Ophthalmic, Otic, and Musculoskeletal Flashcards

1
Q

Describe glaucoma

A

Damage to the optic nerve due to intraocular pressure (IOP)

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2
Q

What can occur after prolonged pressure due to glaucoma?

A

Vision impairment / blindness

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3
Q

In ______, the angle between iris and cornea appears open

A

Open-angle glaucoma

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4
Q

Open-angle glaucoma is ______

A

Asymptomatic

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5
Q

In ______, the angle between iris and cornea is narrowed causing increased intraocular pressure

A

Narrow-angle glaucoma

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6
Q

Narrow-angle glaucoma is considered ______

A

A medical emergency

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7
Q

What is keratitis?

A

Inflammation of the cornea

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8
Q

What is blepharitis?

A

Inflammation of the eyelid

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9
Q

Describe the general side effects associated with eye drops (6)

A
  • Burning / discomfort
  • Blurred vision
  • Photophobia
  • Lacrimation
  • Blepharitis
  • Keratitis
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10
Q

What are the primary indications of eye drops? (2)

A
  • Open-angle glaucoma
  • Ocular hypertension
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11
Q

Why are interactions unlikely with eye drops?

A

Topical application

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12
Q

It is important to have caution when combining ______ with eye drops, as they may enhance the effect

A

Systemic beta-blockers / cardiac drugs

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13
Q

Describe the MOA of betaxolol (Betoptic)

A

Decreases IOP

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14
Q

What is the drug class of betaxolol (Betoptic)?

A

Selective beta-1 blocker

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15
Q

Describe the MOA of timolol (Timoptic) (2)

A
  • Decreases IOP
  • Increases aqueous humor outflow
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16
Q

What is the drug class of timolol (Timoptic)?

A

Non-selective beta blocker

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17
Q

What are the contraindications of timolol (Timoptic)? (3)

A
  • COPD
  • CHF
  • Bradycardia
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18
Q

Describe the MOA of brimonidine (Alphagan) (2)

A
  • Decreases IOP
  • Dilates pupils
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19
Q

What is the drug class of brimonidine (Alphagan)?

A

Sympathomimetic

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20
Q

What are the side effects of brimonidine (Alphagan)? (3)

A
  • Bradycardia
  • Dry mouth
  • Headache
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21
Q

Describe the education associated with brimonidine (Alphagan) (2)

A
  • Avoid ETOH
  • Wait 15 min to insert contact lenses
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22
Q

Describe the MOA of dorzolamide (Trusopt)

A

Decreases IOP

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23
Q

What is the drug class of dorzolamide (Trusopt)?

A

Carbonic anhydrase inhibitor

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24
Q

What is the primary side effect of dorzolamide (Trusopt)?

A

Bitter taste in the mouth

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25
Q

Describe the education associated with dorzolamide (Trusopt)

A

Wait 15 min to insert contact lenses

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26
Q

Describe the application of ophthalmic ointments

A

Apply a thin layer to the conjunctival sac

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27
Q

Describe the administration of eye drops (3)

A
  • Have the patient look up to the ceiling
  • Place the drop in the conjunctival sac - avoid touching the eye with the dropper
  • Apply pressure to the inner canthus for 1 minute
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28
Q

What is the purpose of applying pressure to the inner canthus after administering eye drops?

A

Reduces systemic absorption of the drug

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29
Q

Wait ______ between administration of different eye drops

A

5 minutes

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30
Q

Describe the MOA of earwax emulsifiers / cerumenolytics (2)

A
  • Loosen / remove cerumen
  • Release hydrogen peroxide and oxygen
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31
Q

Earwax emulsifiers / cerumenolytics are combined with ______

A

Glycerin

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32
Q

Describe the administration of carbamide peroxide (Debrox) (3)

A
  • 4 drops twice daily
  • Continue for 4 days
  • Flush ear with warm water on the 5th day
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33
Q

Otitis media most commonly affects ______

A

Children

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34
Q

Otitis media most commonly follows ______

A

Upper respiratory infections

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35
Q

Describe inspection of the ear in adults

A

Pull pinna up and back

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36
Q

Describe inspection of the ear in children under age 3

A

Pull pinna down and back

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37
Q

What is the first line medication used for otitis media?

A

Amoxicillin

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38
Q

______ is used if a patient does not respond to amoxicillin for otitis media / has had amoxicillin for the past 30 days

A

Augmentin

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39
Q

Otitis media affects the ______

A

Middle ear

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40
Q

Otitis externa affects the ______

A

Ear canal

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41
Q

Otitis externa is also known as ______

A

Swimmer’s ear

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42
Q

Hydrocortisone and Dexamethasone contain ______

A

Steroids

43
Q

Which otic medications CANNOT be used with a perforated eardrum? (3)

A
  • Neomycin
  • Polymyxin B
  • Hydrocortiosne
44
Q

Which otic medications can be used with a perforated eardrum? (2)

A
  • Ciprofloxacin
  • Ofloxacin
45
Q

Cold eardrops may cause ______

A

Vomiting / dizziness

46
Q

Prior to eardrop administration, it is important to assess ______

A

Baseline hearing / auditory status

47
Q

Describe otic administration (3)

A
  • Warm eardrops to body temperature
  • Have patient lie on the non-affected side for about 5 minutes
  • Gently massage the tragus of the ear to encourage flow of medication
48
Q

What is the indication of DMARDs?

A

Rheumatoid arthritis

49
Q

What drugs are used for rheumatoid arthritis? (2)

A
  • Methotrexate
  • etanercept (Enbrel)
50
Q

Describe rheumatoid arthritis

A

Autoimmune disorder in which the body attacks synovial fluid

51
Q

Rheumatoid arthritis causes ______

A

Ulnar deviation

52
Q

What are the general adverse effects associated with DMARDs due to their immunosuppressive properties? (2)

A
  • Thrombocytopenia
  • Leukopenia
53
Q

What is the first line medication used for rheumatoid arthritis?

A

Methotrexate

54
Q

Describe the MOA of Methotrexate

A

Immunosuppression

55
Q

What is the drug class of Methotrexate?

A

DMARD I (non-biologic DMARD)

56
Q

What are the contraindications of Methotrexate? (3)

A
  • Alcoholism
  • Liver disease
  • Immunosuppressive disorders
57
Q

What are the adverse effects of Methotrexate? (2)

A
  • Hepatoxicity
  • Nephrotoxicity
58
Q

What are the interactions of Methotrexate? (2)

A
  • NSAIDS
  • Live vaccines
59
Q

What are the routes of Methotrexate? (3)

A
  • PO
  • SQ
  • IM
60
Q

How often is Methotrexate administered?

A

Once per week

61
Q

______ should be taken daily with Methotrexate to reduce side effects

A

Folic acid (1 mg)

62
Q

What laboratory tests should be conducted for a patient on Methotrexate? (4)

A
  • CBC
  • LFTs
  • BUN
  • Creatinine
63
Q

Describe the MOA of etanercept (Enbrel)

A

Blocks tumor necrosis factor (TNF leads to joint destruction)

64
Q

What is the drug class of etanercept (Enbrel)?

A

DMARD II (biologic DMARD)

65
Q

What are the contraindications of etanercept (Enbrel)? (2)

A
  • Infections
  • Sepsis
66
Q

What is the primary side effect of etanercept (Enbrel)?

A

Injection site redness

67
Q

What is the primary adverse effect of etanercept (Enbrel)?

A

Severe infection

68
Q

What is the primary interaction of etanercept (Enbrel)?

A

Live vaccines

69
Q

What is the route of etanercept (Enbrel)?

A

SQ - teach self-injections

70
Q

Describe DMARD nursing implications (2)

A
  • Assess baseline blood counts
  • Perform cardiac, renal, and liver tests
71
Q

With DMARD use, it is important to teach patients to report ______ immediately

A

Signs of infection

72
Q

What are the signs of infection? (4)

A
  • Sore throat
  • Diarrhea
  • Vomiting
  • Fever ≥ 100.5° F (38.1° C)
73
Q

What drugs are used for osteoporosis? (2)

A
  • Bisphosphonates
  • SERMs
74
Q

Describe osteoporosis

A

Low bone mass causing an increased risk of fractures

75
Q

Osteoporosis primarily affects ______

A

Women

76
Q

What are the risk factors of osteoporosis? (3)

A
  • Corticosteroid use
  • Low calcium
  • Low estrogen
77
Q

Strong clinical evidence indicates ______ can reverse lost bone mass and reduce facture risk

A

Bisphosphonates

78
Q

Describe the MOA of alendronate (Fosamax)

A

Increases bone density

79
Q

What is the drug class of alendronate (Fosamax)?

A

Bisphosphonate

80
Q

What is the primary indication of alendronate (Fosamax)?

A

Prevention / treatment of postmenopausal osteoporosis

81
Q

What is the primary contraindication of alendronate (Fosamax)?

A

Esophageal dysfunction

82
Q

______ can occur if alendronate (Fosamax) lodges in the esophagus before reaching the stomach

A

Esophageal burns

83
Q

What is the primary adverse effect of alendronate (Fosamax)?

A

Osteonecrosis of the jaw

84
Q

Describe the administration of alendronate (Fosamax) (3)

A
  • Take upon rising in the morning
  • Take with a full glass of water
  • Take 30 minutes before eating
85
Q

After taking alendronate (Fosamax), the patient must …

A

Sit upright for at least 30 minutes

86
Q

Describe the MOA of raloxifene (Evista) (2)

A
  • Increases bone density
  • Stimulates estrogen receptors
87
Q

What is the drug class of raloxifene (Evista)?

A

Selective estrogen receptor modulators (SERMs)

88
Q

What is the primary indication of raloxifene (Evista)?

A

Prevention / treatment of postmenopausal osteoporosis

89
Q

What are the adverse effects of raloxifene (Evista)? (2)

A
  • Venous thromboembolism
  • Teratogenesis
90
Q

Describe the education associated with raloxifene (Evista)

A

Discontinue 72 hours before and during prolonged immobility

91
Q

Calcium absorption requires ______

A

Vitamin D

92
Q

Describe the MOA of NSAIDs

A

Block COX enzyme activity

93
Q

What is the function of COX 1 enzymes?

A
  • Production of prostaglandins that protect stomach lining
  • Therefore, COX 1 inhibitors are likely to cause stomach / GI irritation
94
Q

What is the function of COX 2 enzymes?

A
  • Production of systemic prostaglandins
  • Therefore, COX 2 inhibitors are LESS likely to cause stomach / GI irritation
95
Q

What is the common function of COX 1 / COX 2 inhibitors?

A

Inhibit prostaglandins - decreased pain and inflammation

96
Q

What are the therapeutic effects of NSAIDs? (3)

A
  • Anti-inflammatory
  • Anti-pyretic
  • Analgesic
97
Q

What are the contraindications of NSAIDs? (4)

A
  • Bleeding
  • Aspirin allergy
  • Renal disease
  • Liver disease
98
Q

What are the black box warnings associated with NSAIDs? (2)

A
  • GI bleeds
  • MI / stroke
99
Q

Which NSAID does not cause a risk of MI / stroke?

A

Aspirin

100
Q

Stop NSAID use ______ prior to elective surgery

A

1 week

101
Q

What drugs are used for osteoarthritis? (2)

A
  • Ibuprofen
  • Celecoxib
102
Q

What is the drug class of ibuprofen (Advil, Motrin)?

A

Non-selective COX inhibitor

103
Q

What are the adverse effects of ibuprofen (Advil, Motrin)? (3)

A
  • Peptic ulcer disease
  • Gastritis
  • GI bleed
104
Q

What is the primary interaction of ibuprofen (Advil, Motrin)?

A

Increased effects of warfarin (highly protein bound)

105
Q

What is the maximum dose of ibuprofen (Advil, Motrin) per day?

A

3.2 grams

106
Q

What is the drug class of celecoxib (Celebrex)?

A

COX 2 inhibitor

107
Q

What are the adverse effects of celecoxib (Celebrex)? (2)

A
  • MI
  • Stroke
108
Q

______ allergy is a contradiction of celecoxib (Celebrex)

A

Sulfa