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PAM Semester 3 > Pharm HEENT Exam 1 > Flashcards

Pharm HEENT Exam 1 Flashcards

1
Q

Eye steroids

A

Do not prescribe eye steroids

Refer

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2
Q

Viral treatment of eye

A

Eye lavage with saline BID 7-14 days

Vasoconstrictor - antihistamine drops may help

Warm to cool compresses reduce discomfort

ABX drops for secondary infection

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3
Q

Bacterial Treatment of eye

A

Hygiene

Hand washing

ABX drops More effective than ointment

Rare pathogens may need concurrent systemic ABX

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4
Q

Allergic treatment of eye

A

Cold compress

Artificial tears

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5
Q

Empiric ABX for Bacterial conjunctivitis

A

Erythromycin ointment
4 times a day x 5-7 days

Trimethoprim -polymyxin B drops
1-2 drops 4 times a day 5-7 days

Ofloxacin drops
1-2 drops x 5-7 days (contacts)

Cipro drops
1-2 drops 4 times a day x 5-7 days (contacts)

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6
Q

Viral conjunctivitis treatment

A

Antihistamine / decongestant drops OTC

1-2 drops 4 times a day for 3 weeks

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7
Q

Allergic conjunctivitis treatment

A

Antihistamine / decongestant drops OTC
1-2 drops 4 times a day for 4 weeks

Mast cell stabilizer drops
1-2 drops 3 times a day

Eye lubricant drops

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8
Q

Antihistamine / decongestant drops

Class and MOA

A

anti histamine

inverse agonism of histamine H1 receptors

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9
Q

Mast cell stabilizer drops

Class and MOA

A

mast cell stabilizer

prevention of mast cell degranulation

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10
Q

Vasoconstrictors

Class and MOA

A

Vasoconstrictors (decongestants)

Activation of Alpha adrenergic receptors

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11
Q

Leukotriene receptor antagonists

Class and MOA

A

Leukotriene receptor antagonist

Competitive binding to leukotriene receptors

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12
Q

NSAIDS

Class and MOA

A

NSAID

prevention of prostaglandin production

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13
Q

Corticosteroids

Class and MOA

A

Corticosteroids

Broad anti-inflammatory action through prevention of proinflammatory mediator synthesis

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14
Q

Single agent antihistamine - mast cell stabilizer

Class and MOA

A

Single agent antihistamine - mast cell stabilizer

Inverse histamine H1 receptor agonism plus prevention of mast cell degranulation

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15
Q

Corneal ulcer treatment

A

Refer

Lesion should be stained and cultured to identify cause and guide treatment

Avoid topical steroids for risk of further tissue loss and increase risk of perforation

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16
Q

Infectious keratitis

A

Risk increased with contacts

extended wear lenses

poor prep and disinfection

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17
Q

95% of bacterial keratitis is

A

contact lens infection

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18
Q

In referral based institutions

bacterial infections are typically

A

Gram negative like Pseudomonas

Followed by

gram positive like staph and strep

These are the normal ocular surface flora

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19
Q

Bacteria keratitis tx

A

4th gen fluoroquinolone

Moxifloxacin, gatifloxacin, besfloxacin

Close follow up in 24 hours

Do not use glucocorticoids

Do not patch

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20
Q

Acute dacrocystitis

most common organisms

A

Alpha hemolytic strep

Staph epidermis

Staph aureus

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21
Q

Acute dacrocystitis

Empiric Tx

A

Depends on age of child
severity of infection
presence and type of complications

Mild infections can be treated with oral clindamycin

Severe infections - IV Vanc with 3rd gen Cef

7-10 days

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22
Q

Blepharitis indications to refer

A 
Severe eye redness
Severe pain
Severe light sensitivity
impaired vision
corneal abnormalities (scarring, ulcers)
malignancy
refractory symptoms
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23
Q

Blepharitis tx

A

Good lid hygiene

eliminate triggers
Allergens, smoking, contacts etc

goal is to minimize symptoms and limit exacerbations

Chronic condition

Can use ABX ointment is severe
(bacitracin, erythromycin)

Can use oral ABX if need further tx
(Doxy, tetra, azithro)

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24
Q

Hordeolum

A

Sty (acute infection of oil gland)

can be associated with blepharitis

warm compress

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25
Q

Chalazion

A

firm non tender eyelid bump

chronic sterile inflammation of oil gland

results in granulomatous inflammatory reaction

warm compress

if needed can be surgically excised
and intra-glucocorticoid injection

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26
Q

Nystagmus tx

A

Treatment is symptomatic

meds depend on type of nystagmus

4 types of therapy

medication
Botox injections
prism lenses and optical solutions
surgery

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27
Q

Nystagmus medications

A

Gabapentin

memantine

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28
Q

Optic neuritis treatment

A

IV methylprednisolone

for severe vision loss or two
or
more white matter lesions

Oral prednisone is not recommended
due to no affect on vison loss and
due to possible increasing recurrent optic neuritis

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29
Q

Papilledema tx

A

Treat cause
Neuro-surg consultation

Reduce ICP = 
mannitol
CSF withdrawal
Sedative (Propofol, barbiturate)
Control hyperventilation
Decompressive craniotomy
Remove mass or lesion
Hypothermia
Steroids
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30
Q

Orbital cellulitis vs pre-septal cellulitis

A

Orbital =
infection of soft tissue posterior to orbital septum

Pre-septal =
Infection of soft tissue anterior to the orbital septum

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31
Q

Orbital cellulitis tx

A

empiric ABX =

Vanc plus Cef
for
staph, strep, MRSA, gram neg bacilli

if concern for intracranial extension
add metronidazole

Should show improvement in 24-48 hours after proper therapy started
if not
imaging, surgery, biopsy, culture, histology

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32
Q

Age related macular degeneration

A

leading cause of legal adult blindness and severe visual impairment in industrialized countries

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33
Q

Dry macular degeneration

A

patients with:
extensive intermediate drusen
one large drusen
or non central geographic atrophy

be treated with

daily oral vitamin eye supplement

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34
Q

daily oral vitamin eye supplement

AREDS2

A 
Vit C 500
Vit E 400
Lutein 10
zeaxanthine 2
zinc 80
copper 2

non smokers can use AREDS 1
which has beta carotene instead of lutein

OTC

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35
Q

Bevaciumab

A

Avastin

Vascular endothelial growth factor inhibitor (VGEFi)

Interactions
Increased risk of CHF and decline with LVEF with concomitant anthracycline based therapy

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36
Q

Retinal detachment Tx

A

Emergent consult

laser surgery or cryosurgery

Patient should remain supine with head turned to side of the retinal detachment

80-15-5% rule

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37
Q

Diabetic retinopathy tx

A

Initial therapy

For most patients with diabetic macular edema (DME) and impaired visual acuity,

we recommend intravitreal vascular endothelial growth factor inhibitors

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38
Q

Hypertensive retinopathy tx

A

Treat underlying condition

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39
Q

Blowout fracture

A

Emergent referral

keep calm, avoid sneezing, coughing etc

start nasal decongestants, ice packs and ABX right away

Patients with orbital fractures that involve the sinus get prophylactic ABX
(same ones as sinusitis)

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40
Q

Acute bacterial rhinosinusitis in children
Mild/Moderate
TX

A

Mild/Moderate

Preferred:
Augmentin PO 45mg/kg QD divided in 2 doses

Alternate
Amoxicillin PO 90mg/kg QD divided in 2 doses

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41
Q

Corneal abrasion tx

A

Refer

Lesion should be stained and cultured to identify cause and guide treatment

Avoid topical steroids for risk of further tissue loss and increase risk of perforation

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42
Q

CRVO
Central retinal vein occlusion
(eye DVT)

A

in patients with macular edema from BRVO or CRVO that cause visual loss, we recommend intravitreal anti-vascular endothelial growth factor inhibitor treatment as first line

Second line
Dexamethasone implant 0.7mg
or
intravitreal triamcinolone acetonide

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43
Q

Amaurosis Fugax

A

ESR and CRP should be checked in patients over 50 for giant cell arteritis

with transient monocular or binocular vision loss

44
Q

Amblyopia

A

It may be caused by strabismus (most common)

uremia,

Toxins (etoh, TOB, lead or others)

45
Q

Amblyopia tx

A

Glasses
Atropine drops
Patching

Patching atropine are equally effective in treating mild to moderate amblyopia

Pathing usually first line and preferred by patients/parents

atropine is reasonable first line when patching is expected to fail

Visual outcome for most children with patching/atropine under 7 is good
(most do not achieve normal vision)

46
Q

Close angle Glaucoma acute attack

A

Emergency use of topical ophthalmic meds to reduce IOP

Beta blockers
alpha agonists
miosis producing agents

Systemic meds

Oral or IV acetazolamide
IV mannitol

Once attack is controlled
Laser peripheral iridotomy is definitive
(small drainage hole through the iris or cataract surgery)

47
Q

Meds that cause

Angle closure glaucoma

A

Anticholinergics

Mydriatics eye drops:
Atropine, homatropine, cyclopentolate, tropicamide

Inhaled:
Ipratropium

Systemic:
Atropine, scopolamine, other meds with anticholinergic effects

Anti-histamines

H1 receptor antagonists
diphenhydramine, chlorpheniramine, loratadine
H2 receptor antagonists
cimetidine

48
Q

IOP of

Close angle glaucoma

A

40 - 70 mmhg

Normal is 8 -21

49
Q

Close angle glaucoma Tx

A

Timolol 0.5% one drop

            wait one minute

Apraclonidine 1% one drop

            wait one minute

pilocarpine 2% one drop

             wait one minute

give acetazolamide 500mg IV (can be PO)

50
Q

Scleritis

A

Up to 50% of patients with scleritis have an underlying systemic illness

Most often a rheumatic disease

51
Q

Scleritis tx

Less severe

A

NSAIDS are intial treatment
for diffuse nodular forms of anterior scleritis
(this is the less severe form)

Indomethacin 25 - 75mg PO TID

52
Q

Scleritis Tx

A

Prednisone 1 mg/kg QD
max of 80mg

Prednisone is usually tapered over a period of 6 months, often closure to 9-12 months

53
Q

Strabismus tx

A

Eye exercises
Patch therapy
Surgery

If left untreated after 2 years of age, amblyopia will occur

54
Q

Foreign Bodies

Small corneal abrasions

A

Small corneal abrasions
(less than or equal to one fourth of corneal surface area) (eg. circular abrasion 4mm in diameter)

Oral analgesia -
Ibuprofen, APAP/Oxy combo

With or without nonsteroidal anti inflammatory ophthalmic drops (ketorolac, diclofenac)

55
Q

Foreign Bodies

Large corneal abrasions

A

Oral opioid analgesia
(APAP/Oxy combo)

cycloplegic drops

and in select patients with abrasions >50% of cornea,
eye patching

56
Q

Corneal abrasion heal time

A

Most small corneal abrasion heal within 24-48 hours

57
Q

Cycloplegics

A

These drugs cause mydriasis like mydriatics,
but they also cause cycloplegia

Paralysis of ciliary muscle

Used to dilate pupils to examine fundus
Prevent ciliary spasm and pain in iritis patients

this stops the patient from constantly accommodating when the Dr. is trying to refract the patient and determine the prescription

58
Q

Ciliary Muscle

A

Ciliary muscle controls focusing of the light rays entering the eye by changing the shape of the crystalline lens

59
Q

Cycloplegic / Mydriatic drugs

A 
Atropine
Homatropine
scopolamine
cyclopentolate
Tropicamide
60
Q

Drugs that can cause cycloplegia

A 
Chloroquine
Phenothiazine
Anticholinergics
Antihistamines
Anti-anxiety
Tricyclic anti-depressants
61
Q

When to have daily follow ups for abrasions

A

Larger abrasions

Abrasions from contact lens

Abrasions associated with decreased vision

Abrasions in young children

62
Q

Which of the below class of eye drops have the MOA of activation of alpha-adrenergic receptors?

Antihistamines
Mast cell stabilizers
Decongestants
Corticosteroids

A

Decongestants

63
Q

What are the most common pathogens associated with bacterial keratitis?

Anaerobes
Spirochetes
Gram-negatives
Gram-positives

A

Gram-negatives

64
Q

What is the most common antibiotic medication used to treat mild infections of dacryocystitis with children?

Azithromycin
Amoxicillin
Doxycycline
Clindamycin

A

Clindamycin

65
Q

What is the best antibiotic therapy for the initial empiric treatment of orbital cellulitis?

Metronidazole plus amoxicillin
Vancomycin plus ceftriaxone
Doxycycline plus gentamycin
Ciprofloxacin plus metronidazole

A

Vancomycin plus ceftriaxone

66
Q

Which of the following medications is not used for bacterial conjunctivitis empiric therapy?

Azithromycin drops
Erythromycin ointment
Ofloxacin drops
Trimethoprim-polymyxin drops

A

Azithromycin drops

67
Q

Which of the below medications is best used for the treatment of mild otitis externa?

acetic acid-hydrocortisone
ciprofloxacin-hydrocortisone
azithromycin-hydrocortisone
clindamycin-hydrocortisone

A

acetic acid-hydrocortisone

68
Q

What is the best therapy for patients with mild acute bacterial rhinosinusitis?

clarithromycin
azithromycin
trimethoprim-sulfamethoxazole
amoxicillin

A

amoxicillin

69
Q

What is the best therapy for patients with mild otitis media in adults?

clarithromycin
azithromycin
trimethoprim-sulfamethoxazole
amoxicillin

A

amoxicillin

70
Q

What is the best therapy for patients with GAS pharyngitis?

clarithromycin
azithromycin
trimethoprim-sulfamethoxazole
amoxicillin

A

amoxicillin

71
Q

Which of the following pathogens is not one of the more common pathogens for a patient with a peritonsillar abscess?

S. pyogenes(group A streptococcus),
Streptococcus anginosus
Fusobacterium necrophorum
Staphylococcus aureus

A

Staphylococcus aureus

72
Q

3 components of managing Otitis Externa

A

Cleaning the ear canal

Treating the inflammation and infection

Pain control

73
Q

Otitis externa tx

Mild Disease

A

Mild Disease
non antibiotic topical preparation containing an acidifying agent and a glucocorticoid
(acetic acid - hydrocortisone)

Moderate disease

74
Q

Otitis externa tx

Moderate disease

A

Moderate disease

Topical preparation that is acidic and contains an antibiotic, antiseptic an a glucocorticoid
Cipro HC, Cortisporin

75
Q

Otitis externa tx

Severe disease

A

Severe disease

Topical preparation that is acidic and contains an antibiotic, antiseptic an a glucocorticoid
Cipro HC, Cortisporin

76
Q

Otitis externa
Antibiotics
First line

A

Coverage of most common pathogens
Staph aureus and pseudomonas

Quinolones are good first line options with few side effects against both pathogens
(Cipro, Ofloxacin)

If infection is outside auditory canal or malignant OE, refer urgently

Combined systemic and topical antibiotics are also indicated in patients who are immunosuppressed

77
Q

Ear pain

A

Oral NSAIDS

78
Q

Otitis externa
Antibiotics
Second line

A

Aminoglycosides
Tobramycin, gentamycin

both are good against Staph aureus and pseudomonas

Beware ototoxicity with aminoglycosides
Tobramycin, gentamycin, neomycin

79
Q

Cipro HC Otic

A

ABX + Steroid

Contra
Perforated tympanic membrane
Viral otic infections (herpes, varicella)

80
Q

Cholesteatoma

Surgical determinants

A

The extent of disease

Size and pattern of mastoid pneumatization

Eustachian tube dysfunction

81
Q

Otitis Media S/S

A 
Pain
Pressure
Popping / Cracking
Drainage
Hearing Loss
Tinnitus
Feels like "water in ear"
Feels like "Ear needs to pop"
82
Q

Otitis Media S/S

by age

A

Neonates / infants

Change in behavior, irritability, ear tugging, decreased appetitive, vomiting

Children 2-4

Otalgia, fever, noise in ears, cant hear properly, changes in personality

Children over 4

Complains of ear pain, changes in personality

83
Q

Acute otitis media bacteria

A

Most common are:
Strep pneumo
H Flu

Less common are:
Group A strep
Staph aureus
M Cat

84
Q

Acute otitis media in adults

A

Drug must work against

Strep pneumo, H Flu, M Cat

Augmentin over amoxicillin

Better against beta lactamase

2nd/3rd gen cef are alternates for Pen allergy

next is doxy

85
Q

Acute otitis media in adults

who don’t respond in 48-72 hours

A

Should be reexamined

Then give
high dose Augmentin (if not initial drug)
or
2nd/3rd gen cef (if not initial drug)

86
Q

Acute otitis media in children

Pain tx

A

Ibuprofen or APAP for ear pain in AOM

Topical benzocaine, procaine, or lidocaine can be used as an alternate in children over 2
(not with TM perf)

Do not use decongestants or antihistamines

87
Q

Acute otitis media in children

ABX tx

A

Children under 6 months should get ABX

Children 6mo - 2yrs should get ABX

Amoxicillin is first line in children
90mg/kg QD divided in to 2 doses (3g max)

Macrolides or clindamycin are alternatives

88
Q

Penicillin reactions

A 
Immediate hypersensitivity reactions
anaphylaxis
angioedema
bronchospasm
urticaria

Severe delayed reactions
SJS, TEN, Hemolytic anemia,

89
Q

Acoustic neuroma

A

Surgery or radiation

90
Q

Eustachian tube functions

A

Protection of the middle ear
pressure regulation
mucociliary clearance

91
Q

Eustachian tube dysfunction

A

in the absence of an underlying cause of obstructive dysfunction

systemic decongestants such as pseudoephedrine or phenylephrine may be helpful for congestive symptoms (ear fullness, pressure)

Do not exceed 3 days of nasal decongestants to avoid mucosal dependency and rhinitis medicamentosa

92
Q

Labrinthyitis

A

Vestibular stimulants and antiemetics to limit symptoms in 24-48 hours

93
Q

Vertigo treatments

A

Treatments aimed at

Underlying vestibular disease
Symptoms of vertigo
Promoting recovery

94
Q

Antihistamines

A

Dimenhydrinate
Diphenhydramine
Meclizine

95
Q

Benzodiazepines

A

Alprazolam
Clonazepam
Diazepam
Lorazepam

96
Q

Antiemetics

A

Metoclopramide
ondansetron
Prochlorperazine
promethazine

97
Q

Drugs that can cause Vertigo

A

Anti-inflammatories
Ibuprofen, indomethacin

Antihypertensive
HCTZ, atenolol, propranolol, f=nifedipine, verapamil
prazosin, terazosin

Anxiolytics
Alprazolam, chlordiazepoxide, clonazepam, diazepam, lorazepam, oxazepam

98
Q

Meclizine

A

Antivert (antihistamine)

Motion sickness prophylaxis
vertigo of vestibular origin

Warnings
Asthma, glaucoma, GI/GU obstruction, Hepatic/renal impairment, elderly, pregnancy, nursing

Interactions
Alcohol, tranquilizers

Adverse
Drowsiness, dry mouth, HA, fatigue

99
Q

Antiemetics

receptor sites for vomiting reflex

A

M1 - Muscarinic

D2 - dopamine

H1 - Histamine

5 HT-3 (5-hydroxytryptamine) - Serotonin

Neurokinin-1 NK1 receptor - Substance P

100
Q

Sudden sensorineural hearing loss (SSNHL)

A

with idiopathic SSNHL

Glucocorticoids within 2 weeks of onset

Can use systemic or intratympanic

this is preferred first line

101
Q

Neurokinin 1 antagonists

A

Aprepitant

102
Q

Antimuscarinincs

A

Atropine
Hyoscine

M1 receptors

103
Q

Antihistamines

A

Hydroxyzine

H1 receptors

104
Q

Prokinetics

A

Metoclopramide
Domperidone
Prochlorperazine

D2 Receptors

105
Q

Serotonin antagonists

A

Ondansetron
Granisetron
Ramosetron
Palonosetron

5HT-3 receptors

106
Q

Acute mastoiditis

A

Strep pneumo
Strep pyrogens
Staph aureus

Consider pseudomonas in children with recurrent AOM

PAM Semester 3 (8 decks)

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