Eye, Nose, Ear, Skin, Vaccines and Anaesthesia Flashcards
What are the clinical features of blepharitis?
Inflammatory conditions affecting lining the the eyelid - bilateral
Burning, itching and crusting of the eyelid
How do you manage blepharitis?
1st line: Eyelid hygiene
Posterior blepharitis - eyelid massage
Anterior blepharitis, consider prescribing a topical antibiotic (such as chloramphenicol) to be rubbed into the lid margin
Which drugs stain lenses orange?
Rifampicin
Salfasalazine
What drugs are used for allergy eye?
Sodium cromoglicate - mast cell stabiliser
Antazoline and azelastine - antihistamine
Xylometazoline and naphazoline - vasoconstrictors
What drugs are used for dry eyes?
Mild - hypermellose or carbomer/ polyvinyl alcohol QDS
Moderate-severe - carmellose or sodium hyaluronate
How do you treat bacterial infected eye?
Chloramphenicol
How do you treat a HSV eye infection?
Aciclovir 5 times a day until 3 days after healing
How do you treat glaucoma and cataracts?
Topical corticosteroids
What are the risks of using corticosteroids for ‘red eye’ caused by HSV?
Corneal ulcers and blindness
How should corneal ulcers be treated?
Ciprofloxacin intensive course
What is used to dilate pupils in eye examinations?
Cycloplegics and mydriatics e.g.
- antimuscarinic: atropine (action up to 7 days)
- Phenylephrine (MAOI interaction - risk of hypertensive crisis = avoid for 14 days after stopping MAOI): Mydriasis occurs within 60–90 minutes and lasts up to 5–7 hours
How is glaucoma characterised?
Raised intraocular pressure and loss of visual field
What are the symptoms of close-angle glaucoma?
Cloudy eyes
N/V
Headache
Intensive eye pain
Blurred vision
Sight loss
Rainbow rings around lights
How is open-angle glaucoma treated?
1st line: prostaglandin eye drops
‘-prost’
SE: long eye lashes, dark iris
then alternative postaglandin
2nd line: BB e.g. betaxolol, levobunolol or timolol
3rd line: carbonic anhydrase inhibitors e.g. brinzolamide or dorzolamide
OR
Topical sympathomimetics e.g. apraclonidine or brimonidine
What are the risks associated with corticosteroids for the eye?
Red eye
Steroid glaucoma
Steroid cataracts
What corticosteroid is licensed for macular oedema?
Intravitreal implant containing dexamethasone
What corticosteroid is licensed for visual impairment associated with chronic diabetic macular oedema
Intravitreal implant containing corticosteroids
What is the minimum gap you should leave between eye preperations?
5 minutes
What excipients in skin preperations cause be toxic yo neonates?
Salicylate - toxicity if applied in large areas
Benzyl alcohol - fatal toxicity
How is eczema treated?
Emollient + topical corticosteroid
- often as required
- directed of hair growth
- damp skin to maximise hydration
Use emollients first then wait 30 minutes before applying steroid cream
What is the MHRA warning for emollients?
Fatal burns with paraffin-based and paraffin-free products
- do not smoke or go near naked flames
- wash clothes at high temperatures to avoid build-up
Which corticosteroid is very potent?
Clobetasol
Which corticosteroids are potent?
Bethamethasone 0.1%
Hydrocortisone Butyrate
Mometasone
Which corticosteroids are moderately potent?
Clobetasone
Which corticosteroids are mildly potent?
Hydrocortisone <2.5%
What are the contraindications for topical corticosteroids?
Rosacea
Acne
Skin infections
What are the side effects of topical corticosteroids?
Skin thinning
Discolouration
Withdrawal
What are the MHRA warnings for topical corticosteroids?
Long-term use especially with moderately or highly potent = rebound flares
- use lowest potency, frequency and duration
What counselling should be provided to a patient using topical corticosteroids?
Seek advise before using on new body area
If skin worsens <2 weeks of stopping - do not restart treatment unless advised by a doctor
What is isotretinoin?
Vitamin A derivative
What are the MHRA warnings for isotretinoin?
Erectile dysfunction and decreased libido
Oral retinoid medicines: revised and simplified pregnancy prevention educational materials for healthcare professionals and women
- neuropsychiatric reactions reported with oral retinoids
Isotretinoin - reminder of risks
New safety meausres
- 2 independent prescribers when initiating for patient <18
- benefits and risks and given time to reflect and ask questions
- improved assessment and monitoring of mental health and sexual function before starting and during treatment
- reviewed one month after starting by specialist in retinoids
- compulsory risk minimising material: risk acknowledgement forms, patient reminder cards, and pharmacist checklists
What are the rules for contraception when using isotreinoin?
Negative pregnancy test every month and 1 month after stopping
- same day prescribing and dispensing (30-day supply)
Effective contraception 1 month before, during and after - IUD or progesterone only implant
What are the side effects of isotretinoin?
Neuropsychiatric reactions
Skin reactions: dry, red, photosensitive, fragile
- counsel: avoid wax, epilation, dermabrasion/ laser for 6 months after
- avoid UV light: SPF!!
- severe skin peeling - STOP
Erectile dysfucntion
Vision disorders
Haemorrhagic diarrhoea and pancreatitis
- risk if high triglycerides - STOP
What allergy should you be careful of with the flu vaccine?
egg
Which group of people should live vaccines be avoided in?
Immunocompromised patients
Which vaccines should 2 month old babies be given?
6 in 1 (1st dose)
Rotavirus (1st dose) - oral vaccine: gastroenteritis
MenB
Which vaccines should 3 month old babies be given?
6 in 1 (2nd dose)
Rotavirus (2nd dose)
Pneumococcal (PCV)
Which vaccines should 4 month old babies be given?
6 in 1 (3rd dose)
MenB (2nd dose)
What vaccines should 1 year old babies be given?
MMR (1st dose)
MenB (booster)
PCV (booster)
Hib/ MenC
What vaccines should babies who are 1 year and 4 months be given?
4 in 1 pre-school booster
MMR (2nd dose)
What vaccines should 12-13 year olds be given?
HPV (1st dose)
- 2nd dose 6-24 months later
What vaccines should 14 year olds be given (year 9)?
3 in 1 teenage booster
Men ACWY
What vaccines are recommended to people ages under 25 before entering uni?
Men ACWY if not had over age 10
What vaccines are recommended for adults aged 65?
Pneumococcal vaccine (PPV)
Shingles Vaccines (VZV) - then again between the ages of 70-79
over 65 - flu’s yearly
When should HepB vaccine be given?
At birth
12 weeks
12 months if mother infected
When is the TB (BCG) vaccine given?
At birth in areas at high risk of TB
What is the treatment for post-immunisation pyrexia?
Paracetamol (120mg/5ml)
- if they are 2 months and >4kg
- 1st dose 60mg ASAP
- Further dose: 60mg after 4 hours + PRN
- no more than 4 doses in 24 hours
Ibuprofen (100mg/5ml)
- if they are over 3 months and weight >5kg
- 1st dose 50mg ASAP
- 2nd dose 50mg after 6 hours PRN
- no more than 2 doses in 24 hours
What is the interaction between corticosteroids and anaesthesia in adrenal insufficiency?
Severe hypotension
What drugs should be stopped before surgery?
COC: risk of VTE
- stop 4 weeks before major surgery, leg surgery or prolonged immobility
HRT: VTE
- stop 4-6 weeks before surgery and restart when fully mobile
Antidepressants
- MAOI: hypertensive crisis
- TCA: arrhythmia and hypotension
Lithium: constant fluid and electrolyte imbalance
- stop 24 hours before major surgery
Oral anticoagulants: bleeding
- high VTE risk, bridge with heparin
Diabetes surgery: hyperglycaemia
ACEi/ARB - hypotension
What diabetes medication should you stop before surgery?
Minor surgery - stop metformin, sulfonylureas and SGLT2
Major surgery - sliding scale insulin
Which drugs should you not stop before surgery?
Antiepileptics
Antiparkinsons
Antipsychotics
Antixiolytics
Bronchodilators
Cardiovascular drugs
Glaucoma drugs
Immunosuppressants
Progesterone- only contraceptives
Thyroid and anti-thyroid drugs
How is facial erythema associated with rosacea treated?
Brimonidine
What are the MHRA warning associated with brimonidine?
Risk of systemic cardiovascular events
- bradycardia, hypotension, dizziness
- to minimise systemic absorption, avoid application to irritated or damaged skin including after laser treatment
Risk of exacerbation of rosacea
- initial treatment with small amount of gel for 1 week then increase gradually based on tolerability and response
- counsel not to exceed maximum daily dose
How do you treat papules and pustules?
Mild-moderate:
- topical ivermectin for 8-12 weeks
- alternative: topical metronidazole 0.75% BD OR azelaic acid 15% BD
Moderate-severe:
- topical ivermectin + MR doxycycline 40mg OD for 8-12 weeks
- alternative Abx = oxytetracycline 500 mg twice daily or tetracycline 500 mg twice daily, or erythromycin 500 mg twice daily for pregnant or breastfeeding women
