Tx only for Opthal/Ear Flashcards

Question

Dry eye

Answer 1

Artificial tears - 1st line 3-4x/d OTC Ointment - 1st line (prolonged lubrication) - ex: sleeping Rx - Cyclosporine (Restasis) - drops MOA: Polycyclic peptide that inhib cellular and humoral immune rsp by inhib IL-2 ↑ tear prod d/t inflam reduction (prevents organ rejection after transplant) Environmental - humidifiers, moister chamber glasses, swim goggles Insertion of punctual plugs to retain lacrimal secretions → blocks drainage and ↑ eyes’ tear films and retains moisture ## Footnote fake sleep for the 1st dry appointment Then psychos spar in the environment (link to heart broken tears)

Answer 2

Refer to ophthalmologist Sx - ind: in pts w/ visual impairment ## Footnote Doctor cat can't see for surgery

Answer 3

Refer to ophthalmologist Inhibitors of VEGF - (wet MD) Reverses choroidal neovascularization - stabilization of vision in neovascular degen Adm into vitreous; monitor BP No specific tx for atrophic degen Antioxidants: vit. C and E, zinc, copper, carotenoids ## Footnote Wet fountain vegetables for dracula's vitreous CCCEZ - antiox

Answer 4

Acetazolamide - 1st line 500mg PO or IV MOA: ↓ prod of aqueous humor When IOP drops: Pilocarpine 2% - 1 drop q15min for 1 hr then QID MOA: ↑ outflow of aqueous humor, ↓ resistance causes miosis (constriction) Others: Latanoprost, Timolol, Apraclonidine Recheck IOP every 30-60min Reduction of IOP (incr aq. outflow or dec inflow) place pt supine analgesia, antiemetic if needed Laser peripheral iridotomy is definitive tx ## Footnote 1st Ace carpenter drops supine 30-60m , then uses lazer (narrow/hard for carpenter to get in)

Answer 5

Laser peripheral iridotomy is definitive tx Laser creates hole in peripheral iris to relieve pupillary block → widened angle → tubular meshwork exposed and fluid outflow is enhanced Aqueous humor goes from posterior to anterior chamber ## Footnote hollow iris into pipes

Answer 6

Topical Prostaglandin - 1st line MOA: selective agonist of PG-R; ↑ outflow of aqueous humor → ↓ IOP Initial tx for open-angle; well-tolerated SE: conjunctival hyperemia, irritation, ↑ number and length of eyelashes, changes in **iris and lash pigmentation**, foreign body sensation - Latanoprost (Xalatan) - genetic - Tafluprost (Zioptan) - no preservatives - Bimatoprost (Latisse) - lengthens eyelashes Topical Beta Blockers MOA: ↓ IOP by inferring w/ **cAMP** (which is used to prod aqueous humor in ciliary process) SE: systemic- MC w/ non-selective BB: Timoptic (timolol) - brady, hypotension (Long-term use - bronchospasm) Ocular - burning Topical α-2 adrenergic agonists - Apraclonidine MOA: causes iris to dilate (mydriasis), ↓ congestion in blood vessels of conjunctiva leading to ↓ IOP by ↓ prod of aqueous humor SE: allergic conjunctivitis, hyperemia, ocular pruritus DIs: **MAOIs, tricyclics, CNS depressant, alc, BB, cardiac glycosides, antihypertensives** Topical carbonic anhydrase inhib - Acetazolamide (Diamox) - not as effective - MOA: slows action of enzyme carbonic anhydrase (directly inhib prod) → ↓ prod of aqueous humor and ↓ IOP CI: sulfa allergy Cholinergic agonists - pilocarpine - Mitotic - causes pupil constriction → ciliary muscles attache to trabecular meshwork and contract → open up Schlemm’s canal → ↑ outflow of aqueous humor and ↓ IOP **Deactivates cholinesterase and allows ACh to continue miosis** for ~4-6hrs SE: abd cramps, D, watery mouth, sweat, fixed small pupils, myopia, visual disturbance, HA ## Footnote first tropical prost ~ frost time camp slows heart tropical apples Ace eggs Carpeter dilates

Answer 7

Topical PGs - 1st line Topical beta blockers Topical a-2 adrenergic agonists (lots of DI's, can't rx BB) Acetazolamade (not as effective) pilocarpine Laser peripheral iridotomy ## Footnote first tropical prost time camp slows heart tropical apples Ace eggs Carpeter dilates

Answer 8

+/- topical anesthetic drops - prior to staining are Proparacaine, Tetracaine Topical abx: bacitracin-polymyxin ointment/drops - 1st line Short-acting cycloplegic if needed - pain relief d/t ciliary spasm Cyclopentolate 1% or Homatropine 5% NSAID eye drops: Diclofenac or Ketorolac Other: Oral opioid analogies, tetanus prophylaxis; Don’t smoke! ## Footnote Fluroescent green back drop Pentagram Home (ciliary) Opiates Tetanus to prevent

Answer 9

**Alkaline (worse**) vs acidic burns Topical anesthetics or abx Irrigation ASAP - Morgan lens: irrigate until pH of 7 Slit lamp exam w/ lid eversion, Measure IOP Cycloplegic-decrease pain iris-ciliary spasm and dilate (Cyclopentolate 1% drops) Steroids or narcotics if severe ## Footnote Pentagram chemicals Steriods for worse chemicals

Answer 10

Binocular patching 1-2 drops Cyclopentolate → dilates pupil and relieves pain ## Footnote Patch pentagram

Answer 11

* Check visual acuity * Topical anesthetic drops If superficial - remove it via saline flush, sterile cotton swab, sterile eye spud, small 25-gauge needle * Topical abx drops or ointment - Bacitracin-polymyxin ointment * Tetanus prophylaxis Short-acting cycloplegic “Rust ring” - iron foreign body → refer for removal if no improvement in 2-3d ## Footnote flush 25 objects back to tropical short rust ring 3 d referally

Answer 12

Prevent of further hemorrhage (most re-bleeding w/i 72hrs d/t clot lysis/retraction; more severe) Keep pt supine position w/ HOB @ 45° Hard eye shield NO NSAIDs, ASA Oral or parenteral pain meds; antiemetics ## Footnote stop the bleed in 72 hrs Supine w head 45, hard eye shield No talking (no said)

Answer 13

Refer! Tetanus prophylaxis/pain mgmt Avoid valsava maneuvers, give antiemetics (no sneezing/blowing nose) +/- systemic abx to cover for sinus pathogens (Augmentin or doxy) +/- systemic steroids for swelling of eye adnexa and ↓ diplopia Long-term tx - possible sx ## Footnote Orb blowing - no blow Augment Doxy with roid and tetanus (doxin? the dog?) long surgery

Answer 14

Protective eye shield HOB @ 45° Vanco + Ceftazidime (or FQ) - IV Tetanus updates, sedation antiemetic Pt NPO d/t Sx CT of orbit ## Footnote Ivy van dime penetrates @ 45 degrees Tetanus Antiemetic Panther, surgery

Answer 15

Consult! Early presentation: lay pt flat, ocular massage, high [ ] of O2, IV acetazolamide or mannitol, VDs Thrombolysis - may induce hemorrhage (generally w/i 4.5hrs) Giant cell arteritis - high dose corticosteroids ## Footnote Man Vampire supine for massage, O2, Ace! Watch Thrombolysis 4.5 hrs High Giants on steroids blocking arteries

Answer 16

* anti-VEGF - 1st line (↓ macular edema and vascular permeability) * Intravitreal corticosteroids - 2nd line * Laser photocoagulation - for sig hemorrhages and neovascularization (seal leaky vessels and prevent formation of VEGF) ## Footnote 1st Veggie tales injecting steroids for baddie lazer

Answer 17

Sx - close all retinal holes/tears w/ permanent adhesion via laser photocoagulation (pneumatic retinopexy) Worse prognosis if macula is detached or detachment is of long duration

Answer 18

Acute demyelinating optic neuritis - IV methylprednisone x 3d then taper w/ PO prednisone Other causes: more prolonged corticosteroid tx (poorer prognosis) Most visual acuity improves w/i 2-3wks ## Footnote metal ivy purse for 3 days Pac n' sow after see clearly after 2 weeks

Answer 19

Refer to ophthalmology Treat underlying causes Do NOT perform LP on pt w/ papilledema - can worse IC | MRI is Dx

Answer 20

Systemic high-dose corticosteroids and refer!

Answer 21

Gait instability, Romberg test, CN and EOM Pursuit/saccades - not a test but a result of the head impulse test. Abnormal is when eyes can't follow target. or there's a delay. abn can ind cerebral patho Nystagmus Head impulse test (move head back and forth) Hearing eval - whisper, Webber, Rinne test Dix-Hallpike Maneuver (BPPV)

Answer 22

Audiometry - comorbidities, hearing acuity, various tones and pitches Caloric testing - cold/warm water or air into ear (COWS) CT/MRI Electronystagmography (ENG) - trace eye movements, records nystagmus or videonystagmography (VNG) - video images of eyes Vestibular-evoked myogenic potentials (VEMPS)- repetitive sound stimulus to one ear and avg rxn time of muscle activitiy in rsp to each soundcheck or pulse

Answer 23

Cervical VEMP - saccule (loud sound in one ear triggers reflex to ipsi SCM muscle) Ocular VEMP - utricle (records EOM potentials during head vibration) -look for asymmetrical or absent response

Answer 24

Repositioning otoliths: The Epley maneuver - most effective Deconditioning exercises: Brandt-Daroff Maneuver or Exposure tx Sermount Maneuver Recurrence is common

Answer 25

Corticosteroids - methylprednisone or prednisone (shorten s/s duration, improve vestibular fxn and hearing recovery) Give w/i 3 days of onset Antimicrobials - not as effective Valacyclovir if viral etiology Abx if febrile or bacterial inf Symptomatic: Vertigo suppression: Antihistamines - meclizine (Antivert) Benzos - diazepam (Valium), lorazepam (Ativan) N/V: Promethazine (Phenergan) Ondansetron (Zofrna) Vestibular rehab tx

Answer 26

Goal - ↓ freq of attacks, preserve hearing, alleviate imbalance Lifestyle mod: Low salt diet Restrict alc and caffeine Acute - vestibular suppressants: Meclizine, diazepam, promethazine Chronie - diuretics: acetazolamide, HCTZ Supportive: Vestibular rehab, hearing aid Refractory - nondestructive interventions: Intratympanic corticosteroids injections Positive pressure pulse generator (Meniett) Deliver pressure to inner ear Endolymphatic shunt Refractory - destructive interventions: Intratympanic gentamicin injections Surgical labyrinthectomy Vestibular nerve resection ## Footnote Mermaids can't have salt, coffee or alcohol. A cutely MMD (depressed b/c can't drink alcohol) Chronic Ace Fountain Interventions: conch shell steriods, endolymph shunt, + pressure Refractory - drummer gentlemen, surgical labrinth, vestibular nerve resection

Answer 27

Prompt ENT referral BR → Head elevation, avoid straining Symptomatic meds PRN Refractory - surgical patch

Answer 28

Symptomatic - analgesics Refractory - Sx (myringotomy, tympanoplasty)

Answer 29

Paraganglioma - Sx Patulous Eustachian Tube- Sx, estrogen drops Sensorineural hearing loss - hearing aids

Answer 30

Underlying dz: Hearing loss → hearing aids Control HTN, review meds Exacerbating factors: depression, insomnia (white noise) Behavioral tx: Tinnitus Retraining tx (TRT) Noise-inducing generators + counseling (habituates pt to tinnitus and diverts attention away from it) Stress reduction programs, CBT Meds - BZDs, intra-TM steroid shots, misoprostol Masking devices Transcranial magnetic stimulation

Answer 31

Tuning fork Whisper test Audiometric screening: use headphones

Answer 32

Abn or failed screen → obtain full hearing eval ASAP, before 3mo Children at risk for acquired hearing loss should repeat hearing test by 2.5yrs

Answer 33

Salicylates - Aspirin Quinine Loop diuretics - Furosemide or Torsemide Aminoglycosides - Gentamicin or Tobramycin Macrolides - Erythromycin Anti-neoplastic drugs - Cisplntin and Carboplantin Heavy metal - Mercury and Lead + NSAIDs, vanco, vincristine, ethacrynic acid | dmg cochlea or CN 8, cause tinnitis or hearing loss

Answer 34

Sx w/ stapedectomy Sensorineural damage → amplification (hearing aid)

Answer 35

Hearing aids (MC) or cochlea implants (severe) OTC CoQ10 - antioxidant vital to healthy hair cells - helps w/ sudden sensorineural hearing loss

Answer 36

May just req monitoring RT or Sx

Answer 37

Refer to audiologist Routine audiologic screening rec for adults w/ prior exposure to high noise levels or 65+y/o

Answer 38

Gold standard for auditory rehab of advanced sensorineural hearing loss (SNHL) and poor speech perception for adults and children Restores partial hearing w/ advanced hearing loss External mic and speech processor worn on ear and receiver implanted under temporalis muscle → internal receiver attached to electrode that is surgically placed in cochlea Completely in canal (smallest) Behind the ear (largest)

Tx only for Opthal/Ear Flashcards

(63 cards)