Common conditions of eyes/ears NAPLEX

What are the sigs for ears?

AD

AS

AU

D= dexteris (right)

S= sinstra (left)

A=auris (ear)

What are the sigs for eyes?

OD

OS

OU

D= dexteris (right)

S= sinstra (left)

O= oculas

Eye and ear solutions 1 drop = how many ml?

0.05ml

How to administer gels to the eye?

with cap on, invert and case once to get the medication into the tip before instilling

What is glaucoma?

damage to the optic nerve and loss for the visual field

IOP is above normal range (goal to decrease it)

What is open angle glaucoma

most common type

asymptomatic

treated with eye drops or surgery

What is closed-angle glaucoma

sudden increase in IOP due to a blockage causing headaches and decreased vision

medical emergency that is treated surgically

what drugs can increase IOP

anticholinergics

decongestants

chronic steroids

topiramate

How do you treat open angle glaucoma?

target aqueous humor in the eye by either increase aqueous humor outflow or reduce production

What is the most effective agent for glaucoma?

Prostacyclin analogues decrease IOP ~30% and are used once daily

Can also use beta blockers (reduce IOP ~22%)

When are beta blockers preferred?

when glaucoma is in 1 eye only (avoids adverse events of thickened eye lashes and darkening of iris seen with prostacyclins)

What eye drops can decrease aqueous humor production

beta blockers and carbonic anhydrase inhibitors

adrenergic alpha-2 agonists

What eye drops increase aqueous humor outflow

prostaglandin analogues

cholinergics

adrenergic alpha-2 agonists

Rho-kinase inhibitors

When should you pursue add on therapy for glaucoma?

when IOP is still high on monotherapy

can add on alpha-2 antagonists

What agents are prostacyclin analogues?

Bimatoprost

Latanoprost

Travoprost

Bimatoprost brand name

Lumigen

Latisse - indicated for eyelash growth. DO NOT USE WITH PROSTAGLANDINS USED FOR GLAUCOMA

Latanoprost brand name

Xalatan, Xelpros

Travoprost brand name

Travatan Z

Dose of prostacyclin analogues

1 drop qhs

any more can decrease efficacy

side effects of prostacyclin

increase of eyelash length and number

blurred vision

stinging

increased pigmentation of iris/eyelashes (Darkening of iris)

Which prostacyclin analogues do not contain BAK?

Travatan Z and Xelpros

what prostacyclin analogues should be stored in the refrigerator before opening

latanoprost

latanoptostene bunod

tafluprost

Beta blocker used for glaucoma

Timolol

Brand name for timolol eye drops

Timoptic, Timoptic-XE, Istalol

Brand name for timolol-dorzolamide

Cosopt, Cosopt PF

Dosing for timolol eye drops

1 drop daily or BID

Timoptic-XE, timolol GFS (gels): daily

Side effects for beta-blocker eye drops

burning, stinging, bradycardia/fatigue, bronchospasm

All beta-blocker eye drops are (selective/nonselective) except for which agent?

nonselective

betaxolol

How long after using eye drops should you wait before using gels

10 minutes

What agents are cholinergic eye drops

Carbachol (Miostat)

Pilocarpine (Isopto)

Side effects of cholinergic eye drops

Poor vision at night due to pupil constriction

What allergy should not use carbonic anhydrase inhibitors?

patients with sulfonamide allergy

(-amide -> caution with sulfonamide) allergy

What eye drop is a carbonic anhydrase inhibitor

dorzolamide

(acetazolamide oral used infrequently)

What agents are adrenergic alpha-2 agonist eye drops

brimodine (alphagan P) - OTC version only indicated for redness

What eye drop is a rho kinase inhibitor

Netarsudil (Rhopressa)

Netarsudil + latanoprost (Rocklatan)

Non-pharm counselling points for conjunctivitis (pink eye)

Avoid touching eye

use proper hand hygiene

change towels and washcloths daily

Discard eye cosmetics, especially mascara

does conjunctivitis need to be treated with antibiotics?

No - can be due to virus, bacteria, or an allergen

what bacteria can cause conjunctivitis?

Staphylococcus Aureus (in adults), streptococcus pneumonia, H. Influenza, M. Cattarhalis

More severe cases caused by neisseria gonorrhoeae or chlamydia

What topical eye drops/ointments should you know for the NAPLEX

Moxifloxacin

Neomycin/polymyxin B/dexamethasone

Ofloxacin

Trimethoprim/polymyxin b

Moxifloxacin eye drop brand name

Vigamox

Neomycin/Polymyxin B/Dexamethasone

eye drop brand name?

Maxitrol

Ofloxacin eye drop brand name

Ocuflox

Trimethoprim / Polymyxin B eye drop brand name?

Polytrim

Which abx eye drop should be stored in the fridge?

Azithromycin

stable for 14 days at room temp

What are the common eye drops for allergies?

Antihistamines: Azelastine and olopatadine (Pataday)

Antihistamines/Mast cell stabilizers: Ketotifen (Alaway, Zaditor)

Can steroid eye drops be used for long term?

No - long term use can increase IOP

can use acutely

What is blepharitis? how can you treat it?

eyelid inflammation

use a warm compress over the eye to loosen the crusty deposits and then use a warm moist washcloth + a few drops of baby shampoo to wipe away the debris

symptom based treatment for inflammation of the eye includes

cold compress and NSAID (if mild)

steroid eye drop (if severe)

Why do most eye drops burn?

the addition of preservatives, most commonly benzalkonium chloride (BAK) can irritate the eye

How long after removing contact lenses to administer an eye drop can the be reinserted

15 minutes

can trap drug and preservative against eye; BAK can damage eyes when used with contacts

What eye drops can be used for inflammation

Prednisolone (pred forte, pred mild)

Dexamethasone (maxidex)

Lotepredinol (lotemax susp/ointment/gel)

remember: only for acute use as long term use will increase IOP

What eye drops can be used for dryness (aka artificial tears)

Refresh

Systane

Contains lubricants and can be used multiple times a day

What agents can be used for chronic dry eye?

Cyclosporine emulsion eye drops (Restasis)

Lifiegrast (Xiidra)

Loteprednol (Eysuvis)

What eye drops can be used for redness

Naphazoline (Clear eyes redness relief)

Naphazoline/Pheniramine (naphcon A)

Tetrahydrozoline (Visine)

can also be used to treat allergic conjunctivitis

What agents can cause retinal changes/retinopathy

Chloroquine and hydroxychloroquine

What agents can cause optic neuropathy

amiodarone (+ corneal depositis)

ethambutol

Linezolid

What agents can cause intraoperative floppy iris syndrom

alpha-blockers

What agents cause color discrimination?

Digoxin (with toxicity) - yellowgreen vision

PDE-5 inhibitors - greenish tinge around objects

Voriconazole - color vision changes

What agents can cause abnormal vision/loss

Digoxin (with toxicity) - halos/blurriness

PDE-5 inhibitors- vision loss in one or both eyes that can be perminant

Isotretinoin - decreased night vision (can be permanent), dryness, irriatation

Topiramate - visual field defects

Vigabatrin - high risk for permanent vision loss

Voriconazole - abnormal vision, photophobia

MOA of cerumenlytics

soften ear wax and allow it to be cleared

What are example of cerumenlytic agents?

Water

Saline solution

Mineral oil

Hydrogen peroxide

Carbamide peroxide (Debrox)

Treatment of mild swimmers ear

ear drops containing acetic acid and a glucocorticoid

Treatment of moderate-severe swimmers ear

antibiotic ear drops (otic):

-Ciprofloxacin/dexamethasone (Ciprodex)

Pain - systemic NSAIDs/analgesics

How should you counsel a patient with swimmers ear?

stay out of the water

avoid flying due to pressure changes

avoid using headphones nad earplugs

How long should you wait in between administering drops of the same eye drop?

5 minutes

How long should you wait in between administering drops of a different eye drop?

5-10 minutes

Should eye gels be applied first or last? does it matter?

LAST

wait 10 minutes after last eye drop

HOw long should you wait to reinsert contact lenses after using eye drops?

15 minutes

How do you counsel a parent/caregiver to administer ear drops to children <3 years old

DOWN AND BACK

keep ear facing up for 5 minutes

How do you counsel a patient/care giver to administer ear drops to patients >/= 3years old?

Up and back

keep ear facing up for 5 minutes