Chapter 5: Eye and Ear Disorders Flashcards
(120 cards)
1
Q
typical disorders of the ear canal
A
otitis media
otitis externa
inflammatory conditions
cerumen impaction
2
Q
Class of drug used to treat ear inflammation
A
corticosteroids
3
Q
class of drugs used in treatment of ear pain
A
topical antipyrine and benzocaine
4
Q
drug classes used to treat cerumen impaction
A
emulsifiers and emolients
5
Q
agents used in treatment of pruritis of the ear
A
emolients such as: glycerin, mineral oil, and olive oil
6
Q
Is substitution of ototopical antibiotics reccommended?
Why or why not?
A
No because different preparations can differ in pH, viscosity, and presence of steroids
7
Q
Advantage of ototopical cipro
A
better activity against gram- bacilli
8
Q
advantage of ototopical ofloxacin
A
longer half-life and higher serum levels
appropriate for aerobic gram-bacilli (staph, strep)
9
Q
What ABT would you use for urethritis if you suspected Chlamydia was present?
A
ofloxacin
10
Q
what is an acceptable substitution for a solution of ofloxacin and why
A
a suspension of ciprofloxacin
has low pH and high viscosity
same chemical classification
11
Q
drug therapy for otitis externa
A
analgesic and antibiotic
12
Q
otic anti-infectives:
mild acids and alcohols
A
make the environment inhospitable for pathogens to reproduce
causes drying of cellular infective agents
topical, antibacterial, and antifungal effects
13
Q
otic anti-infectives:
Fluoroquinolones
A
broad coverage and affect psudomonas species
14
Q
otic anti-infectives:
corticosteroids
A
aid in reducing inflammation and patient symptoms
gives better access for topical medicines
15
Q
Implications of OTC neomycin topical antibiotics
A
associated with severe ototoxicity (especially with perforated tympanic membrane)
can cause contact dermatitis
16
Q
mechanism of action:
topical otic anti-infectives
A
work as either bacteriostatic or bacteriacidal
17
Q
Are topical anti-infectives absorbed
A
Not unless skin is broken
rest of pharmicokinetics is unknown
18
Q
Examples of otic anti-infectives
A
Ofloxacin (Floxin)
Neomycin (Myciguent)
Ciprofloxacin-hydrocortisone (Cipro HC otic)
19
Q
Dosage/administration for topical otic anti-infectives
preparations with and without steroids
A
page 67
20
Q
Proper installation of ear drops
Adults
A
pull ear lobe up and back
21
Q
poper installation of ear drops
children
A
pull ear lobe down and back
22
Q
clinical uses for otic acid-alcohol solutions
A
superficial infections of external auditory canal
23
Q
examples of otic acid-alcohols
A
acetic acid/aluminum acetate (Domeboro Otic)
isopropyl alcohol/propylene glycol (Ear Sol)
24
Q
Antipyrine
A
otic analgesic
also has anti-inflammatory effects because it affects prostaglandin system
25
Benzocaine
otic analgesic
blocks nerve sodium channels
26
What if otitis externa does not clear after 1 week of treatment
obtain cultures to guide further treatment
27
What should you do if a patient has 2 or more ear infections in a 6 month period
further eval for cholesysteatoma, foreign body, or tumor
28
Analgesics that can cause ototoxicity
ASA and NSAIDs
29
antibiotics that can cause ototoxicity
Aminoglycosides
clarithromycin
erythromycin
vancomycin
neomycin
30
antineoplastics that can cause ototoxicity
cisplatin
mechlorethamine
31
Loop diuretics that can cause ototoxicity
bumetanide
ethacrynic acid
furosemide
32
dosage/administration of acid-alcohol solutions
page 68
33
two combination otic analgesics commonly used today
acetic acid and benzocaine/antipyrine/glycerin (Auralgan Otic)
benzocaine/antipyrine/propylen glycol (Tympagesic)
34
dosage/administration of otic analgesics
page 68
35
purpose of cerumenolytics
soften and remove ear wax
36
classifications of cerumenolytics
water based
oil based
nonwater/nonoil based
37
examples of cerumenolytics
carbamide peroxide 6.5% (Debrox)
triethanolamine polypeptide oleate (Cerumenex drops)
38
what is used for "swimmer's ear"
isopropyl alcohol and glycerin
39
What happens if triethanolamine polypeptide drops are left in the ear longer than 30 minutes
inflammation occurs
40
cerumenolytics:
patient education
may hear bubling with Debrox d/t action of releasing O2 from cerumen
using carbamide peroxide longer than 4 days can damage tympanic membrane
41
common eye infections
conjunctivitis
blepharitis
hordeolum
42
What should be monitored when patient
is being treated for eye disorder
effectiveness of treatment
intraocular pressure
43
consideration for infants and children being treated for eye disorders
erythromycin ointment has good coverage and is easier to administer than drops
44
classes of opthalmic anesthetics
tetracaine (Pontocaine)
proparacaine (Ophthaine, Ophthetic)
45
What can result from improper use of opthalmic anesthetics
deep corneal infiltrates
ulceration
perforation
46
mechanism of action:
opthalmic anesthetics
agents penetrate to sensory nerve endings in corneal tissue
(tetracaine, proparacaine)
locally stabilize and block initiation and conduction of nerve impulses by decreasing neuronal membrane's sensitivity to sodium ions
47
doasge/administration of opthalmic anesthetics
page 71
48
acute conjunctivitis is usually caused by
virus
(pink eye)
49
how can you recognized hepres infections of the eyes
severity
vesicular nature
corneal involvement or nerve distribution
patient population
50
cases to refer to opthalmologist
herpes infections of the eyes
deeper infection of the globe or eye socket is suspected
51
what do contact lenses place at risk for
fungal infections
52
treatment of allergic conjunctivitis
antihistamines
NSAIDs
leukotriene inhibitors
corticosteroids
53
best way to treat viral eye infections
saline drops
warm compresses
and time
54
most common organisms that cause bacterial conjunctivitis
staphylococcus aureus
streptococcus pneumoniae
haemophilus influenzae
55
opthalmic anti-infectives mechanism of action
bacteriostatic or bacteriocidal
56
most commonly used opthalmic anti-infectives
tobramycin (Tobrex)
sulfacetamide (Sulamyd, Bleph-10)
sulfacetamide/prednisolone (Blephamide)
fluoroquinolones (Cipro drops)
57
opthalmic anti-infectives
contraindications
tobramycin should not be used if systemic aminoglycosides are being used because it could affect serum levels and lead to toxicity
58
Which opthalmic anti-infective may cause transient blurry vision
bacitracin
59
patent education :
sulfacetamide solution
when it turns dark it has lost its potency and should be discarded
60
opthalmic mast cell stabilizers mechanism of action
inhibit degranulation of mast cells after exposure to an antigen
61
clinical uses of mast cell stabilizers
allergic conjunctivitis and keratitis
62
examples of opthalmic mast cell stabilizers
Nedcromil (Alocril)
Cromolyn (Opticrom)
Lodoxamide (Alomide)
63
dosage/administration of mast cell stabilizers
page 73
64
opthalmic antihistamines mechanism of action
blocks the effects of histamine released during allergic reactions and blunts its symptoms
65
clinical use of opthalmic antihistamines
relief of itching associated with seasonal allergies and allergic conjunctivitis
66
examples of opthalmic antihistamines
azelastine (Optivar)
epinastine (Elestat)
antazoline (Vasocon)
amedastine (Emadine)
ketotofen (Zaditor)
levocabastine (Livostin)
olopatadine (Patanol)
67
opthalmic antihistamines and contact lenses
dont wear while using them
wait 15 minutes before re-applying them
replace them if eye is red
68
opthalmic vasoconstrictors mechanism of action
weak sympathomimetic agents that constrict
blood vessels in conjunctiva
69
clinical use for opthalmic vasoconstrictors
relief of eye redness caused by irritants or allergies
70
opthalmin vasoconstrictors contraindications
narrow angle glaucoma
71
examples of opthalmic vasoconstricotrs
oxymetazoline (Afrin)
tetrahydrozine (Visine)
72
dosage/administration of opthalmic vasoconstrictors
page 74
73
dosage/administration of opthalmic antihistamines
page 73
74
opthalmic vasoconstricotrs interactions
increased pressor effects with MAOIs
75
cyclosporin (Restasis)
polycyclic polypeptide that inhibits interleukin 2
76
clinical uses of Restasis
prevents organ rejection after transplant surgery
opthalmic preparation to prevent rejection of corneal implant
77
opthalmic lubricants actions
contain agents that provide hydration. maintain moisture, and protect eye
can be viscous or non-viscous
78
clincal uses of opthalmic lubricants
supplement natural tears for dry eyes or to wash away irritants
viscosity enhancers
(promotes increased contact time of an opthalmic agent with an ocular surface)
secondary corneal edema
79
Types of agents used to treat glaucoma
direct and indirect acting miotics
topical prostaglandin agonists
carbonic anhydrase inhibitors
sympathomimetic agents
alpha-2 adrenergic agonists
beta blockers
opthalmic osmotics
80
Miotics mechanism of action
contracts the iris sphincter muscle, resulting in miosis
(pupillary constriction)
81
Examples of direct acting miotics
carbachol (Isopto Carbachol)
82
examples of indirect-acting miotics
echothiophate (Phospholine)
83
How do miotics decrease intra-ocular pressure
* when the pupil constricts, it also constricts the ciliary muscles attached to the trabecular mesh work
* This opens the canal of Schlemm which increases the outflow of aqueous humor
* which decreases IOP
84
dosage/administration of miotics
page 77
85
clinical uses of miotics
glaucoma
Sjogren's syndrome
86
Miotics adverse reactions
abdominal cramps, diarrhea, watery mouth, excessive sweating, urinary incontinence, muscle weakness
87
Miotics contraindications
active inflammation of the eye
88
Patient education on miotics
it will impair adjustment to changes in light
89
topical prostaglandin agonists mechanism of action
stabilized, synthetic analogues of prostaglandin that increase outflow of intraocular aqueous humor to lower IOP
(acts on RF prostaglandin receptor)
90
examples of topical prostaglandin agonsits
latanoprost(Xalatan)
bimatoprost (Lumigan)
travoprost (Travatan)
unoprostone (Recula)
91
clinical use of topical prostaglandin agonists
open-angle glaucoma
92
dosage/administration of topical prostaglandin agonists
page 78
93
absorption of topical prostaglandin agonists
* through cornea ad hydrolyzed into active compound:
* Latanoprost and bimatoprost
* not absorbed but active on the cornea:
* travoprost and unoprostone
94
distribution of topical prostaglandin agonists
* bimatoprost: 80% protein bound
* lataoprost: 4h in aqeous humor and 1 hour in plasma
* travoprost: 1 hour in plasma then rapidly eliminated
* unoprostone: not reported
95
metabolism of topical prostaglandin agonists
* latanoprost: hydrolyzed in liver
* bimatoprost: oxidated in liver
* travoprost and unoprostone: hydrolyzed by esterases in the cornea
96
excretion of topical prostaglandin agonists
* latanoprost and bimatoprost: urine
* travoprost and roprostone: urine (rapid and undetectable in an hour)
97
half-life of topical prostaglandin agonists
* latanoprost: 45 minutes
* bimatoprost: about 45 minutes
* travoprost: 45 minutes
* unoprostone: unreported
98
topical prostaglandin agonist adverse reactions
sensation of foreign body in the eye
permanent discoloration of iris with brown pigment
eyelash changes
conjunctival hyperuremia
99
topical prostaglandin agonist contraindications
pregnancy category C
not for children
pulmonary diseases
100
carbonic anhydrase inhibitors
(CAIs)
not first-line therapy
used as diuretics
101
topical CAIs
brinzolamide (Azopt)
dorzolamide (Trusopt)
102
oral CAIs
Diamox
Neptazane
page 78
103
CAI pharmacookinetics
page 78
104
CAI adverse reactions
* DERM: rash, alopecia, STEVENS-JOHNSON SYNDROME
* GI: anorexia, bitter or altered sense of tast with dorzolamide and brinzolamide
* GU: kidney stones
* HEME: blood dyscrasias, bone marrow supression
* META: metabolic acidosis
* MISC: weakness and myalgia, groin/leg pain, malaise, fatigue
* NEURO: depression, headache, nervousness, numbness/tingling
105
CAI interactions:
acetazolamide and methimazole
sulfa derivatives so interacts with salicylates, phenytoin, quinidine, and cyclosporine
106
contraindications to sympathomimetic agents
* hypersensitivities
* cerebrovascular insufficiencies
* cardiovascular disease
* DM
* hyperthyroidism
* parkinson's
* HTN
107
interactions for alpha-2 agnosits
use with MAOIs can cause HTN crisis
108
most common agent to treat open-angle glaucoma
beta blocker eye drops
109
contraindications for opthalmic beta blockers
glaucoma who also have bradycardia, AV block, or HF
DM because it intereferes with glycolysis
hyperthyroidism
Raynaud's or any other peripheral vascular disorder
110
Opthalmic osmotics mechanism of action
makes osmotic pressure of glomerular filtrate hypertonic allowing water and electrolytes to be passively pulled out of cellular and interstitial spaces
excess fluid is excreted in urine
111
clinical use for opthalmic osmotics
interupt acute attack og glaucoma or hypertensive crisis
extremely high IOP
cerebral edema
112
example of opthalmic osmotic
mannitol
113
Mannitol adverse reactions
* EENT: blurry vision, rhinitis
* CV: transient volume expansion, chest pain, edema, tachycardia
* GI: N/V, thirst
* GU: renal failure
* META: dehydration, hyperkalemia, hypernatremia, hypokalemia, hyponatremia
* MISC: phlebitis at injection site
* NEURO: confusion, headache
114
Mannitol interactions
hypokaleia can potentiate digoxin toxicity
115
Mannitol contraindications
cardiac impairement, sever liver dysfunction, dehydration, intracranial bleeding, kidney impairement
116
administration of mannitol
infuse over 30 minutes to reduce IOP
117
pupillary constricters mechanism of action
paralyze accomodation reflex (cytoplegia)
used for eye exams (to examine retina)
118
contraindication for pupillary constrictors and why
closed-angel glaucoma
iris dilation occludes outflow of aqueous humor and increases IOP
119
examples of pupillary constrictors
cyclopentolate (Cyclogyl)
tropicamide (Mydral)
120
pregnancy, geriatric, and pediatric considerations
page 83
