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NAPLEX BABY > Eyes, Ears, Nose & Skin Conditions > Flashcards

Eyes, Ears, Nose & Skin Conditions Flashcards

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1
Q

Intranasal Steroids

A

-moderate - severe, chronic symptoms
–> ex: Flonase, budesonide, triamcinolone
SEs: headache, dry nose, pharyngitis, epistaxis, unpleasant taste, localized infection, nasal septal perforation

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2
Q

Antihistamines: 1st generation

A

-mild-moderate symptoms
–> oral: blocks histamine-1, reduce symptoms of itching, sneezing, rhinorrhea but not congestion

1st gen: diphenhydramine, chlorpheniramine, doxylamine
-more sedation and cognitive impairment
-strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
-seizures/arrhythmias at higher doses
Warnings: caution in elderly, pts with prostate enlargement, glaucoma, CV disease, thyroid disease
-avoid in children < 2 y/o due to risk of SEs

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3
Q

Diphenhydramine

A

1st gen antihistamine, used for many indications:
-tx of acute allergic reactions
-prevention of allergic reactions
-allergic rhinitis
-cough
-sleep
-dystonic reactions
-motion sickness
–> due to its wide range of effects, it can worsen some disease states (BPH, constipation, dementia, glaucoma)

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4
Q

Antihistamines: 2nd generation

A

-cetirizine (Zyrtec), levocetirizine (Xyzal), fexofenadine (allegra), loratadine (Claritan)

-less sedation, response is pt specific

-Fexofenadine (allegra): seperate from juice and antacids by 2 hrs (decs absorption)
-avoid use with erythromycin and ketoconazole

Oral: most indicated in children 2 y/o + (desloratadine and levocetirizine may be used in > 6 month)
Nasal: 5 yrs +

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5
Q

Decongestants

A

Oral: Phenylephrine (Sudafed PE),- 10 mg q 4h Pseudoephedrine (Sudafed) - behind counter- 30-60 mg q4-6 h
Topical: Oxymetazoline (Afrin) - do not use for more than 3 days

CI: do not use within 14 days of MAOIs
Warnings/SE:
-caution in pts with CV disease (tachycardia, palpitaions, inc BP), hyperthyroidism, DM, bowel obstruction, glaucoma, BPH, elderly
-CNS stimulation (anxiety, tremors), dizziness, HA, anorexia

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6
Q

Combat Methamphetamine Epidemic Act of 2005

A

-limit sales of pseudoephedrine to 3.6 grams/day (120 tablets of 30 mg) and 9 grams in 30 days period (exception: 60 mg single pack)
-behind the counter, requires ID and signature

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7
Q

Topical intranasal decongestants

A

-Oxymetazoline (afrin), phenylephrine
Warnings: do not use with MAOIs or if have closed-angle glaucoma
SE: burning, stinging, sneezing - do not use for > 3 days or rebound congestion can occur

fast acting: within 5-10 mins

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8
Q

Intranasal mast cell stabilizer: Cromolyn (Nasalcrom)

A

-start using at onset of allergy season
-dosed every 6-8 hrs regularly (NOT PRN)
-symptom improvement can be seen within 4-7 days but max effect in 2-4 weeks
-good safety profile: can be used in children and pregnancy

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9
Q

Intranasal ipatropium bromide (Atrovent nasal spray)

A

useful to decrease rhinorrhea but not effective for other nasal symptoms

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10
Q

Oral antileukotrienes

A

-Montelukast (Singulair)
-similiar efficacy to oral antihistamines or PSE
-dosed once daily

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11
Q

Sublingual Immunotherapy

A

-for allergic rhibitis caused by specific allergens
-first dose must be given in docs office; subsequent doses at home
–> monitor pt for 30 mins for everes allergic reactions (BBW)
-give rx for autoinjectable epinephrine

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12
Q

Sublingual immunotherapy meds

A

–> Oralair: 5 diff grass pollen extracts - 1 tab is placed under the tongue daily, starting 4 months before and during grass szn
–> Grastek: Timothy grass pollen extract - 1 tab daily, starting 3 months before and during grass szn
–>Ragwitek: ragweed grass pollen extract
–> Odactra: house dust mite allergen - 1 daily

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13
Q

Expectorant: Guaifenesin

A

-decreases viscosity of mucus
-used to treat a productive, wet cough
-may make it easier to cough phlem out of airway tract

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14
Q

Cough Suppressant: Dextromethorphan (DM)

A

-cough suppressant:
–> indicated for dry, unproductive coughs
–> blocks the cough reflex center in the brain
–> acts as a serotonin reuptake inhibitor –> risk of serotonergic syndrome

High doses: NMDA receptor blocker = euphoric and hallucinogenic properties (2012 CA banned sales to minors
–> MDD: 120 mg/day

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15
Q

Cough Suppressants: Codeine

A

-indicated for dry, unproductive coughs
-acts centrally on respiratory center in the medulla to increase the cough threshold

C-II!!

Warnings: respiratory depression and death in children who recieved codeine after tonsel/adenoidectomy
CI: paralutic ileus, children < 12 y/o
SE: CNS depression, constipation, hypotension
CYP2D6 metabolism

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16
Q

Cough suppressants: Benzonatate (Tessalon Perles)

A

-suppresses cough by topical action or respiratory stretch receptors
Warnings: avoid in children < 10 y/o: accidental ingestion and fatal overdose
SE: sedation, confusion, hallucinations

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17
Q

Cough and Cold combo products: whats in a Name?

A

Cough = contains a cough suppressant
Congestion = contains an expectorant

D: decongestant (Mucinex D)
PE: Phenylephrine (Sudafed PE)
DM: Dextromethorphan (Robafen DM)
AC: Codeine (Robafen AC)

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18
Q

Pediatric cough and cold treatment: caution needed

A

-Children < 12 y/o: avoid codeine-containing products
-Children < 6 y/o: avoid ALL OTC cough and cold products
-Children < 4 y/o: avoid many OTC cough and cold products
-Children < 2 y/o: avoid all OTC cough and cold product, avoid promethazine, avoid topical menthol and camphor

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19
Q

Dosing od Tylenol and Motrin in Peds

A

-Acetaminophen
–> 10-15 mg/kg Q4-6 hrs
-do not exceed 5 doses in 24 hrs
-infant drops/childrens liquid - 160 mg/5mL

Ibuprofen
–> 5-10 mg/kg Q6-8H
-do not exceed 40 mg/kg/day
-infant drops = 50 mg/1.25 mL
-childrens liquid: 100 mg/5 mL

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20
Q

Eye and ear formulations

A
  • 1 drop - 5 mL
    -suspension: shake well
    -Ointments: apply to the conjunctive sac or over lid margins. ointments can make vision blurry, do not use with contact lenses
    -Gels: with cap on, invert and shake once to get the medication into the tip before instilling into the eye
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21
Q

Ear & Eye rx interpretations

A

AD: right ear
AS: left ear
AU: each ear

OD: right ear
OS: left ear
OU: each eye

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22
Q

Drugs that can increase Intraoccular pressure

A

-anticholinergics (oxybutynin, tolterodine, benztropine, trihexyphenidyl, TCAs)
-cough, cold, and motion sickness medications (antihistamines, scopolamine)
-chronic steroids, especially eye drops such as prednosolone (PredForte)
-Topiramate (Topamax)

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23
Q

Glaucoma Treatment Goal: Decrease IOP

A

-reduce aqueous humor production (make less fluid)
–> BBs (timolol)
–> carbonic anhydrase inhibitors (dorzolamine)
-increase aqueous humor outflow (move fluid out)
–> prostaglandin analogs, like latanoprost
- or do both: often achieved with add-on treatment
–> alpha-2 agonists (brimonidine)

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24
Q

Prostaglandin Ananlogs

A

-increase aqueous outflow, decrease IOP ~30%
-dosed 1 drop QHS
–> Bimatoprost (Lumigan)
–> Latanoprost (Xalatan)
–> Travoprost (Travatan Z)
–> Latanoprostene bunod (Vyzulta)
–> tefluprost (Zioptan)

Warnings:
-darkening of the eye, skin, and eyelashes, thick eyelashes
-Benzalkonium chloride can be irritating or cause contact lens discoloration

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25
Beta Blockers for Glaucoma
-reduce aqueous humor production, decrease IOP ~22% (non-selective) -dosed 1 drop daily or BID --> Timolol (Timoptic) + dorzolamide (Cosopt) + brimonidine (Combigan) --> Betaxolol --> Carteolol Warnings: cardiac, pulmonary, BAK warnings
26
Other meds to treat glaucoma
--> cholinergics- increase aqueous outflow - carbachol (Isopto Carbachol, Miostat) and pilocarpine (Isopto Carpine) --> Carbonic anhydrase inhibitors: reduce aqueous humor production - dorzolamide (Trusopt) and brinzolamide (Azopt) --> adrenergic alpha-2 agonists: increase outflow AND reduce production - Brimonidine (Alphagen P), timolol/Brimonidine (Combigan), Brinzolamide/Brimonidine (Simbrinza) (SE: sedation/CNS depression) --> Rho kinase inhibitor: increase outflow- Netarsudil (Rhopressa)
27
Conjunctivitis symptoms and treatment
"pink eye" -causes: viral, bacterial, allergic, irritant Symptoms: iching, burning, redness, swelling -usually self limiting Treatment: --> viral: none --> Bacterial: moxifloxacin (Vigamox), Neomycin/Polymyxin B/Dexamethasone (Maxitrol), Ofloxacin (Ocuflox), Trimethoprim/Polymyxin B (Polytrim) --> Allergic: cromolyn, azelastine, Olopatadine (Pataday), Ketotifen (Alaway, Zaditor)
28
Blepharitis
-inflammation of the eyelid Treatment: eyelid hygiene --> place clean, wet washcloth, w/ warm water over the closed eyelid for 5 mins -can add diluted solution of 50% baby shampoo or mild soap
29
Chronic ocular conditions and treatment
--> inflammation: -Steroids: prednisolone, dexamethasone) -NSAIDs (ketorolac, bromfenac) --> Dryness: refresh, systane --> Redness: naphazoline (clear eyes), naphazoline/pheniramine (Naphcon), tetrahydrozoline (Visine)
30
Common drugs that are known to cause vision changes or damage
--> Retinal changes/retinopathy: -chloroquine -hydroxychloroquine --> Optic Neuropathy: -amiodarone (plus corneal deposits) -Ethambutol -Linezolid --> Floppy iris syndrome: -alpha blockers (tamsulosin) --> Color discrimination: -Digoxin (yellow/green halo) -PDE-5i (greenish tint around objects) -Voriconazole: color visions changes
31
Drugs that can cause vision loss/abnormal vision
-Digoxin (with toxicity) - blurred vision, halos -PDE-5i: vision loss (one or both eyes; can be premanent) -Isotretinoin: dec night vision, dryness, irritation -Topiramate: visual field defects -Vigabatrin: permanent vision loss (high risk) -Voriconazole: abnormal vision, photophobia
32
Common ear conditions: otitis externa
-outer ear infection TX: -otic antibiotic drops --> Ciprofloxacin and dexamethasone (Ciprodex) --> Ciprofloxacin and hydrocortisone (Cipro HC) -symptomatic tx w/ APAP, ibuprofen
33
Common ear conditions: ear wax (cerumen) blockage
tx: -removal in medical office --> Carbamide peroxide (Debrox)
34
Drugs that can discolor skin and secretions: brown
-entacapone -levodopa -methyldopa
35
Drugs that can discolor skin and secretions: Brown/black/green
-iron (black stool) -methocarbamol
36
Drugs that can discolor skin and secretions: Brown/yellow
-nitrofurantoin -metronidazole -tinidazole -riboflavin (B2)
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Drugs that can discolor skin and secretions: purple/red/orange
chlorzoxazone
38
Drugs that can discolor skin and secretions: orange/yellow
-propofol -flutamide
39
Drugs that can discolor skin and secretions: red-orange
-phenazopyridine -rifampin (can dye contact lenses) -rifapentine
40
Drugs that can discolor skin and secretions: red
-anthracyclines -deferasirox (urine)
41
Drugs that can discolor skin and secretions: blue (smurf drugs)
-methylene blue -mitoxantrone
42
Drugs that can discolor skin and secretions: blue-gray (smurf drugs)
-amiodarone -chloroquine
43
Acne treatment: Mild
-First line: --> benzyl peroxide --> topical retinoid -Alt tx: --> add topical retinoid or benzyl --> switch to another retinoid --> topical dapsone
44
Acne treatment: Moderate
-First Line: --> topical combination therapy --> oral abx + benzyl P + retinoid (+/- topical antibiotic) -Alt tx: --> other combination therapy --> change oral abx --> add combined oral contraceptives or spironolactone --> oral isotretinoin
45
Acne Treatment: severe
-First line: --> topical combination therapy + oral antibiotic --> oral isotretinoin Alt tx: --> change oral abx --> add combined oral contraceptive or spironolactone --> oral isotretinoin
46
Topical Retinoids for acne tx
--> Tretinon (Atralin) --> Adapalene (Differin) -limit sun exposure, apply daily -pea sized amount -takes 4-12 weeks to work, may worsen acne initially other products: --> benzyl peroxide (BPO) --> Salicylic acid (clearasil) --> Azelaic acid
47
Oral Retinoids for acne tx
--> Isotretinoin (Absorbica) -for severe acne only -females must sign a consent form about birth defects -must have 2 neg pregnancy tests before starting - do NOT with w/ vitamin A, tetracyclines, steroids, progestin only pills or st. johns wort *REMS, 1 month at a time *2 forms of BC
48
Alopecia: causes and treatment
Causes: -hereditary -chemo agents, heparin, valproic acid, spirnolactone -medication conditions: hypothyroidism, scalp infections, lupus -zinc and vit D deficiency TX: --> OTC- minoxidil --> RX: Finasteride (Propecia)- hazardous drug (pregos dont handle it) -Bimatoprost (Latisse): for eyelash growth
49
Cold Sores: causes and tx
Causes: -herpes simplex - HSV-1 -spread with active lesions, kissing and sharing drinks -triggers for sore eruption include stress, fatigue, dental work Treatment: OTC: lysine (prevention), Docosanol (Abreva) RX: acyclovir, penciclovir
50
Dandruff tx
-itchy and/or scaly scalp that sloughs white oily flakes (dead skin) Treatment: --> OTC: selenium sulfide (selsun), pyrithione zinc (head & shoulders), coal tar, ketoconazole shampoo 1% --> RX: ketoconazole shampoo 2% Nizoral
51
Diaper Rash: causes and tx
Causes: exposure of sensitive skin to urine and stools and irritation from the diaper Prevention: frequent diaper changes, thorough cleaning, allowing the skin to air dry --> OTC: plain petrolatum (Vitamin A&D ointment), Petrolatum + zinc oxide (Desitin) --> RX: topicals containing clotrimazole, miconazole (+ zinc oxide + petrolatum; Vusion)
52
Eczema (Atopic dermatitis) causes and tx
-skin inflammation with skin rash: crusty and scaly, itchy, red, dry and sore - commonly affects the elbows, behind the knees/ears. butt and hands -Causes: irritants, allergens, pollution, stress or weather changes Treatment: --> OTC: petrolatum, antihistamines --> RX: steroids, topical tacrolimus, crisaborole, dupilumab, abrocitinib
53
Infections of the skin: athletes foot & ring worm
OTC: -terbinafine (Lamisil) -butenafine (Lotrimin) -clotrimazole (Lortrimin) RX: -Betamethasone/clotrimazole (Lotrisone) -Ketoconazol
54
onychomycosis: infections of the toenail & fingernail
-topical agents are not potent enough to cure most infection Diagnosis via potassium hydroxide (KOH) smear RX: PO meds --> Itraconazole (Sporanox)- DIs, AT prolong, hepatotoxicity- do NOT use in HF pts --> Terbinafine (Lamisol) - hepatotoxicity -treat for 6 weeks
55
Fungal infections: vaginal
-Causes: menstruation, high-dose estrogen or hormone replacement therapy, recent abx use, douching or use of lubricants -Symptoms: itching, pain/burning during urination or sex, cottage-cheese like discharge TX: --> OTC: Miconazole (Monistat), clotrimazole (Gyne-Lotrimin) --> RX: Flluconazole (Diflucan) 150 mg PO x 1
56
Genital Warts
-Cause: HPV, sexually transmitted -TX: --> Gardasil vaccine prevents infection with HPV for most strains causing genital warts --> tx is reuired only if pt is symptomatic RX: Imiquimod cream (Aldara, Zyclara)
57
Hemorrhoids
-Cause: constipation and straining to have a bowel movement -Symptoms: rectal burning, itching and bleeding (bright red blood) TX: --> OTC: -Phenylephrine (preparation H) -Hydrocortisone -Witch hazel (Tucks pads)
58
Lice
-affects primarily children -attach to the hair shafts -insects Tx: OTC --> Premethrin (Nix) --> Pyrethin/Piperonyl butoxide (Rid) -needs repeat treatment RX: --> Ivermectin (Sklice) - topical
59
Scabies
-affects primarily adults -burrow under the skin -mites Tx; RX --> permethrin (Eliminate) cream --> Oral Ivermectin (Stromectol)
60
Pinworms (Vermicularis)
-Causes: easily spread by children, contaminated fingers can transfer eggs to surfaces and are then ingested -Symptoms: anal itching -Diagnosis: tape test (tape to anus in the am before going to br, will see eggs when pulled off) -Treatment: --> OTC: Pyrantel pamoate (Reese's Pinworm Medicine) --> RX: Albendazole, Mebendazole
61
Poison Ivy, Oak and Sumac
-Causes: allergic reaction from touching the sap of the plants contianing the toxin, Urochiol -Treatment: wash any items that came into contact with the plant, including under the fingernails --> OTC: -Aluminum acetate solution (Burrow's Boro-Packs, Domeboro) -Colloidal oatmea; -Calamine lotion + pramoxine --> RX: topical or oral steroids for severe rash
62
Inflammation and rash: Hives (Urticaria)
OTC: --> antihistamines (2nd gen) --> H2RAs RX: --> Hydroxyzine (Vistaril) -topical steroids are first line - ointment > creams > lotions> solutions> gels> sprays -use only lose potency steroids on areas where absorption is higher -long term use can have local effects to the skin
63
Lowest potency topical steroids
-hydrocortisone cream: 0.5, 1% -only ones OTC
64
Medium potency topical steroids
-mometasone furoate 0.1 % lotion -triamcinolone acetonide 0.1% cream
65
high-medium potency topical steroids
-fluocinonide 0.05% cream -dexamethasone 0.05% cream
66
High potency topical steroids
-betamethasone diproplonate 0.05% cream (Diprolene) -Fluocinonide 0.1% ointment -Mometasone furoate 0.1% ointment
67
Very High potency steroids
-clobetasol proplonate 0.05% lotion/spray (Clobex) -fluocinonide 0.1% cream (Vanos)
68

NAPLEX BABY (23 decks)

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