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Influenza/ Opthalmic
| Question | Answer |
|---|---|
| types of influenza humans are susceptible to | A and B |
| pts that qualify for influenza prophylaxis | High risk & exposure within 2 weeks of vaccination High risk & vaccine contraindicated Severe immunosuppression (active cancer tx, uncontrolled HIV, etc.) |
| influenza prophylaxis must be | initiated within 48 hrs of exposure |
| influenza prophylaxis options | Oseltamivir (Tamiflu) Zanamivir (Relenza) Baloxavir marboxil (Xofluza) *1x dose* |
| preventative measure for Reye's Syndrome | AVOID ASPIRIN in age ≤18 if viral illness suspected |
| sx management for influenza | Analgesics/antipyretics -Acetaminophen -NSAIDs (ibuprofen) Decongestants Antihistamines Cough suppressants |
| pts who qualify for influenza tx | Hospitalized Severe, complicated, or progressive High complication risk Age <2 or ≥65 Pregnancy through 2 weeks postpartum |
| pts who you should consider for influenza tx | Anyone symptomatic If Sx onset <48 hrs Symptomatic outpatient ppl living with high risk population Symptomatic health care workers who take care of high risk patients |
| tx for (if sx start w/in 48 hrs) | Oseltamivir (Tamiflu) Peramivir (Rapivab) Zanamivir (Relenza) Baloxavir marboxil (Xofluza) |
| pts that should receive oseltamivir for influenza tx | PREGNANCY, hospitalized, outpatient w/ complications |
| neuraminidase inhibitors | Oseltamivir, peramivir, zanamivir |
| neuraminidase inhibitor MOA | inhibiting neuraminidase on viral surface prevents viral release & spread |
| Oseltamivir (tamiflu) PO ADEs | GI, HA, pain, confusion, delirium, hallucinations |
| Peramivir (Rapivab) IV ADEs | HTN, ↑BG, GI, neutropenia, ↑LFTs, ↑CPK, insomnia; rare: SJS/TENS |
| Zanamivir (Relenza) Inhaler ADEs | sore throat, cough, nasal Sx, tonsil pain, bronchospasm |
| endonuclease inhibitor | Baloxavir marboxil (Xofluza) PO |
| Baloxavir marboxil (Xofluza) PO MOA | inhibiting endonuclease prevents viral gene transcription & replication |
| Baloxavir marboxil (Xofluza) PO ADE | diarrhea, sinusitis |
| Baloxavir marboxil (Xofluza) PO pearls | Binds with Ca, Fe, Mg, selenium, zinc -Not studied in CrCl <50 |
| dosage of Oseltamivir (Tamiflu) | PO 75 mg BID x 5 days (FYI: dose is renally adjusted) |
| influenza medications can be given to pts who are outpatient, with no complications | oseltamivir, peramivir, zanamivir, or baloxavir marboxil |
| 1st line tx for Dry Eyes Syndrome | OTC Artificial tears drops daily or BID+ OTC Artificial tears gel/ointment-more severe DES |
| 2nd line tx for Dry Eyes Syndrome | Cyclosporine (Restasis) or Lifitegrast (Xiidra) |
| Con of OTC artificial gel/ ointment | Likely to cause blurry vision Relief takes a little longer |
| Cyclosporine (Restasis) MOA | Inhibits T cells= anti-inflammatory - ↑ tear production (when tear production is affected by inflammation) |
| Lifitegrast (Xiidra) MOA | binds integrin lymphocyte function-associated antigen-1 (LFA-1) = anti-inflammatory - ↑ tear production (when tear production is affected by inflammation) |
| Cyclosporine (Restasis) ADE | eye burning, pain |
| Lifitegrast (Xiidra) ADE | dysgeusia, irritation, ↓ visual acuity |
| Mucopurulent eye discharge + redness (rarely pruritis) | bacterial conjunctivitis |
| Watery eye discharge + redness (rarely pruritis) | viral conjunctivitis |
| Red eyes + itchy + cobble stone chemosis (rarely has discharge) | allergic conjunctivitis |
| Heavy discharge+ Eye pain, ↓ vision +Rapid progression | hyperacute bacterial conjunctivitis |
| 1st line tx for bacterial conjunctivitis for a non-contact wearer | erythromycin 0.5% OR polymyxin B/ trimethorpim (polytrim) q3-4 hrs while awake x 7-10 days |
| erythromycin ADE | irritation, redness |
| Polymyxin B/ trimethoprim (Polytrim) ADE | Rash, burning, stinging, edema, redness, lacrimation |
| 1st line tx for bacterial conjunctivitis for a contact wearer | Ofloxacin 1-2 drops q 2-4 hrs while awake x 2 days the 4x a day Ciprofloxacin 1-2 drops q2 x 2 days then q4 hr x 7-10 days |
| Ofloxacin ADE | Blurred vision, pain, redness, lacrimation, stinging, swelling, dryness |
| ciprofloxacin ADE | Eye crusting, pain, itch |
| hyperacute bacterial conjunctivitis tx | Ceftriaxone (Rocephin) 1 gram IM +/- topical ABX |
| viral conjunctivitis tx | self limiting 2-3 weeks stay away from others/ wash hands, cool compress PRN, artificial tears PRN |
| 1st line tx Allergic conjunctivitis | artificial tears/ lubricant |
| 2nd line tx Allergic conjunctivitis | Topical antihistamine Topical antihistamine + decongestant Topical mast cell stabilizer Topical NSAID |
| Blepharitis tx | Wash lid margins with baby shampoo & warm compress daily |
| optionally following tx for blepharitis | Erythromycin or bacitracin ointment to lid margins at bedtime Artificial tears if DES |
| red eyes + itchy + burning eyes/ eyelids + crusty eyelids/lashes | blepharitis |
| 1st line tx for open angle glaucoma | Prostaglandin (best) or Beta blocker |
| 2nd line tx for open angle glaucoma | try which ever 1st line option you did not originally try OR Combo prostaglandin + beta blocker |
| Tx for closed angle glaucoma | beta blocker, alpha-2 agonist, carbonic anhydrase inhibitor, or miotic PLUS Iridotomy |
| Prostaglandins | The "Prost" s: Bimatoprost (Lumigan) Latanoprost (Xalatan) Latanoprostene bunod (Vyzulta) Tafluprost (Zioptan) Travoprost (Travatan Z) |
| Prostaglandins ADEs | conjunctival hyperemia, HA, blurred vision, dry eyes, eye pain & stinging, tear production, *iris darkening, eyelash growth* |
| Pearls for prostaglandins | ↑ aqueous humor outflow* ↓ IOP 25-33% Light blue/green; teal cap Given QHS |
| Miotics | PEC: Pilocarpine (Isopto Carpine) Echothiophate iodide Carbachol (Miostat) |
| Miotics ADE | eye pain & stinging, corneal granularity, tear production, retinal detachment, blurred vision, HA, lens opacity |
| Pearls for Miotics | ↑ aqueous humor outflow ↓ IOP 20-25% Green cap |
| Rho kinase inhibitor | Netarsudil (rhopressa) |
| Rho kinase inhibitor ADEs | eye pain, conjunctival hyperemia & hemorrhage, corneal deposits, eyelid swelling, blurred vision, tear production |
| Pearls for Rho kinase inhibitor | ↑ aqueous humor outflow ↓ IOP 10-20% White cap |
| Beta Blockers | The "-olol"s Betaxolol (Betoptic S) Carteolol Levobunolol (Betagan) Timolol (Timoptic) |
| Beta Blockers ADE | eye pain & stinging, conjunctivitis |
| Beta Blockers cautions | HF, DM, myasthenia gravis, PVD, respiratory disease, hyperthyroidism |
| Beta Blockers key points | ↓ aqueous humor production ↓ IOP 20-25% Yellow cap BID (daily if IOP controlled) |
| Carbonic Anhydrase Inhibitors | The "-zolamide"s Brinzolamide (Azopt) Dorzolamide (Trusopt) |
| Carbonic Anhydrase Inhibitors ADEs | eye pain & stinging, keratitis, blurred vision, conjunctivitis, tear production, photophobia, dry eyes, *bitter taste* |
| Carbonic Anhydrase Inhibitors key points | Not studied in CrCl <30 Sulfonamide hypersensitivity ↓ aqueous humor production ↓ IOP 15-20% Orange cap |
| Alpha 2 agonists | The "-onidine"s Apraclonidine (Iopidine) Brimonidine (Alphagan P) |
| Alpha 2 agonists ADEs | conjunctivitis, conjunctival hyperemia, vision changes, blurred vision, dry mouth, drowsiness |
| Alpha 2 agonists key points | Avoid MAOIs (old antidepressants) Preferred in pregnancy ↑ aqueous humor outflow AND ↓ aqueous humor production ↓ IOP 20-25% Purple cap |
Created by:
rew12042000
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