Ocular and Otic Infections- McQuaid - EXAM 4

said to know brand/generic!

What do the following abbreviations mean:

• O

• OS

• OD

• OU

• O- oculus aka EYE

• OS- left eye

• OD- right eye

• OU- both eyes

What do the following abbreviations mean:

• A

• AS

• AD

• AU

• A- auris aka EAR

• AS- left ear

• AD- right ear

• AU- both ears

1 ml= ___ cc = ___ drops

1 ml= 1cc = 20 drops

What does a ribbon or line mean on an rx?

• expressed in cm or in

• some eye meds are expressed this way (see pic)

PRACTICE:

Interpret this rx: 1 gtt OU QD x 14 days

1 drop both eyes every day for 14 days

What is inflammation of the thin, clear membrane covering the white of the eye and eyelid?

conjunctivitis aka pink eye

What are the 3 main types of conjunctivitis?

1. bacterial

2. viral

3. allergic

Compare the presentations of bacterial, viral, and allergic conjunctivitis:

Type of Conjunctivitis	Presentation
Bacterial
Viral
Allergic

Type of Conjunctivitis	Presentation
Bacterial	usually 1 eye PURULENT DISCHARGE may crust tearing
Viral	usually 1 eye WATERY DISCHARGE may crust tearing
Allergic	usually both eyes itching, redness, tearing

pay attention to bolded

Which types of conjunctivitis are contagious?

SATA:

a. bacterial

b. viral

c. allergic

a, b—> HIGHLY CONTAGIOUS!!!!!!!!!!!

What’s the common pathogen or allergen for each type of conjunctivitis?

Type of Conjunctivitis	Common Pathogen or Allergen
Bacterial
Viral
Allergic

Type of Conjunctivitis	Common Pathogen or Allergen
Bacterial	S. aureus S. pneumoniae H. influenzae M. catarrhalis
Viral	**********Adenovirus*********
Allergic	pollen dust mites animal dander molds

What are some exclusions to self-tx for bacterial conjunctivitis?

(use common sense)

• vision changes

• photophobia

• foreign body sensation

• severe HA/n

• corneal opacity (cloudy looking eye)

• hyperacute bacterial conjunctivitis

A concern with bacterial conjunctivitis is progression to _____________________ which is often caused by gonorrhea or meningitis and can result in vision loss.

hyperacute bacterial conjunctivitis

Pharm tx for bacterial conjunctivitis is split into pts. who don’t wear contact lenses and those that do.

What the preferred agents for each? (brand/generic)

• no contact lens

  • erythromycin 0.5% ointment

  • trimethoprim-polymyxin B (Polytrim) drops

• contact lens

  • ofloxacin (Ocuflox) 0.5% drops

  • ciprofloxacin (Ciloxan) 0.3% drops OR ointment

What’s the pharm tx for bacterial conjunctivitis caused by GONORRHEA?

Ceftriaxone (Rocephin) 1g IM once

What’s the pharm tx for bacterial conjunctivitis caused by CHLAMYDIA?

Azithromycin (Zithromax) 20mg/kg PO once

Do all pts. that have bacterial conjunctivitis have to go to the ophthalmologist if symptoms continue/worsen after 2-3 days of abx? exceptions?

ALL PTS. GO

PRACTICE:

Which of the following are exclusions to self-tx? SATA

a. profuse purulent discharge

b. redness/itching

c. eyes are crusty

d. photophobia

e. foreign body sensation

a, d, e

What is the topical tx for VIRAL conjunctivitis?

trick question—> NONE!!!!!

• infection is self-limiting

What are some non-pharm self tx for each type of conjunctivitis:

(just recognize)

Type of Conjunctivitis	Non-pharm/self-tx recommendations
Bacterial
Viral
Allergic

Type of Conjunctivitis	Non-pharm/self-tx recommendations
Bacterial	cold/warm compress change towels/wash c;othes proper contact lens care replace eye cosmetics lubricating eye drops OTC antihistamine eye drops
Viral	hygiene wash hands avoid touching face wash bedding/towels often proper contact lens care replace eye cosmetics
Allergic	cold compress avoid irritants air purifiers lubricating eye drops OTC antihistamine eye drops

What classes of drugs can be used to tx allergic conjunctivitis?

• topical mast cell stabilizers

• topical antihistamines

• combo of mast cell + antihistamine

• oral antihistamines—> non preferred

  • if necessary use 2nd gen H1-antagonists

What ophthalmic mast cell stabilizers can be used for allergic conjunctivitis?

(brand/generic, %)

• cromolyn 4% solution

• Lodoxamide 0.1% solution

• Nedocromil (Alocril) 2% solution

What ophthalmic antihistamines can be used for allergic conjunctivitis?

(brand/generic, %)

• Azelastine 0.05% solution

• Olopatadine (Pataday) OTC 0.1,0.2,0.7% solution

• Cetirizine (Zerviate) 0.24% solution

What drug is a combination ophthalmic mast cell stabilizer/antihistamine used for ALLERGIC conjunctivitis?

Ketotifen (Alaway, Zaditor) OTC 0.025% solution

PRACTICE:

Which of the following is the most common pathogen associated with viral conjunctivitis?

a. Herpes Simplex Virus

b. S. aureus

c. adenovirus

d. norovirus

c

What is Blepharitis?

common eye condition characterized by inflammation of the eyelid margin with eye irritation

What are some predisposing conditions/factors that may lead to Blepharitis?

• chronic inflammatory skin conditions

• colonization of eyelid by S. aureus or other staph

• irritant exposure

  • RETINOIDS

Presentation of Blepharitis? Contagious?

• presentation: red, swollen eyelids, crusting/flaking/scaling of skin of the eyelid

• NOT contagious

What are the self-treatment recommendations and pharm tx for Blepharitis?

(focus on self-tx)

• self-tx

  • WARM COMPRESS

  • OTC eye lid wipes/cleansers

• pharm

  • FOR SEVERE

  • abx ointments, steroid eye drops, artificial tears

PRACTICE:

Which of the following could you recommend to a patient who comes to your pharmacy and asks for an OTC antihistamine eye drop?

a. Cromolyn

b. Azelastine

c. Pataday

d. Zaditor

e. Ketotifen

c—> Pataday brand name of Olopatadine

• others:

  • cromolyn—> mast cell stabilizer

  • azelastine—> antihistamine, but not OTC

  • Ketotifen (Zaditor)—> mast cell+ antihistamine

Which of the following do you NOT need to shake before use?

a. solution

b. suspension

c. gel

a

Answer the following about administering eye drops:

• When you’re administering EYE DROPS how many drops do you place at a time?

• Should you allow the applicator to touch the eye?

• If multiple drops are being administered how long do you WAIT IN BETWEEN DROPS for the SAME medications vs. a DIFFERENT medication

• 1 drop at a time

• don’t let applicator touch eye

• if multiple drops are administered:

  • same medication—> wait 5 MINUTES

  • different medication—> wait 5-10 MINUTES

  • but then 2 slides later she says this:

  • solution—> wait 5 minutes

  • suspension—> wait 10 minutes

  • idk man

Answer the following about administering eye ointment:

• how long to keep eye closed after administering?

• how long to reinsert contacts?

• close eye for 1-2 minutes

• wait 15-30 minutes or overnight to reinsert contacts

PRACTICE:

Select the preferred self-tx for blepharitis:

a. warm compress

b. abx eye drops

c. antihistamine eye drops

d. oral antihistamines

a

Definition of Acute Otitis Externa (AOE)?

(recognize)

• “swimmer’s ear”

• inflammation of the external auditory canal or auricle

Acute Otitis Externa has 3 severities: mild, moderate, and severe. Describe them.

Severity	Symptoms
Mild	minor discomfort and pruritus minimal edema in ear canal
Moderate	increased pain/pruritus canal is partially occluded
Severe	intense pain complete occlusion of ear canal erythema lymphadenopathy fever

Common pathogen that causes AOE?

• S. aureus

• Pseudomonas aeruginosa

What is the tx for AOE? (brand/generic)

• mild

• moderate-severe

• mild

  • acetic acid and hydrocortisone otic drops (VoSol HC)

• moderate-severe

  • ciprofloxacin and dexamethasone otic drops (Ciprodex)

  • ciprofloxacin and hydrocortisone (Cipro HC)

  • neomycin, colistin, hydrocortisone, and thonzonium (Cortisporin-TC)

What is a blockage of the ear canal due to accumulation of wax (cerumen) when it becomes too hard to wash away naturally?

cerumen impaction

Tx of a cerumen impaction?

• cerumenolytics

  • helps soften earwax for easy removal

  • at home or medical office

• manual removal (by a dr.)

• removal by irrigation (by a dr.)

Examples of Cerumenolytics?

• water

• saline solution

• mineral oil

• hydrogen peroxide

• CARBAMIDE PEROXIDE (Debrox) OTC otic solution

instructions for carbamide peroxide (Debrox)?

5-10 drops per ear BID for up to 4 days

When administering ear drops, what’s the difference between adult admin and <3 admin?

• adult—> pull earlobe up and back

• <3 —> pull earlobe down and back