Pharm Exam 2: Ear/Eye/Health Promotion Flashcards
(43 cards)
Blepharitis
Eyelid margin infection/inflammation
Complications: dry eyes
Symptoms: irritated red eyes, burning sensation, increases tearing, blinking, photophobia, eyelid sticking, contact lens intolerance, eyelid margins are red, greasy, crusted, eyelid dermatitis, matted scaly eyelids
More common in adults; chronic in nature
Rarely cause vision troubles
Causes: Staphylococcus aureus, eye makeup, contact lens buildup, smoke, smog, chemicals, meibomian glands, inflammation/hypersecretion of sebaceous glands
No cure
Goal of treatment: control symptoms and prevent secondary complications
Blepharitis
Treatment
Bacitracin (Baciguent-polypeptide antibiotic
Apply fingertip size amount to affected are 1-3 times daily
Side effects: itching, burning, inflammation
Erythromycin Ophthalmic Ointment 0.5% (macrolide abx)
Apply 1cm to infected eye up to 6x daily
Side effects: minor ocular irritation, redness, hypersensitivity
Pregnancy Cat B
Blepharitis
Agent selection
First line:
Erythromycin 0.5% ophthalmic ointment (cause blurry vision)
Bacitracin 500 units ointment (cause blurry vision)
Ophthalmic fluoroquinolone solution (Besifloxacin, gatifloxacin, levofloxacin, moxifloxacin
Second line: refer to ophthalmologist
Blepharitis
Education
Improve eyelid hygiene: warm massages, occasional abx use, no contact lens use during flareups
Conjunctivitis (Pink eye)
Most common cause of red, painful eye
Inflammation of bulbar conjunctiva or palpebral conjunctival.
Symptoms: consistent inflammation of conjunctiva, red eyes, swollen conjunctiva, discharge from eyes
Normal pupil exam, normal vision
All types are self-limiting and usually resolve without tx in 2-5 days. Meds can speed up process, but abx NOT necessary usually
Pts should use cold compress and lubricants (artificial tears) for comfort
Topical vasoconstrictors and antihistamines can be used for severe itching (not usually indicated)
Conjunctivitis
Bacterial
More common in children
contagious
Cause: gram-positive Staph or Strep, gram-negative Moroxella/Haemophilus, Chlamydia or Gonorrhoeae
Transmission: contact with eye by fingertip, neonates by infected mother, contaminated pool
Symptoms: rapid onset of conjunctival redness
swelling of the eyelid
usually in one eye first and spread to other eye in 2-5 days
Grittiness/irritation, stringy, opaque, grayish or yellowish mucopurulent discharge, sticky lids, lid crusts
Foreign body sensation
Conjunctivitis
Viral
contagious
Cause: upper resp tract infection, common cold, sore throat.
Symptoms: excessive watery discharge, itchiness
foreign body sensation, peripheral injection, usually starts in one eye
Treatment: no effective tx
Risk of spreading infection
Topical antihistamines, artificial tears, cool compress
Conjunctivitis
Allergic
Cause: immunoglobulin-E mediated release of mast cells in conjunctiva
Symptoms: watery discharge, itching, burning, both eyes, excessive blinking
Treatment
Minimize allergen
First line: ophthalmic antihistamines alcaftadine or emedastine
Second line: topical corticosteroid
Third line: mast cell stabilizer -> azelastine, epinastine, ketotifen, olopatadine; opthalmic ketorolac
All pts can use cool compress and artificial tears
Conjunctivitis
Bacterial
Treatment
Ointments preferred for children, poor compliance difficult admin
First Line
Erythromycin Ophthalmic Ointment 0.5% (macrolide)
1cm directly to eyes up to 6x daily
Side effects: minor ocular irritation, redness, hypersensitivity
Preg Cat B
Polymyxin B sulfate & trimethoprim Ophthalmic solution
Aeroci gram-positive and gram-negative tx
1 gtt q3h for 7-10 days
Side effects: local irritation, redness, burning, stinging, itching
Preg Cat C
Second line- Fluoroquinolones
Moxifloxin (Vigamox)
1 gtt in 3x daily for 7 days
Side effects: eye burning, stinging, irritation, itching, dryness, redness tearing, blurred vision
1st line for contact lens wearers due to high incidence of pseudomonas
Preg Cat C
Gonococcal (treat immediately) Ceftriaxone (Rocephin) 1g single IM dose plus azithromycinin those who weigh 45 kg < 45kg reduced dose ceftriaxone Plus saline lavage of eye
Chlamydia: tx w/ systemic abx
Neonate: erythromycin taken PO for 14 days
Adults: single PO azithromycin dose
plus topical saline lavage of eye
Dry Eye Syndrome
Keratoconjunctivitis
Common; bilateral disruption of tear film
Most affected > 40 years
More common in women
Causes: decreased tear production, excessive tear evaporation, abnormal production of mucus or lipids in tear duct
Symptoms: dryness, burning, sandy-gritty eye irritation that gets worse as day goes on, pain, redness, pulling sensation, pressure behind eye
Damage to eye surface increases discomfort and sensitivity to bright light
Both eyes affected
Tx: First line
Environmental adjustment: humidity
Artificial tears and lubricants
Second line
Cyclosporine (Restasis) - prevents T cell activation
1-2 gtt q 12hrs
Side effects: burning, stinging, redness, pain, itching, burning, blurred vision, foreign body sensation, eye discharge
Preg Cat C
Glaucoma
Intraocular pressure -> optic neuropathy
Can permanently damage vision in affected areas of eye -> blindness if untreated
Glaucoma
Closed angle
Appears suddenly, painful , visual loss can be quick
Discomfort causes pt to seek help before permanent damage occurs
Glaucoma
Open angle
Chronic
Adult onset
Progress slower at a slower pace; pts do not notice vision loss until disease has progressed significantly
Leading cause of irreversible blindness
Progressive visual loss -> central field loss
Increase aqueous and/or decreased outflow -> increased intraocular pressure
Intraocular Pressure Measurement: best test to dx glaucoma
Acceptable IOP = 10-21
Glaucoma dx = IOP > 15
IOP > 40 = emergency referral
Glaucoma
Treatment
Goal: decrease ocular pressure, pressure retinal fibers
Beta blockers: non-selective (decrease production of aqueous humor)
Tomolol (Cosopt)
Levonbunolol (Betagan)
Carteolol
1 gtt 2x daily
Side effects: transient eye irritation, burning, tearing, conjunctival hyperemia, edema
Systemic effects: HA, hypotension, bronchospasm
Preg Cat C
Beta blockers: selective
Betaxolol (Betopic)
1 gtt 2x daily
Side effects: blurred vision, itching, swelling, eye pain, dryness
Systemic effects rare: fatigue, insomnia, nausea, dizziness, lightheadedness, bradycardia, hypotension, cold extremities, SOB, wheezing, depression
Safe use NOT established during pregnancy
Prostaglandins: improve outflow of aqueous humor
Bimatoprost (Lumigan)
Latanoprost (Xalatan)
Travoprost (Travatan)
1 gtt 1x daily at BEDTIME
Side effects: blurred vision, eye redness, discomfort, itchiness, foreign body sensation, dry eyes, tearing, eyelid crusting, increase in eyelash number number/length/thickness, darkens eyelashes and lids, eyelid changes, increased light sensitivity
Preg Cat C
Carbonic Anhydrase Inhibitors: inhibit carbonic anhydrase -> decreased aqueous fluid formation
Brinzolamide (Azopt)
Dorzolamide (Trust)
1 gtt 3x daily
Side effects: ocular burning, stinging, discomfort, bitter taste in mouth
Preg Cat C
Adrenergic Agonist: decrease norepi release from alpha receptors -> decrease aqueous humor
Apraclonidine (Lopidine)
Brimonidine (Alphaga)
1 gtt Q8h
Side effects: dry eyes, red eyes, eye irritation, HA, blurred vision, foreign body sensation, drowsiness.
Less common: corneal staining, increased sensitivity to light, eyelid redness, eye pain, tearing, eyelid swelling, low BP
Pre Gat B
Cholinergic blocking agents: increase aqueous outflow
Pilocarpine (Akarpine, isopto, pilocar)
1-2 gtt 3-4x/day
Side effects: transient stinging, burning, ciliary spasm, conjunctival vascular congestion, temporal/supraorbital HA, lacrimation, induced myopia
Systemic reactions: HTN, tachycardia, bronchiolar spasm, pulmonary edema, salivation, sweating, n/v/d
Preg cat C
Glaucoma
Treatment
Agent selection
First line:
prostaglandins -> beta blocker can be substituted if pt can’t afford prostaglandins
Second line:
Substitution or addition of beta blocker (if failure to decreased IOP)
Third line:
Addition of Carbonic Anhydrase Inhibitor or Brimonidine
Corneal abrasion
Localized loss of epithelium
Most common eye injury
Symptoms: severe eye pain with photophobia with/out foreign body sensation preventing opening eye
reduced visual acuity
lacrimation
blepharospasm
Causes: direct trauma, foreign body, contact lens
Fluorescein dye uptake (give pt tissue to wipe excess)
Seidel’s sign: possible foreign body does not stain -> streaming dye after insertion
* Do penlight exam prior to fluorescein
Rx treatment:
relieve pain, reduce risk of bacterial infection, promote healing
Usually heal within 48 hrs
AVOID steroids (increase risk of infection)
Corneal abrasion
Treatment
Cycloplegic therapy: paralyze ciliary muscle
Anticholinergics (cause pupillary dilation and paralysis of accommodation)
* Rapid action, but shorter duration than atropine
Maximal cycloplegia: 25-75 min after instillation
Accommodation recovery: 6-24 hrs
Homatropine (more cost effective) Cyclopentolate 1-2 gtt before abx Side effects: burning, stinging, redness, eye irritation, temporary blurred vision C/I: narrow angle glaucoma Preg Cat B/C
*Consider if pt will have to work, drive, use heavy machinery bc blurred vision lasts several hours
Corneal Abrasion
Abx Tx
Efficacy established when relief of pain, decreased inflammation, no infection
Antipseudomonal agents: used only for contact lens wearers
Gentamicin: most inexpensive
Can cause pseudomonas resistance
Aminoglycoside: (gram negative and positive)
1-2 gtt q4h for 7-10 days
Side effects: ocular burning, irritations, conjunctivitis
Preg Cat C
Tobramycin: used in place of gentamicin secondary to resistance
1-2 gtt q4h for 7-10 days
Side effects: localized ocular toxicity and hypersensitivity, lid itching, swelling, conjunctival erythema
Preg Cat B
Sulfonamides (inhibit bacterial synthesis)
Sulfacetamide
1-2 gtt into conjunctival sac q2-3 hrs for 7-10 days
Side effects: local irritation, stinging, burning
Preg Cat C
Stye (Hordelolum)
Rx treatment not recommended
Acute infection of secretory glands of eyelid, abscess of eyelid
Cause: Staph aureus; obstructed orifices of oil glands in eyelid
- incomplete removal of eye makeup, use of outdates or infected cosmetics, poor eyelid hygiene, inflammatory diseases of eyelid, stress and hormonal changes
Resolve on their own, pt w/ underlying skin issue are more prone
Use warm compress -> stimulates drainage of gland
if still present -> drain w/ lancet
Moxfloxin (vigamox): fluorquinolone
1 gtt 3x daily for 7 days
Side effects: eye burning, stinging, irritation, itching, dryness, redness, tearing, blurred vision
Preg Cat C
Otitis Media
Eustachian tube blockage:
trapped air in middle ear is absorbed in surrounding tissues -> vacuum in middle ear
Effusion:
fluid from surrounding tissues is sucked into middle ear cavity -> middle ear effusion
Cause: Strep pna (most common), Haemophillus influenza, Moraxella, Staph aureus (resp inf)
Risk: cigarette smoke exposure, daycare, non-breast fed children, allergies
Common < 15 yo, most common <2yo
Symptoms: ear pain, trouble sleeping, cranky, pulling on ear, fever, irritability
Diagnosis:
- Acute onset of s/s
- Signs of middle ear effusion: bulging TM, limited or absent TM mobility, otorrhea, air-fluid level behind TM
- s/s of middle ear inflammation: TM erythema, pain, tugging ear
Tx: only when symptoms of infection present, bilateral presentation, or otorrhea
Observe unless: bilateral s/s, < 6 yo, otorrhea, severe/prolonged s/s, fever > 102.2F
Otitis Media
Treatment
Start w/ amoxicillin to prevent resistance to Cephalosporins
First line - unless allergy PCNs or use within 30 days
Amoxicillin/clavulanate: well tolerated, tastes like bubblegum (can change flavor to
<88 lbs: 90mg/kg divide into 2 daily doses q 12 hrs
>88 lbs: 875mg q 12 hrs
Side effects: stomach pain, n/v, vaginal itching/discharge, HA, swollen or black or hair tongue
Preg Cat B
2nd line allergy to PCN Cefuroxime (Ceftin) Ceftriaxone (Rocephin) Azithromycin (Zithromax) Clindamycin Bactrim
Otitis Externa
Swimmers ear
Cellulitis of ear canal skin and subdermis
Occurs suddenly
Risk factors: eczema, seborrhea, excessive itching, trauma from cerumen removal, chronic otorrhea, immunocompromised (DM).
Causes: swimming, local trauma, hearing aids, high/humid temp
* Pseudomonas aeruginosa, Staph aureus, occasionally fungus
Wax + swelling -> conductive hearing loss
Symptoms: painful outer ear, itching, fullness, tenderness of tragus or pinna (pull on upper ear -> pain, erythematous ear canal
Otitis Media
Treatment
First line Fluoroquinolone gtt Ciprofloxacin + dexamethasone (Ciprodex) tx of bacteria and inflammation Side effects: ear discomfort, itchiness, unusual taste Preg Cat C
2nd line
Neomyxin/polymixin B + Hydrocortisone gtt
Adults: 4 gtt 3-4x daily for 10 days
Infants + children: 3 gtt 3-4x daily for 10 days
Side effects: skin sensitization
Preg Cat C
Ruptured/perforated tympanic membrane
ALL DROPS CONTRAINDICATED
