1- Ophthalmic and Otic Disorders

Question 1

What ophthalmic disorders are self treatable?

Answer 1

dry eyes and allergic conjuctivitis

Question 2

What otic disorders are self treatable?

Answer 2

excessive or impacted cerumen and water clogged ears

Question 3

What are exclusions for self care for ophthalmic disorders?

Answer 3

-severe eye pain
-blunt trauma to eye
-chemical exposure to eye
-heat exposure
-blurred vision
-sensitivity to light
-contact lense wearer
-symptoms last or worsen > 72h

Question 4

What is the recommended duration of use of ophthalmic products?

Answer 4

72h

Question 5

What drugs can be used to treat dry eyes?

Answer 5

-artificial tear solution/gel
-non-medicated lubricant ointment

Question 6

What drugs can be used to treat allergic conjuctivitis?

Answer 6

-artificial tears solution/gel
-antihistamine/mast cell stabilizer drops
-decongestant (w/ or w/o antihistamine)
-decongestant/astringent drops

Question 7

What are the signs/symptoms of dry eyes?

Answer 7

-mild red eye
-gritty feeling in eye with sensation of something stuck in eye
-possible excessive tearing as a compensatory mechanism

Question 8

What are the causes of dry eyes?

Answer 8

-age
-allergens
-corneal or lid defects
-dry air
-loss of lid tissue turgor
-menopause
-thyroid disorders
-medications (antihistamines, beta blockers, decongestants, diuretics)

Question 9

What are the treatment goals for dry eyes?

Answer 9

-alleviate and control dryness of the ocular surface
-relieve symptoms (irritation)
-prevent possible tissue/eye damage

Question 10

What are nonpharmacological recommendations for dry eyes?

Answer 10

-avoid dusty/dry areas
-avoid wind or air flow
-avoid prolonged viewing of computers
-eliminate offending medications (add supplements such as omega-3 or flaxseed)
-humidifier
-warm compress to eyelids
-wear sunglasses or goggles when outdoors

Question 11

What is the first line treatment for dry eyes?

Answer 11

artificial tear solution

Question 12

When would preservative-free formulations of artificial tears be preferred?

Answer 12

frequent use due to less ocular surface irritation

Question 13

What characteristics of artificial tear products may increase side effects?

Answer 13

increased viscosity and preservatives

Question 14

What is the dosing for artificial tears preparations?

Answer 14

-mild= 1-2 times a day
-moderate= 3-4 times/daily up to hourly

Question 15

What is the use of demulcents in ophthalmic preparations?

Answer 15

increase viscosity to slow drainage of active ingredients and increase retention time and bioavaliability

Question 16

What is the use of non-medicated lubricant ointment for dry eyes?

Answer 16

last line treatment, but reduces burning and stinging and also prevents evaporation- apply 2 times daily up to every couple hours if needed
note: causes blurred vision

Question 17

What are the signs and symptoms of allergic conjuctivitis?

Answer 17

-red eyes
-watery discharge
-itching
-blurred vision due to excess tears
-bilateral

Question 18

What are the causes of allergic conjuctivitis?

Answer 18

animal dander, pollen, topical eye preparations

Question 19

What are the treatment goals of allergic conjuctivitis?

Answer 19

-remove and avoid the allergen
-limit or reduce allergic reaction severity
-provide symptomatic relief
-protect the ocular surface

Question 20

What are the nonpharmacological recommendations for allergic conjuctivitis?

Answer 20

-close windows and doors
-change home filters regularly
-cold compress 3-4 times daily
-use sunglasses outside
-avoid contact lenses until condition resolves

Question 21

What is the first line treatment for allergic conjuctivitis?

Answer 21

artificial tears solution/gel

Question 22

What is the second line treatment for allergic conjuctivitis?

Answer 22

2nd gen ophthalmic antihistamine/mast cell stabilizer (with or without oral antihistamine, note oral antihistamine may cause dry eyes)

Question 23

What drugs are 2nd gen Ophthalmic H1 Antihistamine/Mast Cell Stabilizer?

Answer 23

-ketotifen
-OLOPATADINE
-alcaftadine

Question 24

What is the dosing of olopatadine?

Answer 24

-0.1%= twice daily, be sure to leave 6-8h between each dose
-0.2%/0.7%= once daily

Question 25

What drugs are oral antihistamines?

Answer 25

-cetirizine
-chlorpheniramine
-clemastine
-diphenhydramine
-fexofenadine
-levocetirizine
-loratadine

Question 26

What drugs are ophthalmic decongestants?

Answer 26

-brimonidine
-naphazoline
-oxymetazoline
-phenylephrine
-tetrahydrozoline

Question 27

What is the MOA of ophthalmic decongestants?

Answer 27

alpha-adrenergic receptor agonists

Question 28

What is the dosing of ophthalmic decongestants?

Answer 28

1-2 drops up to 4 times a day

Question 29

What are the contraindications for ophthalmic decongestants?

Answer 29

age <6 yo, angle closure glaucoma, contact lens user, and pregnancy
USE CAUTION in cardiovascular disease, diabetes, HTN, hyperthyroidism

Question 30

What are the adverse effects of ophthalmic decongestants?

Answer 30

stinging, burning, rebound congestion, epithelia xerosis

Question 31

What drugs are ophthalmic antihistamines?

Answer 31

pheniramine maleate and antazoline phosphate

Question 32

What is the MOA of ophthalmic antihistamine?

Answer 32

H1 blocker

Question 33

What are the adverse effects of ophthalmic antihistamines?

Answer 33

pupil dilation and discomfort upon instillation

Question 34

What is the use of ophthalmic astringent (zinc sulfate 0.25%) for allergic conjuctivitis?

Answer 34

eliminate mucous build up on the eye due to debris exposure to relieve symptoms from environmental irritants (pollen, dust, or smoke)