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Pharm II - Week 8
Eye, Ear, Skin Drugs
| Question | Answer |
|---|---|
| Leading cause of preventable blindness is _____ and is caused by damage to the ___ _______ | Glaucoma. Optic nerve. |
| True or false: closed-angle glaucoma is the more common type of glaucoma seen in pts. | False. Open-angle (90%) |
| Describe the pathophysiology of open-angle glaucoma | Angle that allows fluid to rain out of anterior chamber is open but passes too slowly through the mesh-like drain. Fluid builds up, intraocular pressure increases and compresses optic nerve |
| True or false: a person with normal intraocular pressure does not have to worry about glaucoma | False. Possible to have optic nerve damage with normal IOP. Occurs in 10% of glaucoma cases |
| Damage to optic nerve can cause vision loss, starting with _____ vision | Peripheral |
| True or false: glaucoma often has no symptoms until there is damage so regular eye exams are important | True |
| The primary goal in Tx glaucoma is to... | Decrease intraocular pressure |
| The following drug categories will reduce the production of aqueous humor: (list 3) | Selective and non-selective beta blockers, alpha2 agonists |
| The following drug categories will assist in outflow of aqueous humor: (list 2) | Prostaglandins, cholinergics |
| True or false: eye drops, when given TOPICALLY, can cause SYSTEMIC effects | True |
| Using ____ drugs may have an effect on a person's glaucoma | ANS |
| The prototype beta blocker to reduce production of aqueous humor is: | Timolol/TimOptic |
| ______ are better for glaucoma pts. with history of asthma | Selective |
| What are adverse effects of beta blockers in glaucoma Tx? | Stinging, blurred vision, dry eyes. Blocking of beta1 cause bradycardia, AV heart block. |
| Which types of pts. should you be cautious giving Timolol to? | Asthma and CHF pts. |
| The prototype for alpha2 adrenergic agonists in glaucoma Tx is called: | Brimonidine/Alphagan |
| ADE of Brimoidine include: | Burning, stinging, dry mouth, itching, decrease of sympathetic outflow to blood vessels. |
| True or false: Alphagan/Brimonidine can cross the blood brain barrier | True |
| What should a contact lens wearer consider when administering brimonidine/alphagan? | Medication can get into contacts. Wait 15 minutes before putting in |
| Prostaglandin analogs are _______ compared to beta blockers with _____ AE | Just as effective; less |
| The prototype for prostglandin analogs used in glaucoma Tx is: | LatanoPROST/Xalatan |
| How does Latanoprost/Xalatan work? | Lowers IOP by relaxing the ciliary muscle and increases outflow of aqueous humor |
| What are the ADE of Latanoprost/Xalatan? | Rare, little systemic effects. Include permanent browning of iris and possible browning of eyelid/lashes |
| What is one reason a doctor may Px Timolol instead of Latanoprost? | Latanoprost/Xalatan is very costly and pts. cannot afford w/o insurance |
| The prototype cholinergic drug used to Tx glaucoma is: | Pilocarpine |
| How does Pilocarpine work? | Constriction of pupil d/t miosis and contraction of ciliary muscle widen the space where aqueous humor drains to decrease IOP |
| Pilocarpine would be contraindicated in what type of pts.? | Asthmatics |
| True or false: pilocarpine has systemic parasympathetic effects | True |
| List the LOCAL ADE of pilocarpine | Retinal detachment, decreased visual acuity/near vision compromised |
| List the SYSTEMIC ADE of pilocarpine | Bradycardia, bronchospasms, hypotension, urinary urgency, diarrhea |
| To reverse the systemic effects of pilocarpine, one would administer ______ | Atropine (anticholinergic) |
| ____ _______ is a common ADE of some ANS drugs | Worsening glaucoma |
| These types of drugs can cause blockade of nerve impulses that contract the ciliary muscle and as a result raise IOP | Adrenergic agonists (alpha1 prazosin), anticholinergic drugs (mydratrics), cyclopegics, sympathomimetic drugs (Sudafed) |
| How should a nurse administer eye gtt to pts.? | Pt. should lie down. Use clean or gloved forefinger to gently pull lower lid to create pocket and drop med into pocket. |
| True or false: eye gtts should be put directly onto eye | False. Not recommended |
| How does one apply ointment onto eye? | Small strip into pocket of lower lid. Blinking helps distribute med over eye |
| Conjunctivitis is ___, ______, or _______ | Allergic, seasonal, or chronic |
| Conjunctivitis is highly contagious and symptoms (list 3) are d/t immune mediators (list 3) from mast cells | Symptoms: mucous production, itching, and burning. Histamine, protaglandins, leukotrienes |
| Tx of conjunctivitis includes the following drugs: | Antihistamine drops, Ketorolac, OTC decongestants |
| Which drug provides temporary, immediate relief in pts. with conjunctivitis? | Antihistamine gtts |
| Which drug used to Tx conjunctivitis is a NSAID? | Ketorolac |
| Long-term use of OTC decongestants like Clear Eyes and Visine LR may lead to ADE such as: | Cataracts, glaucoma, eye infection, rebound congestion is d/c |
| Rebound congestion is also an issue with ____ type of drugs | Antihistamines |
| Mydriatrics do what to the eye? When are they used? | Dilate the pupil. Assist in eye exams and Dx |
| Cycloplegics do what to the eye? | Paralyze the ciliary muscle so eye cannot respond to bright light |
| What types of drugs are given during eye exams? (List specific drug names) | Anticholinergics (Atropine drops), Adrenergic Agonists (alpha1 phenylephrine) |
| List ADE of atropine | Blurred vision (safety issue), photophobia (sunglasses), systemic effects |
| List ADE of phenylephrine | Ocular pain, can precipitate acute IOP. Systemic effects include HTN, MI arrest, diaphoresis, blanching, confusion |
| In narrow angle-closure glaucoma, a pt. given eye exam drugs would experience ____ | Acute pain |
| What is otitis media? What is the onset? Symptoms? Causes? | Inflammation of middle ear. Rapid onset with middle ear fluid. Symptoms: painful. Due to bacterial/viral infections. |
| Otitis media can be ____, ____, and _______ to hearing | Chronic, recurring, damaging to hearing |
| ___% of otitis media cases resolve on their own in _____ | 80%; 7-10 days |
| If a child is _______ then you would Tx with _____ | < 6 months; antibiotics |
| Usually, otitis media starts as a _____ infection. If it does not heal, it can develop into a _____ infection. | Viral; bacterial |
| Between 6-24 months, what should you do with a child who has otitis media? | If not severe infection, observe for several days initially, then treat |
| If a child is >2 years, how should you treat otitis media? | If uncertain that it is otitis media then do NOT Tx. Only Tx is severe (fever with moderate-severe pain) |
| With adults, otitis media is usually secondary to ______ | URI (upper respiratory infection) |
| Which types of drugs are administered to pts. with ear infections? | Antibiotics: amoxicillin po; azithromycin if serious allergy to penicillins. Pain: acetaminophen, NSAIDs po/rectal |
| When giving antibiotics for ear infections, preferred reigmen is: | Amoxicillin/Clavulanate high dose (to prolong amoxicillin effect) |
| How can one prevent ear infections? | 1) smoke-free house, 2) flu shot, 3) eliminate pacifier after 6 mo., 4) do not put child to bed with bottle; 5) tympanostomy tubes (uncommon) |
| True or false: if a child is greater than 6 months, should be given flu shot | True |
| Two babies are put to bed. One has a bottle of water and another has a bottle of milk in their bed. Who is more likely to get an ear infection? | Baby with milk bottle since it can host pathogens which can reach ears |
| Why are tympanostomy tube procedures as less common nowadays? | Discovered procedure doesn't reduce NUMBER of infection, only SEVERITY. It is a last ditch effort after other Tx failed |
| Topic ear gtts include (list 3) | 2% ETOH and acetic acid (dries and lowers pH); ciPROfloxacin for adults; Cephalexin/Keflex is <18 |
| What is an uncommon but serious ADE of ciPROfloxacin (and reason why it would be contraindicated in children)? | Rupture of Achilles tendon |
| Things to consider when administering ear medications | Wash hands, use warm solution, tug pinna to straighten canal. (Adults: up and out. Children: back and down) |
| A pt. should be positioned this way when being given ear gtts and should stay in position for how long? | Lay on side for 30-60 seconds. Can massage below/behind ear to increase spread of meds. |
| True or false: when giving ear gtts, you must wear gloves | False. Don't need to if hands are clean |
| To prototype GC anti-inflammatory skin drug is: | Hydrocoristone |
| Considerations for using hydrocoristone for skin Tx | Hydrocoristone varies widely in potency; some OTC. Absorption can be systemic if used often. |
| ADE of hydrocoristone: | Local: irritation, thinning of skin, acne. Systemic: growth retardation, adrenal suppression |
| Hydrocoristone is used to Tx what sort of skin problems? | Dermatitis, psoriasis, eczema, bites |
| When administering hydrocoristone, one must... | Clean hands, apply THIN layer. Occlusive dressing ONLY if advised, otherwise can cause systemic effects |
| Acne Tx re: hygiene and diet | Gently clean areas 2-3x a day to decrease oil on skin, avoid oil-based moisturizers |
| True or false: changing your diet will improve your acne | False. Diet changes not shown promise to Tx acne |
| Topic acne Tx include: | Antibiotics (benzoyl peroxide, Clindamycin). Retinoids (Retin-A; derivative of Vit A) |
| Oral acne Tx include: | Antibiotics (Vibramycin), Retinoids (Accutane), Hormones (combo oral birth contraceptives) |
| Other acne Tx include: | Laser, dermabrasion, invasive removal, surgery to repair scarring |
| True or false: benzoyl peroixide is a bactericidal drug | False; bacteriostatic |
| Oral retinoids are considered ______ line Tx | Last |
| Benzoyl peroxide treats ___ acne, takes ___ to be effective | Mild to moderate; takes days to work |
| Mechanisms of benzoyl peroxide | 1) Decreases pH of skin (inhibit bac growth); 2) reduces inflammation; 3) encourages peeling of epidermis (allow new skin to form) |
| Considerations for using benzoyl peroxide: | 1) start with lower concentrations, increase as skin adjusts; 2) 1x/day then up to 3x/day as skin adjusts; 3) not used on inflamed skin; 4) avoid eyes/mouth; 5) allergic rxns |
| True or false: itching, rash are normal side effects of benzoyl peroxide d/t peeling of epidermis | False. Itching/rash signs of allergic reaction |
| PO antibiotics are often used with ____ ______ | Topical retinoid (Rein-A) |
| Vibramicin is an PO antibiotic. Used for ___ time, then switch to ___ _____ | Shortest time possible. Switch to topical antibiotic |
| PO Retinoid known as _____ is used to Tx ____ acne | Isotretinon/Accutane; severe acne |
| What is the mechanism of action of Isotretinon/Accutane? | Decrease sebum production, which promotes bacterial growth |
| Most common Accutane regimen is ___ course, which lasts ____. | Single course; 15-20 weeks |
| Why is Isotretinon a drug of last choice? | Teratogenicity |
| Accutane/Isotretinon is category __ and requires the following: | X. Serial pregnancy testing, contract, mandatory contraception (2 forms of BC, abstinence, iPledge registration) require. 30 day supply to allow for pg test |
| ADE of Isotretinon/Accutane include: | Nosebleeds, inflammation of lips/nose/eyes/skin, backpain, hair loss, loss of skin from palmar surfaces, stop long bone growth, sun sensitivity, rising triglycerides |
| Rare but significant ADE of Isotretinon/Accutane include: | Depression, vision, hearing loss |
| Three combo PO contraceptives are used to Tx acne: | Ortho Tri-cyclen, Yaz, Estrostep |
| __% of radiation from sun is ___ and is fairly consistent throughout day/year | 95%; UVA |
| UVA reaches dermis to cause: | Immunosuppression, premature aging, photosensitivity to many drugs |
| True or false: only UVA causes burning and damages DNA to cause skin cancers | False. UVB too |
| The most common cancer in US is __. WA state ranks ____ in rate of melanoma | Sikn; 5th place |
| Organic/chemical screens include: | Most sunscreens. Products contain mixture of compounds to protect against full range of UVA/UVB |
| Physical screen for skin protection includes: | Zinc oxide. Good for limited areas |
| SPF is an index of protection against ____ only | UVB |
| What does SPF measure? Is it precise? | Ratio of time takes to see skin damage between naked/no use event and use event. Not very precise |
| True or false: SPF of 30 provides 4% more protection as SPF 15% | True. SPF 15 blocks 93%, SPF 30 97% |
| True or false: is there such thing as a sweet proof/water proof suncreen? | No. Somewhat water resistant, but not completely |
| Sunscreen may have this ingredient which can cause allergic reactions in some people | PABA |
| Nursing teaching points with sunscreen should include: | Find sunscreen that cover both UVA/UVB, at least SPF 15, put on 30 minutes PRIOR to exposure to sun; use enough; and reapply after swimming/sweating; wear protective clothing |
| True or false: a person who reapplies sunscreen after getting wet does not need to apply more hours later like his friends | False. Must reapply consistently |
| At what times should one avoid the sun? | 1000-1600 |
| Psoriasis occurs during this period of development, is ____, but not ____ | Familial; NOT contagious |
| Pathophysiology of psoriasis: | Excessive activity of T lymphocytes; accelerated growth of keratin cells |
| Psoriasis has a _____, _____ course. | Chronic, unpredictable |
| Psoriasis can be triggered by: | Stress, bacterial infection, certain medications |
| True or false: there is only palliative Tx for Psoriasis | True |
| Psoriasis presents as: | Red, scaly skin patches |
| Topic drugs used to Tx psoriasis: | GCs (NOT to face, groin, axilla d/t atrophy). Vit D/A deriatives. Salicytic acid (break down keratin) |
| Topical GCs used to Tx Psoriasis will do what to the skin? | Cause thinning. Avoid in sensitive regions. Thinner skin can cause too much systemic absorption |
| Systemic drugs used to Tx psoriasis: | Methotrexate to reduce growth/proliferation of epidermal cells (PO/IV). Used only in very severe cases |
| What is an alternative Tx for psoriasis? | Phototherapy. May increase risk of skin cancer. |
Created by:
choel
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