Final Exam Flashcards
What is amblyopia?
Lazy eye
Why should you not press on the eye with a pt presenting with eye trauma?
Extrusion of vitreous humor into cheek
When should you refer a pt with eye trauma to an ophthalmologist?
Diminished vision
Disturbed or asymmetric pupils
Evidence of retinal damage
Ocular misalignment (diplopia)
Hyphema (can precipitate acute glaucoma)
Homeopathy for eye trauma
Acontite - trauma, abrasions; scratched cornea, severe pain
Symphytum - blunt trauma to GLOBE
Arnica - orbit injuries, typical arnica pic
What is a Subconjunctival hemorrhage?
Spontaneous appearing patch of hemorrhage over sclera; painless, normal vision
Causes and RF Subconjunctival hemorrhage
Usually follow minor trauma, coughing, sneezing
Inc incidence with HTN, bleeding disorders
If you have a patient complaining of gradual loss of vision, difficulty driving at night; what is your ddx?
Cataracts
Ophthalmoscopic exam findings with cataracts
Red light reflex dec or absent
Difficult to see in the eye
Pathogenesis mechanisms for glaucoma
Mechanical (IOP related)
Vascular (HTN)
Glutamate toxicity
Signs/sx acute angle closure glaucoma
Red eye, N/V, diminished vision
Can come on after exposure to dark environment
Perilimbal injection, cloudy cornea, ant angle narrow, pupil fixed and dilated
Tactile tonometry firm
Wet v dry ARMD
Dry - gradual loss of vision in one/both eyes, difficulty reading or driving, using lights/magnification, slow onset with intact peripheral vision
Wet - new vessels form and break easily; occurs acutely, difficulty with seeing straight lines or central vision, usually one eye
What is a cholinergic medication?
Meds that ach through Ach, either by binding to its receptors or changing its concentration
What are muscarinic agonists also called?
Parasympathomimetic meds ; Muscarinic agonists will mimic parasympathetic nervous system stimulation.
What EENT conditions use muscarinic agonists?
Acute angle-closure glaucoma
Maintenance med in primary open-angle glaucoma
Dry mouth and dry eyes in sjogrens
for what EENT conditions are muscarinic antagonists used?
Topically for pupil dilation during ophthalmic procedures
Used as cycloplegics for uveitis, iritis, UV keratitis
what patient population should avoid muscarinic antagonists?
Elderly due to risk of confusion, sedation, dry mouth and eyes, constipation, and urinary retention
Patients with glaucoma and those at risk of acute angle-closure glaucoma
What are adrenergic medications?
Act by binding to adrenergic receptors or by changing the concentration of norepinephrine and epinephrine.
What are adrenergic agonists also called?
Sympathomimetics
For what EENT conditions are alpha 1 agonists used?
Nasal congestion and red eyes
For what EENT conditions are Alpha 2 agonists used?
Glaucoma
For what EENT conditions are Beta blockers used?
Glaucoma
What patient population should avoid alpha 1 agonists?
HTN/CVD
Angle closure glaucoma
Urinary retention
Bowel obstruction
What patient population should avoid Beta blockers?
Pts with asthma or obstructive airway disease
What are the effects of histamine in the allergic response?
Vasodilation and inc vascular permeability (edema, redness, inc mucosal secretions)
Stimulation of afferent neurons, leading to pruritis and pain
Contraction of bronchial smooth muscle, leading to bronchoconstriction
Role of H1 histamine receptors
Allergic response
Role of H2 histamine receptors
Regulation of acid secretion by gastric mucosa
What EENT conditions are treated with H1 antagonists?
Reduce itching, sneezing, rhinorrhea, and congestion of allergic rhinitis
Itching, redness, and watery eyes of allergic conjunctivitis
Which pt populations should avoid antihistamines?
Children <2
Elderly (fall down ouch ouch)
MOA of antihistamines vs mast cell stabilizers
Antihistamines: block histamine receptors
Mast cell stabilizers: prevent release of histamine from mast cells
What EENT conditions are treated with mast cell stabilizers?
IN for allergic rhinitis
Eye drops for allergic conjunctivitis
Topically for allergic conjunctivitis
What are the 2 eicosanoid synthetic pathways and what eicosanoids are made by each?
cyclooxygenase (COX) pathway - prostaglandins and thromboxane
Lipoxygenase (LOX) pathway - leukotrienes
How are NSAIDs used to treat EENT conditions?
fever and pain
How are prostaglandins used to treat EENT conditions?
Glaucoma
How are leukotriene antagonists used to treat EENT conditions?
Allergic rhinitis
Chronic rhinosinusitis
What is Episcleritis?
Inflammation of CT under conjunctiva
What is Episcleritis?
Inflammation of CT under conjunctiva
Episcleritis vs scleritis
Episcleritis - sudden onset, no vision changes, blanches with topical phenylephrine
Scleritis - more intense, red eyes, blurred vision, photophobia, intense eye pain, dec visual acuity
RF senile cataracts
Ocular disease, injury, surgery
DM
Galactosemia
UV light
Smoking
Genetics
Statin use
Cataract PE findings
Red light reflex dec or absent
Sx of acute closure glaucoma
Red eye
N/V
Diminished vision
Sx may begin after exposure to dark environment
PE/signs acute angle glaucoma
Perilimbal injection
Cornea cloudy, ant angle narrow, pupil fixed and dilated
Tactile tonometry firm
Mechanisms of primary open angle glaucoma
Mechanical
Vascular
Glutamate toxicity
Primary open angle glaucoma sx/signs
Loss of peripheral vision > loss of central visual acuity
Loss of peripheral fields
Inc cup to dis ratio
Inc IOP
____ makes up 80-95% of cases of ARMD
DRY ARMD
the presence of _____ indicates age related macular degeneration
Drusen bodies
Signs/sx of retinal detachment may be preceded by:
Dark, large, irregular floaters
Flashes of light and blurred vision
Curtain or veil in field of vision
PE findings retinal detachment
Irregular, folded, darkened BVs
euphrasia officinalis common name and parts used
Eyebright, leaf and flower
Euphrasia/eye right actions
Decongestant
Antiinflammatory
Astringent
Antiseptic
Expectorant
Euphrasia/eyebright indications
Conjunctivitis and nasal congestion
What types of conditions is euphrasia/eyebright specific for?
Acute disorders of the nasal mucus membranes, esp with kids
Accompanied by watery dc, earache, headache, eye distress in acute catarrhal affections > direct action on lachrymal apparatus
Amoracia rusticana common name and parts used
Horseradish
Fresh, Raw, grated roots
Amoracia/horseradish actions
Decongestant
Mucolytic
Stimulant
Diaphoretic
Rubefacient
Digestive stimulant
Amoracia/horseradish Indications
Sinusitis
Topically for neuralgia and chilblains
allium sativum common name/parts used
Garlic
Cloves
Allium/garlic actions
Antimicrobial
Anthelmintic
Antiparasitic
Antifungal
Immune support
Spares lactobacillus
Synergistic to antibiotics
Circulatory stimulant
Mucolytic
Urtica/nettle actions
Antihistamine
Antiinflammatory
Urtica/nettle indications
Allergic rhinitis
Tanacetum parthenium common name and parts used
Feverfew, leaf and flower
Tanacetum/feverfew Energetics
Drying and warming
Tanacetum/feverfew Actions
Antimicrobial
Antiinflammatory
Febrifuge
Reduces inflammatory mediators
Inhibits prostaglandin synthesis
Vascular stabilizer - prevents dilation/contraction, inhibits release of histamine from mast cells
Tanacetum/feverfew Indications
Migraine headache with internal heat
RA pain and inflammation
Febrile illnesses
Petasites hybridus common name and parts used
Butterbur
Rhizomes, roots and leaves
Petasites/butterbur actions
Smooth muscle antispasmodic
Antiinflammatory
Anti allergy
Petasites/butterbur Indications
Respiratory conditions such as asthma, bronchitis, hay fever
Migraine headache
What herb was found to be equally effective as cetrizine (Zyrtec) but without sedation, just as effective as Allegra, and more effective than desloratadine (Claritin)?
Petasites hybridus (butterbur)
Ganoderma lucidum common name and parts used
Reishi, ling zhi
Fruiting body
Ganoderma/reishi actions
Anti allergic
Antihypertenive
Dec platelet aggregation, LDL, arrythmia, insomnia, angina
Protects against ionizing radiation
Ganoderma/reishi Indications
In allergy to dec histamine response
Cancer treatment to inc immune function and help treat fatigue
HTN
Immune deficiency
Insomnia
Hepatitis
Scutellaria baicalensis part used
Root
Scutellaria actions
Anti allergic
Antiinflammatory
Antineoplastic
Antioxidant
Cardioprotective
Antimicrobial
Scutellaria indicatinos
Regulation of sleep cycle
Anxiety
Synergistic relationship with eleutherococcus with blocking allergic mediators/cytokines
Phytolacca Americana common name and part used
Poke root
Phytolacca/poke root energetics
Cooling
Phytolacca/poke root Actions
Lymphagogue
Antiviral
Emetic
Purgative
Laxative
Phytolacca/poke root Indications
Hard, painful glandular swellings
Mastitis
Phytolacca/poke root CI
Pregnancy
Toxic at high dose
Can cause dermatitis when collected
Stillingia sylvatica common name and part used
Queens root
Stillingia/queens root actions
Lymphagogue
Emetic
Cathartic
Stillingia/queens root indications
Dry, red, irritated mucous membranes of larynx, pharynx, bronchi
Croup cough
Stillingia/queens root Caution/CI
Sylvacrol in fresh root tincture may cause GI burning, diarrhea, N/V, tachycardia, muscular weakness, prostration
HEMP formula for pharyngitis
Hydrastis
Echinacea
Myrrh
Phytolacca
Herb for conjunctivitis
Euphrasia/eyebright compresses for relief of redness, swelling and visual disturbances in eye inflammations and injuries and corneal ulcers
Herbs to treat/prevent cataracts
Cineraria maritima
Trigonella foenum-graecum
Ginkgo
Cineraria maritima common name
Dusty miller
Cineraria/dusty miller uses
Juice dropped into eyes to treat cataracts, prevention of cataract formation
Trigonella foenum graecum common name
Fenugreek
Trigonella/fenugreek uses
Prevention of cataracts - restoration of antioxidant enzymes
Ginkgo cataract MOA
EGb761 -
Reduced intensity of oxidative stress
Dec aldose reductase activation and AGEs
Suppressed transforming growth factor B2
Inc the expression of E cadherin
Dec alpha smooth muscle actin
Herbs for macular degeneration and glaucoma
Ginkgo
Vaccinum
Vaccinum myrtillus part used
Berry
Vaccinium myrtillus actions
Inflammation modulator
Antioxidant
Improves circulation
Stabilizes collagen
Inhibits platelet aggregation
Prevention of release and synthesis of pro inflammatory compounds such as histamine, prostaglandins, leukotrienes
Vaccinium myrtillus indications
Dry eyes
Eye fatigue
Diabetic retinopathy
Macular degeneration
Glaucoma
