OTC Exam 3- Insomnia, Eye/Ear, Home Diagnostics

What are the 5 stages of sleep?

Wake stage

Non-REM Sleep: N1, N2, N3

REM Sleep

What types of insomnia do we treat?

All of them except Chronic Insomnia

What impacts insomnia?

Antidepressants, AntiHTN med, Sympathomimetic amines (PSE and Phenylephrine)

Alcohol

Caffeine

Exercise

Environmental distractions

Nonpharmacologic for Insomnia?

Bed restriction

Regular sleep patterns

Comfortable sleeping space

Avoiding electronics 1-2 hrs before bed

Avoid napping (ONLY POWER NAPS)

Mindfulness meditation

DONT WATCH THE CLOCK

Pharmacologic for insomnia?

Benadryl 30 mins QHS/Doxylamine

Max sedation 1-3 hrs after dose

LIMIT TO 7-10 days

Adverse effects for insomnia meds?

ANTI SLUD

SEDATION DUH

What should we consider before prescribing insomnia meds?

BPH

Resp conditions

Angle closure Glaucoma

Dementia

Age

How does dry eye disease present?

Sandy, gritty sensation, lacrimation, and mild erythema

How do we treat Dry eye disease?

Warm washcloth to closed eye for 5 minutes

Ocular lubricant

Humidifier

When would we refer for dry eye disease?

When a patient is taking antibiotics, secretagogues, immunomodulators, cholinergics, corticosteroids, LFA-1 Antagonists

What ocular lubricants cause blurriness? When should they be taken?

Gel and ointment AT NIGHT!!

How do we administer eye drops/solution?

How do we administer eye gel/ointment?

What if you need to administer more than one drop?

Wait 5 mins (drops)

Wait 10 mins (Gel/ointment)

What if you use both drops and gel/ointment?

Drops first, wait 10 mins then gel/ointment

What if you wear contacts? (Gel/ointment)

BAK in it?

Take out contacts, administer, and replace after 15 mins

How does allergic conjunctivitis present?

Eye erythema, Burning, Dryness, Swollen eyes, Pruritus, Lacrimation w/ or w/o discharge

How to treat for Allergic Conjunctivitis?

Non Pharm:

Allergen avoidance

Cold compress every 3-4 hrs for itching and redness

Pharm:

1st: Artificial tears as needed for symptoms

2nd: Antihistamine/mast cell stabilizer combo, Decongestant, decongestant/antihistamine combo

When do we refer for contact dermatitis of the eye lid?

INFECTION or if OTC treatment doesn’t fix it after 3 days or IT GETS WORSE w/ treatment

How does diagnosed Corneal Edema present?

Corneal swelling, distorted/blurry vision, Halos/starbursts in visual field, Dryness, Discomfort

How to treat for Diagnosed Corneal Edema?

1st: Topical Hyperosmotic therapy (2%, 5% NaCl solution)

Higher strength more effective but more likely to cause irritation

How does minor eye irritation present?

Red and itchy

How to treat Minor eye irritation?

Sterile saline/irrigation solution (SHORT TERM & NO CONTACT CLEANING)

How does Contact Dermatitis of the eyelid present?

Swelling, scaling, redness, sunburn?

How to treat Contact dermatitis of the eyelid?

Avoid risk factors (Cosmetics, Detergent, UV radiation)

Oral antihistamine

Cold compress 3-4x daily for inflammation and Pruritus

How does Age related Macular degeneration present?

Wet (20%)

Sudden vision loss

Haziness/blurriness

Distorted vision

Dry (80%)

Asymptomatic sometimes distorted vision

How do we treat AMD?

Non Pharm:

Exercise

Heart healthy diet

Manage chronic disease states

Pharm:

AREDS or AREDS 2 Supplementation

When do we refer for AMD?

Signs and symptoms of infection

Blunt trauma

Chemical/thermal exposure

>72 hrs w/ w/o OTC treatment

Sensitive to light

Blurred vision

Significant eye pain

What kind fo contact lenses are used for visual correction?

Rigid Gas Permeable lenses

Who shouldn’t use contacts?

Acute dry eye disease/ocular infection

History of poor lens care

Occupational exposure to toxins/chemical irritants

Use of medications that discolor secretions??

When should you recommend Hydrogen peroxide and a rinsing product?

If they have a:

Preservative allergy or intolerance

History of ocular infections (MOST EFFECTIVE DISINFECTANT)

When should you recommend a multipurpose solution?

If they have a:

Preference for one product

Infrequently use it

Poor adherence/can’t follow directions for use

Price

How does excessive/impacted cerumen present?

Feeling of ear fullness, Transient hearing loss

How do we treat excessive/impacted cerumen?

Non Pharm:

Manual removal by PCP

Irrigation w/o carbamide peroxide

Pharm:

Carbamide peroxide 6.5% - 5-10 drops in affected ear w/ or w/o irrigation keep in place for several minutes up to twice daily

How do water clogged ears present?

Feeling of ear fullness, Transient hearing loss, discharge or drainage, pruritus or PAIN

How do we treat Water clogged ears?

Non pharm:

Ear plugs

Shower caps

Blow dryer on low heat

Risk avoidance

Pharm:

Isopropyl Alcohol 95% in anhydrous glycerin 5% - 4-5 drops in affected ear and keep in place for 1-2 mins

When to refer w/ ear disorders?

INFECTION SIGNS AND SYMPTOMS

Blunt trauma

Impaction w/ foreign object

Any disorder affects middle ear or Eustachian tubes

Patients < 12 yrs

> 4 days of self treatment w/o improvement/worsening

What are types of Home diagnostics?

What are the key counseling points for BP?

Keep a log of BP readings

If monitoring therapy, take reading every morning after rising

Be alert for BP changes w/ Meds

Don’t use products that affects readings (Tobacco, Caffeine, PSE)

DONT adjust meds based on home measurements unless instructed

Contact PCP if elevated

What does the guidelines define HTN as?

BP >/= to 130/80

What is elevated HTN?

120-129/less than 80

What is stage 1 HTN?

130-139/80-89

What is Stage 2 HTN?

140+/90+

What is considered a HTN Crisis?

Over 180/over 120

Large gauge = ________ Needle size

Small!

What is the max range for a glucometer?

400-600 mg/dL

What should we counsel patients using Blood glucose monitors?

DONT SHARE/REUSE LANCETS

What happens when a wrong sized cuff is used?

Too small → False High reading

Too big → False Low reading

What are the limitations of using alternative testing sites? When should you use your fingertip?

Variation of glucose concentration throughout the body

Rapid changes in glucose

Fingertip should be used:

Possible hypoglycemic episode

History of hypoglycemic unawareness

Site results don’t agree with feelings

How often should patients check A1c?

Every 2-3 months

What happens when an egg gets fertilized?

Trophoblactic cells produce Human Chorionic Gonadotropic Hormone (hCG)

How do pregnancy tests work?

HCG hormone levels as early as 1-2 weeks after fertilization are detected in the urine

THEY ARE THE MOST SENSITIVE WHEN USED 1 WEEK AFTER FIRST DAY OF MISSED PERIOD

What produces a false positive in Pregnancy tests?

Miscarriage or birth within previous 8 weeks

Medications: Profasi (hCG injection)

Ovarian cysts

What produces a false negative in pregnancy tests?

Performed on or before the 1st day of missed period

Waxed cups used for urine collection

Refrigerated urine

Diluted urine (USE MORNING PEE)

If received a negative result for a pregnancy test what should happen next?

Review test procedure and ensure proper technique

Test again if period hasn’t come in another week

What is infertility? Types of tests?

Medical inability to conceive after 1 year

Basal thermometer/urine test

How do urine ovulation tests work?

It detects LH surge which typically occurs 24-48 hrs prior to ovulation

Best time to conceive is 24 hrs after LH surge

What indicates an LH surge? No surge?

No surge: Circle, test again at same time

Surge: :)

What can lead to false positives for ovulation tests?

Fertility meds (Clomiphene)

PCOS

Menopause

Pregnancy, breastfeeding

Discontinuation of oral contraceptives

Impaired liver/kidney function

Tetracyclines (NOT oxytretacycline/minocycline)

How can you get a false positive with Illicit drug tests?

Decongestants, Dextromethorphan, Antidiarrheal, Cough medicines w/ Codeine, Sertaline-Benzos, Propanolol-Amphetamines

What can lead to false positives in UTI tests?

Phenazopyridine (discolors urine)

Menstruation

What can lead to false negatives?

Vegetarian diet

Tetracycline

Vitamin C