Treatments and Pharm Flashcards
1
Q
Myopia
A
Concave (-) diopter lens
2
Q
Hyperopia
A
Convex (+) diopter lens
3
Q
Astigmatism
A
Cylindrical lens
4
Q
Blepharitis
A
Lid hygiene, warm compress; topical azithromycin if refractory
5
Q
Hordeolum
A
Warm compress, I&D if no improvement w/in 48 hours; topical erythromycin if needed
6
Q
Chalazion
A
Lid hygiene, warm compress
7
Q
Entropion
A
Lubricating eye drops; surgery if needed
8
Q
Ectropion
A
Lubricating eye drops; surgery if needed
9
Q
Dacryocystitis
A
Augementin, warm compress
10
Q
Viral conjunctivitis
A
Supportive; cold compress, artificial tears, prevent spread (contagious while symptomatic)
11
Q
Gonococcal conjunctivitis
A
Ceftriaxone IM + topical antibiotics
12
Q
Bacterial conjunctivitis
A
W/ contacts: topical Cipro;
W/o: topical erythromycin ok
13
Q
Chlamydial conjunctivitis
A
Azithromycin, improvement of living conditions if possible
14
Q
Orbital cellulitis
A
Confirm via CT, admit, IV antibiotics (vanco + ceftriaxone)
15
Q
Preseptal cellulitis
A
Confirm via CT, clindamycin
Admit if <1 YO or moderate/severe symptoms
16
Q
Bacterial keratitis
A
Urgent referral; topical FQs (-floxacin) hourly night and day for first 48 hours
17
Q
HZV ophthalmicus
A
Urgent referral, high dose acyclovir, pain management
18
Q
Open angle glaucoma
A
Prostaglandin drops
Add on B-blocker drops if needed
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”)
20
Q
Acute reduction of IOP
A
Osmotic agents: glycerol, isosorbide, IV mannitol
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!
22
Q
Uveitis
A
Topical prednisone
Cyclogyl/mydriatic
23
Q
Cataracts
A
Surgical removal
24
Q
Amaurosis fugax
A
Full workup for vessel occlusion, MRI, ECG
25
Retinal detachment
Emergent referral, do NOT dilate (no mydriatics/cyclogyl)
26
Diabetic retinopathy
Non-proliferative: strict glucose control, f/ups every 6-9 months
Proliverative: strict glucose control, anti-VEGF injections; f/ups every 3 months
27
Papilledema
MRI/CT to r/o mass; LP; acetazolamide
28
Optic neuritis
Immediate referral, steroids, MRI entire spine and evaluate for MS
29
Macular degeneration
Dry: no reversal, can try antioxidant vitamins to slow progression
Wet: anti-VEGF injections; laser photocoagulation
30
Corneal abrasion
Fluorescein dye to visualize, antibiotic drops, do not patch
31
Foreign body
Fluorescein dye to visualize, numb and flush, if not successful: remove manually with moist cotton swab or 25 g needle
Treat abrasion/rust ring
32
Pterygium/Pinguecula
Artificial tears; may spontaneously resolve; surgery if necessary
33
Hyphema/hypopyon
Urgent referral, admission
34
Globe rupture
Emergent referral, check pupillary response, fox shield, do not remove any foreign bodies
35
Blow-out fracture
CT w/o contrast; steroids; clindamycin; consider surgery
36
Congenital strabismus
Referral; prism glasses, patch healthy eye, possible recession and/or resection
37
Hearing loss
Consider hearing aids, bone anchored hearing device, or cochlear implant
38
Cholesteatoma
Surgical removal of ALL cells (often two procedures)
39
Mastoiditis
Admit, CT with contrast of temporal bone, IV antibiotics, surgical I&D
40
TM perforation
Often resolves spontaneously; PO amoxicillin
NO AMINOGLYCOSIDES! ("-micin"s)
41
Acute otitis media
Observation vs WASP vs high-dose amoxicillin --> augmentin if necessary; cefdinir if allergic
42
Otitis media with effusion
Don't give antibiotics or Ms. Ridenour will come for you!
| Try valsalva, treating allergies/reflux, etc
43
Acoustic neuroma
Observation vs surgical removal vs radiation
44
Labyrinthitis/vestibular neuritis
IV meds for symptomatic relief
Prednisone with taper
Vestibular rehab
Consider need for hearing aids
45
Benign paroxysmal vertigo
Dx with Dix Hallpike, Tx with Epley
46
Sudden sensorineural hearing loss
Need steroids quickly!
| Any patient with acute, unilateral, sensorineural hearing loss gets MRI to r/o vestibular schwannoma
47
Meinere's disease
Low Na diet, diet log, betahistine, diuretics
```
Symptomatic relief:
Zofran
Vestibular suppressants:
- valium (benzo)
- meclizine (antihistamine)
```
48
Nasal polyps
Nasal steroids (fluticasone, triamcinolone); assess for allergic rhinitis; surgery if needed
49
Epistaxis
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
Acute sinusitis
Usually viral; supportive
51
Bacterial sinusitis
Watchful waiting vs amoxicillin (augmentin if necessary; cefixime if allergic)
52
Chronic sinusitis
3-4 weeks augmentin; consider steroids; controll allergies/GERD
Supportive therapies
53
Allergic rhinitis
Nasal steroids (triamcinolone, fluticasone)
Can add on nasal antihistamine
Other options = oral antihistamines, montelukast, allergy shots
54
Non-allergic rhinitis
Nasal antihistamines (olopatadine, azelastine)
55
Leukoplakia
Biopsy, refer
56
Erythroplakia
High index of suspicion, biopsy, refer
57
Apthous ulcers
If recurrent: topical steroid gel or rinse if severe
58
Oral HSV
If primary infection: acyclovir; otherwise tx not indicated (prevent spread)
59
Bacterial sialadenitis
Augmentin; gland massage, hydration, sialogoues, oral hygiene, warm compress
60
Viral parotitis
Gland massage, oral hygiene, sour candy/lemon, hydration
61
Laryngitis
Usually viral - supportive
62
Croup
Steroids
63
Pharyngitis
Usually viral; supportive
64
Pharyngitis with palatal petichae and no cough, anterior cervical lymphadenopathy, tonsillar exudate
Indicative of strep; rapid + culture; PCN V
65
Epiglottitis
Airway emergency; emergent referral; ceftriaxone IV; don't visualize airway w/o being ready to intubate
66
Enlarged adenoids
Consider need for removal
67
Deep neck mass
Airway emergency; CT with contrast; may need surgical I&D; IV antibiotics
68
CVID
Life-long IgG replacement, IV or SubQ
| Manage infections with aggressive antibiotic use
69
Systemic drugs that can increase IOP
Amphetamines, steroids, succinylcholine
70
Systemic drugs that can cause cataract formation
Steroids, haloperidol, quetiapine
71
Systemic drugs that can cause complications after cataract surgery
Tamsulosin (used to tx BPH)
72
Systemic drugs that can cause optic neuropathy
Ethambutol/isoniozid for TB
73
Systemic drugs that can cause miosis
Opiods
74
Systemic drugs that can CAUSE/exacerbate acute angle closure glaucoma
Antimuscarinics (atropine, scopolamine)
75
AE of topical B-blockers
Most notable = bradycardia and possibility of tachyphylaxis
76
AE of topical steroids
Increased susceptibility to infection
77
AE of lantanoprost/bimatoprost
(Prostaglandins)
| Underlined AEs were darkened iris/lashes/lids
78
Name of muscarinic agonist
Pilocarpine (3rd line for chronic glaucoma)
79
Used to acutely reduce IOP
Osmotic agents (glycerol, isosorbide, IV mannitol)
80
Tetracaine indication, mechanism, and considerations
Ocular topical anesthetic; Na+ channel blocker; don't send home with patient
81
Topical phenylephrine indication, mechanism, and considerations
```
Dilates pupil (mydriatic)
Selective A1 agonist
Wide range of concentrations, use lowest effective
```
82
What do topical antimuscarinics do?
Atropine and scopolamine
Dilate and fix pupil (no accommodation, fixed at far vision)
Mydriatic and cycloplegic effects
83
Indications, considerations, and AE of topical ocular steroids
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
Considerations with ocular topical NSAIDs
Can delay wound healing
85
Tx for allergic conjunctivitis
Antihistamine drops (H1 blockers) - not Visine A
Or cromolyn (mast cell blocker; must be taken few days before exposure)
86
Tx for dry eye
Artificial tears (cellulose): weigh risk/benefit of preservatives vs no preservatives
87
Tx for severe dry eye
Cyclosporine, an immunomodulator
88
Which classes of antibiotics can help cover for G +, G - (including pseudomonas) infections in the eye?
Fluoroquinolones (="-floxacin"s)
| Aminoglycosides (="-micin"s)
89
MOA of acyclovir
2-deoxyguanosine analog; gets converted by thymidine kinase and inhibits viral DNA synthesis
90
Tx for oral candidiasis
Infants:
Nystatin topical oral solution
Treat mom with azole cream
Others: best compliance with PO fluconazole, but nystatin is technically 1st line
91
MOA of -azoles
Inhibition of fungal CYP450 enzymes = reduced ergosterol synthesis
92
Considerations with nasal steroids
Inhibit late stage of allergic rhinitis (tissue remodeling); not good for quick relief
93
What kind of drug is azelastine?
Antihistamine (H1 blocker)
94
Considerations with decongestants
A1 agonism can --> HTN, palpitations, tachycardia
Do not use in late pregnancy
95
Tx for gonococcal pharyngitis
Ceftriaxone IM + azithromycin
Do not use FQs (-floxacins)
