OTC Exam 3 (eye and ear - insect bites)

which of the following medications may cause a mjor drug interaction with OTC triamcinolone

all of the following

which of the following is an appropriate adult dose of OTC vitamin C when used for cough/cold

3000 - 4000 mg/day for 3-5 days

what is the appropriate OTC dose for diphenhydramine 2% cream

apply to the affected area 3-4 times/day for up to 7 days

appropriate dose for OTC pyrethrins/piperonyl butoxide shampoo

apply to dry hair and leave on for 10 mins, rinse, repeat in 7-10 days

brand name for OTC permethrin 1% cream rinse

Nix

which of the following is an FDA approved indication for OTC permethrin 1%

head lice

which of the following meds will cause a major drug interaction when used with adapalene gel 0.1%

sulfur, resorcinol, salicylic acid

common side effects for adapalene 0.1%

scaling, dry skin, burning

which of the following is/are the drug class(es) for benzoyl peroxide

bactericidal, keratolytic, comedolytic

contraindication for salicylic acid

• children < 12 yrs

• patients with weakened immune systems

important counselling points for benzoyl peroxide

• use sunscreen and avoid excess sun exposure

• safe for children > 7 yrs

which is a serious side effect of acetaminophen

hepatotoxicity

what is the MOA of OTC chlorpheniramine

competes with histamine for H! receptor sites of effector cells

OTC indication for vitamin D

• low calcium absorption

• vitamin D deficiency

MOA for OTC carbamide peroxide

breaks down and loosens cerumen through effervescence caused by oxygen release when exposed to air

MOA for Ulipristal

postpones follicular rupture and inhibits/delays ovulation

contraindication for bismuth subsalicylate (pepto bismol)

• nausea and vomiting

• pregnancy

appropriate dosing for varenicline in smoking cessation

• day 1-3: 0.5 mg daily

• day 4-7: 0.5 mg BID

• day 8-end: 1 mg BID

MOA of butenafine 1%

inhibition of squalene epoxidase

indication for OTC methylcellulose

constipation

OTC dose for topical zinc oxide

apply to affected area as often as needed

what type of sunscreens are zinc oxide and titanium dioxide

physical sunscreens

which of the following is a common, available OTC formulation of tioconazole

ointment

brand name of OTC selenium sulfide

Selsun blue

exclusions to self-care for eye symptoms

• light sensitivity

• blurred vision prior to using ointment

• blunt trauma to the eye

• signs of infection

• head lice

• symptoms persist > 72 hrs

first line treatment for dry eye disease

artificial tears

counselling for artificial tears

• look for “lubricating eye drops” - oil based eye drops wont evaporate as quickly

• use 2-4 times/day depending on severity

• products with less preservatives are less likely to irritate

demulcents

• carboxymethylcellulose

• hydroxypropyl methylcellulose

• polyvinyl alcohol (PVA) like PEG or glycerin

• povidone

• propylene glycol

ophthalmic preservatives

• benzalkonium chloride (BAK)

• chlorhexidine

counselling for non-medicated ointments/gels for dry eye

• causes blurred vision - many patients prefer bedtime administration

• used 2 times/day, can be up to 4 times/day

• can contain lanolin - avoid in wool allergy

presentation of allergic conjunctivitis

• nasal congestion, light sensitivity, swelling, not contagious

• bilateral red, dry eyes, some itching

• blurred vision from excessive tears

pharmacologic treatment for allergic conjunctivitis

• artificial tears

• ophthalmic antihistamines + mast cell stabilizers

• ophthalmic antihistamines + decongestant

• ophthalmic decongestants

• oral antihistamines

ophthalmic antihistamines + mast cell stabilizers

• Ketotifen fumarate (Zaditor)

• Olopatadine (Pataday)

MOA of ophthalmic antihistamines + mast cell stabilizers

potent H1 receptor antagonist, inhibits mast cell degranulation

Ketotifen fumarate (Zaditor) dosing

• can be used > 72 hrs

• instill 1 gtt into affected eye 2-3 times/day (Q8-12H)

• approved for patients >3 yrs

Olopatadine (Pataday) dosing

• can be used > 72 hrs

• instill 1 gtt into affected eye 1-2 times/day

• approved for patients >2 yrs

contraindications for ophthalmic antihistamines + mast cell stabilizers

• patients with closed-angle glaucoma

• Zaditor: patients < 3 yrs

• Pataday: patients < 2 yrs

ophthalmic antihistamines + decongestant

• Pheniramine maleate + naphazoline (Naphcon A, Opon-A, Visine-A)

• Antazoline phosphate + naphazoline (not available in US)

MOA of ophthalmic antihistamines + decongestant

• act as specific H1 receptor antagonists

• alpha adrenergic agonists to constrict conjunctival blood vessels

dosing for ophthalmic antihistamines + decongestant

• instill 1-2 gtts in affected eye up to 4 times/day for 3 days

• anticholinergic activity - can cause pupillary dilation

contraindications for ophthalmic antihistamines + decongestant

patients with or at risk for closed-angle glaucoma

ophthalmic decongestants

• Phenylephrine

• Naphazoline

• Tetrahydrozoline

• Oxymetazoline

• Brimonidine

MOA of ophthalmic decongestants

• alpha adrenergic agonists to constrict conjunctival blood vessels

• no effect on allergic response

counselling for ophthalmic decongestants

• do not use > 72 hrs due to rebound conjunctival hyperemia (rebound redness)

• ingestion of these medications can cause coronary emergencies and death

• caution in patients with HTN, CVD, diabetes, hyperthyroidism, pregnancy

Ketotifen fumarate (Zaditor) is a

ophthalmic antihistamines + mast cell stabilizer

Olopatadine (Pataday) is a

ophthalmic antihistamines + mast cell stabilizer

Pheniramine maleate + naphazoline (Naphcon A) is a

ophthalmic antihistamines + decongestant

Antazoline phosphate + naphazoline is a

ophthalmic antihistamines + decongestant

Naphazoline (All clear, Naphcon) is a

ophthalmic decongestant

Tetrahydrozoline (Visine) is a

ophthalmic decongestant

Oxymetazoline is a

ophthalmic decongestant

Brimonidine (Lumify) is a

ophthalmic decongestant

treatment for corneal edema

• must be diagnosed by eye care provider

• sodium chloride soln 2% - 1-2 gtts Q3-4H

• add 5% nighttime ointment if symptoms persist

• if no improvement, switch to 5% soln and continue 5% nighttime ointment

• if no improvement in 1-2 weeks, medical referral needed

MOA of sodium chloride soln in corneal edema

• increases tonicity of tear film, promotes movement of fluid from cornea to tear film

• helps eliminate excess fluid

corneal edema presentation

• from over-wear of contacts

• patients may see halos or starbursts around lights

presentation of bacterial conjunctivitis

• red eye with sticky yellow/green discharge - eyelids may be stuck together upon waking

• spread by direct contact

presentation of viral conjunctivitis

• “pinkeye”

• red, itchy, watery eye, clear watery discharge

• highly contagious, self limiting

medications that can increase IOP

• anticholinergics - antihistamines, oxybutynin, tolterodine, benztropine, scopolamine, tricyclic antidepressants

• decongestants

• chronic steroids - prednisolone

• topiramate

closed-angle glaucoma

• sharp, sudden increase in IOP due to a blockage

• eye pain, headaches, decreased vision

• medical emergency - surgical intervention needed

open-angle glaucoma

• often presents without symptoms

• chronic, slowly progressive disease

• primarily in patients > 50 yrs

• visual field loss, IOP normal or elevated, optic disc changes

eye drops for open-angle glaucoma

• first-line therapy: prostaglandin analogs

• ophthalmic beta blockers

• adrenergic A2 agonists

• carbonic anhydrase inhibitors

• rho kinase inhibitors

• parasympathomimetic (cholinergic) agents

prostaglandin analogs for open-angle glaucoma

• Bimatoprost (Lumigan) - Latisse for eyelash growth

• Latanoprost (Xalatan)

• Travoprost (Tratavan Z)

• Latanoprostene bunod (Vyzulta)

• Tafluprost (Zioptan)

prostaglandin analogs that need to be refrigerated

• Latanoprost

• Latanoprostene bunod

• Tafluprost

Bimatoprost is a

prostaglandin analog

Latanoprost is a

prostaglandin analog

Tafluprost is a

prostaglandin analog

counselling for prostaglandin analogs for open-angle glaucoma

• darkening of iris color, eyelid skin, eyelashes

• can increase eyelash number and length

• 1 gtt every night before bedtime

MOA of prostaglandin analogs for open-angle glaucoma

increased aqueous humor outflow thorough trabecular meshwork

ophthalmic beta blockers for open-angle glaucoma

• Timolol (Timoptic) - + Brimonidine (Combigan)

• Betaxolol (Bentopic S)

• Cartelol

• Levobunolol (Betagan)

Timolol is a

ophthalmic beta blocker

Betaxolol is a

ophthalmic beta blocker

Cartelol is a

ophthalmic beta blocker

Levobunolol is a

ophthalmic beta blocker

counseling for ophthalmic beta blockers for open-angle glaucoma

• preferrable if pressure is high in one eye only

• 1 gtt once or twice daily

• contraindicated in patients with bradycardia, AV block

adrenergic A2 agonists for open-angle glaucoma

• Brimonidine (Alphagan P, Lumify)

• Apraclonidine (Lopidine)

MOA of ophthalmic beta blockers for open-angle glaucoma

reduces aqueous humor production

Brimonidine is a

adrenergic A2 agonist

Apraclonidine is a

adrenergic A2 agonist - only short term after surgery

counselling for adrenergic A2 agonists for open-angle glaucoma

• dosed TID

• caution for CNS depression, using heavy macinery, driving

• can cause sedation, dry mouth

topical carbonic anhydrase inhibitors for open-angle glaucoma

• Dorzolamide (Trusopt) - more stinging

• Brinzolamide (Azopt) - more blurry vision

systemic carbonic anhydrase inhibitors for open-angle glaucoma

• Acetazolamide - 250mg PO 1-4 times/day, can be used for altitude sickness

• Methazolamide

counselling for carbonic anhydrase inhibitors for open-angle glaucoma

• 1 gtt TID

• caution in sulfonamide allergy

rho kinase inhibitor for open-angle glaucoma

Netarsudil (Rhopressa) - 1 gtt/day in the evening

parasympathomimetic (cholinergic) agents for open-angle glaucoma

• Pilocarpine (Istopo carpine)

• Carbachol (Miostat)

counseling for parasympathomimetic (cholinergic) agents for open-angle glaucoma

• causes poor vision at night due to pupil constriction

• 1-2 gtts up to TID

red eye drop cap

pupil dilation

dark green eye drop cap

miotics

turquoise eye drop cap

prostaglandin analogs

gray eye drop cap

NSAIDs

tan eye drop cap

antibiotics

purple eye drop cap

alpha-adrenergic agonists

light green eye drop cap

adrenergic agonist combinations

orange eye drop cap

carbonic anhydrase inhibitors

yellow eye drop cap

beta blockers

dark blue eye drop cap

beta blocker combinations

pink eye drop cap

steroids

white eye drop cap

topical anesthetics and OTC products

exclusions to self-care for ear disorders

• age < 12 yrs (for compacted cerumen)

• signs of infection

• pain with ear discharge

• bleeding or signs of trauma

• tympanostomy tubes present

• ear surgery within prior 6 weeks

OTC product for excessive cerumen

carbamide peroxide 6.5% in anhydrous glycerin (Debrox)

MOA of carbamide peroxide

• anhydrous glycerin softens earwax

• carbamide peroxide mechanically breaks down and loosens cerumen via effervescence - oxygen release when exposed to air

• 5-10 gtts in ear

• can be used twice daily for up to 4 days

• prevent tip from entering ear canal

• keep soln in ear for 15 mins