Eyes, Ears, and Skin Flashcards
(59 cards)
1
Q
What is age-related macular degeneration?
A
- A disease of the macula of the eye that affects the sharpnes of central vision - this is needed for reading and driving and close work
- Onset may be slow, or progresses quickly in one or both eyes
- Dry AMD is characterized by the presence of “drusen” that can be visualized by an optometrist/opthamologist
2
Q
What is wet AMD?
A
Wet AMD is a serious cause of vision loss, sometimes sudden, caused by leaky blood vessels in the retina
3
Q
What are the symptoms of AMD? (3)
A
- Blurry region in the center of vision, which may get larger or become spots that are blank (no image).
- Possibly less brightness
- Straight lines may look wavy, in late AMD (normal on the right grid, AMD on the left)
4
Q
What are the risk factors for AMD? (10)
A
- Age >60
- F>M
- Family history of AMD
- Caucasian
- Smokers (free radical damage is involved) Stopping smoking is essential for AMD patients or those at risk.
- Consumption of a diet high in saturated fat
- Overweight
- Hypertension
- Hypercholesterolemia
- Heart disease
5
Q
What are some ways dry AMD is managed? (3)
A
- Stop smoking
- Healthy diet
- Leafy green veggies, fish, low-fat - Antioxidant vitamins
6
Q
What is AREDS2 composed of? (6)
A
- Vitamin C
- Vitamin E
- Lutein
- Zeaxanthin
- Copper
- Zinc
7
Q
What is the purpose of vitamin E in AREDS2?
A
Antioxidant, reduces damaging reactive oxygen species
8
Q
What is the purpose of vitamin C in AREDS2?
A
Reduction in vascular leakage in advanced/wet AMD
9
Q
What is the purpose of zinc in AREDS2? (2)
A
- Has a role in bringing vitamin A from the liver to the retina in order to produce melanin.
- Zinc is highly concentrated in the retina and choroid, the vascular tissue layer lying under the retina
10
Q
What is the purpose of copper in AREDS2?
A
To reduce the risk of copper deficiency anemia, a condition associated with high levels of zinc intake
11
Q
What is the purpose of lutein and zeaxanthin in AREDS2? (2)
A
- Lutein and zeaxanthin are antioxidants found in the retina and lens
- They may help absorb damaging, high-energy blue and ultraviolet light
12
Q
AREDS vs. AREDS2, which should smokers be given and why?
A
AREDS2
- Beta-carotene in AREDS is bad for smokers’ eyes. HAVE TO GIVE AREDS2
13
Q
What were the major findings in the AREDS2 studies and AMD? (4)
A
- AREDS2 supplements reduces the risk of progression of AMD by 25%
- Omega-3’s do not help
- Supplements do not help mild AMD but may reduce progression for moderate or advanced
- AREDS supplements do not prevent AMD or cataracts
14
Q
What are some foods that are high in zinc? (2ish)
A
- Meat
- Seafood
- Vegetarians need to supplement to obtain enough to support eye health in AMD
15
Q
What are some foods that are high in vitamin E? (3)
A
- Walnuts
- Eggs
- Grape seed oil
16
Q
What are some “other” herbals that might be used for eye health? (4)
A
- Bilberry and blueberry - anti-oxidant
- Cucumber - anti-inflammatory
- Eyebright - for conjunctivitis
- Chamomile - for irritations, suggested for eye infections (as a wash)
17
Q
What is tinnitus?
A
Constant ear noise
18
Q
What is the difference between subjective and objective tinnitus?
A
Subjective - 95% - only the pt can hear it
Objective - 5% - Dr. can hear it, due to muscular spams or blood vessel issues
19
Q
Potential causes of tinnitus include? (7)
A
- Age-related hearing loss
- Wax buildup
- Hypertension
- Noise injury (concerts, occupational)
- Fluid in the ear
- Head trauma,
- Certain medications can also cause or worsen tinnitus
20
Q
What potential herbals are useful for tinnitus?
A
Trick question, there are none
21
Q
Mr. J. comes to your pharmacy window with these products in his basket: Auralgan, isopropyl alcohol, olive oil, Q tips, mineral oil, a squeeze bulb and a packet of candles. He says he has a lot of wax in his ears and would like to know what method of removal you recommend. Which method is most safe and effective?
a. Olive oil
b. Candling, following by Auralgan applied with Qtips
c. Mineral oil
d. Isopropyl alcohol with a squeeze bulb for flushing
A
c.
22
Q
What are the symptoms of atopic dermatitis? (5)
A
- Dry skin
- Itching, which may be severe, especially at night.
- Red to brownish-gray patches (depends on skin tone)
- Especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees
- In infants, the face and scalp. - Small, raised bumps, which get worse if scratched and may leak
fluid and crust - Itching leads to scratching – increases inflammation
23
Q
What are some causes of atopic dermatitis? (3)
A
- Familial tendency
- Atopy - allergies, eczema, asthma
- Worsened by dry skin and triggers such as gragrances in skin products
24
Q
What are the common “bath” recommendations given for atopic dermatitis? (6)
A
- Neutral bath oils with no fragrances for moisturizing
- One-quarter cup of household bleach to a full tub of bathwater to decrease inflmmation and bacteria on the skin
- One cup of vinegar to bathwater help kill bacteria
- One-quarter cup of baking soda to bathwater to relieve itching
- One cup of table salt to bathwater to reduce the sting of the lukewarm water if you have a severe flare
- “Oatmeal” baths should be avoided in pts with eczema due to the risk of sensitization and allergy development, b/c their skin barrier is compromised
25
What are some NHPs for atopic dermatitis? (3)
1. Aloe-containing topical products
- May cause hypersensitivity, allergic reactions
- Conflicting evidence
2. Omega-3's
- Fish consumption in young children may reduce eczema
3. Probiotics
- Low-level evidence
- More controlled trials needed to improve data quality and safety
26
What is rosacea? (4)
1. Rosacea is a chronic skin condition characterized by redness and irritation particularly the central face, prone to flare-ups.
2. It can progress to telangiectasias (enlarged blood vessels) and pustules – can be confused with acne but will not respond to acne medicines!
3. In older men it can cause a large, bumpy nose.
4. The eye can also be involved, which creates redness and irritation.
27
What are some adjunctive natural products that may improve skin irritation and inflammation in rosacea? (6)
1. Topical vitamin C and E containing products
2. Diet high in anti-inflammatory foods and fiber
3. B vitamins: 400-800mcg of vitamin B12 during a rosacea flare-up
4. Probiotics: to balance normal flora, reduce inflammation
5. Topical sulfur, honey
6. NHPs for menopausal hotflashes, if appropriate
28
Common rosacea triggers include: (9)
1. Coffee
2. Consumption of alcoholic beverages
3. Extreme temperatures (hot or cold)
4. Fatty foods
5. Harsh winds
6. Hot drinks
7. Spicy foods
8. Stress and anxiety
9. Sun exposure
29
What are some anti-aging strategies? (3)
1. Stop smoking
2. Healthy diet
3. Vitamins
- Retinols (Vitamin A)
- Vitamin E, C, D - and avoid sun exposure
30
How does Vitamin A Retinol work for anti-aging?
Vitamin A Retinol palmitate can increase collagen production in order to help diminish facial wrinkles. Best in combination with Vitamin C or hydroquinone
31
How does melatonin work for anti-aging?
Melatonin is a hormone from the pineal gland that regulates sleep cycles. It also has a role in reducing UV damage to skin. Melatonin levels decline starting in the 40s.
32
How does phytoestrogens work for anti-aging?
Phytoestrogens Estrogen depletion occurs with age and can lead to thinning and wrinkling of skin. Estrogen can improve skin moisture, elasticity, and firmness. Phytoestrogens are less potent but presumed to have a similar effect. Soy helps firm and soothe skin and has the ability to slow down elastin breakdown
33
How does collagen work for anti-aging?
Collagen is necessary for skin elasticity and adequate moisture content in order to have a smooth skin appearance.
34
How does DHEA work for anti-aging?
DHEA is a natural steroid hormone that increases epidermal thickness slightly. It may counteract skin dullness and epidermal thinning
35
How does sodium hyaluronate work for anti-aging?
Hyaluronic acid induces collagen synthesis and improves skin elasticity. Due to its hydrophilic properties, it can help retain water and prevent loss of water from the skin
36
What are a few NHPs for hyperpigmentation? (10)
1. Soy
2. Niacinamide
3. N-acetyl glucosamine
4. Licorice extract
5. Arbutin
6. Vitamin c
7. Kojic acid
8. Emblica extract
9. Lignin peroxidase
10. Glutathione
37
What are some potential NHPs for acne?
1. Aloe
2. Alpha hydroxy acids
3. Tea tree oil
38
How might aloe be used for acne?
In children and adults with acne, clinical research suggests that topical application with a 50% aloe gel in the morning and evening, in addition to topical application of tretinoin gel 0.025% and twice daily cleansing with a medical soap, improves acne lesions by approximately 35% over the same treatments without the aloe
39
How might alpha hydroxy acids be used for acne?
- For acne, AHA reduces lesions significantly, similar in efficacy to benzoyl peroxide
- Likely safe when used topically in concentrations of less than 10%. Higher concentrations can cause severe skin irritation and require supervision by a dermatologist
40
How might tea tree oil be used for acne?
- Applying a 5% tea tree oil gel is as effective as 5% benzoyl peroxide. It may work more slowly but is less irritating.
- Possibly safe when used topically. Side effects may include skin irritation, dryness, and redness. Likely unsafe when used orally
41
Which of the following AREDS supplements has a mechanism of action directed against cellular damage from oxidative stress?
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin E
d.
42
Which of the following claims for cucumber are supported by at least some evidence?
a. anti-oxidant
b. anti-inflammatory
c. anti-infective
d. anti-depressant
b.
43
Which of the following promotes collagen production in the skin?
a. hyaluronic acid
b. retinol
c. all of these choices
d. estrogens and phytoestrogens
c.
44
Which of the following is NOT an AREDS or AREDS2 component?
a. vitamin C
b. copper
c. iron
d. lutein
c.
45
Cosmetics and cosmeceuticals may include natural substances in their formulations for skin health. What are some limitations of this approach?
a. The product becomes prohibitively expensive, reducing mass sales.
b. Dose may be insufficient or not absorbed to the proper depth
c. Customers are reluctant to apply products containing "herbals".
d. There is nothing known about how natural products can affect the skin.
b.
46
Which of the following is a rational anti-aging combination?
a. retinol palmitate and Vitamin C
b. tea tree oil and hydroquinone
c. aloe vera and collagen
d. DHEA and fish oil or flax oil
a.
47
Which of the following can be a trigger for or worsen atopic dermatitis?
a. oatmeal bath
b. emollients if applied often
c. topical corticosteroids
d. fragrances
d.
48
Liposomes are commonly used in skin products containing natural products. Which of the following is correct about liposomes?
a. They are also known as micelles and their role is similar to that of a detergent.
b. Liposomes reduce hyperpigmentation through an oxidation mechanism.
c. They aid penetration of poorly soluble substances into deeper layers of the skin
d. Their main role is moisturization.
c.
49
AREDS (not AREDS 2) supplements should not be used by:
a. diabetics
b. smokers
c. people with cardiovascular disease
d. people allergic to shellfish
b.
50
Lipo-flavinoids are highly effective for:
a. ear infections
b. subjective tinnitus
c. objective tinnitus
d. none of the above
d.
51
To reduce the incidence of eczema in young children, it may be recommended to:
a. supplement with high doses of Vitamin A
b. include fish in the diet regularly
c. avoid heavy emollients if a rash does break out
d. use oatmeal baths regularly
b.
52
Which of the following is the mechanism of action for zeaxanthin in eye supplements?
a. absorption of blue light
b. transport of Vitamin A for production of retinoids
c. corneal protection from cataracts
d. conversion of dry to wet macular degeneration
a.
53
A patient of yours comes in to pick up a refill and you notice her usual facial skin rash from rosacea is looking worse than usual with more redness and bumps. She is also picking up a skin cream containing vitamin C and vitamin E recommended by her dermatologist. You know this patient well and you are comfortable asking her in a professional way about her skin condition. She says it has gotten worse with the cold and windy weather, and she has been quite tired and drinking more coffee than usual, which seems to have made it worse on her nose and cheeks. She wants to try a tea tree oil product to reduce this flare-up. What will you tell her?
a. She can certainly try it, and increase the amount of time spent outside to get more UV exposure which can help in healing.
b. It may help, but there is mixed evidence. It might be better to try the cream recommended by the dermatologist first, and cover the face when out in the wind.
c. She should avoid the tea tree oil due to risk of allergies, and increase consumption of spicy foods.
d. It would be more effective and less irritating than the vitamin C moisturizer she is considering.
b.
54
Which of the following is/are risk factors for developing tinnitus?
a. age-related hearing loss
b. vitamin B deficiency
c. hypertension
d. all of the choices are correct
d.
55
Which of the following is a potential cause of adverse drug reactions in topical NHPs for skin conditions?
a. contain corticosteroids
b. all of these choices
c. photosensitization
d. contamination with heavy metals
b.
56
Which of the following is correct regarding zinc as a supplement?
a. Those deficient in zinc must avoid copper containing foods to avoid further lowering zinc levels
b. Vegans should take this supplement
c. Nuts are a very high source of vitamin A and zinc
d. It may cause flatulence
b.
57
AREDS supplements are most useful for:
a. improvement of myopia
b. prevention of cataracts
c. prevention of dry macular degeneration
d. moderate to severe age-related macular degeneration
d.
58
Licorice extract is indicated for which skin condition:
a. atopic dermatitis
b. anti-aging
c. nodular acne
d. solar lentigines
d.
59
Ms. B. has eczema on the backs of her hands, which are rough-appearing and excoriated. She does not want to use topical steroids. Which of the following OTCs/NHPs/non-pharmacological choices may be helpful?
a. use moisturizer frequently
b. avoid scratching to prevent infection
c. wear gloves consistently in cool or cold weather
d. all of these choices are acceptable
d.
