitivity
loss of enamel or gingival recession
dentin tubules must be open to both oral cavity and the pulp
short, sharp pain results when stimuli touch exposed dentin, which stimulates the underlying nerves
195
risk factors of tooth hypersensitivity
regular consumption of acidic beverages
whitening products
teeth clenching or grinding
excessive brushing with hard bristled toothbrush
regurgitation of gastric contents into the mouth (GERD)
orthodontal or periodontal procedures
196
clinical presentation of tooth hypersensitivity
pain from hot, cold, sweet, or acidic beverages, or hot or cold air
pain varies from mild discomfort to sharp, excruciating pain
self-treatable
197
toothache
bacterial invasion
pain that remains even in the absence of stimulus; intermittent, short, and sharp pain on stimulation may indicate reversible pain
continuous, dull, and throbbing pain without stimulation usually indicates irreversible damage
198
tooth hypersensitivity: exclusions for self-care
toothache
fever or swelling
trauma to the mouth with bleeding, swelling, and soreness
loose teeth
bleeding gums
broken or knocked out teeth
severe tooth pain triggered or worsened by hot, cold, or chewing
mouth soreness from dentures
199
nonpharm treatment of tooth hypersensitivity
eliminate predisposing factors-minimize consumption of acidic food or drinks
minimize symptoms of GERD-avoid larges, fattening meals/acidic or spicy foods
correct harsh toothbrushing-soft bristled toothbrush
200
pharm treatment of tooth hypersensitivity
desensitizing toothpaste
201
contraindication of desensitizing toothpaste
products containing potassium nitrate 5% are not recommended in children < 12 years->fluroride toothpaste
202
referrals for tooth hypersensitivity
after 4 weeks if symptoms do NOT resolve with treatment
or if symptoms worsen
203
relief of tooth hypersensitivity
takes several days to weeks
204
do NOT recommend tooth hypersensitivity
eugenol (oil of cloves)
topical anesthetics
205
teething discomfort
emergence of baby teeth through tissues
normal process
occurs over an 8 day period with each tooth
206
clinical presentation of teething discomfort
reddening, irritation, mild pain, low grade fever, gum swelling, drooling, sleep disturbances
eruption cysts->LEAVE ALONE
207
exclusions of self care for teething discomfort
vomiting, diarrhea, fever >101, nasal congestion, malaise, pain
208
nonpharm treatment of teething discomfort
massage gums
cold (NOT frozen) teething rings
cold wet cloth
dry toast or teething biscuits
avoid foods high in sucrose
209
pharm treatment for teething discomfort
AVOID unless nonpharm treatments do not provide adequate relief
acetaminophen: 10-15 mg/kg/dose every 4-6 hrs as needed
ibuprofen: 5-10 mg/kg/dose every 6-8 hrs
210
when to refer to PCP for teething discomfort
do not resolve in 3-5 days of treatment or if pain worsens or new symptoms develop
211
do NOT recommend teething discomfort
topical anesthetics->toxicity (methemoglobenemia) and death
212
monitor and evaluate of teething discomfort
evaluate in 2 days of treatment
213
herpes simplex labialis (HSL)
cold sores
caused by HSV-1
once host is infected, the virus undergoes periods of latency, but the host is infected for life
214
common triggers of herpes simplex labialis (HSL)
stress, fatigue, cold, windburn, UV radiation, injury, fever, infections, or immunosuppression
215
clinical presentation of herpes simplex labialis (HSL)
prodrome
HSL lesions
lips/border of lips
painful, small, red papules of fluid
if pus or pustules appear under crust, secondary infection should be considered and treated
may be surrounded in a red border
216
exclusions for herpes simplex labialis (HSL)
no previous diagnosis of a cold sore
lesions present > 14 days
increased freq of outbreaks
immunocompromised
symptoms of systemic infection
recurrance
217
nonpharm treatment of herpes simplex labialis (HSL)
keep lesions clean (warm water and mild soap)
wash hands
apply lip balm
avoid triggers
218
pharm treatments of herpes simplex labialis (HSL)
topical analgesics
topical antivirals
OTC triple antibiotic (secondary bacterial infection)
systemic analgesics (NSAIDs, tylenol)
219
topical analgesics for herpes simplex labialis (HSL)
relieve burning, itching, and pain
does NOT reduce duration of symptoms
use after meals
safe and effective products: benzocaine, camphor, or menthol
avoid eating or drinking for at least 30 minutes after application
220
contraindication of topical analgesics for herpes simplex labialis (HSL)
>1% menthol bc its a counterirritant
221
topical antivirals for herpes simplex labialis (HSL)
docosanol 10%
-reduce duration and severity of HSL symptoms
-prevents viral replication
5 times daily for up to 10 days
222
complimentary therapy herpes simplex labialis (HSL)
tea tree oil
lysine
lemon balm
223
do NOT recommend herpes simplex labialis (HSL)
topical steroids
highly astringent products
zinc sulfate
224
monitor and evaluate of herpes simplex labialis (HSL)
immunocompetent patients
-HSL is mild and self-limiting
-healing of lesions 10-14 days
referral to PCP
225
referral to PCP for herpes simplex labialis (HSL)
lesions do NOT heal in 14 days
self-treatment measures do not relieve discomfort
signs or symptoms of systemic illness
symptoms change or worsen
226
clinical presentation of xerostomia (dry mouth)
difficulty talking or swallowing
burning tongue
loss of sense of taste and appetite
decline in nutritional status
thrush
halitosis
stomatitis
tooth hypersensitivity
increased risk of dental caries
227
xerostomia (dry mouth) exclusions
sjogren's syndrome or salivary gland stone
bleeding and swelling +/-trauma
loose teeth or tooth erosion/decay
mouth soreness due to poor fitting dentures/reduced denture wearing time
presence of fever and swelling of lymph nodes
candidiasis/gingivitis/periodontitis
severe tooth pain triggered or worsened by hot, cold, or chewing
228
xerostomia (dry mouth) nonpharm
discontinue meds and other substances that reduce salivation: tobacco, caffeine, hot spicy foods, alcohol; or take 1 hr prior to meals
maintain good oral hygiene
chew sugar free gum
increase water intake, especially if it is fluoridated
humidifiers-some relief
use soft bristle toothbrushes
229
xerostomia (dry mouth) pharm treatment
artificial saliva products-NOT cure, replacement therapy
230
xerostomia (dry mouth) referral
should occur if improvement is NOT seen within 7 days of treatment
231
monitor and evaluate for xerostomia (dry mouth)
evaluation after 5-7 days of self-treatment
mouth dryness lessened
-continue using artificial saliva and fluoride products
-continue nonpharm
dryness becomes worse or additional symptoms of complications develop
-referral to PCP for further evaluation
232
self treatment restricted of otic disorders
external disorders-auricle
external auditory canal (EAC)
233
risk factors for cerumen excess or impaction
narrow or irregularly shaped ECAs
excessive hair growth in the ear canal
irritation from foreign objects
atrophy of ceruminous glands (older adults)
genetics
234
clinical presentation for cerumen excess or impaction
fullness/pressure, mild, dull pain, chronic cough, gradual hearing loss, vertigo, tinnitus, impaired cognition (older adults)
235
exclusions for self care for cerumen excess or impaction and water clogged ears
severe pain
signs of infection or ear discharge (irrigation or rash)
bleeding or signa of trauma
presence of ruptured tympanic membrane
tympanostomy tube(s) present
ear surgery within 6 weeks
<12 years of age
worsening of condition after attempted self-treatment
236
nonpharm treatments of cerumen excess or impaction
may self-resolve in mild cases
remove cerumen by using a wet, wrung out wash cloth draped over a finger to prevent impact
DO NOT USE:
cotton swabs, Q tips, or other foreign objects
237
treatment for cerumen excess or impaction
1. cerumen softening agent
2. follow with irrigating the ear canal with an otic bulb and warm water
3. referral if no improvement is seen within 4 days of treatment or if worsening occurs
238
cerumen softening agents
carbamide peroxide
others are least effective
239
carbamide peroxide
2x daily for up to 4 days
intended use: children > 12 years
240
water clogged ears
excessive moisture within the EAC
241
risk factors for water clogged ears
physical or anatomic changes within EAC
-excessive hair growth and canal narrow->excessive ear wax or debris build up
excessive moisture from sweating, swimming, bathing or hot, humid climate
242
clinical presentation of water clogged ears
feeling of wetness, fullness, gradual hearing loss, may lead to tissue maceration that can cause itching, pain, inflammation, or infection
243
water clogged ears nonpharm treatment
pull on ear to get water out
blow dry
clear ears-will not prevent water from entering
244
pharm treatment of water clogged ears
isopropyl alcohol 95% in anhydrous glycerin 5%: swim ear
no mini age
245
referral for PCP for water clogged ears
after 4 days
