Chapter 5: Eye and Ear Disorders Flashcards Preview

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Flashcards in Chapter 5: Eye and Ear Disorders Deck (120):
1

 

 

typical disorders of the ear canal

 

 

otitis media

otitis externa

inflammatory conditions

cerumen impaction

2

 

 

Class of drug used to treat ear inflammation

 

 

corticosteroids

3

 

 

class of drugs used in treatment of ear pain

 

 

topical antipyrine and benzocaine

4

 

 

drug classes used to treat cerumen impaction

 

 

emulsifiers and emolients

5

 

 

agents used in treatment of pruritis of the ear

 

 

emolients such as: glycerin, mineral oil, and olive oil

6

 

 

Is substitution of ototopical antibiotics reccommended?

Why or why not?

 

 

No because different preparations can differ in pH, viscosity, and presence of steroids

7

 

 

Advantage of ototopical cipro

 

 

better activity against gram- bacilli

8

 

 

advantage of ototopical ofloxacin

 

 

longer half-life and higher serum levels

appropriate for aerobic gram-bacilli (staph, strep)

9

 

 

What  ABT would you use for urethritis if you suspected Chlamydia was present?

 

 

ofloxacin

10

 

 

what is an acceptable substitution for a solution of ofloxacin and why

 

 

 

a suspension of ciprofloxacin

has low pH and high viscosity

same chemical classification

11

 

 

drug therapy for otitis externa

 

 

analgesic and antibiotic

12

 

 

otic anti-infectives:

mild acids and alcohols

 

 

make the environment inhospitable for pathogens to reproduce

causes drying of cellular infective agents

topical, antibacterial, and antifungal effects

13

 

 

otic anti-infectives:

Fluoroquinolones

 

 

broad coverage and affect psudomonas species

14

 

 

otic anti-infectives:

corticosteroids

 

 

aid in reducing inflammation and patient symptoms

gives better  access for topical medicines

15

 

 

Implications of OTC neomycin topical antibiotics

 

 

associated with severe ototoxicity (especially with perforated tympanic membrane)

can cause contact dermatitis

16

 

 

mechanism of action:

topical otic anti-infectives

 

 

work as either bacteriostatic or bacteriacidal

17

 

 

Are topical anti-infectives absorbed

 

 

Not unless skin is broken

rest of pharmicokinetics is unknown

18

 

 

Examples of otic anti-infectives

 

 

Ofloxacin (Floxin)

Neomycin (Myciguent)

Ciprofloxacin-hydrocortisone (Cipro HC otic)

19

 

 

Dosage/administration for topical otic anti-infectives

preparations with and without steroids

 

 

page 67

20

 

 

Proper installation of ear drops 

Adults

 

 

pull ear lobe up and back

21

 

 

poper installation of ear drops

children

 

 

pull ear lobe down and back

22

 

 

clinical uses for otic acid-alcohol solutions

 

 

superficial infections of external auditory canal

23

 

 

examples of otic acid-alcohols

 

 

acetic acid/aluminum acetate (Domeboro Otic)

isopropyl alcohol/propylene glycol (Ear Sol)

24

 

 

Antipyrine

 

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