Lecture 1 Stuff

Question 1

What are the components of STEPS?

Answer 1

Summarize the problem and characterize severity. (determines where your patient should be treated)
Take into consideration key pieces of information and data. (determines what drug therapy you should recommend)
Evaluate the options.
Provide a recommendation. (ensures patient will follow recommendations)
Suggest an appropriate monitoring and follow up plan. (ensures safety and efficacy of your recommendations)

Question 2

What are the components of QuEST?

Answer 2

Quickly and accurately asses the patient. (SCHOLAR MAC)
Establish that the patient is an appropriate self-care candidate.
Suggest appropriate self-care strategies.
Talk with the patient.

Question 3

What are the components of SCHOLAR MAC?

Answer 3

Symptoms
Characteristics
History
Onset
Location
Aggravating factors
Remitting factors
Medications
Allergies
Coexisting Conditions

Question 4

What illness/injuries are self care options?

Answer 4

Cold/Flu Symptoms
Minor Allergic Reactions
Bumps, Cuts, and Scrapes
Allergies
Immunizations
Coughs/Sore Throat
Rashes and Minor Burns

Question 5

What illness/injuries are retail health clinic options?

Answer 5

Eye Irritation, swelling pain
Ear or sinus pain
Burning with urination
Fevers

Question 6

What illness/injuries are physician’s office options?

Answer 6

Blood Work
Foreign Object in Eye or Nose
Minor Headaches
Mild Asthma
Nausea, Vomiting, Diarrhea
Sprains and Strains
Back Pain

Question 7

What illness/injuries are urgent care center options?

Answer 7

Stitches
X-Rays
Animal Bites
Minor Fracture

Question 8

What illness/injuries are emergency department options?

Answer 8

Poisoning
Labor
Spinal Cord or Back Injury
No Pulse
Significant, Uncontrolled Bleeding
Symptoms of an MI or Stroke
Major Fractures or Burns

Question 9

When a patient has dry eye it is important to prevent blepharitis which is one of the most common causes of dry eye. This can be prevented by washing eyelids with what?

Answer 9

Eye lids can be scrubbed at base of the lash with a cotton swab dipped in baby shampoo/sodium bicarbonate solution, dilute tree oil, or commercially available wipes.

Question 10

What can cyclosporine be used for?

Answer 10

When a patient has severe dry eye. Must be under the care of an eye care professional.

Question 11

Artificial Tear Solutions for dry eyes are usually applied how often?

Answer 11

1-2 times daily but can be given hourly if necessary

Question 12

What are the vehicles that act as ocular lubricants and what are their benefits?

Answer 12

Cellulosoe ethers - Stabilize tear film, slowing evaporation
Polyvinyl alcohol (PVA) - Enhances stability of tear film
Povidone - Promotes wetting of the ocular surface.

Question 13

Should preservative containing products be used?

Answer 13

They should be avoided because of the possibility of causing a patient to develop a hypersensitivity.

Question 14

How should eye drops be administered?

Answer 14

Wash your hands and remove contacts, if applicable.
Tilt back head and grasp lower outer eyelid below the lashes and pull out to create a pouch.
Place bottle above the eye.
Look up just before administering the drop.
Apply the drop and slowly release eyelid.
Close eyes and tilt head down for 3 minutes.

Question 15

How often are ointments administered?

Answer 15

Typically administered twice daily but can be administered every few hours as needed.

Question 16

What are the different ophthalmic ointment ingredients and what are their benefits?

Answer 16

White Petrolatum - Lubricant and ointment base
Mineral Oil - Facilitates melting of ointment at body temperature
Lanolin - Facilitates incorporation of water-soluble medications and prevents evaporation.

Question 17

What are some ophthalmic preservatives?

Answer 17

benzalkonium chloride (BAK), Chlorhexidine, Methylparaben, Propylparaben, Purite, Thimerosal

Question 18

What are disappearing-preservative products and how can they help patients?

Answer 18

These products allow for the preservative to disassociate into a non-toxic compound in the eye. They are ideal for patients who are sensitive to preservatives, use drops frequently, and/or have compromised corneas.

Question 19

What other ophthalmic preparations are reserved for moderate to severe cases of dry eye and must be used under the care of an eye care professional?

Answer 19

Anti-inflammatory agents - Cyclosporine, topical or systemic corticosteroids, systemic tetracycline, and systemic fatty acids.
Secretagogues such as pilocarpine and cevimeline- stimulate tear production, limited by systemic effects like sweating nausea, GI cramping

Question 20

What is appropriate eye ointment administration?

Answer 20

Wash your hands and remove contacts, if applicable.
Tilt back head and grasp lower outer eyelid below the lashes and pull out to create a pouch.
Place 1/4 to 1/2 inch of ointment inside the lower eyelid as pictured below. Avoid touching the lube to the eye.
Release eyelid slowly and close eyes for 1-2 minutes.

Question 21

What does the term “pink eye” refer to?

Answer 21

Any type of conjunctivitis and should be avoided due to the negative connotation associated with it

Question 22

What are ophthalmic decongestants(alpha-adrenergic agonists) that could be used for allergic conjunctivitis?

Answer 22

Phenylephrine, naphazoline, tetrahydrozoline, and oxymetazoline. All OTC and cause vasoconstriction which reduces ocular redness, vascular congestion, and eyelid edema but not the allergic response. Rebound congestion may occur limiting use to 72 hours but less likely to occur with naphazoline and tetrahydrozoline. Caution should be used with patient with hypertension, cardiovascular disease, or diabetes. May cause ocular dryness.

Question 23

What are the ophthalmic antihistamines that may be used?

Answer 23

Pheniramine maleate
Antazoline phosphate
- only available in combination with decongestants. They tend to burn, sting, and produce discomfort upon application. Should not be used in patients with angle-closure glaucoma.

Question 24

What is first line therapy for allergic conjunctivitis after failure of ophthalmic lubricants?

Answer 24

Ophthalmic Antihistamine/Mast Cell Stabilizers. Inflammatory mediator release is inhibited by the mast cell stabilization activity of this drug. These products also burn, sting, and produce discomfort upon contact with the ocular surface.

Question 25

When should topical agents be used for allergic conjunctivitis?

Answer 25

When there are ocular symptoms present. Oral antihistamines are most often used when systemic symptoms are present in addition to ophthalmic symptoms, but can also be used if symptoms persist with topical AH/Mast cell stabilizer use.

Question 26

What is important to tell patients with viral conjunctivitis about their bottle?

Answer 26

If it touches their eye, it will need to be discarded.

Question 27

What organisms usually cause bacterial conjunctivitis?

Answer 27

Staphylococci, Streptococci, and H. influenza

Question 28

What ophthalmic preparations may you refrigerate if you have trouble telling if it is hitting the ocular surface?

Answer 28

Solutions. Do not refrigerate Suspensions!!!

Question 29

How often should drops be administered apart when using multiple medications?

Answer 29

5 minutes

Question 30

What dosage form should be shaken well before use?

Answer 30

Suspensions

Question 31

How many minutes should you use drops before using a ointment?

Answer 31

10 minutes

Question 32

What is the order of application?

Answer 32

Solutions - suspensions - ointments

Question 33

How many days should you use eye drops before discarding?

Answer 33

30 days after opening. Original manufacturer’s expiration date no longer valid after opening.

Question 34

What is the recommendation for someone who has dry eyes?

Answer 34

Artificial tears 1-2 times daily. Ophthalmic lubricants bid. If symptoms do not improve within 3 days see provider.

Question 35

What is the recommendation for someone who reports foreign body sensation in one eye; pink and watery?

Answer 35

Likely viral conjunctivitis because of no itching and single eye. It is self limiting so you could do nothing. You could use preservative free ophthalmic lubricants bid and cold compresses. If symptoms do not improve within 7-10 days see a provider.

Question 36

What is the recommendation for someone who reports of itchy watery eyes and has tried ocular lubricants with no relief?

Answer 36

Probably has allergic conjunctivitis. Ketotifen OU BID and cool compresses. If symptoms do not improve within 3 days see provider.

Question 37

What is the recommendation for someone who reports of a red bump on her right eyelid that is slightly swollen and tender upon palpation?

Answer 37

Patient likely has a hordoleum(sty). Warm compresses. Topical antibiotic bid to tid. If symptoms do not improve within a week or if they worsen see provider.

Question 38

Why would you use a cold compress?

Answer 38

Reduce inflammation

Symptom relief

Question 39

Why would you use heat therapy?

Answer 39

Increases blood flow

Treatment or drainage