SelfCare: Ophthalmic, Otic, & Oral (Exam I)

dry eye

multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles

tears

those with dry eye experiences either decreased production of ______, or increased evaporation of ocular lubrication

humidity

common exacerbating environmental factors of dry eye can be dry or dusty environment, heating/AC, or reduced ______

beta blockers

drugs that can cause dry eye are antihistamines, decongestants, diuretics, and _______

ocular

when patients present to the pharmacy to treat dry dry eye, it can be characterized as a normal appearing sclera or mildly red eye, patient may complain of a sandy or gritty feeling or feeling of something is in the eye, and/or there is potential initial presentation of excessive tearing: dry eye can lead to _____ tissue damage if untreated so it is important we treat patients when they come to the pharmacy with their concerns

tissue damage

the treatment goals of dry eye is to alleviate dryness of the ocular surface, relieve symptoms of irritation, and prevent possible corneal and noncorneal _______

eye pain

exclusions for treating those with dry eye include if the patient is experiencing ______, blurred vision not associated with use of ophthalmic ointments, or sensitivity to light

contact lens

exclusions for treating those with dry eye include if the patient has a history of ________ wear, blunt trauma to the eye, or any chemical exposure affecting the eye

72

exclusions for treating those with dry eye include if the patient's eye has been exposed to heat excluding sun exposure, or if symptoms have persisted for longer than ____ hours

lubricants

the general treatment approach for dry eye is ocular ______ and nonpharmacy recommendations like removing themselves from dry conditions, not sleeping with fan directly in face, etc.

low

if the patient is experiencing mild discomfort dry eye symptoms, we will recommend ____ viscosity artificial tears 1-2 times a day (follow up in 1 week)

high

if the patient is experiencing moderate discomfort dry eye symptoms, we will recommend low viscosity artificial tears 3-4 times a day OR a _____ viscosity solution (follow up in 1 week)

preservative-free (PF)

if the patient is experiencing severe discomfort dry eye symptoms, we will recommend _____ artificial tears every hour as needed AND a night time eye ointment (follow up in 1 week)

evaporation

nonpharmacologic therapy to treating dry eye includes avoidance of environments that promote _______ of tear film: to do this you can use a humidifier or reposition work areas away from air vents

computer screens

nonpharmacologic therapy to treating dry eye includes avoiding prolonged use of _______ or the use of eye protection in windy outdoor environments

warm

nonpharmacologic therapy to treating dry eye includes eyelid function improvement like applying a ____ compress, discontinuing offending agent, and maintaining good eyelid hygiene

dietary

nonpharmacologic therapy to treating dry eye includes ______ modification: omega-3 oils and flaxseed oils can be used as supplements

less

the less viscous a pharmacologic therapy is, the _____ contact time it will have with the eye

more

the more viscous a pharmacologic therapy is, the ______ contact time it will have with the eye

solution

is the dosage form of artificial tears that has the shortest contact time but causes the smallest amount of blurred vision

gel

is the dosage form of artificial tears that has the second shortest contact time but causes the second smallest amount of blurred vision

ointment

is the dosage form of artificial tears that has the longest contact time but causes the largest amount of blurred vision

suspension

if your eye drop is in the form of a _______, you must shake before use

5

if you are combining multiple eye drop solutions, you should wait at least ____ minutes before instilling the next drop combination of drops and ointments

10

if you are combining multiple eye drop ointments, you should instill the drops at least ____ minutes before the ointment: if you add drops after ointments, the drop would never reach the sclera due to the ointment acting as a protective agent

pouch

when administrating an eye drop, you should look up to the ceiling and pull down on the lower eyelid with the non-dominant hand to create a _____, then instill the drop with your dominant hand

blink tears

Active Ingredient: Polyethylene Glycol 400 0.25% — acts as an eye lubricant to hydrate and soothe dry eyes. 

Use: For temporary relief of burning, irritation, and discomfort due to dry eyes or exposure to wind/sun; helps protect the eye surface from further irritation by restoring tear balance.

Refresh Optive - Preservative Free

Active Ingredients: Carboxymethylcellulose Sodium (0.5%) and Glycerin (0.9%) — both act as eye lubricants to moisturize and relieve dryness. 

Use: Temporarily relieves burning, irritation, and discomfort due to dryness; helps protect against further irritation. 

NO Preservative: without preservatives, it's gentler and safer for frequent or daily use, especially for sensitive eyes or after surgery

Sooth Allergy + Dry Eye

Active Ingredients: Ectoine 2% (protects cells and may reduce allergic inflammation) and Sodium Hyaluronate 0.24% (a natural lubricant to hydrate the eye surface). 

Use: For relief of dry eye symptoms and allergy-related irritation — soothes dryness while helping protect against allergens that can cause inflammation and discomfort.

Refresh Optive

Active Ingredients: Carboxymethylcellulose Sodium (0.5%) and Glycerin (0.9%) — both act as eye lubricants to moisturize and relieve dryness. 

Use: Temporarily relieves burning, irritation, and discomfort due to dryness; helps protect against further irritation. 

Preservative: Some multi-dose bottles contain preservatives like Purite® or benzalkonium chloride (BAK) — gentler options exist and may be better for sensitive eyes, but PF is preferred for frequent use.

preservative-free (PF)

_______ ophthalmic agents have a higher risk of contamination and must be packaged as single use products

Benzalkonium chloride (BAK)

common ophthalmic preservative: for long-term use associated with conjunctival and corneal damage

Mercury

common ophthalmic preservative: patients who become sensitized to thimerosal can develop contact blepharitis or conjunctivitis after several weeks of exposure and must discontinue the use of products that contain this ingredient

Chlorobutanol

common ophthalmic preservative that is less effective than BAK as an antimicrobial preservative: breaks down in bottles with prolonged storage

P-hydroxybenzoic acid derivatives

common ophthalmic preservative like Methylparaben and Propylparaben: is unstable at high pH and can induce allergic reactions

Sodium perborate (GenAqua)

common ophthalmic preservative: disappearing preservative (dissociates to hydrogen peroxide which rapidly dissociates to oxygen and water), amount of hydrogen peroxide formed is so small that it does not cause irritation

Stabilized oxychloro complex

common ophthalmic preservative like Purite and OcuPure: another disappearing preservative (breaks down to water and sodium chloride with UV exposure)

allergens

common _____ of allergic conjunctivitis are pollen, animal dander, and topical eye preparations: clinical presentation includes red eye, watery discharge, pruritis, and may also present with seasonal allergic rhinitis

symptomatic relief

treatment goals of allergic conjunctivitis is to remove or avoid the allergen, limit or reduct the severity of the allergic reaction, provide _______, and to protect the ocular suface

cold

nonpharmacologic therapy for treating allergic conjunctivitis includes allergy removal/avoidance (check pollen count, keep doors/windows closed, hypoallergenic bedding, wash clothes frequently, bathing before bedtime, use of air filters, wear sunglasses), ______ compress application 3-4x a day, and removal of contact lenses until symptom resolution

artificial tears

the first line pharmacologic treatment for treating allergic conjunctivitis is ________

antihistamine

the next consideration pharmacologic treatment for treating allergic conjunctivitis is ophthalmic ______ or mast cell stabilizer

decongestant

to reduce redness in allergic conjunctivitis, and ophthalmic ______ or alpha-adrenergic agonists should be recommended

oral

if systemic allergic symptoms are presents, an _____ antihistamine may be considered for treating allergic conjunctivitis

72

you should refer a patient with allergic conjunctivitis to their PCP if symptoms have not been relieved after _____ hours of therapy

Zaditor

ophthalmic antihistamine/mast cell stabilizer thats; active ingredient is Ketotifen 0.025% and should be used for ages 3 and up: 1-2 drops every 8-12 hours

Pataday Once Daily Relief Extra Strength

ophthalmic antihistamine/mast cell stabilizer thats; active ingredient is Olopatadine 0.7% for ages 2 and up: 1 drop every 24 hours

Pataday Once Daily Relief Original Strength

ophthalmic antihistamine/mast cell stabilizer thats; active ingredient is Olopatadine 0.2%: 1 drop every 24 hours

Pataday Twice Daily Relief

ophthalmic antihistamine/mast cell stabilizer thats active ingredient is Olopatatdine 0.1%: 1 drop every 12 hours

vasoconstriction

the general mechanism of action of ophthalmic decongestants/alpha-adrenergic agonists is to reduce redness via _________: it does not address allergic responses!!

hypertension

ophthalmic decongestants/alpha-adrenergic agonists agents are used in cautions in patients with _______, arteriosclerosis, cardiovascular disease, diabetes, or hyperthyroidism

72

except for Brimonidine, decongestants should not be used for more than _____ hours due to rebound congestion

Brimonidine

______ is a decongestant that may be used for up to 4 weeks due to minimal rebound congestion

rebound congestion

_____ is less likely with the use of naphazoline or tetrahydrozoline as compared to oxymetazoline or phenylephrine

Clear Eyes Redness Relief

ophthalmic decongestants/alpha-adrenergic agonists thats active ingredient is Naphazoline 0.012%: 1-2 drops up to 4 times a day

Lumify

ophthalmic decongestants/alpha-adrenergic agonists thats active ingredient is Brimonidine tartrate 0.025%: 1 drops every 6 to 8 hours up to 4 times a day

Visine Advanced Redness + Irritation Relief

ophthalmic decongestants/alpha-adrenergic agonists thats active ingredient is Tetrahydrozoline HCl 0.05%: 1-2 drops every 4 hours

Visine A

antihistamine + decongestant eye drop thats active ingredient is Pheniramine maleate 0.3% & Naphazoline HCl 0.025%: 1-2 drops 3-4 times a day

ocular irrigant

if loose foreign substances enter the eye, remove the foreign substance with an ______: if unavailable, flush with copious amounts of water

refer

we should _____ a patient if foreign substance is a fragment of wood or metal, if substance is not removed by irrigation, or if there is pain, changes in vision, continued redness, or worsening of condition after irrigation

tooth hypersensitivity

experiences of oral pain from hot, cold, sweet, sour, and/or spicy foods: pain can range from mild discomfort to sharp, excruciating pain

toothpaste

the goals of therapy for treating tooth hypersensitivity is to repair the damaged tooth surface using appropriate ______ and to replace aggressive or improper toothbrushing practices with optimal technique

toothache

exclusions for treating a patient presenting with tooth hypersensitivity is if they are experiencing a _______, mouth soreness associated with poor fitting dentures, presence of fever or swelling, loose teeth, bleeding gums in the absence of trauma, broken or knocked out teeth, severe tooth pain triggered or worsened by hot, cold, or chewing, and/or trauma to the mouth with bleeding, swelling, and soreness

soft-bristled

one general treatment approach for tooth hypersensitivity is the use of a ______ toothbrush and standard toothpaste with fluoride then follow up in 7 days

desensitizing

another general treatment approach for tooth hypersensitivity is twice daily use of _______ toothpaste with a soft-bristled toothbrush then follow up in 14 days: if unresolved after day 14, a dental referral is required

acidic

nonpharmacologic therapy for treating tooth hypersensitivity includes avoiding aggressive brushing, avoiding brushing within 30-60 minutes of consuming _____ foods, and to use a soft-bristled toothbrush

potassium nitrate & sodium fluoride

pharmacologic therapy for treating tooth hypersensitivity includes desensitizing toothpastes containing ______, and avoidance of abrasive toothpaste (ex: whitening, stain removal)

Colgate Sensitive

Toothpaste designed to relieve tooth sensitivity by helping block exposed dentin tubules and protecting nerves from triggers like cold, heat, sweets, or brushing. Often contains potassium nitrate or stannous fluoride to reduce sensitivity while also preventing cavities and strengthening enamel.

Sensodyne Pronamel

Toothpaste specifically formulated for sensitive teeth that also helps strengthen and protect enamel from acid erosion. Uses fluoride to remineralize enamel while providing gentle sensitivity relief, making it useful for people with acid-related enamel wear and tooth sensitivity.

recurrent aphthous stomatitis (RAS)

painful epithelial ulcer or mucosa of the mouth also known as canker sores: round or val, flat or with a depressed center, gray or yellowish gray, cannot be cured (symptom relief only)

10-14

most cases of recurrent aphthous stomatitis (RAS) peak onset is 10-19 years of age and may spontaneously resolve after _____ days: though to be primarily idiopathic

secondary infections

the treatment goals of recurrent aphthous stomatitis (RAS) is to relieve pain and irritation to enable lesion healing and prevention of complications such as _______

14

exclusions for self treatment of recurrent aphthous stomatitis (RAS) is if the lesions are associated with underlying pathology, if lesions are present for more than _____ days, if the patient has frequently systemic illness, symptoms of systemic illness, and/or failure of prior appropriate self-treatment

vitamin supplement

nonpharmacologic treatment for treating recurrent aphthous stomatitis (RAS) includes a ______ if cause if vitamin deficiency (iron, folate, B12), avoid spicy or acidic food, avoid sharp textured food, and applying ice in 10 minute increments, but no more than 20 minutes per hour

oral debriding

the 1st line pharmacologic treatment for treating recurrent aphthous stomatitis (RAS) is using _____ and wound-cleaning agents

Hydrogen peroxide

oral debriding and wound-cleaning agent pharmacologic treatment for treating recurrent aphthous stomatitis (RAS): mix with an equal amount of water before rinsing for at least 1 minute

Carbamide peroxide

oral debriding and wound-cleaning agent pharmacologic treatment for treating recurrent aphthous stomatitis (RAS): place a few drops on the tongue, mix with saliva, and swish in the mouth for 1 minute

7

the max duration of oral debriding and wound-cleaning agent pharmacologic treatment for treating recurrent aphthous stomatitis (RAS) therapy is _____ days: it can result in transient tooth sensitivity due to decalcification of enamel

3

when using oral debriding and wound-cleaning agent pharmacologic treatment for treating recurrent aphthous stomatitis (RAS), use after meals, avoid eating or drinking for at least ____ minutes, and do not swallow

topical oral anesthetics

pharmacologic treatment for treating recurrent aphthous stomatitis (RAS) includes _______ like benzocaine and benzyl alcohol for ages 2 and up

topical oral protectants

pharmacologic treatment for treating recurrent aphthous stomatitis (RAS) includes ________ like denture adhesive used to coat and protect the ulcerated area and patches are also available

oral rinses

pharmacologic treatment for treating recurrent aphthous stomatitis (RAS) includes _____ like saline rinse (1-3 teaspoons of salt in 4-8 ounces of warm tap water then swish & spit), and listerine

systemic analegsics

pharmacologic treatment for treating recurrent aphthous stomatitis (RAS) includes ______ like NSAIDs or acetaminophen but in appropriate dosage form (no powders)

7

you should refer a patient presenting with recurrent aphthous stomatitis (RAS) when lack of resolution after ____ days of therapy, canker sores are present for more than 14 days from initial presentation, and/or if there are signs of systemic infection

Herpes Simplex Labialis (HSL)

caused from the Herpes Simplex Virus (HSV) commonly called the cold sore

prodromal phase

the _____ of Herpes Simplex Labialis (HSL) is 2-48 hours prior to lesion appearance: burning, itching, numbness is common presentation and other potential symptoms at this stage includes pain, fever, localized bleeding, swollen lymph nodes, and malaise

transmission

treatment goals for Herpes Simplex Labialis (HSL) is to relieve pain and irritation while wounds are healing, prevent secondary infections, and to minimize _______

14

exclusions for self-treatment is if the lesions are present for more than _____ days, increased frequency of outbreaks (may need to be prescribed anti-viral over any OTC medications), immunocompromised, symptoms of infections, no previous diagnosis of cold sore, and/or frequency recurrence

moisturizing

nonpharmacologic therapy for Herpes Simplex Labialis (HSL) is handwashing and _____

Docosanol 10% (Abreva)

only FDA-approved OTC product for cold sores: reduces severity and duration of symptoms, only improves healing time by 1 day, inhibits direct fusion between the herpes virus and the human cell plasma membrane preventing viral replication, apply at first sign of outbreak 5 times per day for a max of 10 days

Oragel

topical anesthetic that can also be used to treat Herpes Simplex Labialis (HSL): follow up in 14 days

Xerostomia

dry mouth

loose teeth

exclusions for self-treatment of xerostomia is tooth erosion and decay, candidiasis, gingivitis, periodontitis, reduced denture-wearing time, mouth soreness associated with poor-fitting dentures, presence of fever or swelling, ______, bleeding gums in absence of trauma, broken or knocked-out teeth, severe tooth pain triggered by hot cold, or chewing, trauma to the mouth, Sjogren's syndrome, and/or salivary gland stones

salivary flow

a nonpharmacologic treatment for xerostomia is to help prevent a reduction in _______ by avoiding the use of cigarettes and smokeless tobacco and not drinking or using products that contain alcohol (including mouth rinses) or medications that cause depletion of salivary flow

caffeine

a nonpharmacologic treatment for xerostomia is to avoid food or drinks that contain _____, avoid hot spicy foods, limit consumption of sugary, starchy, and acidic foods: do not suck on hard candy or lozenges sweetened with sugar, if desired chew gum sweetened with sugar alcohol such as xylitol to help increase flow of saliva

fluoridated

a nonpharmacologic treatment for xerostomia is if possible take medications 1 hour before meals so that the natural saliva flow caused by food can counteract any mouth dryness, use a very soft toothbrush to reduce abrasion of the teeth, drink plenty of water especially if it is ______, and/or to use a cool mist humidifier at home to help moisten the air

carboxymethyl or hydroxyethylcellulose

pharmacologic therapy by xerostomia includes artificial saliva with active ingredients of _______: not a cure, only provide replacement therapy and use as needed

sugarless gum

dental hygiene counseling points include: brush at least twice daily, floss at least once daily, replace toothbrushes at least every 3 months, chewing _____ for 20 minutes after meals decreasing tooth decay by increasing saliva, toothpastes containing baking soda, brush with mildly abrasive toothpaste and soft-brush toothbrush to minimize enamel erosion, and/or supervise children under the age of 12 when using fluroride-containing products to minimize swallowing

excessive or impacted cerumen (EOC)

commonly called ear wax: function is to clean, protect, and lubricate the external auditory canal (EAC)

removed

a common myth about excessive or impacted cerumen (EOC) or ear wax is that is should be _______: inappropriate removal can push wax deeper into the ear, damage the EAC or tympanic membranes, and can potentially result in otitis media