Eye and Ear Disorders

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Eye and Ear Disorders
2013-03-31 21:28:14

Flashcards for Eye and Ear
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  1. What is glaucoma caused by?
    High intraocular pressure in the eye caused by aqueous humor behind the iris
  2. What three parts of the eye are involved in vision?
    • 1. cornea
    • 2. inner lense
    • 3. pupil

  3. What is the difference between bacteriocidal vs. bacterostatic?
    • Bacteriocidal: bacteria killing
    • Bacteriostatic: bacteria inhibiting
  4. An eye infection, allergy, inflammation, or irritation directly effects:
    • Conjunctiva or mucous membrane of the eyeball &/or eyelid
  5. Name 5 Examples of Fluroquinolones.

    • 1. ciprofloxacin
    • 2. gatifloxacin
    • 3. moxifloxacin
    • 4. norfloxacin
    • 5. levofloxacin
  6. What are two examples of Macrolides?
    • 1. Erythromycin
    • 2. Azithromycin
  7. What two things are mixed to make Polytrim?
    polymyxin B + trimethoprim
  8. What two things are mixed to make polysporin?
    polymyxin B + bacitracin
  9. Macrolides are : bacterio_____.
    Macrolides are bacterstatic
  10. True or False:
    Use of Macrolides had decreased due to resistance by staph aureus.
  11. Fluroquinolones are bacterio____.
    Fluroquinolones are bacteriocidal.
  12. Fluroquinolones work against gram____.
    Gram positive & gram negative

    *Fluroquinolones are broad spectrum!
  13. Polymyxin is bacterio_____.
    Polymyxin is bacteriocidal.
  14. What two things are combined to make Polymyxin?
    • Polytrim + Polysporin
    • *comes in combination
  15. Polymyxin works against gram ____.
    Gram negative
  16. True or False:
    Polymyxin penetrates tissues poorly.

    -This is the reason use has diminished
  17. What are examples of aminoglycosides?
    • 1. Gentamycin
    • 2.Tobramycin
  18. Aminoglycosides are bacterio_____.
    Aminoglycosides are bacteriocidal.
  19. Aminoglycosides work primarily on gram___.
    Aminoglycosides work primariily on gram negative bacteria
  20. True or False:
    Vigamox is moxifloxacin.

    Only available as brand name drug [$$], cheaper alternative is a generic ciprofloxacin.
  21. True or False:
    Ophthalmic anti-infectives have little systemic absorption.

    -Mostly just ocular penetration
  22. What 4 bacteria are common causes of conjunctivitis in neonates?
    • 1. Chlamydia trachomatis
    • 2. Staph aureus
    • 3. Haemophilus influenzae
    • 4. Streptococcus pneumoniae
  23. What 7 bacteria are common causes of conjunctivitis in children?
    • 1. H influenzae
    • 2. S pneumoniae
    • 3. Moraxella sp.
    • 4. Staphlococci sp.
    • 5. Coagulase-neg staphloccocci sp.
    • 6. Eschericia coli
    • 7. Psuedomonas sp

    *classroom conjunctivitis
  24. What 5 bacteria are common causes of conjunctivitis in adults?
    • 1. Staph aureus
    • 2. coagulase-negative staphlococci sp
    • 3. H influenzae
    • 4. S pneumoniae
    • 5. S epidermidis
  25. What is the most potent ophthalmic antibacterial agent?
  26. True or False
    Over the past two decades, there has been an increased in bacterial resistance to antibiotics.

    *Especially for erythromycin
  27. True or False:
    Fluoroquinolones are the most potent agents against bacterial pathogens.
  28. Pregnancy Category for Erythromycin, Azithromycin, and Tobramycin.
    Pregnancy Category B
  29. Pregnancy Category for Gentamicin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin, polymyxin B, and Sulfacetamide.
    Pregnancy Category C
  30. Which ophthalmic medications should be avoided during lactation?
    Fluoroquinolones and Sulfacetamides
  31. Which two ophthalmic antibiotics are safe and effective in children?
    erythromycin and tobramycin
  32. Which two medications has safety not been established for kids?
    Fluoroquinolone and azithromycin
  33. What are some adverse reactions to ophthalmic antibiotics?
    • -Local irritation (burning, irritation, inflammation)
    • -Superinfection (with prolonged or repeated use)
    • -Stevens Johnson syndrome (rare) (related to sulfa allergies/drugs)
  34. What characteristics/symptoms indicate bacterial conjunctivitis?
    • -Mucousy appearance/drainage
    • -HALLMARK: crusty eye on awaking & can't open eye
    • -Redness, irritation
  35. What is the most serious cause of opthalmia neonatorum? (AKA neonatal conjunctivitis)

    What's recommended treatment?

    -CDC recommends prophylactic erythromycin .5%  1/4-1/2 of an inch within 1 hour of delivery
  36. What are the three most common pathogens for ages 3 months to 8 years?
    • -Staphlococcal
    • -Haemophilus
    • -Streptococcal
  37. What is the preferred antibiotic delivery for bacterial conjunctivitis?
  38. Sulfacetamide 10% solution Dosing
    1-2 drops every 2-3 every hour during the day
  39. Erythromycin .5% ointment Dosing
    1/2 to 1 inch ribbon 2-3 times daily
  40. Polytrim solution Dosing
    1 drop every 3 hours for 7-10 days
  41. Polysporin Ointment Dosing
    1/2 to 1 inch ribbon every 3-4 hours
  42. True or False:
    Antibiotic treatment is for all patients with eye complaints.

    -Only for patients with hallmark symptoms for an eye infection
  43. What is blephartis?
    Acute or Chronic Inflammation of the eyelash follicles
  44. What is the treatment for blephartis?
    • 1. Scrub the eyelashes with no tear shampoo
    • 2. Erythromycin .5 ointment (1/4" BID until symptoms clear then for additional 7 days after that)
  45. What are important teaching considerations for patients with blephartis?
    • 1. Don't wear contacts
    • 2. Don't wear make up
    • 3. Throw away makeup that has come into contact with your eye!

    (teaching point for all patients with eye infections)
  46. What is Hordeolum?
    -typically referred to as a stye

    -infection of sebaceous gland of eyelash or eyelid caused by staph aureus
  47. What is the treatment for Hordeolum?
    • 1. moist, warm compresses four times a day for 15 minutes (allow for greater blood flow)
    • 2. Sulfacetamide 10% eyedrops OR erythromycin 5% ointment four times daily until symptoms subside and for additional 2-3 days
  48. How does Hordeolum typically clear?
    -spontaneously ruptures and immune system gets rid of it naturally
  49. What is viral conjunctivitis typically caused by?
    • -Adenovirus
    • -HIV
    • -Herpes Zoster
  50. What is the course of treatment for viral conjunctivitis?
    • -RARELY treated with sulfacetamide 10% drops or ointment 4x daily to prevent secondary bacterial infection
    • -course is usually 12-15 days and gets cleared out naturally by the immune system
  51. What is a KEY clinical pearl for a patient with an eye infection?
    Hands should be washed before and after instillation of medication.
  52. Describe the best way to administer an eye medication.
    • 2. Pull the eye down with one hand to create a pocket (so the med doesn't roll off the eye)
    • 3. Keep tip of dropper/tube from touching eye, fingertips, other surfaces
  53. True or False
    Eye medications can be shared between family members.
  54. True or False
    It is important to tell patients with eye infections to through out eye makeup.
    True. (otherwise they'll just continue to spread the infection)
  55. What are two examples of antiglaucoma Beta Blockers?
    • 1. Levobunolol
    • 2. Timolol
  56. What is the mechanism of action of antiglaucoma Beta-blocker medications?
    Decreases cAMP-induced production of aqueous humor
  57. What is an example of an antiglaucoma cholinesterase inhibiting miotic?
  58. What is the mechanism of action of antiglaucoma cholinesterase inhibiting miotics?
    Decreases resistance to aqueous outflow
  59. What is an example of an antiglaucoma direct acting miotic?
  60. What is the mechanism of action of antiglaucoma direct acting miotics?
    • 1. muscarinic effects for pupillary constriction
    • 2. increased aqueous humor outflow
  61. Name SEVEN categories of antiglaucoma medications
    • 1. Beta Blocker
    • 2. Alpha Adrenergic Agonist
    • 3. Miotic (direct acting)
    • 4. Miotic (cholinesterase inhibiting)
    • 5. Sympathomimetic
    • 6. Carbonic Anhydrase Inhibitors
    • 7. Prostagladin Agonists
  62. What are three examples of antiglaucoma carbonic anhydrase inhibitors?
    • 1. Acetazolamide (Diamox)
    • 2. Brinzolamide (Azopt)
    • 3. Dorzolamide (Trusopt)
  63. What is the mechanism of action for antiglaucoma carbonic anhydrase inhibitors?
    Slow bicarbonate ion formation leading to decreased aqueous humor outflow
  64. What is an example for antiglaucoma alpha-adrenergic agonists?
  65. What is the mechanism of action for antiglaucoma alpha-adrenergic agonists?
    • 1. reduce aqueous humor production
    • 2. increase aqueous humor outflow
  66. What are two examples of antiglaucoma sympathomimetics?
    *Not commonly used

    • 1. Epinephrine
    • 2. Diprevefren
  67. What is the mechanism of action of antiglaucoma sympathomimetics?
    Causes vasoconstriction and therefore reduces aqueous humor production
  68. What are two examples of antiglaucoma prostaglandin agonists?
    • 1. Latanoprost
    • 2. Bimatoprost
  69. Basically, all antiglaucomas reduce intra-ocular pressure by:
    • 1. decreases production of aqueous outflow
    • 2. decreases resistance to aqueous outflow (increases outflow)
    • 3. BOTH
  70. What is the mechanism of action for antiglaucoma prostaglandin agonists?
    Increase aqueous humor outflow
  71. What is a commercially marketed prostaglandin agonist?
    Latisse! (originally a antiglaucoma medication with a side effect of browning the eyelashes)
  72. What are some general side effects for antiglaucoma medications?
    blurred vision, photophobia
  73. What are some adverse reactions to Beta Blockers? (antiglaucoma)
    headache, dizziness
  74. What are some adverse effects of miotics? (antiglaucoma)
    corneal clouding, induced myopoia

    *Anticholinergic symptoms: salivation, sweating, N&V
  75. What are some adverse reactions to sympathomimetics?
    Corneal pigmentation
  76. What are some adverse reactions to prostaglandin agonists? 
    brown pigmentation in the iris
  77. What is myopia?
    Narrow focused vision
  78. What are some contraindications/precautions for Beta Blockers? (antiglaucoma)
    Contraindications: COPD, pulmonary disease, asthma, hypotension (BP<100mmHG)

    Precautions: Diabetes
  79. What are some contraindications/precautions for Miotics? (antiglaucoma)
    Contraindicated for patients with active inflammation
  80. What are some contraindications/precautions for Carbonic Anhydrase Inhibitors? (antiglaucoma)
    • Contraindicated: methazolamide contraindicated in patients with hyponatremia, hypkalemia, renal disease, and liver disease
    • Precaution: Patients with sulfa allergies
    • Dorzolamide contain sulfamide which can cause a hypersensitivity reaction
  81. What are some contraindications/precautions for Alpha adrenergic agonists? (antiglaucoma)
    Contraindicated: with MAOI's

    Precaution: Patients with cardiac, renal, or liver disease
  82. When using Romitidine and Latanoprost, it's important to teach the patient not to:
    Wear contacts
  83. What is the pregnancy category of Beta-Blockers? (antiglaucoma)
    Category C
  84. What is the pregnancy category of Miotics? (antiglaucoma)
    Category C

    *except for Humorsol!: Cat. X
  85. What is the pregnancy category of Carbonic anhydrase inhibitors? (antiglaucoma)
    Category C
  86. What is the pregnancy category of Bromonidine? (antiglaucoma) (alpha adrenergic agonist)
    Category B
  87. What is the pregnancy category of Latanoprost? (antiglaucoma) (Prostaglandin agonist)
    Category C
  88. What is the mechanism of action of anti-allergy ophthalmic medications?
    • 1. mast cell stabilizers limit hypersensitivity reactions
    • 2. inhibit release of histamine
  89. What are examples of anti-allergy ophthalmic medications?
    • Cromolyn sodium (Crolom)
    • Ketotifen (Zaditor)
    • Pheniramine (Naphcon-A)
    • Azelastine (Optivar)
    • Olopatadine (Patanol, Pataday)
  90. What is the NSAID/anti-inflammatory mechanism of action for ophthalmic medications?
    inhibit prostaglandin synthesis
  91. What are examples of NSAID/anti-inflammatory ophthalmic medications?
    • diclofenac (Voltaren)
    • Nepafenac (Nevanac)
    • Ketoralac (Acular)

    *Voltaren and Ketoralac are sold as oral NSAIDs as well
  92. What are the general adverse reactions for anti-allergy and anti-inflammation ophthalmic medications?
    *little systemic absorption, so side effects are mild

    blurry vision, photophobia, transient discomfort, tearing
  93. With an aspirin sensitivity, caution using any:
    NSAIDs; due to possible cross sensitivity
  94. What are some adverse reactions to histamine blocking ophthalmic medications?
  95. What are some adverse reactions to NSAID ophthalmic medications?
    ocular irritation
  96. True or False:
    Over the counter products that combine an antihistamine and decongestant (Ex. Naphcon A) are for temporary relief of minor eye symptoms only.

    Decongestant causes vasoconstriction, could lead to eye problems with prolonged use
  97. Pregnancy Category of Cromolyn Sodium (ophthalmic anti-allergy medication)
    Pregnancy Category B
  98. Pregnancy Category of Ketotifen, Nepafenac, and NSAID (ophthalmic medications)
    Pregnancy Cateogry C
  99. Ophthalmic histamine blockers are safe for children over:
    3 years old
  100. Naphazoline/Antazoline pediatric Dosing
    1-3 drops every 3-4 hours
  101. Azelastine Pediatric Dosing
    1 drop twice a day
  102. Ketotifen Pediatric Dosing
    1-2 drops two to three times a day
  103. Naphazoline/Pheniramine Pediatric Dosing
    1-2 drops every 3-4 hours

    *only use 1-2 days; DECONGESTANT!
  104. Olapatadine Pediatric Dosing
    1-2 drops twice a day
  105. What is an example of an ocular lubricant?
    Artificial Tears
  106. What are trade name examples of artificial tears?
    • Murine, Tears Naturale, Dry Eyes, Moisture Drops
    • *available generically
  107. What are ocular lubricants used for?
    eye irritation and dryness
  108. What for things are lubricants made of?
    • 1. Balance of salts to maintain ocular tonicity
    • 2. buffers to adjust pH
    • 3. viscosity to prolong eye contact time
    • 4. preservatives
  109. What type of eye medication is NOT recommended for use in children? (of any age)
    Ophthalmic vasoconstrictors
  110. What is the mechanism of action of ophthalmic vasoconstrictors?
    sympathomimetic agents that constrict the conjunctival blood vessels
  111. What are three examples of ophthalmic vasoconstrictors?
    • 1. Naphazoline
    • 2. Oxymetazoline
    • 3. Tetrahydrozoline
  112. What are ophthalmic vasoconstrictors used for?
    Temporary relief of eye redness due to irritation or allergies
  113. Ophthalmic vasoconstrictor Dosing
    1-2 drops four times a day
  114. Contraindications for Ophthalmic Vasoconstrictors
    Patients with narrow angle glaucoma
  115. What are some adverse reactions of ophthalmic vasoconstrictors?
    • -transient stinging
    • -temporary blurring of vision
    • -increased lacrimation, irritation, discomfort
    • -rebound congestion or redness with frequent use
  116. What is lacrimation?
    Tearing of the eye

    -specifically related to ophthalmic vasoconstrictors: because of discomfort the eye is experiencing
  117. Ophthalmic Vasoconstrictor Pregnancy Category
    Category C
  118. What lines the external ear canal?
    • Cerumen
    • -acts as a protective bacteriostatic layer that protects epithelium against hyperhydration
  119. Factors that can effect cerumen protective ability
    • 1. abrasions in the ear
    • 2. water in the ear canal
  120. What is otitis externa?
    acute, painful inflammatory condition of the external auditory canal
  121. What is the most common cause of doctors visits for ear pain?
    Otitis externa
  122. What are common causitive organisms of otitis externa?
    • 1. psuedomonas
    • 2. enterobacter
    • 3. proteus
  123. What two things can help reduce inflammation in otitis media?
    • 1. corticosteroids
    • 2. acid-alcohol solutions*also are antibacterial
  124. What corticosteroid/antibiotic treatments are available for otic infections?
    • Cortisporin 
    • Ciprodex
    • Ciloxan HC
  125. What antibiotic only treatments are available for otic infections?
    • Garamycin (gentamicin)
    • Floxin (ofloxacin)
  126. Whata acid-alcohol treatments are available for otic infections?
    • VoSol Otic
    • VoSol HC Otic (hydrocortisone added)
  127. What is an important teaching point when prescribing Ofloxacin?
  128. Gentamicin Ophthalmic Pediatric Dosing
    4 drops four times a day for 7-10 days
  129. Ofloxacin Otic Pediatric Dosing
    6mo-12 years: 5 drops once a day x10days

    >12 years: 10 drops once a day x10days
  130. Ciprofloxacin:hydrocortisone Otic Pediatric Dosing
    >1 year: 3 drops twice a day x7days
  131. Ciprofloxacin:Dexamethasone Otic Pediatric Dosing
    >6 months: 4 drops BID x7days
  132. Hydrocortisone:neomycin:polymyxin B Otic Pediatric Dosing
    Children: 3 drops BID x7days
  133. Cortisporin Otic Solution and Ciprofloxacin are contraindicated in:
    tympanic membrane perforation
  134. Which otic medication is okay to use with a perforated tympanic membrane?
    Cortisporin Otic
  135. Prolonged use of Otic Anti-infectives may lead to:
  136. Otic Anti-infective adverse reactions:
    taste alterations, dizziness, vertigo

    *ear involved in balance: directly related to the # of drops instilling into the ear
  137. To acclimate an otic medication to patient body temp:
    warm bottle in hand for a few minutes!
  138. Correct Administration of Ear Drops:
    Pull ear back to straighten the ear canal
  139. What can be done if ear canal is too swollen for drops to be instilled?
    A wick can be inserted into the ear or medication can be put through it
  140. How can you prevent Swimmers Ear?
    Isopropyl ear drops (Swim-ear; Ear-sol) or rubbing alcohol

    Instill 2-3 drops into ear canal after swimming to dry up water
  141. What is a common otic analgesic?
    Auralgan (antipyrine:benzocaine)
  142. What are otic analgesics used for?
    provide pain relief until antibiotic takes effect
  143. To instill otic analgesics, the tympanic membrane must be:
  144. Pregnancy Category of Otic Analgesic
    Pregnancy Category C
  145. Otic Analgesic Administration Dosing
    Instill 1-5 drops (enough to fill ear canal) every 1-2 hours PRN
  146. Excessive accumulation of cerumen can lead to:
    hearing loss, impaction, environment for otitis externa
  147. Why can Qtips do more harm than good?
    Can push wax farther into ear canal
  148. What is a ceruminolytic?
    Medication that softens and emulsifies ear wax
  149. What is an example of a ceruminolytic?
    Carbanide Peroxide (Debrox, Murine Ear Wax Removal)
  150. Carbamide Peroxide Administration/Dosing Instructions
    1. Instill 1-4 drops (enough to fill ear canal) twice a day for up to 4 days

    2. Once cerumen is softened, can irrigate ear with warm water or saline
  151. Pregnancy Category of Carbamide Peroxide (Ceruminolytic)
    Pregnancy Category C
  152. True or False:
    Patient needs a prescription to get a ceruminolytic.
    • FALSE!
    • OTC medication!