Lecture 1 Stuff Flashcards
What are the components of STEPS?
Summarize the problem and characterize severity. (determines where your patient should be treated)
Take into consideration key pieces of information and data. (determines what drug therapy you should recommend)
Evaluate the options.
Provide a recommendation. (ensures patient will follow recommendations)
Suggest an appropriate monitoring and follow up plan. (ensures safety and efficacy of your recommendations)
What are the components of QuEST?
Quickly and accurately asses the patient. (SCHOLAR MAC)
Establish that the patient is an appropriate self-care candidate.
Suggest appropriate self-care strategies.
Talk with the patient.
What are the components of SCHOLAR MAC?
Symptoms Characteristics History Onset Location Aggravating factors Remitting factors Medications Allergies Coexisting Conditions
What illness/injuries are self care options?
Cold/Flu Symptoms Minor Allergic Reactions Bumps, Cuts, and Scrapes Allergies Immunizations Coughs/Sore Throat Rashes and Minor Burns
What illness/injuries are retail health clinic options?
Eye Irritation, swelling pain
Ear or sinus pain
Burning with urination
Fevers
What illness/injuries are physician’s office options?
Blood Work Foreign Object in Eye or Nose Minor Headaches Mild Asthma Nausea, Vomiting, Diarrhea Sprains and Strains Back Pain
What illness/injuries are urgent care center options?
Stitches
X-Rays
Animal Bites
Minor Fracture
What illness/injuries are emergency department options?
Poisoning Labor Spinal Cord or Back Injury No Pulse Significant, Uncontrolled Bleeding Symptoms of an MI or Stroke Major Fractures or Burns
When a patient has dry eye it is important to prevent blepharitis which is one of the most common causes of dry eye. This can be prevented by washing eyelids with what?
Eye lids can be scrubbed at base of the lash with a cotton swab dipped in baby shampoo/sodium bicarbonate solution, dilute tree oil, or commercially available wipes.
What can cyclosporine be used for?
When a patient has severe dry eye. Must be under the care of an eye care professional.
Artificial Tear Solutions for dry eyes are usually applied how often?
1-2 times daily but can be given hourly if necessary
What are the vehicles that act as ocular lubricants and what are their benefits?
Cellulosoe ethers - Stabilize tear film, slowing evaporation Polyvinyl alcohol (PVA) - Enhances stability of tear film Povidone - Promotes wetting of the ocular surface.
Should preservative containing products be used?
They should be avoided because of the possibility of causing a patient to develop a hypersensitivity.
How should eye drops be administered?
Wash your hands and remove contacts, if applicable.
Tilt back head and grasp lower outer eyelid below the lashes and pull out to create a pouch.
Place bottle above the eye.
Look up just before administering the drop.
Apply the drop and slowly release eyelid.
Close eyes and tilt head down for 3 minutes.
How often are ointments administered?
Typically administered twice daily but can be administered every few hours as needed.
What are the different ophthalmic ointment ingredients and what are their benefits?
White Petrolatum - Lubricant and ointment base
Mineral Oil - Facilitates melting of ointment at body temperature
Lanolin - Facilitates incorporation of water-soluble medications and prevents evaporation.
What are some ophthalmic preservatives?
benzalkonium chloride (BAK), Chlorhexidine, Methylparaben, Propylparaben, Purite, Thimerosal
What are disappearing-preservative products and how can they help patients?
These products allow for the preservative to disassociate into a non-toxic compound in the eye. They are ideal for patients who are sensitive to preservatives, use drops frequently, and/or have compromised corneas.
What other ophthalmic preparations are reserved for moderate to severe cases of dry eye and must be used under the care of an eye care professional?
Anti-inflammatory agents - Cyclosporine, topical or systemic corticosteroids, systemic tetracycline, and systemic fatty acids.
Secretagogues such as pilocarpine and cevimeline- stimulate tear production, limited by systemic effects like sweating nausea, GI cramping
What is appropriate eye ointment administration?
Wash your hands and remove contacts, if applicable.
Tilt back head and grasp lower outer eyelid below the lashes and pull out to create a pouch.
Place 1/4 to 1/2 inch of ointment inside the lower eyelid as pictured below. Avoid touching the lube to the eye.
Release eyelid slowly and close eyes for 1-2 minutes.
What does the term “pink eye” refer to?
Any type of conjunctivitis and should be avoided due to the negative connotation associated with it
What are ophthalmic decongestants(alpha-adrenergic agonists) that could be used for allergic conjunctivitis?
Phenylephrine, naphazoline, tetrahydrozoline, and oxymetazoline. All OTC and cause vasoconstriction which reduces ocular redness, vascular congestion, and eyelid edema but not the allergic response. Rebound congestion may occur limiting use to 72 hours but less likely to occur with naphazoline and tetrahydrozoline. Caution should be used with patient with hypertension, cardiovascular disease, or diabetes. May cause ocular dryness.
What are the ophthalmic antihistamines that may be used?
Pheniramine maleate
Antazoline phosphate
- only available in combination with decongestants. They tend to burn, sting, and produce discomfort upon application. Should not be used in patients with angle-closure glaucoma.
What is first line therapy for allergic conjunctivitis after failure of ophthalmic lubricants?
Ophthalmic Antihistamine/Mast Cell Stabilizers. Inflammatory mediator release is inhibited by the mast cell stabilization activity of this drug. These products also burn, sting, and produce discomfort upon contact with the ocular surface.
