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Flashcards in 7 - Eye & Ear Deck (38)
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1

Debrox

Dose / Indication / Ingredient + strength

Carbamide Peroxide 6.5%

prepared in anhydrous glycerol

5-10 drops BID 

for 3-4 days if needed

>12 y/o

indicated for IMPACTED EARWAX

2

Visine

(Tetrahydrozoline HCL / oxymetazoline HCL / naphazoline HCL / pheniramine maleate)

Dose / Indication

Opthalmic DECONGESTANT / ANTIHISTAMINE

 

1-2 Drops < QID

 

Third line therapy for Allergic Conjungtivitis

3

Systane

(PEG 400 / propylene glycol)

Dose / Indication

Artificial Tears

1-2 Drops

 

First line therapy for Allergic Conjunctivitis

Also treatment for Dry Eye Syndrome

4

NonPharmacologic Treatment

of Water-Clogged Ears

  • Tilt affected ear DOWNWARD
    • manipulate the auricle gently
  • Blow Dryer
    • on LOW HEAT & SPEED
      • (NOT DIRECTLY INTO EAR)
  • ​​One-Time use of WATER-ABSORBING EAR PLUGS
    • remove after 10 min
    • for use for patients >16 y/o

5

Ocular Irrigants

Cleanse ocular tissues of unwanted debris

while still maintaining MOISTURE

Chemical Burn / Loose Foreign Object

 

Specifically balanced pH & Osmolality

6

EX-ST for self treatment

of OTIC DISORDERS

  • SUDDEN hearing loss
  • Signs of infection
  • Sharp / severe PAIN
  • Bleeding or signs of trauma
    • presence of ruptured tympanic membrane
  • <12 y/o
  • Ear surgery within 6 weeks
  • Tympanostomy tubes present
  • Hypersensitivity to recommended angents
  • Incapable of following proper instructions

7

Purpose of Earwax

(Cerumen)

Lubricates ear canal

Traps debris

WATERPROOF BARRIER

Antimicrobial properties = Contains lysosimes / ACIDIC pH

8

Key Points for

OTIC DISORDERS

Know EX-ST

Limit self-treatment to minor symptoms

Contact PCP if symptoms persist or worsen >4 days

Provide instructions on proper use / effective products

Proper ear hygiene importance of earwax

9

Treatments that we DO NOT RECOMMEND

for Impacted Earwax

  • Docusate
    • conflicting data
  • Hydrogen Peroxide 3%
    • contains WATER --> ear infection possible
  • Olive Oil
    • delay seeking proper treatment
  • Ear Candles
    • INEFFECTIVE --> ear injury / burns
  • Garlic Oil / Willow Bark / Chamomilla
    • lacking data on efficacy / safety

10

S/Sx + Goals

Allergic Conjuctivitis

RED eyes + Watery discharge

 

Remove / Avoid ALLERGEN

Limit or reduce the severity of allergic rxn

symptomatic relief

11

S/Sx of

IMPACTED EARWAX

MOST common cause of temporary hear loss

  • Feeling of fullness/pressure
  • GRADUAL HEARING LOSS
  • Dull Pain
  • Vertigo / Tinnitus
  • Chronic Cough

12

Debrox

Carbamide Peroxide 6.5%

ADR / CI-P / Consult

DNU if h/o of perforation of eardrum or prior ear surgery

discharge / drainage / SEVERE ear pain

AIDS / DM

 

Mild Tingling + CRACKLING NOISES are normal

DNU for more than <4 days

avoid eye contact

13

S/Sx of

WATER-CLOGGED EARS

NOT THE SAME AS SWIMMER'S EAR

  • Feeling of wetness / fullness
  • GRADUAL HEARING LOSS
  • Ear exposed to excessive moisture
    • Trappped moisture -->
      • --> itching / pain / inflammation / infection

14

Zaditor

KETOTIFEN FUMARATE

Dose / Indication

Opthalmic Antihistamine / Mast Cell Stabilizer

0.035% Ketotifen

1 Drop BID q8-12hrs

 

2nd line therapy for Allergic Conjunctivitis

15

EX-ST for Self-Treatment of

Ocular Disorders

  • Eye PAIN
  • Blurred visionnot associated with ointment/drops
  • Light sensistivity
  • History of contact lens wear
  • Blunt trauma to eye
  • Chemical exposure to eye
  • HEAT - eye exposure ( excluding sun exposure )
  • Lack of response to therapy
    • ​in >72hours

16

Adult vs Child

Ear Canal

Adult = S-Shaped canal

Eutachian tube lengthens DOWNWARD (towards mouth/nose)

 

Child = normal

SHORTER / STRAIGHTER

FLATTER ear canal

17

What goes first, Solutions or Suspensions?

And how long do you wait?

Solutions FIRST suspensions

 

wait 5 minutes  between drops

 

shake SUSPENSIONS well

18

ADR / CIs

Opthalmic Antihistamine / Mast Cell Stabilizer

Ketotifen Fumarate (Zaditor)

Can cause Burning / Stinging / Discomfort

can cause Pupil DILATION

esp w/ light-colored irises & contact wearers

 

CI in ppl w/ risk for angle closure glaucoma

19

Flowsheet of Impacted Earwax

  1. Complaint of consistant earwax excess / impact
  2. Obtain medical/medication history​​
    1. ​intended use / previous use / length&history of use
  3. Any EX-ST?
    1. yes --> SEE MD
  4. If no, Ask if using IMPROPER removal methods / unapproved meds
    1. yes --> S/Sx of infection --> SEE MD
  5. If no, use Carbamide Peroxide
    1. if treatment didnt work --> SEE MD
  6. Counsel on proper ear hygiene

20

Opthalmic DECONGESTANTS

Visine Redness Relief

Treatment for Allergic Conjuctivitis

  • A-adrenergic agonist -> constriction -> reduced redness
  • Can cause eye dryness 
    • and REBOUND CONGESTION, limit use to 72 hours
      • oxymetazoline/PE > naphazoline/tetrahydrozoline
  • Contraindicated in angle closure glaucoma
  • Use in caution in:
    • HTN / DM
    • CVD / Arteriosclerosis
    • HYPEthyroidism

21

Risk factors for Dry Eye Syndrome

Female!

Older Age!

Postmenopausal estrogen therapy

Medications :

Antihistamines / Antidepressants / Decongestants

Diuretics / Beta Blockers

22

Steps to Instill

Eye OINTMENT

  1. Wash hands
  2. Tilt head back
    1. grasp lower outer lid below lashes,
    2. pull down form pocket
  3. Place ointment tube over eye, look up
    1. place 1/4in to 1/2in of ointment into LOWER EYELID pocket
      1. using a sweeping motion
  4. Close eye for 1-2 minutes
  5. Vision may be temporarily blurred
    1. prefer to use ointment at night

23

Visine - Decongestant/AH

(Tetrahydrozoline HCL / oxymetazoline HCL / naphazoline HCL / pheniramine maleate)

ADR / CI+P / Consult

MILD STINGING

Limit use to <72 hours, Rebound Congestion

>6y/o, remove contact lenses

  • Contraindicated in angle closure glaucoma
  • Use in caution in:
    • HTN / DM
    • CVD / Arteriosclerosis
    • HYPERthyroidism

24

Steps to Instill

EYE DROPS

  1. WASH HANDS
  2. Tilt head back
  3. Grasp lower eyelid below lash line, pull away to make pouch
  4. Place dropper over eye by looking directly at it
  5. Before applying drop, LOOK UP
  6. Release eyelid after drop is applied
  7. Use finger to put pressure over tear duct
  8. Wait 5 min b4 instilling next drop

25

Pharmacologic Treatment for

Dry Eye Syndrome

Artificial Tears

Stabilize tear film / reduce tear evaporation / lubricate occular surface

Non-Medicated Ointments

INCREASE retention time in eye / enhance tear film integrity

Topical Cyclosporine

RX only, long term benefit nclear

26

Drops or ointments first

and how long do you wait?

DROPS FIRST >> ointments

 

wait 10 MINUTES between products

27

Non-pharmacologic Treatment

for Dry Eye Syndrome

AVOID-  dry/dusty places + prolonged computer use

Use humidifiers + Eye Protection outdoors

Elmininate offending medications

Reposition work station away from air vents

28

Refresh

(carboxymethhylcellulose sodium, glycerin, mineral oil, petrolatum, povidone, polysorb80)

Dose / Indication

NON-MEDICATED OINTMENT

 

Use as often as needed

 

used for Dry-Eye Treatment

29

Opthalmic Antihistamines

 

Treatment for Allergic Conjunctivitis

More effective when taken w/ Opthalmic Decongestant

  • Histamine1 receptor antagonist
    • Pheniramine maleate & Antazoline phosphate

 

 

30

  • SUDDEN hearing loss
  • Signs of infection
  • Sharp / severe PAIN
  • Bleeding or signs of trauma
    • presence of ruptured tympanic membrane
  • <12 y/o
  • Ear surgery within 6 weeks
  • Tympanostomy tubes present
  • Hypersensitivity to recommended angents
  • Incapable of following proper instructions

EX-ST for self treatment

of OTIC DISORDERS