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NAPLEX 2022 > Weight Loss, Motion Sickness, Eye/Ear Conditions, Overactive Bladder, BPH, ED, IBD, Constipation & Diarrhea > Flashcards

Weight Loss, Motion Sickness, Eye/Ear Conditions, Overactive Bladder, BPH, ED, IBD, Constipation & Diarrhea Flashcards

1
Q

Constipation

What is the recommended treatment?

A

Increase fiber intake + osmotic agent

**Osmotic agents: Milk of Magnesia or PEG/Miralax

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2
Q

Constipation

Milk of Magnesia is not recommended in what disease state?

A

Renal impairment

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3
Q

Constipation

What can be used if the patients need to defecate?

A

Glycerin or bisacodyl suppository

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4
Q

Constipation

Oral stimulants & onset of action

A

1st line: Senna 2 tabs HS

Alt: Bisacodyl

Onset of action: ~10 hours to cause a bowel movement

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5
Q

Constipation

Drugs that cause constipation

A

Opioids
Anticholinergics
Verapamil
Iron

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6
Q

Constipation

What is recommended for patients on long-term opioids?

A

Stimulant laxative

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7
Q

Constipation

If a stool is hard what should be added?

A

Docusate (stool softener)

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8
Q

Constipation

What is the 1st line treatment & drug of choice in pregnancy?

A

Bulk-forming agents (aka fiber)

CP: take 2 hours before or after other drugs

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9
Q

Constipation

Name the bulk-forming agents.

A

Psyllium (Metamucil)
Calcium Polycarbophil (FiberCon)
Methylcellulose (Citrucel)

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10
Q

Constipation

What drug class is also 1st line when used with bulk-forming agents?

A

Osmotic agents work by pulling water into the stool

*can cause electrolyte imbalances

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11
Q

Constipation

Name the osmotic agents

A

Magnesium hydroxide (Milk of Magnesia)
PEG (Miralax)
Glycerin suppository

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12
Q

Constipation

Name the stimulant laxatives

A

Senna (Senokot)
Bisacodyl (Dulcolax)

*work by irritating the mucosal lining of the colon

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13
Q

Constipation

What drug class reduce the surface tension in the stool by allowing water & fat to mix into the stool?

A

ONLY emollient: Docusate (Colace)

**Preferred when straining should be avoided (post-partum, post-MI & hemorrhoids)

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14
Q

Constipation

Name a lubricant

A

Mineral oil

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15
Q

Constipation

Name the osmotic agents used for bowel preps.

A 
PEG (Golytely)
Sodium phosphate (OsmoPrep)
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16
Q

Constipation

Contraindications to bowel prep agents include:

A
  1. Acute phosphate nephropathy
  2. Gastric bypass
  3. Stapling surgery
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17
Q

Constipation

The day before a colonoscopy, what should the patient do?

A

Be on clear liquid diet ONLY

  • No red, blue, or purple food coloring
  • No solid foods at all
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18
Q

Constipation

What drug can be used for treatment of chronic idiopathic constipation (CIC), opioid-induced constipation (OIC), & IBS-C?

A

Lubiprostone (Amitiza)

MOA: activates chloride channels in gut causing peristalsis

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19
Q

Constipation

What drug can be used for CIC & IBS-C?

A

Linaclotide (Linzess)

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20
Q

Constipation

Alvimopan - MOA, Brand, Indication

A

Brand: Entereg

MOA: mu-opioid receptor antagonist

Used ONLY in hospitalized patients prior to surgery to reduce risk of post-op ileus

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21
Q

Constipation

Name mu-opioid antagonists used for treatment of opioid-induced constipation (OIC).

A
  1. Methylnaltrexone (Relistor)

2. Naloxegol (Movantik)

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22
Q

Constipation

What agents are contraindicated in patients who have used opioids for 7 consecutive days prior to use?

A
  1. Alvimopan (Entereg)
  2. Methylnaltrexone (Relistor)
  3. Naloxegol (Movantik)
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23
Q

Diarrhea

What is the most common bacterial cause of diarrhea?

A

E. coli

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24
Q

Diarrhea

Drugs that cause diarrhea (broad question)

A

Antibiotics & Magnesium products

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25
Q

Diarrhea

What agent is both an antisecretory agent with antimicrobial effects?

A

Bismuth subsalicylate (Pepto-bismol)

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26
Q

Diarrhea

Pepto-bismol contraindications & SE

A

CI: sulfa allergy, coagulopathy, & concomitant use of salicylates

SE: cause black tongue/stools

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27
Q

Diarrhea

Name the Antimotility agents, MOA, & contraindication.

A
  1. Loperamide (Imodium)
  2. Diphenoxylate/Atropine (Lomotil) –> CV

MOA: works by slowing motility & prolonging water absorption into the intestines

CI: patients with C. diff

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28
Q

Diarrhea

What mu-opioid agonist is used for treatment of IBS-D?

A

Eluxadoline (Viberzi)

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29
Q

Diarrhea

What should be ruled out prior to suspecting diarrhea?

A

Lactose intolerance

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30
Q

Inflammatory Bowel Disease

Name the 2 types of IBD

A
  1. Ulcerative colitis (UC)

2. Crohn’s disease (CD)

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31
Q

Inflammatory Bowel Disease

Classic symptom of IBD

A

Persistent blood diarrhea

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32
Q

Inflammatory Bowel Disease

When do flares occur?

A
  1. Develop an infection
  2. NSAID use
  3. Food triggers (pt specific)
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33
Q

Inflammatory Bowel Disease

What is Irritable Bowel Syndrome (IBS)?

A

Similar to IBD, but does NOT cause inflammation.

Can cause IBS-C/D

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34
Q

Inflammatory Bowel Disease

What is characterized as ulcerative colitis (UC)?

A

Characterized by mucosal inflammation confined to the rectuum & colon w/ SUPERFICIAL ULCERS.

  • Effects descending colon & rectum - distal disease
  • Effects recctum ONLY - proctitis

Typically UC causes bloody stools

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35
Q

Inflammatory Bowel Disease

What is characterized as Crohn’s disease (CD)?

A

Characterized by deep tissue inflammation that can affect part of GI tract.

  • Ileum & colon
  • damage to the bowel wall can cause strictures & fissures

May OR may not cause bloody stools

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36
Q

Inflammatory Bowel Disease

What can cause GI distress?

A

Sorbitol & lactose - are used as binders in many foods & drugs

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37
Q

Inflammatory Bowel Disease

Treatment of acute exacerbations of both UC & CD?

A

Short courses of oral or IV steroids

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38
Q

Inflammatory Bowel Disease

Maintenance therapy in ulcerative colitis?

A

Aminosalicylates

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39
Q

Inflammatory Bowel Disease

Name the aminosalicylates

A

Preferred: Mesalamine

Alt: Sulfasalazine, balsalazide, olsalazine are all converted to mesalamine in the body

**Sulfasalazine many SE

These products are NOT recommended in CD because they do not maintain remission

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40
Q

Inflammatory Bowel Disease

Mesalamine counseling point

A

CP: ghost tablet in stool

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41
Q

Inflammatory Bowel Disease

First-line treatment for mild-moderate Crohn’s Disease.

A

Topical steroid or oral budesonide

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42
Q

Inflammatory Bowel Disease

Name an immunosuppressive agent used for moderate-severe Crohn’s disease.

A

MTX

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43
Q

Inflammatory Bowel Disease

What agent is used in patient with refractory IBD after 1st line therapies?

A

Anti-TNF agents

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44
Q

Inflammatory Bowel Disease

How long can you self treat with Anti-diarrheal agents for symptom control?

A

Max 2 days

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45
Q

Inflammatory Bowel Disease

Dicyclomine - Brand, Class, Contraindication

A

Brand: Bentyl

Class: Antispasmodic

CI: elderly (BEERs)

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46
Q

Inflammatory Bowel Disease

Name oral steroids

A
  1. Prednisone
  2. Budesonide (Entocort ES, Uceris)

*Uceris indicated in ulcerative colitis ONLY

if steroid use > 2 wks, must taper

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47
Q

Inflammatory Bowel Disease

Name monoclonal antibodies used for refractory IBD.

A

Anti-TNF

infliximab (Remicade)
adalimumab (Humira)
certolizumab (Cimzia)

Cimzia approved for Crohn’s ONLY

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48
Q

Inflammatory Bowel Disease

Prior to infliximab use what should be obtained first?

A

CBC, TB & HBV tests

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49
Q

Inflammatory Bowel Disease

Natalizumab - Brand, MOA, Indication, Dosage, & Boxed Warning

A

Brand: Tysabri

MOA: integrin receptor antagonist

Indication: Crohn’s Disease ONLY who have failed anti-TNF therapy

Dosage: 300 mg IV q 4 weeks; d/c if no response by week 12

Boxed warning: PML
*REMS - Prescribers must be enrolled in TOUCH prescribing program**

50
Q

Inflammatory Bowel Disease

Entyvio - Generic, MOA, Indication, CI, & SE

A

Generic: Vedolizumab

MOA: integrin receptor antagonist

Indication: approved for both CD & UC

CI: live vaccines

SE: nasopharyngitis & arthralgia

51
Q

Sexual Dysfunction

Common causes of erectile dysfunction

A
  1. HTN
  2. Peripheral neuropathy
  3. Atherosclerosis

All decrease blood flow to penis

52
Q

Sexual Dysfunction

Drugs that cause ED

A

SSRIs & SNRIs
Beta-blockers
BPH medications (Finasteride, Dutasteride, etc)
H2RAs (Cimetidine)

53
Q

Sexual Dysfunction

Name the PDE-5 Inhibitors

A

First-line treatment

Vardenafil (Levitra)
Avanafil (Stendra)
Sildenafil (Viagra)
Tadalafil (Cialis)

54
Q

Sexual Dysfunction

PDE-5 Inhibitors MOA

A

Cause release of nitric oxide (NO) –> cGMP & smooth muscle relaxation = blood flow to penis

55
Q

Sexual Dysfunction

PDE-5 Inhibitors Contraindication & Caution Use with

A

CI: Nitrates (NTG)

Caution: alpha blockers or anti-hypertensives –> hypotension

56
Q

Sexual Dysfunction

PDE-5 inhibitors Warnings

A
  1. Impaired color discrimination
  2. Hearing loss
  3. Vision loss
  4. Hypotension
  5. Priapism

*if pt experiences an erection for > 4 hours, seek medical attention**

“Now why do you want to have an erection longer than an hour much less 4 hours?”

57
Q

Sexual Dysfunction

Sildenafil, Vardenafil & Tadalafil counseling points & Strengths

A

Sildenafil & Vardenafil taken 1 hour prior to sex

Tadalafil taken 30 minutes prior

Strengths:
Sildenafil - 50 mg
Vardenafil - 10 mg
Tadalafil - 10 mg

58
Q

Sexual Dysfunction

What agent is a prostaglandin E1 thatis either injected or inserted into the penis causing vasodilation & blood flow to the penis? SE & Storage

A

Alprostadil

SE: Priapism & Penile pain (No Shit!)

Storage: Requires refrigerations

59
Q

Sexual Dysfunction

What agent is used for premenopausal women ONLY for treatment of hypoactive sexual desire disorder (HSDD)?

A

Flibanserin (Addyi)

MOA: 5HT1a agonist & 5HT2a antagonist

CI: alcohol use (severe hypotension - REMS), 3A4 inhibitors, or hepatic impairment

Dosing: 100 mg HS

**DOES NOT enhance sexual performance, just increase desire

60
Q

Benign Prostatic Hyperplasia (BPH)

Symptoms of BPH

A

Lower urinary tract symptoms (LUTS): difficulty storing urine and voiding

61
Q

Benign Prostatic Hyperplasia (BPH)

Treatment options are based on what? What are the options?

A

Patient’s perception of BPH symptom severity

Options: watchful waiting, medication or surgery

62
Q

Benign Prostatic Hyperplasia (BPH)

Medication treatment options

A

Alpha blocker +/- 5 alpha-reductase inhibitor

63
Q

Benign Prostatic Hyperplasia (BPH)

Alpha blocker MOA

A

MOA: work by inhibiting alpha-1 receptors –> relaxing smooth muscle on bladder neck

64
Q

Benign Prostatic Hyperplasia (BPH)

3 Types of alpha blockers

65
Q

Benign Prostatic Hyperplasia (BPH)

Name the non-selective alpha blockers

A

Terazosin & Doxazosin (Cardura)

MORE SE so needs to be titrated up slowly

66
Q

Benign Prostatic Hyperplasia (BPH)

Name the selective alpha blockers

A

Tamsulon (Flomax)
Alfuzosin (Uroxatral)
Silodosin (Rapaflo)

67
Q

Benign Prostatic Hyperplasia (BPH)

Tamsulosin SE

A

Floppy Iris Syndrome

Notify ophthalmologist if patient has cataracts & has EVER taken an alpha blocker

68
Q

Benign Prostatic Hyperplasia (BPH)

Side effects of alpha blockers

A
  1. Orthostatic hypotension
  2. Floppy iris syndrome
  3. Abnormal ejaculation or retrograde ejaculation (Silodosin & tamsulosin)
  4. QT prolongation (alfuzosin)
69
Q

Benign Prostatic Hyperplasia (BPH)

Name the types of 5 alpha-reductase inhibitors

A

Finasteride (Proscar)

Dutasteride (Avodart)

70
Q

Benign Prostatic Hyperplasia (BPH)

5 alpha-reductase inhibitors MOA

A

Works by reduces PSA levels & decreasing prostate size –> should NOT be used in patients with LUTS without prostate enlargement

MUST have enlarged prostate

71
Q

Benign Prostatic Hyperplasia (BPH)

5 alpha-reductase inhibitors SE

A
  1. Impotence
  2. Decrease libido
  3. Abnormal ejaculation
  4. Breast enlargement
72
Q

Benign Prostatic Hyperplasia (BPH)

5 alpha-reductase contraindication

A

Pregnancy category X

should NOT be HANDLED by women of childbearing potential

73
Q

Overactive Bladder (OAB)

Definition

A

OAB occurs when the detrusor muscle contracts before bladder is actually full (hyperactive)

  • Detrusor muscle contractions are mediated by activation of muscarinic receptors by ACh
  • M3 receptors are responsible for emptying the bladder
74
Q

Overactive Bladder

First-line treatment for OAB

A

Behavioral therapies

Kegel exercises to strengthen pelvic floor muscles

75
Q

Overactive Bladder

Second-line treatment for OAB

A

Anticholinergic drugs block ACh

76
Q

Overactive Bladder

Name the non-selective anticholinergics used in OAB

A
  1. Oxybutynin (Ditropan)
  2. Oxybutynin patch (Oxytrol)
  3. Tolterodine (Detrol)
77
Q

Overactive Bladder

Name the selective anticholinergic used in OAB

A

Solifenacin (Vesicare)

78
Q

Overactive Bladder

What agent is available OTC for women > 18 yoA

A

Oxytrol patch

79
Q

Overactive Bladder

Mirabegron - Brand, MOA, SE

A

2nd line

Brand: Myrbetriq

MOA: beta-3 agonist that relaxes the detrusor muscle causing increased urine capacity

SE: HTN

80
Q

Overactive Bladder

Third-line treatment

A

Botox

MOA: inhibits release of ACh

Indication: For refractory OAB

81
Q

Motion Sickness

Most common herbal treatment

82
Q

Motion Sickness

Antihistamines available OTC for motion sickness

A
  1. Diphenhydramine (Benadryl)
  2. Dimenhydrinate (Dramamine)
  3. Meclizine (Bonine)
  4. Cyclizine (Marezine)
83
Q

Motion Sickness

Side effects of antihistamines

A

Sedation, blurry vision, dry mouth, confusion, dizziness (anticholinergic effects)

NO alcohol or other CNS depressants

84
Q

Motion Sickness

What agent has a black box warning if used in children?

A

Promethazine

85
Q

Motion Sickness

Major counseling points for scopolamine

A
  1. Apply 4-6 hours prior to need
  2. Do not touch eyes
  3. Wash hand after use
  4. Alternate ears
  5. Do NOT cut patch
  6. Remove patch prior to MRI (will burn skin)
  7. Common SE: dry mouth
86
Q

Motion Sickness

What agent is prescribed for motion sickness that is not more effective than OTC products, but last 3 days?

A

Scopolamine patch (Rx ONLY)

87
Q

Motion Sickness

Scopolamine warning

A

Hypersensitivity to belladonna alkaloids

88
Q

Motion Sickness

When should oral agents for motion sickness be taken?

A

30-60 minutes prior to travel

89
Q

Motion Sickness

Avoid this administration of promethazine

A

do NOT give IV –> cause severe skin necrosis (vesicant)

90
Q

Weight Loss

Drugs that cause weight gain

A 
Steroids
Insulin 
Clozapine
Paroxetine
Mirtazapine
Gabapentin
TZDs
Pregabalin

“So, I Couldn’t Picture Mary Gaining Those Pounds”

91
Q

Weight Loss

How many kcals per day is 1 lb per week of weight loss?

A

500 kcal/day = 1 lb/wk

92
Q

Weight Loss

What percentage still has meaningful health benefits if loss?

93
Q

Weight Loss

Guidelines for bariatric surgery

A

BMI > 40

BMI > 35 w/ comorbid conditions

94
Q

Weight Loss

Drugs that cause weight loss

A

Topiramate
Methylphenidate
GLP-1 agonist
Bupropion

Newer drugs = Maintenance therapy:

Phentermine/Topiramate ER (Qsymia)
Lorcaserin (Belviq)
Naltrexone/Bupropion (Contrave)
Liraglutide (Saxenda)
Semaglutide (Ozempic/Wegovy)
95
Q

Weight Loss

What agent is available OTC & Rx?

A

Orlistat

OTC: Alli

Rx: Xenical

96
Q

Weight Loss

All weight loss medications should be stopped if __% is not achieved in __ weeks.

A

5% in 12 weeks

97
Q

Weight Loss

Contrave - MOA, SE, CI

A

MOA: Naltrexone decreases food cravings; bupropion decreases appetite

SE: abnormal dreams

CI: Pregnancy Category X, concurrent use of opioids, seizures & anorexia

98
Q

Weight Loss

Lorcaserin MOA, SE, CI

A

MOA: 5HT agonist which increases satiety (fullness)

SE: hypoglycemia

CI: Pregnancy Category X

99
Q

Weight Loss

Phentermine CI, length of tx, SE

A

Short-term stimulant used for a max of 12 weeks to jump start a diet

CI: Avoid use with HTN, PAH, Hyperthyroidism, & glaucoma

SE: high BP, tachycardia, CV complications, dry mouth

100
Q

Weight Loss

Orlistat counseling points

A

Low-fat diet & supplemental vitamins ADEK

101
Q

Weight Loss

Micronutrients necessary post-bariatric surgery

A
  1. Calcium (calcium citrate preferred)
  2. ADEK
  3. B12
  4. Iron (prevent anemia)
102
Q

Weight Loss

What agent may be required in some patients post surgery to prevent gallstones due to rapid weight loss?

A

Ursodiol (Actigall)

103
Q

Weight Loss

Topiramate MOA

A

Decreases appetite

104
Q

Weight Loss

Post-bariatric surgery counseling point

A

Medications may need to be crushed or put in liquid for up 2 months post surgery

105
Q

Eye Conditions - Glaucoma

Drugs that cause increase intraocular pressure (IOP)

A

Antihistamines
Anticholinergics
Chronic corticosteroid use
Topiramate

106
Q

Eye Conditions - Glaucoma

Which type of glaucoma is emergent and which is common?

A

Medical emergency: Closed angle glaucoma

Common: Open angle glaucoma

107
Q

Eye Conditions - Glaucoma

First-line treatment

A

Beta-blockers & Prostaglandin analogues

108
Q

Eye Conditions - Glaucoma

Formulation counseling points

A

Suspension - shaken well

Gel - inverted & shaken once

109
Q

Eye Conditions - Glaucoma

Name the non-selective beta-blockers - MOA, CI & SE

A

Timolol (Timoptic)
Betaxolol (Betoptic)

MOA: reduce aqueous humor production

CI: Avoid use in pts with asthma, COPD or advanced cardiac disease

SE: burning & stinging

110
Q

Eye Conditions - Glaucoma

Name the Prostaglandin Analogues - MOA & SE

A

Latanoprost (Xalatan)
Travoprost (Travatan)
Bimatoprost (Lumigan)

MOA: increase aqueous outflow

SE: darkening of eyelids, iris & eyelashes; increased growth of eyelashes; blurred vision

111
Q

Eye Conditions - Glaucoma

Name the Cholinergic/Miotic agent -MOA

A

Pilocarpine (Isopto Carpine)

MOA: increase aqueous outflow

112
Q

Eye Conditions - Glaucoma

Name the Carbonic anhydrase inhibitors - MOA & Caution

A

Dorzolamide (Trusopt)

MOA: reduce aqueous humor production

Caution: sulfa allergy

113
Q

Eye Conditions - Glaucoma

Name the alpha-2 agonists - MOA

A

Brimonidine (Alphagan P)

MOA: decreased aqueous humor production AND increases outflow

114
Q

Eye Conditions - Glaucoma

Counseling points

A
  1. Wait 15 min after use before putting in contacts if the eye drop contains BAK
  2. Wait 5-10 min in between multiple drops
  3. Latanoprost stored in fridge
115
Q

Eye Conditions - Conjunctivitis (Pink Eye)

Treatment options

A
  1. NSAIDs & steroid eye drops to reduce inflammation
  2. Warm compress
  3. Artificial tears for lubrication
116
Q

Eye Conditions - Conjunctivitis (Pink Eye)

Name the steroid eye drops

A

Loteprednol (Lotemax)

Prednisolone (Pred Forte)

117
Q

Eye Conditions - Conjunctivitis (Pink Eye)

Most cases will resolve without treatment

A

Treat symptoms

118
Q

Eye Conditions - Blepharitis (Eyelid inflammation)

Symptoms

A

inflamed, itchy eyelids

119
Q

Eye Conditions - Blepharitis (Eyelid inflammation)

Preferred treatment

A

Gentle washing & warm compress

Use warm moist towel with baby shampoo to wipe away debris

120
Q

Ear Conditions

Application instructions

A
  1. Warm cold ear drops in hand to avoid pain & dizziness
  2. Lie down or tilt ear up
  3. Adults: pull lobe up & back | Children: Pull lobe down & back
  4. Administer drops & keep ear facing up for 5 minutes

NAPLEX 2022 (25 decks)

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