Exam 2 Flashcards
(73 cards)
1
Q
- among the most common disorders affecting the anterior eye, associated with aging, result of lid or corneal defects, loss of lid tissue turgor, etc., characterized by normal appearing white sclera or mildly red eye often associated with patient complaints of sandy/gritty feeling or sensation of something in the eye
- treatment goals: alleviate dryness of the ocular surface, relieving symptoms of irritation and preventing possible corneal and non-corneal tissue damage
- pharm therapy: artificial tears
- non-pharm therapy: avoiding environments that increase evaporation of tear film, using humidifiers or not being near heating/AC vents, avoid prolonged use of computer screens, use eye protection
A
dry eye
2
Q
- common allergens include pollen, animal dander, topical eye preparations, red eye with watery discharge, itching
- treatment goals: remove or avoid the allergen, limit/reduce the severity of allergic reaction, provide symptomatic relief, protect ocular surface
- pharm therapy: artificial tears may help wash out allergens, if symptoms persist should switch to ophthalmic antihistamine or mast cell stabilizer, H1 receptor antagonist product
- non-pharm therapy: removing/avoiding exposure, applying cold compresses, wearing sunglasses
A
allergic conjunctivitis
3
Q
- overwear of contact lenses, surgical damage to cornea, inherited corneal dystrophies, subjective perception of halos or starbursts around lights, eye care specialist must diagnose this before self-treatment attempted
- treatment goals: draw fluid from cornea to relieve symptoms
- pharm therapy: hyperosmotic agents increase tonicity of tear film promoting the movement of fluid from the cornea to the more highly osmotic tear film, sodium chloride 5% in ointment form most effective but tends to cause stinging/burning
- no non-pharm therapy options
A
corneal edema
4
Q
- pain and watering (tearing), if exposure to substance causes only minor irritation with no abrasion of the eye surface then self treatment is appropriate
- treatment goals: remove the irritant by copious irrigation, if foreign substance is fragment of wood/metal/not easily removed by irrigation then see eye care specialist
- pharm therapy: ocular irrigants used to cleanse ocular tissues while maintaining moisture in eye, products must be physiologically balanced with respect to pH and osmolality
- no non-pharm therapy options
A
loose foreign substances in the eye
5
Q
Eye pain, blurred vision not associated with use of ophthalmic ointments, sensitivity to light, history of contact lens wear, blunt trauma to the eye, chemical exposure affecting the eye, eye exposure to heat (excluding sun exposure), symptoms that have persisted for more than 72 hours
A
exclusions for self treatment of eye disorders
6
Q
wash hands thoroughly, contact lenses should be removed, tilt head back (if administering in children have them lie down before placing drops in eyes), gently grasp lower eyelid below lashes and pull eyelid away from eye to create pouch, look up before applying a drop, apply drop and then slowly release the eyelid, close eyes gently for a few minutes and position head as if looking at the floor, put gentle pressure over opening of tear duct
A
counseling on eye drops
7
Q
when are preservatives used in eye products? when would preservative free be preferred in some cases?
A
preservatives used in multidose eye products, preservative free in patients who are sensitive to preservatives, use drops frequently, compromised corneas
8
Q
MOA: add to the aqueous part of the tears or to the fatty acid (lipid) part of tears
A
artificial tears solutions or gels
9
Q
MOA: provide lubrication to eye surface through oily base, alleviate dryness by maintaining a protective barrier on the cornea and conjunctiva
A
non-medicated ointments (white petrolatum, mineral oil)
10
Q
MOA: stimulate alpha adrenergic receptors on vascular smooth muscle resulting in vasoconstriction of conjunctival blood vessels and reduction in ocular redness
A
decongestant eye drops - phenylephrine, naphazoline, oxymetazoline, tetrahydrozoline, brimonidine
11
Q
MOA: competes with histamine for H1 receptors
A
antihistamines - pheniramine, antazoline
12
Q
MOA: blocking histamine receptors in the eye preventing histamine from binding and causing symptoms like itching, redness, swelling
A
antihistamine/mast cell stabilizer eye drops - olopatadine, ketotifen, alcaftadine
13
Q
MOA: create a concentration gradient drawing fluid out of corneal tissue due to their high solute concentration
A
hyperosmotic eye preparations - 2% sodium chloride drops, 5% sodium chloride drops and ointment
14
Q
- lodged, wedged, firmly packed cerumen in the external auditory canal, sensations of ear fullness, dull pain, itching, discomfort, tinnitus, dizziness, vertigo
- treatment goals: remove the cerumen using safe and effective products while preventing potential adverse effects
- pharm therapy: carbamide peroxide 6.5% in anhydrous glycerin
- non-pharm therapy: use an ear cleaning tool (curette) to remove earwax manually
- exclusions: signs of infection, pain associated with ear discharge, bleeding or signs of trauma, presence of ruptured tympanic membrane, ear surgery within prior 6 weeks, tympanostomy tubes present, incapable of following proper instructions, hypersensitivity to agents, less than 12 years old, worsening condition after self-treatment
A
excessive or impacted cerumen
15
Q
- certain host and environmental factors are recognized to contribute to presence of excessive moisture in the external auditory canal, excessive moisture may become trapped within ear from sweating, high humidity, swimming, transient hearing impairment, sensation of localized discomfort or fullness
- treatment goals: dry the external auditory canal using a safe and effective agent and prevent recurrences in persons who are prone to retaining moisture in ears
- pharm therapy: isopropyl alcohol 95% in anhydrous glycerin 5%, no minimum age, instill 4-5 drops in affected ear
- non-pharm therapy: prevent exposure and accumulation of moisture within EAC, earplugs, bathing cap, wiping ears well with towel after bathing/showering
- exclusions: signs of infection, pain associated with ear discharge, dizziness, bleeding or signs of trauma, presence of ruptured tympanic membrane, ear surgery within prior 6 weeks, tympanostomy tubes present, incapable of following proper instructions, hypersensitivity to recommended agents, worsening of condition after attempted self-treatment
A
water-clogged ears
16
Q
Lie down or tilt head, have dropper over the ear and make sure that tip of dropper does not touch or become inserted into the ear canal, let product remain for 1-2 minutes after application
A
counseling points for administration of ear drops
17
Q
MOA: releases hydrogen peroxide which breaks up cerumen
A
carbamide peroxide 6.5% in anhydrous glycerin
18
Q
MOA: used as a drying agent primarily by rapidly evaporating and removing excess moisture from the ear canal
A
isopropyl alcohol 95% anhydrous glycerin 5%
19
Q
pain lasting less than 4 weeks is _______ and pain lasting at least 3 months is _______
A
acute, chronic
20
Q
- location: muscles of the body
- signs: possible swelling (rare)
- symptoms: dull constant ache (sharp pain rare), weakness and fatigue of muscles
- onset: varies depending on cause
- modifying factors: elimination of cause, use of stretching, rest, heat, topical/systemic analgesics
A
myalgia
21
Q
- location: tendon locations around joint areas
- signs: warmth, swelling, erythema
- symptoms: mild-severe pain generally occurs after use, loss of range of motion
- onset: often gradual but can develop suddenly
- modifying factors: elimination of cause, use of stretching, rest, ice, topical or systemic analgesics
A
tendonitis
22
Q
- location: inflammation of the bursae within joints, common locations are knee, shoulder, big toe
- signs: warmth, edema, erythema, possible crepitus (cracking, grinding when joints move)
- symptoms: constant pain that worsens with movement or application of external pressure over the joint
- onset: acute onset with injury, recurs with precipitant use of joint
- modifying factors: joint rest, immobilization, topical/systemic analgesics
A
bursitis
23
Q
- location: stretching or tearing of a ligament within a joint
- signs: swelling, bruising
- symptoms: initial severe pain followed by pain particularly with joint use, tenderness, reduction in joint stability and function
- onset: acute onset with injury
- modifying factors: RICE, stretching, use of protective wraps, topical/systemic analgesics
A
sprain
24
Q
- location: hyperextension of a joint that results in overstretching or tearing of the muscle or tendon
- signs: swelling, bruising
- symptoms: initial severe pain with continued pain upon movement and at rest, muscle weakness, loss of some function
- onset: acute onset with injury
- modifying factors: RICE, stretching, use of protective wraps, topical/systemic analgesics
A
strain
25
- location: weight-bearing joints like knees, hips, low back, hands
- signs: noninflammatory joints, narrowing of joint space, restructuring of bone and cartilage resulting in joint deformities, possible joint swelling
- symptoms: dull joint pain relieved by rest, joint stiffness, localized symptoms to joint, crepitus
- onset: insidious onset over years
- modifying factors: continuous light to moderate exercise/activity, weight loss, heat, topical/systemic analgesics
osteoarthritis
26
- decreasing subjective intensity/severity of pain
- decreasing duration of pain when possible
- restoring function of the affected area
- preventing re-injury and disability
- preventing acute pain from becoming chronic persistent pain
treatment goals for musculoskeletal pain
27
severe pain, pain that lasts longer than 10 days, pain that continues more than 7 days after treatment with topical analgesic, increased intensity or change in character of the pain, pelvic or abdominal pain (other than dysmenorrhea), accompanying nausea/vomiting/fever/other signs of systemic infection or disorder, visually deformed joint, abnormal movement, weakness in any limb, numbness, suspected fracture, pregnancy, less than 2 years old, back pain and loss of bowel/bladder control, arthritis pain that requires use of topical NSAID for longer than 21 days, arthritis pain that has not improved after 7 days of using a topical NSAID
exclusions to self treatment for musculoskeletal pain
28
rest the injured area and continue until pain is reduced (generally 1-2 days), slings, splints, crutches can be used if necessary
rest (R in RICE)
29
as soon as possible apply ice to the area in 15-20 minute increments at least 3-4 times per day, continue until swelling subsides (1-3 days)
ice (I in RICE)
30
apply compression to the injured area with elastic support or elasticized bandage, choose appropriate size bandage, if ice is also being applied then soak the bandage in water to aid transfer of cold, wrap injured area by overlapping previous layer of bandage by about 1/3 to 1/2 its width, wrap the point most distal from the injury, decrease the tightness of the bandage as you continue to wrap (cold toes or swollen fingers indicate too tight), after removal wash the bandage in lukewarm soapy water without scrubbing it
compression (C in RICE)
31
elevate the limb or body part with the injured area at or above the level of the heart to decrease swelling and relieve pain
elevation (E in RICE)
32
when to use heat and when to not use heat?
use for pain of noninflammatory nature, should not be applied to inflamed areas because can intensify vasodilation and exacerbate vascular leakage
33
therapy that works through alteration of pain transmission and an increase in production of natural endorphins, electrodes should not be placed on throat, chest, head, carotid arteries, open wounds, rashes, cancerous lesions, inflamed skin, areas of skin with altered sensation, or areas treated with topical analgesics, patients with internal or attached medical devices (pacemakers, etc.), pregnant women, pediatrics should NOT use this
TENS therapy
34
magnesium sulfate solution that can be applied to minor sprains/bruises for relief of discomfort - however little evidence of support for effectiveness of this treatment is present
epsom salt
35
for which musculoskeletal injuries/disorders are NSAIDs considered first line therapy over acetaminophen?
osteoarthritis
36
What are the risks of chronic NSAID use and what recommendations can be made to mitigate risks?
more severe and prevalent adverse effects like nephropathy, GI ulcerations and bleeding, increased risk for cardiac events, proton pump inhibitor should be considered for GI protection
37
this topical analgesic inhibits prostaglandins to reduce pain and inflammation but is applied locally to the targeted joint that is experiencing pain, should be applied 4g 4 times per day, should not be used in patients with history of asthma, urticaria or other allergic reactions with use of drugs like it or patients who have undergone coronary artery bypass surgery, may take up to 7 days to work but patients should stop using after 21 days or contact PCP
topical diclofenac
38
counterirritant that is a rubefacient (increases blood flow and causes redness), apply no more than 3-4 times per day as needed for up to 7 days
methyl salicylate
39
counterirritants that produce a cooling sensation, apply no more than 3-4 times per day as needed for up to 7 days
camphor and menthol
40
counterirritant that causes vasodilation, apply no more than 3-4 times per day as needed for up to 7 days
methyl nicotinate
41
counterirritant that incites irritation without rubefaction, apply no more than 3-4 times per day as needed for up to 7 days for acute pain, 3-4 times per day for duration of pain for chronic pain (usually under medical supervision)
capsaicin
42
topical analgesic that is absorbed through skin resulting in synovial fluid salicylate concentrations below those of oral aspirin, 10-15% concentration applied to affected area not more than 3-4 times per day as needed
trolamine salicylate
43
topical anesthetic, primary role in neuropathic pain, inhibits conduction of nerve impulses, time frame is 7 days of use, every 6-8 hours as needed not to exceed 3 applications in 24 hours
lidocaine
44
type of insomnia that describes patients who have sleep difficulty that may be idiopathic, paradoxical, or psychophysiological
primary insomnia
45
insomnia that is caused by inadequate sleep hygiene or acute stressors like medical illness, anxiety, travel, hospitalization, divorce, death of a loved one
adjustment insomnia
46
insomnia in the presence of significant sleep symptoms with poor correlation between patient reports of symptoms and objective measures of sleep
paradoxical insomnia
47
insomnia caused by another sleep disorder, general medical or psychiatric conditions, substance use disorder, or medications
secondary insomnia
48
this type of insomnia lasts less than 3 months
short term insomnia
49
this type of insomnia persists at least 3 months with symptoms occurring at least 3 times per week
chronic insomnia
50
improve patient's presenting symptoms, quality of life and functioning
treatment goals of insomnia
51
cognitive behavioral therapy, sleep restriction
nonpharmacologic therapy for insomnia
52
antihistamines
pharmacologic therapy for insomnia
53
less than 12 years old, greater than or equal to 65 years old, pregnant or breastfeeding, frequent nocturnal awakenings or early morning awakenings, chronic insomnia (lasting longer than 3 months), sleep disorder secondary to psychiatric or general medical disorders
exclusions to self treatment for insomnia
54
use bed for sleeping or intimacy only, establish a regular sleep pattern, go to bed and rise at about the same time daily even on the weekends, make the bedroom comfortable for sleeping, avoid temperature extremes, noise, bright lights, engage in relaxing activities before bedtime, avoid using electronic devices within 1-2 hours of bedtime, dim brightness of smart devices in the evening, exercise regularly but not within a few hours of bedtime, if hungry then eat a light snack but avoid eating meals within 2 hours before bedtime, avoid daytime napping or limit naps to 20-30 minutes, avoid using caffeine, alcohol, nicotine for at least several hours before bedtime, avoid excessive fluids before bedtime, if unable to fall asleep for more than 20 minutes do not continue to try and sleep, get out of bed and perform a relaxing activity until you feel tired, do not watch the clock at night
good sleep hygiene
55
what can happen if diphenhydramine and alcohol are used in combination in patients with insomnia?
diphenhydramine may enhance the central nervous system depressant effect of alcohol, avoid alcohol in patients with insomnia because it decreases REM sleep and overall sleep quality
56
what is the dosing regimen for diphenhydramine for insomnia?
50 mg diphenhydramine HCl or 76 mg diphenhydramine citrate for patients 12 and older taken 30 minutes prior to bedtime, should be limited to 7-10 days and use as sleep aid should be limited
57
dry mouth/throat, constipation, blurred vision, urinary retention, tinnitus, significant drowsiness, dizziness, weakness
adverse effects of diphenhydramine
58
identify and eliminate underlying cause to improve mental alertness and productivity
treatment goals for drowsiness/fatigue
59
nonpharmacologic therapy for drowsiness/fatigue
emphasizing good sleep hygiene principles
60
pharmacologic therapy for drowsiness/fatigue
caffeine and related products
61
less than 12 years old, pregnancy, breastfeeding, cardiac conditions, anxiety disorders, medication-induced drowsiness, chronic fatigue (lasting greater than or equal to 6 months)
exclusions to self treatment of drowsiness/fatigue
62
do not exceed the recommended caffeine dose of 100-200mg every 3-4 hours as needed, avoid caffeine tablets in combination with coffee or other caffeinated products, discuss safe daily caffeine intake with PCP if pregnant, no caffeine for children under 12 years old, seek medical attention if get increases in HR/BP, headache, symptoms of anxiety/insomnia, increase in hand tremor
counseling points for patients with drowsiness/fatigue
63
thin (watery) white or gray sometimes foamy discharge, unpleasant "fishy" odor that increases after intercourse or menses, increased vaginal pH, foul odor strongly associated with this and an absence of odor rules this out, vaginal irritation and dysuria are less frequent, polymicrobial infection resulting from imbalance in normal vaginal flora, risk factors include multiple or new sexual partners, use of an IUD, douching, sexual practices, tobacco use, prior pregnancy, responsible for 30% of vaginal symptoms, predominantly affects sexually active women but can arise spontaneously regardless of sexual activity
bacterial vaginosis
64
frothy malodorous yellow-green or discolored discharge, pruritus, possible vaginal irritation, dysuria, no symptoms initially in −50% of affected women with approximately 30% developing symptoms in 6 months, most men asymptomatic --> serve as reservoirs of the infection, vaginal pruritus (itching) and possible irritation may occur, STI, risk factors include multiple sex partners, new sexual partner, nonuse of barrier contraceptives, and presence of other STIs, responsible for 15%–20% of vaginal infections
trichomoniasis
65
thick white "cottage cheese" discharge without odor, dysuria, normal pH, "yeast infection", vaginal itching, irritation, erythema, absence of malodor increases likelihood of this, risk factors include pregnancy, use of medications such as antibiotics and immunosuppressive agents, no identifiable cause for most infections, responsible for 20%–25% of vaginal infections
vulvovaginal candidiasis (VVC)
66
pregnancy, less than 12 years old, concurrent symptoms (fever or pain in the pelvic area, lower abdomen, back, shoulder), medications that can predispose to this (corticosteroids, antineoplastics), medical disorders that can predispose to this (diabetes, HIV infection), recurrent infections of this nature, first vulvovaginal episode
exclusions for self treatment for VVC
67
consumption of yogurt containing live cultures or utilization of vaginal mixtures containing yogurt can decrease this, can discontinue drugs known to cause this
nonpharmacologic therapy for VVC
68
insert cream into vagina daily for 7 days, apply to vulva twice daily as needed for itching
clotrimazole 1% cream
69
insert cream into vagina daily for 3 days apply to vulva twice daily for itching
clotrimazole 2% cream
70
apply cream to vulva twice daily as needed to relieve itching for up to 7 days, insert suppository into vagina daily for 1 day
monistat 1 combination pack (miconazole nitrate 2% cream and miconazole nitrate 1200 mg suppository)
71
insert ointment into vagina daily for 1 day
tioconazole 6.5% ointment
72
ella (Rx only) may start to lose effectiveness at a BMI of _____ and may become ineffective at BMI of ______
30, 35
73
which emergency contraceptive has no issue with BMI?
copper IUD
