Eyes and ears

Question 1

presentation of dry eye disease

Answer 1

discomfort, sandy or gritty feeling, sensation that something is in the eye, and mildly red eye

Question 2

causes of dry eye disease

Answer 2

aging, dry or dusty working environments, humidity, vitamin A deficiency, surgery, or anticholinergic drugs

Question 3

examples of drug classes that can cause dry eye disease

Answer 3

1. antihistamines
2. TCAs
3. decongestants
4. diuretics
5. beta blockers

Question 4

goals of therapy for dry eye disease

Answer 4

1. alleviate ocular surface dryness
2. relieve symptoms; improv QOL
3. prevent tissue damaga

Question 5

non- pharm treatment or DED

Answer 5

warm compresses, humidifier, good eyelid hygiene, and environmental modifications

Question 6

first line pharm treatment for dry eye disease

Answer 6

artificial tears

Question 7

other treatments for dry eye disease

Answer 7

nonmedicated ophthalmic ointments

Question 8

exclusions for self-care of DED

Answer 8

1. pain
2. unresponsive to therapy for more than 72 hours
3. evidence of damage to cornea
4. suspected systemic disease
5. severe discomfort

Question 9

examples of ocular lubricants

Answer 9

polyethylene glycol, polyvinyl alcohol, povidone, and propylene glycol

Question 10

examples of preservatives

Answer 10

benzalkonium chloride, chlorhexidine, chlorobutanol, methyl paraben, propylparaben, sodium perborate

Question 11

shelf-life for eye drop medications containing preservatives

Answer 11

typically 28 days after opening

Question 12

shelf-life for eye drop medications that are preservative free

Answer 12

discard immediately after open and used

Question 13

do you look down at the floor or up at the ceiling after applying eyedrops

Answer 13

down at the floor and apply gentle pressure with finger to tear duct opening

Question 14

how long do you wait between multiple drops

Answer 14

at least 5 minutes

Question 15

would you place a suspension first or last if you had more than one dosage form

Answer 15

last

Question 16

drops need to be administered _____________ before ointment

Answer 16

10 minutes

Question 17

presentation of allergic conjunctivitis

Answer 17

pruritis, red eye + watery discharge, excessive tearing

Question 18

causes of allergic conjunctivitis

Answer 18

pollen, animal dander, topical eye preparations

Question 19

goals of therapy for AC

Answer 19

remove or avoid allergen, reduce severity of allergic reaction, relieve symptoms, and protect ocular surface

Question 20

non pharm treatment for AC

Answer 20

cold compress 3-4 times daily, check pollen count, run air condition, use air filters, wear sunglasses

Question 21

first line treatment for AC

Answer 21

artificial tears prn

Question 22

second line treatment for AC

Answer 22

ketotifen fumarate

Question 23

MOA of ketotifen fumarate

Answer 23

blocks histamine release, inhibits release of mediators from mast cells, and contains preservatives

Question 24

third line treatment for AC

Answer 24

add an oral antihistamine or ophthalmic decongestants

Question 25

presentation of loose foreign substances in the eye

Answer 25

mild pain and tearing/watering of eye

Question 26

treatment for loose foreign substances in the eye

Answer 26

irrigation - rinse with ocular irrigate solution - nonmedicated eye petroleum application at bedtime

Question 27

exclusions to self-care of loose foreign substances

Answer 27

1. systemic symptoms 2. wood or metal fragments 3. severe eye pain 4. vision changes 5. continued redness or irritation 6. condition persists or worsens after treatment 7. open would in or near the eyes

Question 28

presentation of minor eye irritation

Answer 28

eye redness or feeling of sand in eyes

Question 29

causes of minor eye irritation

Answer 29

loose foreign substances in the eye, contact lens, wind/sun/snow, chemical fumes, chlorine

Question 30

first line therapy for minor eye irritation

Answer 30

artificial tears

Question 31

other treatments for minor eye irritation

Answer 31

non medicated ointments or zinc sulfate

Question 32

exclusions for minor eye irritation

Answer 32

1. systemic symptoms 2. eye pain 3. blurred vision 4. blunt trauma to eye 5. chemical exposure 6. sensitivity to light 7. history of wearing contacts 8. symptoms longer than 72 hours

Question 33

presentation of excessive or impacted cerumen

Answer 33

ear fullness or dull pain, discomfort, itching, tinnitus, dizziness, vertigo, cough, hearing loss

Question 34

causes of excessive or impacted cerumen

Answer 34

narrowing or irregular shape of EAC, presence of excessive hair, irritation from foreign objects, use of cotton-tipped swabs, increasing age

Question 35

non pharm treatment for excessive or impacted cerumen

Answer 35

only remove when migrated to outer portion, curette --> removes cerumen

Question 36

pharm treatment for excessive cerumen if symptomatic

Answer 36

carbamide peroxide 6.5%

Question 37

application of carbamide peroxide

Answer 37

twice daily for up to 4 days, 5-10 drops instilled and leave in ear up to 15 minutes

Question 38

ADE carbamide peroxide

Answer 38

pain, rash, irritation, tenderness, redness, discharge, and dizziness

Question 39

exclusions for impacted or excessive cerumen

Answer 39

1. systemic symptoms or signs of infection 2. incapable of following instructions 3. less than 12 years 4. pain with or without ear discharge 5. bleeding/signs of trauma 6. ruptured tympanic membrane 7. tympanostomy tubes present 8. ear surgery within prior 6 weeks 9. after 4 days symptoms or ADE persist

Question 40

presentation of water-clogged ears

Answer 40

sensation of hearing impairment, localized discomfort, and sensation of fullness

Question 41

causes of water-clogged ears

Answer 41

excessive moisture, wax or debris buildup, excessive hair growth, narrowing of ear canal, overproduction or the absence of cerumen, sweating, humidity, and swimming

Question 42

non pharm treatment for water-clogged ears

Answer 42

prevention of water retention (ear plugs/bathing cap), lowest heat setting on blow dryer

Question 43

pharm treatment for water-clogged ears

Answer 43

isopropyl alcohol 95% in anhydrous glycerin 5% (drying agent, 4-5 drops in ear)

Question 44

exclusions for self-care of water-clogged ears

Answer 44

1. systemic symptoms or signs of infection 2. pain associated with ear discharge 3. bleeding or trauma 4. ruptured tympanic membrane 5. tympanostomy tubes present 6. ear surgery in past 6 weeks 7. ear surgery in past 6 weeks 8. no improvement after 4 days of therapy 9. < 12 years of age