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HEENT > Treatments and Pharm > Flashcards

Treatments and Pharm Flashcards

1
Q

Myopia

A

Concave (-) diopter lens

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2
Q

Hyperopia

A

Convex (+) diopter lens

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3
Q

Astigmatism

A

Cylindrical lens

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4
Q

Blepharitis

A

Lid hygiene, warm compress; topical azithromycin if refractory

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5
Q

Hordeolum

A

Warm compress, I&D if no improvement w/in 48 hours; topical erythromycin if needed

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6
Q

Chalazion

A

Lid hygiene, warm compress

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7
Q

Entropion

A

Lubricating eye drops; surgery if needed

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8
Q

Ectropion

A

Lubricating eye drops; surgery if needed

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9
Q

Dacryocystitis

A

Augementin, warm compress

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10
Q

Viral conjunctivitis

A

Supportive; cold compress, artificial tears, prevent spread (contagious while symptomatic)

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11
Q

Gonococcal conjunctivitis

A

Ceftriaxone IM + topical antibiotics

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12
Q

Bacterial conjunctivitis

A

W/ contacts: topical Cipro;

W/o: topical erythromycin ok

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13
Q

Chlamydial conjunctivitis

A

Azithromycin, improvement of living conditions if possible

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14
Q

Orbital cellulitis

A

Confirm via CT, admit, IV antibiotics (vanco + ceftriaxone)

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15
Q

Preseptal cellulitis

A

Confirm via CT, clindamycin

Admit if <1 YO or moderate/severe symptoms

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16
Q

Bacterial keratitis

A

Urgent referral; topical FQs (-floxacin) hourly night and day for first 48 hours

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17
Q

HZV ophthalmicus

A

Urgent referral, high dose acyclovir, pain management

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18
Q

Open angle glaucoma

A

Prostaglandin drops

Add on B-blocker drops if needed

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19
Q

2 categories of MOA for chronic glaucoma treatments

A

Target aqueous humor outflow

  • topical prostaglandins (“-prost”)
  • topical muscarinic agonist (pilocarpine)

Target aqueous humor production

  • topical B blockers (timilol)
  • topical a2 agonist (“-inidine”)
  • topical carbonic anhydrase inhibitors (“-lamide”)
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20
Q

Acute reduction of IOP

A

Osmotic agents: glycerol, isosorbide, IV mannitol

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21
Q

Acute angle closure glaucoma

A

Do not dilate!
Acetazolamide (carbonic anhydrase inhibitor)
Topical B-blockers
Osmotic agents if needed
Do NOT use antimuscarinics such as atropine!

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22
Q

Uveitis

A

Topical prednisone

Cyclogyl/mydriatic

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23
Q

Cataracts

A

Surgical removal

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24
Q

Amaurosis fugax

A

Full workup for vessel occlusion, MRI, ECG

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25
Q

Retinal detachment

A

Emergent referral, do NOT dilate (no mydriatics/cyclogyl)

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26
Q

Diabetic retinopathy

A

Non-proliferative: strict glucose control, f/ups every 6-9 months

Proliverative: strict glucose control, anti-VEGF injections; f/ups every 3 months

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27
Q

Papilledema

A

MRI/CT to r/o mass; LP; acetazolamide

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28
Q

Optic neuritis

A

Immediate referral, steroids, MRI entire spine and evaluate for MS

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29
Q

Macular degeneration

A

Dry: no reversal, can try antioxidant vitamins to slow progression

Wet: anti-VEGF injections; laser photocoagulation

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30
Q

Corneal abrasion

A

Fluorescein dye to visualize, antibiotic drops, do not patch

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31
Q

Foreign body

A

Fluorescein dye to visualize, numb and flush, if not successful: remove manually with moist cotton swab or 25 g needle

Treat abrasion/rust ring

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32
Q

Pterygium/Pinguecula

A

Artificial tears; may spontaneously resolve; surgery if necessary

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33
Q

Hyphema/hypopyon

A

Urgent referral, admission

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34
Q

Globe rupture

A

Emergent referral, check pupillary response, fox shield, do not remove any foreign bodies

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35
Q

Blow-out fracture

A

CT w/o contrast; steroids; clindamycin; consider surgery

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36
Q

Congenital strabismus

A

Referral; prism glasses, patch healthy eye, possible recession and/or resection

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37
Q

Hearing loss

A

Consider hearing aids, bone anchored hearing device, or cochlear implant

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38
Q

Cholesteatoma

A

Surgical removal of ALL cells (often two procedures)

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39
Q

Mastoiditis

A

Admit, CT with contrast of temporal bone, IV antibiotics, surgical I&D

40
Q

TM perforation

A

Often resolves spontaneously; PO amoxicillin

NO AMINOGLYCOSIDES! (“-micin”s)

41
Q

Acute otitis media

A

Observation vs WASP vs high-dose amoxicillin –> augmentin if necessary; cefdinir if allergic

42
Q

Otitis media with effusion

A

Don’t give antibiotics or Ms. Ridenour will come for you!

Try valsalva, treating allergies/reflux, etc

43
Q

Acoustic neuroma

A

Observation vs surgical removal vs radiation

44
Q

Labyrinthitis/vestibular neuritis

A

IV meds for symptomatic relief
Prednisone with taper
Vestibular rehab
Consider need for hearing aids

45
Q

Benign paroxysmal vertigo

A

Dx with Dix Hallpike, Tx with Epley

46
Q

Sudden sensorineural hearing loss

A

Need steroids quickly!

Any patient with acute, unilateral, sensorineural hearing loss gets MRI to r/o vestibular schwannoma

47
Q

Meinere’s disease

A

Low Na diet, diet log, betahistine, diuretics

Symptomatic relief:
Zofran
Vestibular suppressants:
- valium (benzo)
- meclizine (antihistamine)
48
Q

Nasal polyps

A

Nasal steroids (fluticasone, triamcinolone); assess for allergic rhinitis; surgery if needed

49
Q

Epistaxis

A

Head down, squish nares

If packing is indicated, consider co-morbidities (absorbable if there is bleed risk, otherwise removable)

Give antibiotics to prevent TSS

Other options for posterior bleed: balloon pack, embolization, clip

50
Q

Acute sinusitis

A

Usually viral; supportive

51
Q

Bacterial sinusitis

A

Watchful waiting vs amoxicillin (augmentin if necessary; cefixime if allergic)

52
Q

Chronic sinusitis

A

3-4 weeks augmentin; consider steroids; controll allergies/GERD
Supportive therapies

53
Q

Allergic rhinitis

A

Nasal steroids (triamcinolone, fluticasone)

Can add on nasal antihistamine

Other options = oral antihistamines, montelukast, allergy shots

54
Q

Non-allergic rhinitis

A

Nasal antihistamines (olopatadine, azelastine)

55
Q

Leukoplakia

A

Biopsy, refer

56
Q

Erythroplakia

A

High index of suspicion, biopsy, refer

57
Q

Apthous ulcers

A

If recurrent: topical steroid gel or rinse if severe

58
Q

Oral HSV

A

If primary infection: acyclovir; otherwise tx not indicated (prevent spread)

59
Q

Bacterial sialadenitis

A

Augmentin; gland massage, hydration, sialogoues, oral hygiene, warm compress

60
Q

Viral parotitis

A

Gland massage, oral hygiene, sour candy/lemon, hydration

61
Q

Laryngitis

A

Usually viral - supportive

62
Q

Croup

63
Q

Pharyngitis

A

Usually viral; supportive

64
Q

Pharyngitis with palatal petichae and no cough, anterior cervical lymphadenopathy, tonsillar exudate

A

Indicative of strep; rapid + culture; PCN V

65
Q

Epiglottitis

A

Airway emergency; emergent referral; ceftriaxone IV; don’t visualize airway w/o being ready to intubate

66
Q

Enlarged adenoids

A

Consider need for removal

67
Q

Deep neck mass

A

Airway emergency; CT with contrast; may need surgical I&D; IV antibiotics

68
Q

CVID

A

Life-long IgG replacement, IV or SubQ

Manage infections with aggressive antibiotic use

69
Q

Systemic drugs that can increase IOP

A

Amphetamines, steroids, succinylcholine

70
Q

Systemic drugs that can cause cataract formation

A

Steroids, haloperidol, quetiapine

71
Q

Systemic drugs that can cause complications after cataract surgery

A

Tamsulosin (used to tx BPH)

72
Q

Systemic drugs that can cause optic neuropathy

A

Ethambutol/isoniozid for TB

73
Q

Systemic drugs that can cause miosis

74
Q

Systemic drugs that can CAUSE/exacerbate acute angle closure glaucoma

A

Antimuscarinics (atropine, scopolamine)

75
Q

AE of topical B-blockers

A

Most notable = bradycardia and possibility of tachyphylaxis

76
Q

AE of topical steroids

A

Increased susceptibility to infection

77
Q

AE of lantanoprost/bimatoprost

A

(Prostaglandins)

Underlined AEs were darkened iris/lashes/lids

78
Q

Name of muscarinic agonist

A

Pilocarpine (3rd line for chronic glaucoma)

79
Q

Used to acutely reduce IOP

A

Osmotic agents (glycerol, isosorbide, IV mannitol)

80
Q

Tetracaine indication, mechanism, and considerations

A

Ocular topical anesthetic; Na+ channel blocker; don’t send home with patient

81
Q

Topical phenylephrine indication, mechanism, and considerations

A 
Dilates pupil (mydriatic)
Selective A1 agonist
Wide range of concentrations, use lowest effective
82
Q

What do topical antimuscarinics do?

A

Atropine and scopolamine
Dilate and fix pupil (no accommodation, fixed at far vision)
Mydriatic and cycloplegic effects

83
Q

Indications, considerations, and AE of topical ocular steroids

A

Used to reduce inflammation (esp post-procedure)
Need to taper and use minimal effective concentration
AE: cataracts, possible rise in IOP, increased susceptibility to infections (sometimes prescribed with an antibiotic)

84
Q

Considerations with ocular topical NSAIDs

A

Can delay wound healing

85
Q

Tx for allergic conjunctivitis

A

Antihistamine drops (H1 blockers) - not Visine A

Or cromolyn (mast cell blocker; must be taken few days before exposure)

86
Q

Tx for dry eye

A

Artificial tears (cellulose): weigh risk/benefit of preservatives vs no preservatives

87
Q

Tx for severe dry eye

A

Cyclosporine, an immunomodulator

88
Q

Which classes of antibiotics can help cover for G +, G - (including pseudomonas) infections in the eye?

A

Fluoroquinolones (=”-floxacin”s)

Aminoglycosides (=”-micin”s)

89
Q

MOA of acyclovir

A

2-deoxyguanosine analog; gets converted by thymidine kinase and inhibits viral DNA synthesis

90
Q

Tx for oral candidiasis

A

Infants:
Nystatin topical oral solution
Treat mom with azole cream

Others: best compliance with PO fluconazole, but nystatin is technically 1st line

91
Q

MOA of -azoles

A

Inhibition of fungal CYP450 enzymes = reduced ergosterol synthesis

92
Q

Considerations with nasal steroids

A

Inhibit late stage of allergic rhinitis (tissue remodeling); not good for quick relief

93
Q

What kind of drug is azelastine?

A

Antihistamine (H1 blocker)

94
Q

Considerations with decongestants

A

A1 agonism can –> HTN, palpitations, tachycardia

Do not use in late pregnancy

95
Q

Tx for gonococcal pharyngitis

A

Ceftriaxone IM + azithromycin

Do not use FQs (-floxacins)

HEENT (4 decks)

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