Pharm HEENT Exam 1 Flashcards
(106 cards)
Eye steroids
Do not prescribe eye steroids
Refer
Viral treatment of eye
Eye lavage with saline BID 7-14 days
Vasoconstrictor - antihistamine drops may help
Warm to cool compresses reduce discomfort
ABX drops for secondary infection
Bacterial Treatment of eye
Hygiene
Hand washing
ABX drops More effective than ointment
Rare pathogens may need concurrent systemic ABX
Allergic treatment of eye
Cold compress
Artificial tears
Empiric ABX for Bacterial conjunctivitis
Erythromycin ointment
4 times a day x 5-7 days
Trimethoprim -polymyxin B drops
1-2 drops 4 times a day 5-7 days
Ofloxacin drops
1-2 drops x 5-7 days (contacts)
Cipro drops
1-2 drops 4 times a day x 5-7 days (contacts)
Viral conjunctivitis treatment
Antihistamine / decongestant drops OTC
1-2 drops 4 times a day for 3 weeks
Allergic conjunctivitis treatment
Antihistamine / decongestant drops OTC
1-2 drops 4 times a day for 4 weeks
Mast cell stabilizer drops
1-2 drops 3 times a day
Eye lubricant drops
Antihistamine / decongestant drops
Class and MOA
anti histamine
inverse agonism of histamine H1 receptors
Mast cell stabilizer drops
Class and MOA
mast cell stabilizer
prevention of mast cell degranulation
Vasoconstrictors
Class and MOA
Vasoconstrictors (decongestants)
Activation of Alpha adrenergic receptors
Leukotriene receptor antagonists
Class and MOA
Leukotriene receptor antagonist
Competitive binding to leukotriene receptors
NSAIDS
Class and MOA
NSAID
prevention of prostaglandin production
Corticosteroids
Class and MOA
Corticosteroids
Broad anti-inflammatory action through prevention of proinflammatory mediator synthesis
Single agent antihistamine - mast cell stabilizer
Class and MOA
Single agent antihistamine - mast cell stabilizer
Inverse histamine H1 receptor agonism plus prevention of mast cell degranulation
Corneal ulcer treatment
Refer
Lesion should be stained and cultured to identify cause and guide treatment
Avoid topical steroids for risk of further tissue loss and increase risk of perforation
Infectious keratitis
Risk increased with contacts
extended wear lenses
poor prep and disinfection
95% of bacterial keratitis is
contact lens infection
In referral based institutions
bacterial infections are typically
Gram negative like Pseudomonas
Followed by
gram positive like staph and strep
These are the normal ocular surface flora
Bacteria keratitis tx
4th gen fluoroquinolone
Moxifloxacin, gatifloxacin, besfloxacin
Close follow up in 24 hours
Do not use glucocorticoids
Do not patch
Acute dacrocystitis
most common organisms
Alpha hemolytic strep
Staph epidermis
Staph aureus
Acute dacrocystitis
Empiric Tx
Depends on age of child
severity of infection
presence and type of complications
Mild infections can be treated with oral clindamycin
Severe infections - IV Vanc with 3rd gen Cef
7-10 days
Blepharitis indications to refer
Severe eye redness Severe pain Severe light sensitivity impaired vision corneal abnormalities (scarring, ulcers) malignancy refractory symptoms
Blepharitis tx
Good lid hygiene
eliminate triggers
Allergens, smoking, contacts etc
goal is to minimize symptoms and limit exacerbations
Chronic condition
Can use ABX ointment is severe
(bacitracin, erythromycin)
Can use oral ABX if need further tx
(Doxy, tetra, azithro)
Hordeolum
Sty (acute infection of oil gland)
can be associated with blepharitis
warm compress