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mpharm stage 3 > Special senses > Flashcards

Special senses Flashcards

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1
Q

what is the function of the aqueous humour of the eye

A

transports nutrients to the eye and waste products from the eye.

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2
Q

what is IOP

A

intraocular pressure

  • It is the balance between aqueous humour production and aqueous humour removal.
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3
Q

What is normal IOP

A

12-21 mmHg

  • IOP usually lowest at night and highest during the day
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4
Q

What is Glaucoma

A

Optic nerve damage due to an increased IOP.

  • Loss of retinal ganglion cells
  • atrophy of optic nerve
    ^ these are usually asymptomatic
  • then peripheral vision is lost, if left untreated could cause blindness.
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5
Q

What is POAG

A

Primary open angle glaucoma

  • a type of glaucoma: where the drainage channels of the eye become blocked, causing an increase in IOP.
  • where the anterior chamber angle appears to be normal, but IOP is high with no sign of disease.
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6
Q

POAG treatment:

A

Decrease IOP by 20-40%

Drug therapy
then
laser therapy
then
surgery

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7
Q

What are 5 common reasons for treatment failure generally ?

A

1) lack of adherence
2) Intolerance to treatment
3) Hypersensitive to excipient
4) OTC drugs
5) Other contraindicated prescription drugs, not disclosed during prescribing.

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8
Q

What types of drugs reduced aqueous humour production

A

B antagonists

  • carbonic anhydrase inhibitors
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9
Q

Examples and side effects of Beta antagonists that reduce aqueous humour production

A

Examples:
Timolol
Betaxolol
Brinzolamide
Dorzolamide
Acetazolamide

Side effects

Timolol: Blurred vision, burning/ stinging in the eye, discharge.

Betaxolol: Nausea, diarrhoea, joint pain, heart burn

Brinzolamide:
Eye irritation, blurred vision, allergic reaction

Dorzolamide: blurred vision, skin rash, redness or sweeling of the eye.

Acetazolamide:
Skin rash, swelling, headache, nausea, vomit.

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10
Q

Timolol mechanism of action ?

A

Decreases aqueous humour production, causing decrease in blood supply to ciliary body, decreasing IOP.

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11
Q

What type of drugs reduce aqueous humour production and increase aqueous humour removal
(dual effect)

A

Alpha 2 receptor agonists

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12
Q

Examples and side effects of A2 agonists (dual effect)

A

Examples:
Apraclonidine
Brimonidine

Side effects:
Apraclonidine:
Red swollen. itchy eyes
blurred vision
irregular heartbeat
dry eyes

Brimonidine:
Itchy eyes
eye irritation
red stinging/burning eyes
dry eyes
blurred vision
headache
drowsiness.

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13
Q

What type of drugs increase Aqueous humour removal

A

Prostaglandin analogues

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14
Q

Examples and side effects of prostaglandin analogues

A

Bimatoprost: itchy eye, red eye, eye swelling, blurred vision, headache.

Latanoprost: change in eye colour, dry eyes, headache, dizziness

Travoprost: Eye discolouration, dry eye, eye discomfort, headache, blurred vision

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15
Q

What is another drug type that treats POAG ?
And what is the MOA ?

A

Cholinergic agents

  • by stimulating cholinergic receptors in the eye,

causing spasm of ciliary muscle and contraction of the pupil

causes trabecular meshwork to open and increases aqueous humour removal out of the eye. Lowering IOP.

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16
Q

Examples and side effects of cholinergic agents?

A

Pilocarpine: headache, nausea, diarrhoea, fainting

Carbachol: blurred vision, headache, stomach pain

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17
Q

Other treatment options for POAG

A

Laser trabeculoplasty: 120 burns made in the trabecular meshwork, to increase drainage of aqueous humour, causing lower IOP

Laser ciliary body ablation: applying burns to ciliary body, reduces aq humour production, lower IOP.

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18
Q

PCAG

A

Primary closed angle glaucoma

  • Increase in IOP, due to decreased aqueous humour removal, due to the closure of the chamber angle by the peripheral iris.
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19
Q

symptoms of pcag

A

headache
blurred vision
vomit

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20
Q

What may cause PCAG

A

1) Small or large lens size
2) small corneal diameter
3) secondary to late stage POAG
4) Dilator and
5) sphincter muscle theory

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21
Q

Dilator muscle theory (PCAG)

A

1) Dilator muscle contracts, causing posterior movement , increases apposition between iris and anteriorly located lens.

2) pupil dilates simultaneously

3) Peripheral iris becomes more flaccid, causing posterior chamber pressure to increase

4) Iris bows anteriorly, peripheral iris obstructs angle, IOP increases.

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22
Q

Sphincter muscle theory

A

1) Sphincter of the pupil precipitates angle closure
2) pupilary blocking force of the sphincter is highest when diameter of pupil is around 4mm.

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23
Q

Pre surgery preparation for PCAG

A

1) Timolol 0.5% (one drop every 30 mins) 2 doses

2) Pilocarpine 2-4% one drop every 15 mins for the first 1-2 hours

3) Apraclonidine 0.5-1% one drop every 30 mins (2 doses)

4) Acetazolamide 500mg oral initially, then 250 mg every 6 hrs.

5) Osmotic agent (e.g. oral glycerol) 1ml/kg diluted with a equal amount cold water

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24
Q

Viral conjuctivitis treatment

A

warm compress and eye drops

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25
Adults chronic onjuctivitis treatment
chloramphenicol or fusidic acid
26
Neonatal conjunctivitis treatment
Oral erythromycin (50mg/kg 4 times a day for 14 days)
27
Scleritis
NSAIDs
28
symptoms of excess build up of earwax
Earache hearing loss tinnitus itchiness in/around ear Vertigo (spinning sensation) ear infection
29
Rinne test (ear test)
1) Strike a 512 Hz tuning fork gently 2) Place the vibrating tuning fork onto the mastoid bone, located behind the ear. 3) Ask patient, when they can no longer hear the sound. 4) move the tuning fork to the auditory meatus, which is in the front of the ear canal 5) Ask the patient when they can no longer hear the sound.
30
Weber's test (ear test)
same as rinnes but hold the fork by the stem and place it on the middle of the patient's head, - then ask if they hear the sound louder in one ear, or equally.
31
Non pharmalogical treatment for earwax build up
Olive oil drops warm water in a bulb syringe
32
Different types of Pharmalogical ear drops ?
1) sodium bicarbonate 2) urea-hydrogen peroxide 3) docusate sodium
33
Sodium bicarbonate MOA (ear drops)
Reacts with ear wax neutralising it to produce water and salt, dissolves ear wax. causes ear wax to break down
34
Urea-hydrogen peroxide MOA (ear drops) 2 ways
Releases oxygen, breaking up ear wax - Reduces keratin load in ear wax debris, by inducing keratolysis.
35
Docusate sodium MOA (ear drops)
Emulsifying action, softens ear wax plug.
36
Should ear drops be used if the ear drum is perforated
no
37
What to do if ear drops don't work
Syringing use warm water to wash out softened ear wax - dont use cold water- could cause diziness - can cause increased risk of ruptured ear drum, infection, tinnitus - if syringing doesn't work- then transferred to ENT specialist
38
what are the 3 different ways ear wax removed by ENT
1) ear irrigation: electric pump pushes water in ear and washes wax out 2)Micro suction: Small device sucks ear wax out of ear 3) Aural toilet: small instrument used to clean and scrape ear wax out
39
Otitis Externa
inflammation of the external ear canal - also known as "swimmers ear" - usually only one ear is affected
40
Symptoms of otitis externa
1) ear pain 2) itchy ear canal 3) Discharge 4) Hearing loss
41
What are the 4 main causes for otitis externa ?
1) Seborrheic dermatitis: Skin condition, where greasy areas of the skin become irritated and inflamed, which can affect the ears. 2) Fungal infections: more common if ear drop use is long term. 3) Middle ear infection (otitis media): an infection deeper in the ear, causes discharge, may lead to otitis externa. 4) Allergies
42
6 drugs to treat otitis externa:
1) Otomize 2) Sofradex 3) Gentamicin 4) FML drops 5) Clotrimazole drops 6) Betnesol
43
Otomize mechanism of action (otitis externa)
The glacial acetic acid present, creates an acidic environment making it harder for the bacteria to grow.
44
Sofradex mechanism of action (otitis externa)
1) contains antibiotics framycetin sulfate and gramicidin, to kill bacteria 2) contains dexamethasone: to stop inflammation and itching.
45
Gentamicin
Bind to the 30S subunit of the bacterial ribosome, causing an affect on protein synthesis.
46
FML drops mechanism of action
Fluorometholone A type of corticosteroid Inhibits phospholipase A2 . This causes inhibition of arachidonic acid, which reduces levels of prostaglandins and leukotrienes.
47
Clotrimazole drops mechanism of action
1) By inhibiting ergosterol, clotrimazole disrupts the integrity of the fungal cell membrane. 2) leading to membrane permeability changes and cell death
48
Betnesol moa
Betamethasone 1) Blocks production of prostaglandins - also reduces activity of leukocytes and macrophages in the inflamed area. 2) Reduces inflammation (redness, itching and soreness). Neomycin 1) Binds to 30S sub unit of bacterial ribosome, prevents synthesis of proteins.
49
two types of otitis media
1) Otitis media with effusion (OME)- non infection: just thick fluid build up behind tympanic membrane in the middle ear. Also known as glue ear 2) Acute Otitis media (AOM)- infection symptoms: earache/fever, hearing loss, perforated ear drum, feeling unwell. - treated with paracetamol/ibuprofen or if antibiotics necessary: then amoxicillin, or clarithromycin/erythromycin if allergic to penicillin.
50
how to reduce middle ear infection (children)
1) keep up to date with routine vaccine 2) avoid smoky environments 3) breastmilk over formula milk 4) not giving dummy after 6-12 moths of age 5) avoid contact with other children that are infected.
51
complications of otitis media and their signs
1) Mastoiditis: fever, swelling behind ear, redness/ pain behind ear, headache, hearing loss. 2) cholesteatoma: hear loss, dizziness, tinnitus 3) labyrinthitis: vertigo, dizziness, loss of balance facial paralysis 4) meningitis: severe headache, high temp, stiff neck, blotchy red rash, rapid breathing. 5) brain abscess: pus filled swelling. signs: headache, confusion, weakness/paralysis, high temp, seizure.
52
Pharmalogical treatment motion sickness
anticholinergics: hyoscine hydrobromide antihistamines: cinnarizine phenothiazines: prochlorperazine promethazine cyclizine
53
non-pharmalogical treatment
- distract themselves- listen to music - remain still - look at a stable object - fresh air - eating ginger
54
Tinnitus symptoms
hearing sound, when there is no external sound ringing sound cause: damage of tiny sensory hair cells in cochlea of inner ear.
55
Pharmalogical treatment tinnitus
benzodiazepines or antidepressants
56
non pharmalogical treatment tinnitus
- hearing aid - sound therapy: dont keep environment to quiet -
57
what is vertigo
sensation that the environment around you is spinning
58
Pharmalogical treatment vertigo
betahistine cinnarzine
59
non Pharmalogical treatment vertigo
vestibular rehabilitation simple head movements to treat BPPV sleep with head slightly raised
60
Meniere disease
Affects inner ear, and can cause vertigo and tinnitus and pressure deep in ear feeling,
61
symptoms of Meniere disease
vertigo, dizziness, imbalance and spatial disorientation, vision disturbance, hearing changes, cognitive changes
62
treatment of meniere disease
antihistamines betahistine vestibular rehabilitation balance training benzodiazepenes
63
Antihistamines
moa: prevents histamine from binding to H1 receptor example: cinnarizine indications vertigo, nausea, motion sickness counsel: may cause drowsiness, avoid alcohol, cautious whilst driving
64
Phenothiazines
moa: blocks D2 dopamine receptors, blocks CTZ indications: nausea, vomiting, motion sickness counsel: may cause dystonic functions (involuntary muscle contraction), monitor movement disorders.
65
Anti- vertigo
moa: improves blood flow to inner ear example: betahistine indication: vertigo, tinnitus counsel: take with food
66
Anti-emetics
moa: blocks serotonin, acetylcholine, dopamine receptors from reacting with 5-HT3 receptor. examples: metoclopramide, domperidone, ondansetron. indication: nausea, vomiting counsel: may cause drowsiness, or affect bowel movements.
67
Topical steroids
example: vistamethasone indication: ear inflammation (otitis externa). counsel: avoid long term use, monitor for skin thinning.
68
Topical anitbiotics
example: gentisone indication: otitis externa counsel: avoid if perforated eardrum
69
Anti-muscarinics
moa: blocks muscarinic acetylcholine receptors (M1,M2, M3). example: hyoscine indication: motion sickness, nausea counsel: can cause dry mouth, blurred vision, drowsiness.
70
Benzodiazepines
moa: enhances effects of GABA, by binding to GABA-A, causing chloride channel to open, leading to influx of cl- ions into neurons, causing hyperpolarisation, less likely to fire action potential. examples: diazepam, lorazepam, alprazolam indications: anxiety, insomnia, seizures. counsel : may cause drowsiness, avoid alcohol.
71
What are the 4 classes of antidepressants ?
1) SSRI: Fluoxetine, sertraline, citalopram 2) SNRI: Venlafaxine, duloxetine, desvenlafaxine 3) TCAs: Amitriptyline, nortriptyline, Imipramine 4) MAOI: Phenelzine, tranylcypromine, isocarboxazid
72
Lubricating ear drops
moa: moisturises and prevents dryness example: olive oil indication: earwax removal counsel: not for perforated ear drum.
73
ear wax preparations
moa: softens and removes earwax examples: Otex, sodium bicarbonate indication: earwax removal. counsel: follow instruction to avoid ear canal damage.
74
questions to ask if eye symptoms ?
1) Has vision been affected: loss of vision ? 2) discomfort: itchy eyes (could be conjunctivitis) 3) Discharge: common for conjunctivitis 4) Duration: e.g. red eye for more than a week should be referred, unless its due to conjunctivitis. 5) nausea/vomiting: could suggest glaucoma 6) cold symptoms: could suggest conjunctivitis
75
treatment of blepharitis
- Pharmalogical treatment rare but topical antibiotic like erythromycin ointment can be given. - don't wear contact lenses - clean eye lids daily - warm compress 3/4 times a day (5-10 mins)
76
what is cause of motion sickness
conflict between sensory input from vestibular organs in the inner ears and eyes.
77
symptoms of motion sickness
skin paleness cold sweating dizziness nausea, vomiting increased saliva production
78
general treatment for mild dermatitis
- OTC emollients: Exocream, Dermacool - topical corticosteroids: hydrocortisone, Hc45 hydrocortisone cream
79
example of mild, moderate, potent, very potent topical corticosteroids ?
mild: hydrocortisone moderate: alclometasone dipropionate clobetasone butyrate hydrocortisone butyrate potent: betamethosone, fluticasone, mometasone furoate very potent: clobetasol propionate
80
cellulitis treatment
for streptococci: cefuroxime for penicillin allergies: clindamycin or vancomycin
81
prevention and treatment of staphylococcal infections
flucloxacillin
82
what causes acne
blockage of hair follicles by keratin build up
83
Pharmalogical treatment acne
1) Benzoyl peroxide 2) or combo with clindamycin to treat systemically use doxycycline or isotretinoin (its a retinoid) for severe acne
84
isotretinoin dose
0.5 mg/kg/day for 4 weeks increase until dose of 120-150 mg/kg reached
85
Pharmalogical treatment genital warts
podofilox (topical)
86
Pharmalogical treatment for anogenital warts
Trichloroacetic acid cryotherapy
87
Pharmalogical treatment for warts and veruca
verruca gel Bazuka (salicylic acid and lactic acid)
88
shingles treatment
povidone iodine aciclovir
89
aciclovir moa
activated by thymidine kinase and is converted into aciclovir triphosphate competes with deoxyguanosine triphosphate for viral dna chain aciclovir triphosphate then prevents further elongation of viral DNA chain.
90
ring worm treatment
antifungal: terbinafine - inhibits squalene epoxidase, leading to accumulation of squalene, which is toxic to fungal cell antifungal: griseofulvin - binds to fungal microtubules inhibiting and disrupting fungal cell division
91
amphotericin B
treatment for systemic fungal infection same moa as nystatin same as ketoconazole and itraconazole, fluconazole
92
nyastatin
indication; oral candidiasis - binds to ergosterol in fungal cell membrane, disrupting structure, forming pores, weakening structure, cell contents leak.
93
how do most antifungals work
by inhibiting fungal cytochrome p450 enzyme, disrupting ergosterol synthesis, causing fungal membrane damage
94
ring worm and athletes foot OTC treatment
miconazole 2% cream terbinafine
95
headlice OTC treatment
dimeticone gel 4% headlice comb

mpharm stage 3 (10 decks)

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