Eyes, Ears, Nose & skin conditions Flashcards
intranasal steroids
first line for chronic, moderate-to-severe symptoms of allergic rhinitis
oral antihistamines
used in milder, intermittent symptoms of allergic rhinitis
Common intranasal steroids
budesonide (rhinocort allergy) - OTC (preferred in pregnancy)
Fluticasone (flonase) - RX and OTC
Triamcinolone (Nasacort) - OTC
antihistamines
-blocking histamine at the H1 receptor
-effective at reducing symptoms of itching, sneezing, rhinorrhea
-have little effect on nasal congestion
1st generation antihistamines
benadryl, hydroxyzine, mecliizine cause more sedation
diphenhydramine (benadryl)
-treatment of acute allergic rxns
-prevention of allergic rxns
-allergic rhinitis
-cough
-sleep
-dystonic reactions (anticholinergic properties)
-motion sickness
*avoid in elderly (BEERS List-anticholinergic effects)
what disease states can benadryl worsen
BPH, constipation, dementia, glaucoma
benadryl dose
25 mg PO Q4-6H or 50 mg PO Q6-8H
benadryl in those < 6
do not use unless directed by healthcare provider
fenofaxidine
do not take with fruit juice due to decrease absorption
antihistamines to use in pregnancy
loratadine and cetirizine
most sedating second generation antihistamines
cetirizine and levocetirizine
least sedating second generation antihistamines
fexofenadine and loratidine
problems with afrin
rebound congestion if used longer than 3 days (rhinitis medicamentosa)
intranasal cromolyn
OTC mast cell stabilizer used for tx or ppx of allergic rhinitis
montelukast
leukotriene modifying agent indicated for treatment of both allergic rhinitis and asthma
common cold
zinc or vitamin C (shown to decrease days of cold symptoms)
dextromethorphan
-acts as a serotonin reuptake inhibitor at usual doses
-high doses act as an NMDA-receptor blocker and cause euphoria and hallucinations
safety of dextromethorphan +/- guaifenesin
-do not use within 14 days of MAOi
-risk of serotonin syndrome
codeine safety (C2 as a single agent and CIV as combined)
-respiratory depression/death
-ultra-rapid metabolizers due to CYP450 2D6 polymorphisms
-do not use in children under 12 or in children < 18 who underwent a tonsillectomy and/or adenoidectomy
combined products: D
decongestant (phenylephrine or pseudoephedrine)
combined products: PE
phenylephrine
combined products: DM
dextromethorphan
combined products: AC
contains codeine
guaifenesin
ycolytic
analgesic
contains cough and cold products
chlorpheniramine/hydrocodone
Tussicaps/Tussionex
CII
cough/cold products: children < 18 years
avoid codeine and hydrocodone - containing cough and cold products (FDA)
cough/cold products: children < 4 years
avoid otc cough and cold products
cough/cold products: children < 2 years
-avoid otc cough and cold products
-avoid promethazine
-avoid topical menthol and camphor
AD
right ear
AS
left ear
AU
each ear
OD
right eye
OU
each eye
OS
left eye
eye/ear solutions: 1 drop
0.05 mL
drugs that increase IOP
-anticholinergics
-decongestants
-chronic steroids
-topiramate
normal IOP
12-22
open-angle glaucoma
no symptoms and treated with eye drops or surgery
close-angle glaucoma
blockage and sudden increase of IOP - medical emergency and treated surgically
glaucoma treatment
-prostaglandin analogs (most effective at reducing IOP)
-ophthalmic beta-blockers (timolol) is preferable if the pressure is high in only one eye
reduce aqueous humor production (make less fluid)
-beta blockers
-carbonic anhydrase inhibitors like dorzolamide
increase aqueous humor outflow (move fluid out)
prostaglandin analogs (lantanoprost)
if you want to make less fluid and move the remaining fluid out
alpha-2 agonists (brimonidine)
Prostaglandin analogs (bimatoprost, latanoprost, travoprost)
-darkening of the iris and eyelashes
-increase eyelash length and strength
-blurred vision, stinging
eye drop BB (timolol)
burning, stinging, bradycardia/fatigue, bronchospasm
dorzolamide
caution use in those with sulfa allergy
bacterial pink eye
moxifloxacin, neomycin/polymyxin B/dexametasone, ofloxacin, trimethoprim/polymyxin B
eye inflammation
prednisolone (Pred Forte, Pred Mild)
Ketorolac (Acular)
-short term use due to increased IOP
eye dryness
Refresh (OTC) and Systane
-artifical tears
chronic dry eye
cyclosporine emulsion eye drops (Restatsis)
eye redness
Naphazoline (clear eye redness relief)
Naphazoline/Pheniramine (Naphcon A, Visine A)
Tetrahydrozoline (Visine)
drugs that cause retinal changes/retinopathy
chloroquine
hydroxychoroquine
drugs that cause optic neuropathy
amiodarone, ethambutol, linezolid
drugs that cause intraoperative floppy iris syndrome (IFIS)
alpha-blockers (tamsulosin)
drugs that cause color discrimination in the eye
digoxin, PDE-5 inhibitors (greenish tinge), voriconazole (color vision changes)
drugs that cause vision loss/abnormal vision
digoxin (halos), PDE-5 (vision loss; can be permanent), isotretinoin (decreased night vision - can be permanent, dryness, irritation), topiramate (visual field objects), vigabatrin (permanent vision loss), voriconazole (abnormal vision, photophobia)
otitis externa
ciprofloxacin and dexamethasone (ciprodex)
ciprofloxacin and hydrocortisone (cipro HC)
neomycin, colistin, hydrocortisone and thonzonium (Cortisportin-TC)
ear wax (cerumen)
carbamide peroxide (Debrox)
drugs that turn skin/secretions: brown
entacapone, levodopa, methyldopa
drugs that turn skin/secretions: brown/black/green
iron (black stool)
methocarbamol
drugs that turn skin/secretions: brown/yellow
nitrofurantoin
flagyl
tinidazole
riboflavin
drugs that turn skin/secretions: purple/orange/red
chlorzoxazone
drugs that turn skin/secretions: orange/yellow
sulfasalazine
drugs that turn skin/secretions: yellow-green
propofol, flutamide
drugs that turn skin/secretions: red-orange
phenoazopyridine, rifampin, rifapentine
drugs that turn skin/secretions: red
anthracyclines, deferasirox (urine)
drugs that turn skin/secretions: blue
methylene blue, mitoxantrone
drugs that turn skin/secretion: blue-gray
amiodarone, chloroquine
acne treatment options
OTC benzoyl peroxide and salicylic acid
retinoids, topical or systemic oral abx, and systemic isotretinoin
-some women benefit from birth control
-azelaic acid
-clascoterone
retinoids
take 4-12 weeks to work and acne can worsen initially
isotretinoin (Acutane)
-severe, recalcitrant nodular acne only
-REMS
-Tetraogenic - pregnancy test required; do not get pregnant for 1 month before, while taking, or 1 month after this drug; 2 negative test required before starting
-cholesterol testing required
-dry chapped lips, eyes, and skin
mild acne treatment
first line: topical - BPO and/or retinoid
moderate acne treatment
first line: topicals combination or PO abx + BPO + topical retinoid +/- topical antibiotic
severe acne treatment
first line: topical combination + PO abx or PO isotretinoin
minocycline
photosensitivity, fetal harm, discoloration in teeth `
cold sores
abreva: apply 5x daily at first sign of outbreak
Zovirax: apply 5x daily for 4 days
Dandruff
OTC: ketoconazole 1% shampoo, selenium sulfide, pyrithione zinc (head and shoulders), coal tar shampoos
RX: ketoconazole 2%
drugs that can cause alopecia
chemotherapy, valporate, spironolactone, heparin, warfarin
alopecia: finasteride
-finasteride (propecia) - takes 3 months to see effect
-procar is used for BPH
-do not dispense propecia if patient is on procar for BPH
-contraindicated in pregnancy
-hazardous to women in child bearing age
alopecia: minoxidil
-OTC solutions and Rx used for HTN
bimatoprost (latisse)
used for thining of eyelashes - do not use with prostaglandin analogs due to risk of increased IOP
eczema: OTC
aquaphor, eucerin
eczema: topical calcineurin inhibitors
tacrolimus (protopic) or pimecrolimus (elidel)
-do not use in children < 2 years of age; associated with lymphoma and skin cancer; use only as second-line drugs for short term
eczema: topical phosphodiesterase-4 inhibitor
crisaborole (Eucrisa)
eczema: IL-4 antagonist
dupilumab (dupixent)
eczema: janus kinase inhibitors
ruxolitinib (opzelura) and upadacitinib (rinvoq)
athlete’s foot (tinea pedis)
itching, peeling redness, mild burning
jock itch (tinea cruris)
red, itchy, sometimes ring shaped rash in the genitals, inner thighs, or buttocks
ringworm (tinea corporis)
circular, red, flat sores
cutaneous (skin) candida infections
red, itchy, rashes in the groin, armpits, and skin folds
counseling for topical antifungals
apply 1-2 inches beyond rash
apply for 2-4 weeks even if it appears healed
reduce moisture to the infected area
onychomycosis (toe nail fungus)
terbinafine (topical for mild infections and systemically for severe infections) - typically used with topicals
-labs for liver function prior to therapy due to hepatotoxicity
vaginal fungal infection
-mild infection: 1, 3, 7 day tx available
-severe infection needs to be evaluated by physician for longer tx of 7-10 days
clomtrimazole, miconazole, butoconazole, fluconazole oral
diaper rash
destin (petrolatum/zinc oxide)
hemorrhoids
preparation H (phenylephrine)
pinworm
pyrantel pamoate
lice
permethrin or pyrethrin/piprtonyl butoxide
minor wounds
neosporin (polymyxin/bacitracin/neomycin)
bactroban (mupirocin)
cortisporin (bacitracin/neomycin/polymixin B/ hydrocortisone)
topical steroids: very high potency
clobetasol proprinate
flucinonide 0.1% cream
topical steroids: high potency
betamethasone dipropionate 0.05% cream
fluocinonide 0.05% ointment
mometasone furoate 0.1% ointment
topical steroids: high-medium potency
fluocinonide 0.05% cream
topical steroids: medium potency
mometasone furorate 0.1% cream
triamcinolone acetonide 0.1% cream
