Term
| What does atropine do to eyes? pilocarcpine? |
|
Definition
-mydriasis (dilation of the pupil) (be careful bc of comas and hallucinations)
-miosis (constriction of pupil) (muscarinic activator) (can do to see if eye works) |
|
|
Term
| What does the cerebellum do? |
|
Definition
coordinates voluntary movements
maintains balance and eye movements
motor learning- "hand and eye coordination" |
|
|
Term
| What part of the brain is alcohol toxic towards? |
|
Definition
|
|
Term
| What does the brainstem connect? what does it give rise to? |
|
Definition
-brain to spinal cord
-cranial nerves |
|
|
Term
| The medulla (located in the brainstem) has autonomic control over what? |
|
Definition
|
|
Term
| What is the peripheral nervous system functionally divided into? |
|
Definition
1. Voluntary:
-sensory and somatic
-controls the skeletal system
2. Involuntary
-Autonomic
-controls smooth muscle, cardias muscle, glands, G.I., or neurons |
|
|
Term
| Where do sensory neurons have endings? what do these convey? |
|
Definition
skin and joints
-conveys impulses of pain, temperature, pressure, etc, to spinal cord for transmission to the brain |
|
|
Term
| What involuntary responses does the autonomic nervous system regulate? |
|
Definition
heart rate and contractility
vascular tone
respiration
sweating and salivation
secretions
GI motility
Bladder functions
Pupillary constriction |
|
|
Term
| What is the autonomic nervous system anatomically divided into? |
|
Definition
Sympathetic NS
Parasympathetic NS |
|
|
Term
| What might patient be on if their pupils are constricted? |
|
Definition
|
|
Term
| What are the 6 different kinds of NTs? |
|
Definition
-aa NTs
-biogenic amines (NE, E, serotonin, dopamine, histamine)
-acetylcholine
-adenosine, ATP
-neuropeptides
-NO |
|
|
Term
| What are the two types autonomic receptors? (each has 2 classes) what are they? |
|
Definition
cholinergic: muscarinic (M1,M2,M3) and nicotinic N subscriptN, N subscript M
adrenergic: alpha or beta |
|
|
Term
| In the eye, what does the parasympathetic do? sympathetic? |
|
Definition
-contracts iris circular sphincter muscle (pupil contracts) and contracts ciliary muscle (lens accommodating for near vision)
-contracts iris radial sphincter muscle (pupil dilates) |
|
|
Term
| In the trachea and bronchioles, what does the parasympathetic do? sympathetic? |
|
Definition
-constriction and increased secretions
-dilation |
|
|
Term
| In the adrenal medulla, what does the parasympathetic do? sympathetic? |
|
Definition
-nothing
-secretes epinepherine and norepineoherine |
|
|
Term
| In the kidney, what does the parasympathetic do? sympathetic? |
|
Definition
-nothing
-secretes renin (beta 1 increases, alpha 1 decreases) |
|
|
Term
| In the ureters and bladder, what does the parasympathetic do? sympathetic? |
|
Definition
-contraction of detrusor; relaxation of trigone and sphincter
-relaxation of detrusor
-contraction of trigone and sphincter |
|
|
Term
| In the genitalia, what does the parasympathetic do? sympathetic? |
|
Definition
-erection
-ejaculation (male), relaxation of uterus (female) |
|
|
Term
| In the lacrimal glands, what does the parasympathetic do? sympathetic? |
|
Definition
-stimulation of tears
-nothing |
|
|
Term
| In the salivary glands, what does the parasympathetic do? sympathetic? |
|
Definition
-copious, watery secretion
-thick, viscous secretion |
|
|
Term
| In the heart, what does the parasympathetic do? sympathetic? |
|
Definition
-decreased heart rate and contractility
-increased rate and contactility |
|
|
Term
| In the GI, what does the parasympathetic do? sympathetic? |
|
Definition
-increased muscle motility and tone
-decreased muscle motility and tone; contraction of sphincters |
|
|
Term
| In the blood vessels, what does the parasympathetic do? sympathetic? |
|
Definition
-nothing special
-skeletal muscle vessels: dilation and skin, mucous membranes and splanchnic area vessels: constriction |
|
|
Term
| What is alpha 1 the receptor for? |
|
Definition
| sympathetic: radial muscle contraction, contraction of skin and splanchnic blood vessels |
|
|
Term
| What is the alpha 2 receptor for? |
|
Definition
| sympathetic: relaxes smooth muscle walls in the GI tract and contracts sphincter muscles |
|
|
Term
| What are Beta 1 and 2 receptors involved with together? |
|
Definition
| sympathetic: accelerates SA node, ectopid pacemakers and increases contractility |
|
|
Term
| What does the Beta 2 receptor do without Beta 1? |
|
Definition
| sympathetic: relaxes skeletal muscle blood vessels, relaxes smooth muscle of the walls in the GI tract, relaxes bronchiolar smooth muscles. |
|
|
Term
|
Definition
| parasympathetic: contracts circular eye muscle and ciliary muscles, relaxes blood vessels of the endothelium (releases EDRF), contracts bronchial smooth muscles, contracts smooth muscle walls of GI tract, relaxes GI sphincters, increases GI secretions and activates myenteric plexus |
|
|
Term
|
Definition
| -parasympathetic: decelerates the SA node and contractility of the atria |
|
|
Term
|
Definition
| releases NO when M3 receptor is activated parasympatheitcally in the endothelium |
|
|
Term
| Do you have a lot of effect on vascular tone if you activate the parasympatheic NS? |
|
Definition
|
|
Term
|
Definition
| GI walls to relax and sphincter to contract |
|
|
Term
| What two drugs affect the respiratory system? |
|
Definition
|
|
Term
| Where are proprioceptors and what do they do? |
|
Definition
| in the joints, tell your brain where your limbs are. |
|
|
Term
| What is NsubscrtiptN? NsubscriptM? |
|
Definition
-2 types from the nicotinic class of cholinergic receptors
-NN: neural ganglion
-NM: neural muscular junction |
|
|
Term
| input to cardiovascular centers in the brain come from where? and then how is the output regulated? |
|
Definition
higher centers: cerebral cortex, limbic system and hypothalamus
sensory centers: proprioceptors, chemoreceptors and baroreceptors
-output is then regulated by either cardiac accelerator nerves (sympathetic) or vagus nerves (parasympathetic) |
|
|
Term
| What is a cholinergic agonist? |
|
Definition
-aka parasympathomimetics
-mimic effects of ACh by binding directly to cholinoreceptors.
-can be direct acting or indirect acting
-direct acting are long lasting, but not specific (so used little in clinical setings)
-indirect acting terminates actions of AChE, thus prolonging the effects of naturally occurring Ach |
|
|
Term
| What are some direct acting cholinergic agonists? |
|
Definition
-pilocarpine
-Ach (Miochol-E)
-Carbachol |
|
|
Term
| What are some indirect acting cholinergic agonists? |
|
Definition
-these can be reversible, these 3 are used for Alzheimer Dx
-Tacrine (Cognex)
-Donepezil (Aricept)
-Rivastigmine |
|
|
Term
| What are some adverse effects seen with cholinergic agents? |
|
Definition
-diarrhea
-mitosis
-urinary urgency
-diaphoresis
-nausea |
|
|
Term
| What are some actions of physostigimine? |
|
Definition
-contraction of visceral smooth muscle
-miosis
-hypotension
-bradycardia |
|
|
Term
| What is a cholinergic antagonist? |
|
Definition
aka anticholinergic drugs
-bind to cholinoceptors but do not trigger usual receptor-mediated response
-3 groups: antimuscarinic agents, ganglionic blockers and neuromuscular blocking agents |
|
|
Term
| What are effects of antimuscarinic agents? |
|
Definition
-selectively block muscarinic receptors of parasympathetic nerves.
-most useful of cholinergic antagonists
-blocks parasymp, and then sympatheic stimulation can then be left unopposed. |
|
|
Term
| What are effects of ganglionic blocker agents? |
|
Definition
-preference for nicotinic receptors of parasymp and symp ganglia
-clinically are least important cholinergic antagonists |
|
|
Term
| What are effects of neuromuscular-blocking agents? |
|
Definition
-interfere with transmission of efferent impulses to skeletal muscles
-used as skeletal muscle relaxant adjuvants in anesthesia during surgery. |
|
|
Term
| What are some antimuscarinic agents? ganglionic blockers? neuromuscular blockers? |
|
Definition
-atropine, Tolterodine ,Scopolamine
-nicotine
-Pancuronium, Cistracurium |
|
|
Term
| What are the effects of Scopolamine? |
|
Definition
-for motion sickness
-dries up mouth and secretions
-transdermal via a patch |
|
|
Term
| What can nicotine be used for? (nicoderm) |
|
Definition
-help with smoking cessation
-helps more with physical than psychological dependence |
|
|
Term
| What do cholinergic antagonists compete for with acetylcholine? |
|
Definition
| nicotinc or muscarinic receptor sites. |
|
|
Term
| With regards to effects of atropine, what is on the low does end (0.5 mg)? the high dose end (>10.0 mg)? |
|
Definition
-slight cardiac slowing, dryness of mouth, inhibition of sweating
then, same effects but increased with dilation of the pupil
-hallucinations, delirium and coma. |
|
|
Term
| What are some adverse effects observed with cholinergic antagonists? |
|
Definition
-blurred vision
-mydriasis
-urinary retention
-confusion
-constipation |
|
|
Term
| What are the actions of nicotine? |
|
Definition
-depolarizes autonomic ganglia resulting first in stimulation and then in paralysis of all ganglia
-some neurochemical effects include: dopamine release, norepinepherine, acetylcholine, glutamate, serotonin, Beta-endorphin, GABA |
|
|
Term
| What does dopamine cause when stimulated by nicotine? |
|
Definition
| pleasure and appetite suppression |
|
|
Term
| What does NE cause when stimulated by nicotine? |
|
Definition
| arousal and appetite suppression |
|
|
Term
| What does acetylcholine cause when stimulated by nicotine? |
|
Definition
| arousal and cognitive development |
|
|
Term
| What does glutamate cause when stimulated by nicotine? |
|
Definition
| learning, memory enhancement |
|
|
Term
| What does serotonin cause when stimulated by nicotine? |
|
Definition
| mood modulation, appetite suppression |
|
|
Term
| What does Beta-endorpin cause when stimulated by nicotine? |
|
Definition
| reduction of anxiety and tension |
|
|
Term
| What are the pharmokinetics when neuromuscular-blocking drugs are given intravenously? |
|
Definition
-does not readily enter cells
-some drugs (vecuronium and rocuronium) appear mainly in bile
-most are excreted in urine |
|
|
Term
| What are the two ways in which adrenergic agonists can act? |
|
Definition
|
|
Term
| What are some direct acting agents? (so are sympathomimetic and act directly on the receptor site) |
|
Definition
| -Clonidine, Dobutamine, Dopamine, Epinepherine (Adrenalin, Epipen), Isoproterinol (resp), Metaproterenol (resp), Phenylepherine (resp), Terbutaline (resp) |
|
|
Term
| What are some indirect acting adrenergic agonist agents? |
|
Definition
|
|
Term
| What are some mixed action adrenergic agonists? |
|
Definition
ephedrine
pseudoephedrine (sudafed) |
|
|
Term
| What do adrenergic drugs stimulate? |
|
Definition
| receptors that are typically stimulated by norepinepherine and epinepherine |
|
|
Term
| What are adrenergic receptors called, and what 2 types can they be split up into? |
|
Definition
adrenoceptors
alpha and beta |
|
|
Term
| What do alpha-1 adrenoreceptors cause when stimulated? |
|
Definition
| vasoconstriction, increased peripheral resistance, increased BP, mydriasis, increased closure of internal sphincter |
|
|
Term
| What do alpha-2 adrenoreceptors cause when stimulated? |
|
Definition
-inhibition of NE release
-inhibition of Ach release
-inhibition of insulin release |
|
|
Term
| What do beta-1 adrenoreceptors cause when stimulated? |
|
Definition
-tachycardia
-increased lipolysis
-increased myocardial contractility
-increased release of renin |
|
|
Term
| What do beta-2 adrenoreceptors cause when stimulated? |
|
Definition
-vasodilation
-decreased peripheral resistance
-bronchodilation
-increased muscle and liver glyconeogenesis
-increased release of glucagon
-released uterine smooth muscle. |
|
|
Term
| What are the cardiovascular effects of IV infusion of epinepherine? |
|
Definition
-strengthens the contractility of the myocardium and
increases its rate of contraction
-therefore CO increases |
|
|
Term
| What are the 4 different ways in which epinepherine can get into the CNS? |
|
Definition
-Aerosol
-topical
-IV
-subcutaneously
-metabolites will appear in the urine. |
|
|
Term
| What are the effects of isoproterenol? |
|
Definition
Beta 2- bronchodlation and peripheral vasodilation
Beta1 - increased CO
Dopamine can be an adjunct to increase CO and blood flow. |
|
|
Term
| What four drugs cause bronchodilation? what are the onset and duration times for each? |
|
Definition
epinepherine- quick onset, short duration
isoproterenol- quick onset, medium duration
albuterol- quick onset, duration longer than isoproterenol
salmeterol- slow onset, loooooong duration
terbutaline- quickest onset, medium length duration |
|
|
Term
| Why would you not want your epinepherine effects to last too long? which drug do you use before exercise to avoid induced attacks? |
|
Definition
|
|
Term
| What are some adverse affects observed with adrenergic agonists? |
|
Definition
-arrhythmias
-HA
-insomnia
-nausea
-tremors
-hyperreactivity |
|
|
Term
| Typically, what ends in ol? |
|
Definition
|
|
Term
|
Definition
| -combine powder and liquid and then withdraw with a needle. |
|
|
Term
| What are the 2 classes of adrenergic antagonists? |
|
Definition
| alpha blockers and beta blockers |
|
|
Term
| What are prazosoin (minipress) and tamsulosin (flomax)? |
|
Definition
| alpha blockers that slightly change BP |
|
|
Term
| What can the first dose of Alpha-1 receptor blocker produce? |
|
Definition
-an orthostatic, hypotensive response that can result in syncope
-anytime you decrease BP, heart rate or volume be aware of potential syncope |
|
|
Term
| What are some adverse effects commonly observed with nonselective alpha blocking agents? |
|
Definition
-orthostatic hypotension
-tachycardia
-vertigo
-sexual dysfxn |
|
|
Term
|
Definition
Beta blocker
-of all beta blockers, has a middle of the way therapeutic window (nadolol being the widest and esmolol being the most narrow)
-reduces BP
-increased Na retention (so, could put pt in on a thiazie diuretic)
-bronchoconstriction
-reflex peripheral vasoconstriction
-decreased CO |
|
|
Term
| What are the adverse effects of propanolol? |
|
Definition
-fatigue, bronchoconstriction, sexual dysfxn, arrythmias (upon abrupt withdrawal)
-want to taper this drug as to avoid any huge peeks in effects. |
|
|
Term
| What are some clinical applications of propanolol? |
|
Definition
| TX for hypertension, glaucoma, migraine, thyrotoxicosis, arrhythmia prophylaxis after MI, supraventricular tachycardias, angina pectoris |
|
|
Term
|
Definition
-beta blocker
-for tx of glaucoma |
|
|
Term
| When are there possible genetic factors for Parkinson's? |
|
Definition
when onset before age of 50 yrs.
-15% will have a first degree relative with PD |
|
|
Term
| What are some risk factors of PD? |
|
Definition
rural areas--> well water
heavy metal exposure
hydrocarbon exposure
drugs that deplete central dopamine (antipsychotics, metroclopramide, antinausea drugs (prochlorperazine) |
|
|
Term
| What percent of dopamine neurons are lost at onset of PD? |
|
Definition
50-60%
-threshold is loss of 80% or more of neurons. |
|
|
Term
| What are some ways to treat the symptoms of PD? |
|
Definition
PT, up nutritional value, diet modification,
Levadopa/Carbidopa
COMT inhibitors
MAOI extends action of levadopa
dopamine receptor agonist
low dose estrogen therapy in post menopausal women
anticholinergic agents for tremor and drooling
amantadine for temor
surgery is last- deep brain stimulation |
|
|
Term
|
Definition
|
|
Term
| What types of drugs would you take for diabetic neuropathy? What are some examples? |
|
Definition
TCAs (tricyclic antidepressants)
-main one is Nortryptyline with Gaba pentin (better than any drug alone)
-Amitryptyline, Desipramine |
|
|
Term
|
Definition
|
|
Term
| What is a therapy for seizures that is best for kids? What effect do they have? |
|
Definition
Phenobarbital
-barbituate drug therapy for seizures
-has a sedative and anticonvulsant effect
-GABA could also be used |
|
|
Term
| Why would you rather use a phenobarbital over phenytoin? |
|
Definition
| phenytoin has adverse side effects. |
|
|
Term
| What are the main anticonvulsants? |
|
Definition
phenytoin
gabapentin
phenobarbital
diazepam
clonazepam
carbamazepine
oxycarbazepine |
|
|
Term
| Therapy for seizures is based on what? |
|
Definition
| the classification of the seizure. |
|
|
Term
|
Definition
| -periodic recurrence of seizures with or without convulsions |
|
|
Term
| What is the prevalence of epilepsy? |
|
Definition
50 million have it worldwide
2.7 million are Americans
$12.5 billion in direct and indirect costs
One in 11 people will have at least one seizure at some time in their lifetime. |
|
|
Term
| If 300,000 people in the US have their first seizure each year, and 200,000, what does this mean? |
|
Definition
| 100,000 people who have seizures each year are not diagnosed with epilepsy |
|
|
Term
| Who has an increased risk for epilepsy? |
|
Definition
mental retardation- 10%
cerebral palsy- 10%
MR + CP- 50%
Alzheimer's- 10%
Stroke- 22%
Heredity- mother- 8.7%, father- 2.4%
Single seizure- 33%
Smoking he says! |
|
|
Term
| What are the causes of seizure disorders? |
|
Definition
-70% idiopathic
-head trauma
-brain tumor and stroke
-poisoning
-infection
-pregnancy complication
-genetics
-withdrawal of antiepileptic drugs (AEDs) |
|
|
Term
| What are the classifications of seizures and their subclasses? |
|
Definition
PARTIAL: simple partial, complex, secondarily generalized
GENERALIZED: absence, myoclonic, tonic-clonic, tonic, clonic, atonic or infantile spasms |
|
|
Term
| What are absence seizures? |
|
Definition
-generalized
-non-convulsive
-short loss of consciousness (10-30 seconds)
-patient seems to stare, motionless with distant facial expression |
|
|
Term
| What are myoclonic seizures? |
|
Definition
generalized
-brief jerking movements of whole body or upper body, occasionally lower extremities |
|
|
Term
| What is a tonic-clonic seizure? |
|
Definition
generalized
-convulsive motor activity with loss of consciousness
-5 phases: flexion, extension, tremor, clonic, postictal |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the 3 types of causes of epilepsy syndromes? |
|
Definition
1.idiopathic
-genetic or no underlying etiology is documented or suspected
-famly hx common
-neuroloigc fxn normal
2. symptomatic
-evidence of brain damage or a known cause
3. cryptogenic
-cause is suspected but cannot be documented |
|
|
Term
| What are the goals of therapy with epilepsy? |
|
Definition
-seizure eradication
-decrease in frequency
-minimize adverse effects of therapy and drug interactions
-address quality of life issues
-evaluate the risk benefit ratio of drug therapy in deciding on whether or not to treat |
|
|
Term
| What is one thing phenytoin can induce? |
|
Definition
|
|
Term
| What are the effects of phenytoin and what are some things to consider? |
|
Definition
-dental care should be monitored
-MONITOR SERUM LEVEL, CBC and LFTs
-preg class D
-drug interactions-enzyme inducer
-indications: partial, secondarily generalized
-worsens absence seizures |
|
|
Term
| What drugs decrease effects of phenytoin? |
|
Definition
chronic alcohol
barbituates
rifampin
vigabatrin |
|
|
Term
| What drugs increase phenytoin levels? |
|
Definition
acute alcohol
fluconazoles
metronidazole
ibuprofen
etc.. |
|
|
Term
| What drugs does phenytoin decrease? |
|
Definition
oral contraceptives
carbamazepine
cyclosporin |
|
|
Term
| What are some trigger words with drug interactions? |
|
Definition
|
|
Term
| How is phenytoin administered? What are adverse effects of this? |
|
Definition
IV
-phenytoin crystals deposit into muscle
-adverse effects: hypotension, bradycardia, arryhthmias |
|
|
Term
| What is the limit rate of phenytoin? |
|
Definition
|
|
Term
| What is the management of a seizure? |
|
Definition
ABC (airway, breathing, circulation)
Diagnosis
Stop seizures
Prevent recurrence |
|
|
Term
| What are some diabetic neuropathy treatments? |
|
Definition
Nortriptyline with gaba pentin is better than any drug alone
Desipramine
Amitryptyline (has side effects!)
these are TCAs (tricyclic antidepressants) |
|
|
Term
| How can most eye medications be administered? |
|
Definition
one drop at a time
-of indicates 2, separate drops by at least 5 minutes
-pull down lower eyelid to form a pouch for the drop |
|
|
Term
| What is a mast cell stabilizer? What are some examples? |
|
Definition
work to prevent allergy cells called mast cells from breaking open and releasing chemicals that help cause inflammation
-Azelastine
-Epinastine
-Ketotifin
-Olopatadine |
|
|
Term
| How can you keep an eye drop from getting in the throat? What would you want to do this? |
|
Definition
-have pt gently place a finger on the inside corner of the eye and nose to block the pathway
-some drops taste REALLY bad
-this maximizes absorption into eye |
|
|
Term
| What are some antibacterials to use in the eye? What does Wickeizer call them? |
|
Definition
-Polysporin
-Polytrim
-Sulfacetamide
-inexpensive old work horses |
|
|
Term
| When using ointments in the eye, start at the _______ of the eye and place a ______ ________ across the eye (pull the eyelid down), gently _________ __ ___ ___ ____ to stop the flow into the eye. |
|
Definition
corner
small ribbon
pulling up at the end |
|
|
Term
| Why should pateints have someone else administer antibacterials or other drops? |
|
Definition
| -wont be able to see well after |
|
|
Term
| When should antiviral agents be used? |
|
Definition
| when a specialist indicates (such as with Herpes Zoster) |
|
|
Term
| Why should antiviral suspensions be shaken well? |
|
Definition
|
|
Term
| Why are use of corticosteroids with the eye dangerous? |
|
Definition
overgrowth of stuff
mistake could lose an eye |
|
|
Term
| Opthalmologists or optometrists should prescribe opthalmic steroids, what could their prolonged use lead to? |
|
Definition
infection
cataract
corneal/ scleral perforation
glaucoma risk
-so monitor intraocular pressure |
|
|
Term
| Why should you not use other eyedrops within 5-10 minutes before antibiotic/ antiviral eyedrop use? |
|
Definition
| -could wash the drug away |
|
|
Term
| If using a decongestant or steroid with antiviral/ antibiotics, why should you administer them 30 minutes before the antiviral/ antibiotic? |
|
Definition
| to prepare the eye for the antibiotics/antivirals |
|
|
Term
| Which drug should you always use first in the eye? |
|
Definition
the most important. one may wash the other away
-UNLESS first drug is to open the eye up. |
|
|
Term
| WHat are sulfonamide derivatives and what should you verify first? |
|
Definition
-glaucoma agent-carbonic anhydrase inhibitors
-absence of sulfa allergy |
|
|
Term
| What is a glaucoma agent-miotic? |
|
Definition
|
|
Term
| When are artificial tears used? |
|
Definition
for most situations:
-seasonal dry eye
-lots of drugs cause dry eye
-aging may diminish tears |
|
|
Term
| What is an ointment for dry eyes? When would it be convenient to use? |
|
Definition
-Petrolatum, use minimally so there are no DDIs
-at night |
|
|
Term
| What is one of the worst things health care does, and how can we prevent this? |
|
Definition
-overprescribe atibiotics
-culture! |
|
|
Term
| With conjunctivitis, when should you use antibiotics? when should you not? |
|
Definition
-when is bacterial
-when is viral or seasonal |
|
|
Term
| What eye antibiotics does Wickeizer suggest? |
|
Definition
cipro
sulfacetamide is the standard
erythromycin ointment |
|
|
Term
| What should you always do before and after treating eyes? |
|
Definition
|
|
Term
| What is in saline drops that prevents from running out of the eye? |
|
Definition
|
|
Term
| How long does conjunctivitis "pink eye" last? |
|
Definition
3 weeks or longer
extremely contagious
spread by touching infected area. CHILDREN! |
|
|
Term
| When treating conjunctivitis, what should pt not wear and why? |
|
Definition
| contacts, bc are porous and could absorb stuff |
|
|
Term
| What is the most common conjunctivitis and what should use on it? |
|
Definition
Viral Conjunctivitis Acute
artificial tears
-if chronic see specialist |
|
|
Term
| What are the S/S of viral conjunctivitis? |
|
Definition
minimal lid swell
no itching
inflamm
clear discharge |
|
|
Term
| When should you suspect a viral conjunctivitis is Herpes Zoster and send them to a specialist? |
|
Definition
|
|
Term
| What are the S/S of bacterial conjunctivitis? |
|
Definition
-moderate lid swell
-inflammation
-no itching
-purulent discharge
-crusting, eyes stuck together upon awaking
-irritation |
|
|
Term
| What should you do for bacterial conjunctivitis? |
|
Definition
-culture (to figure out what it is)
-1st line: sulfacetamide TID or QID |
|
|
Term
| In order from completely absorbed to least absorbed, rank these: ointments, solutions and suspensions? |
|
Definition
ointments
suspensions
solutions |
|
|
Term
| When CANT artificial tears be useD? |
|
Definition
| 30 minutes before or after other drugs |
|
|
Term
| If put something in eye that is more or less than ___% it will burn. |
|
Definition
|
|
Term
| What should you use for superficial infections of the ear? |
|
Definition
|
|
Term
| For ear problems, most likely will use orl and topical bc ear drops are not ________ very well. |
|
Definition
|
|
Term
| How can you prevent Swimmer's ear?How can you treat? |
|
Definition
make sure cerumen is removed
-use OTC, as bacteria get under wax.
Burow's solution, or make your own at home (2% acetic acid, boric acid and isopropyl acid) |
|
|
Term
| Isopropyl acid must be at least ____% to be able to sterilize stuff. |
|
Definition
|
|
Term
| How can you prevent cerumen build up? |
|
Definition
-glycerin or a mineral or vegetable oil regularly (weekly to monthly)
-OTC product with triethanolamine or carbamide |
|
|
Term
| What should use for impacted cerumen? |
|
Definition
OTC ear drops nightly for 4-7 days
NO EAR CANDLES=BURNS |
|
|
Term
| In the ear, use phenylepherine for _______. |
|
Definition
|
|
Term
| What has both antibacterial and antiviral activity? |
|
Definition
-acetic acid
-boric acid
-benzalkonium cholride
-aluminum acetate (Burow's solution) (tablet dropped in a solution and mixed up) |
|
|
Term
|
Definition
| local anesthetic (ear lecture) |
|
|
Term
|
Definition
|
|
Term
| For antipyrine, need to keep cold to keep good, but this is uncomf. for patient. what to do? |
|
Definition
| so warm between hands before administering so is comfortable for patient. |
|
|
Term
| What do we use for CHF now? |
|
Definition
|
|
Term
| What do high doses of atropine cause? |
|
Definition
| >10 mg can cause hallucinations and delerium |
|
|
Term
| What does a Beta adrenoceptor cause? |
|
Definition
|
|
Term
| What might the first dose of an alpha-1 receptor blocker produce? |
|
Definition
|
|
Term
| How is Alzhemier's Dx most commonly diagnosed? |
|
Definition
by exclusion
-not a normal part of dementia
-nonreversible and progressive |
|
|
Term
| What is the clinical manifestation of Alzhemier's Dx? |
|
Definition
insidious onset
-mood changes
-have been profoundly disabled for >5-10 yrs |
|
|
Term
| What do you use to treat the symptoms of Alzhemier's? |
|
Definition
|
|
Term
| What is Aricept (donepezil)? |
|
Definition
An acetylcholinesterase inhibitor
it is thought that AD is contributed to the degeneration cholinergic neurons and cholinergic transmission throughout the cortex
-by blocking Ach it is thought that cholinesterase transmission can be improved |
|
|
Term
| What is Namenda (Memantine)? |
|
Definition
used for AD
-stimulation of glutamate receptors seems to be critical for the formation of certain memories... however if they are overstimulated can result neurodegeneration and apoptosis
-Namenda is a NMDA-glutamate receptor antagonist, preventing the loss of neurons after ischemic and other injuries, this prevents calcium levels from becoming toxic inside the cell.
-Thus... slowing the progression of memory loss. |
|
|
Term
| What is the most important things to do before physically treating the eye? |
|
Definition
|
|
Term
|
Definition
An angiotensin-receptor blocker.
-have more complete blockage of Angiotensin action (esp. Ang I) over ACE inhbitors |
|
|
Term
| What is the most sedative antihistamine? least sedative? |
|
Definition
Benadryl (dephenhydramine)
Allegra (fexofenadrine) |
|
|
Term
| What do decongestant drugs act as? What affect does this have on mucus membranes? |
|
Definition
vasoconstrictors to reduce blood flow via alpha receptors)
- this decreases the swelling of the mucous membranes to alleviate nasal stiffness and sinus congestion |
|
|
Term
| What are some decongestants? *** |
|
Definition
-Naphazoline (Pravine)
-Oxymetazoline (Afrin 12 hour)
-Pheylephedrine (Afrin)
-***Pseudoephedrine (Dimetapp, Sudafed, Drixoral)- NEW LAWS FOR THESE
-Tetrahydrozoline (Tyzine)
-Xylometazoline (Ortrivin) |
|
|
Term
| How should Afrin be taken? Afrin 12 hour?*** |
|
Definition
-One nostril at a time only 3 days @ a time
OTC
-once in one nostril at night, because of the ***rebound effect it will allow one nostril to rest--> drainage will be much better then through the day
-reduce consumption of stimulants such as coffee or cola
-monitor symptoms of CNS stimulation |
|
|
Term
| Any drug that crosses the BBB will either do what or what? |
|
Definition
|
|
Term
| What do antihistamines do? |
|
Definition
| symptomatic relief of allergic and vasomotor rhinitis, allergic conjunctivitis and common cold (temporary relief from runny nose/ sneezing) |
|
|
Term
| When should an antihistamine be used for skin? |
|
Definition
| allergic and non-allergic pruritic symptoms; mild urticaria and angioedema |
|
|
Term
| What should you use for anaphylactic reactions? |
|
Definition
|
|
Term
| What do antihistamines do in the body? what about in young children? |
|
Definition
binds histamine
causes drowsiness so do not mix with other drugs
photosensitivity
in young children- paradoxical excitation |
|
|
Term
| When should you not use an antihistamine? |
|
Definition
| URI, including colds and sinusitis-only allergy |
|
|
Term
| When is the only time you use an antihistamine? What should you do for a cold? |
|
Definition
-for allergies- to tighten things up
- use things that treat single symptoms... dont use a drug that treats everything |
|
|
Term
| What are intranasal steroids the most effective agents for?*** |
|
Definition
|
|
Term
| How should intranasal steroids be used? |
|
Definition
-if taste or odor issues, use products
-use for one month, then determine benefit
-do not exceed recommended doses
-demonstrate how to use before
-as soon as you can stop it, do |
|
|
Term
| What should you do for a sore throat? |
|
Definition
| -gargle and spit with warm water |
|
|
Term
| When should intranasal mast cell stabilizers be started? |
|
Definition
3-4 wks before peak allergy season
-short acting and multiple doses needed |
|
|
Term
| What is an example of a mast cell stabilizer? |
|
Definition
| Cromolyn- very effective with intermittent allergies |
|
|
Term
| Should you use mast cell stabilizers and steroids first or antihistamines? |
|
Definition
| mast cell stabilizers and steroids before you go to antihistamines |
|
|
Term
| What is a leukotriene receptor antagonist and what do they do? |
|
Definition
monotelukast sodium
-for the relief of symptoms of allergic rhinitis in adults, particularly those with asthna
-used for kids if >2 yo
-used in combo with other agents |
|
|
Term
| What are antitussives used for? |
|
Definition
to control or suppress cough (RT irritation, colds or allergies)
-is a cough syrup, has alcohol and sugar so be careful with diabetics |
|
|
Term
| Which antitussives are most effective? |
|
Definition
Narcotic (codeine)
2nd semi-synthetic Dextromethorpan (DM) |
|
|
Term
| When are antitussives best used? and what should you avoid? |
|
Definition
-best used at night to help with sleep
-avoid other CNS products |
|
|
Term
| What antitussive can be used in elderly patients bc it doesn't affect the CNS, but is often not effective? |
|
Definition
|
|
Term
| What is an expectorant? What is best to be used for the relief of a dry, non-productve cough? |
|
Definition
-tells the body to increase the amount of hydration or secretion
-water |
|
|
Term
| What are some examples of expectorants, what are they usually used in combination with? When should the patient return? |
|
Definition
-Guaifenesin, Robitussin, Mucinex
-usually ised in combination with antitussives (GG-DM)
-pt should return if cough lasts longer than 2 weeks. |
|
|
Term
| How many office visits are around Otitis media per year? By 12 mos, hoe many babies experience OM? What is the peak age for OM? |
|
Definition
-24.5 MILLION
-75%
-6 mos- 2yrs |
|
|
Term
| What is useful in the TX of AOM? |
|
Definition
|
|
Term
| In OM with effusion (OME), where does liquid accumulate? What are the symptoms usually? Is an antibiotic useful? |
|
Definition
-middle ear
-asymptomatic
-NO |
|
|
Term
| What is the onset of OME? Although is usually asymptomatic, what else might OME cause? When should you finally try antibiotics? |
|
Definition
-insidious and chronic, usually in the middle of the night----may have pain or discomfort, hearing deficit, spontaneous rupture of TM, discharge into external ear canal, vertigo.
-if lasts longer than 3 mos. |
|
|
Term
| What are Acute Otitis Media (AOM) risk factors? |
|
Definition
-season: winter
-malformations: cleft palate, adenoid hypertrophy, Down's syndrome
-age of first episode
-environment: siblings, daycare, second hand smoke, lack of breast feeding
-anatomy and the eustachian tube |
|
|
Term
| What is the microbiology of AOM? |
|
Definition
-viral (40%)
-Strep pneumoniae (~50%), H. flu becoming more prevalent due to pneumococcal conjugate vaccine
-H. Flu
-Moraxella catarrhalis
-no pathogen found |
|
|
Term
| Which population is more at risk for penicillin resistant strep. pneumoniae (PRSP)? *** |
|
Definition
-<6 yrs old
-recent antibiotics
-children with previous AOM
-group daycare due to exposure |
|
|
Term
| What is the clinical manifestation of AOM? |
|
Definition
| fever, middle ear effusion, otorrhea (due to middle ear perofration), bulging TM, limited or absent mobility of TM, opaque or cloudy TM obscuring or reducing visibility of middle ear |
|
|
Term
| How will younger pts present rapid onset of AOM? older? |
|
Definition
-ear tugging, irritability, poor sleeping and eating habits
-ear pain , fullness and hearing impairment |
|
|
Term
| If the AOM has an effusion will it take longer or shorter to resolve? |
|
Definition
|
|
Term
| When diagnosing AOM what 3 things indefinitely identify it? |
|
Definition
rapid onset of S/S
middle ear effusion findings
inflammation indicated by erythema or otalgia |
|
|
Term
| What makes an AOM severe? nonsevere? |
|
Definition
if presented with a fever > 102
with a fever <102 |
|
|
Term
| What can you use to evaluate AOM? |
|
Definition
|
|
Term
| What are the tx goals for OM? |
|
Definition
control pain
eradicate infection
prevent complications
avoid unnecessary antibiotics
minimize adverse effects of tx |
|
|
Term
| Why should OM tx be conservative versus early? |
|
Definition
-81% dissolve on their own
-really just need to treat symptoms with an analgesic and 72 hours... unless is a pt |
|
|
Term
| In AOM, what are some symptomatic treatments? |
|
Definition
| analgesics, antipyretic, local heat, tympanosotomy tubes |
|
|
Term
| When treating AOM, what are some reasons you are conservative with antibiotics? |
|
Definition
susceptibility
penetration into middle ear
efficacy
compliance
adverse effects
costs |
|
|
Term
| By how much do tympanosotomy tubes reduce recurrent episodes? |
|
Definition
|
|
Term
| What are the treatments for AOM?*** |
|
Definition
Amoxicillin
80-90 mg/kg/day in 2 doses (child)
875 mg BID (adults)
If have a penicillin allergy, then:
Erythromycin/sulfisoxazole
50 mg erythromycin/kg/day in 3-4 doses
(dosed by erythromycin component)
Trimethoprim/sulfamethoxazole
8-10 mg tmp/kg/day BID (child)
1 double-strength tablet BID (adult)
Azithromycin or clarithromycin |
|
|
Term
| How id treatment failure defined in AOM? What should you use then? |
|
Definition
by lack of improvement over 3 days.
-Amoxicillin-clavulanate
-Second or third generation cephalosporins Cefuroxime, cefpodoxime, cefdinir |
|
|
Term
| What does the duration of therapy depend on in AOM? |
|
Definition
pt age and disease severity
standard 10 day oral therapy |
|
|
Term
| Who needs prophylaxis in AOM? What did prophylaxis used to be? What is it now? |
|
Definition
Antibiotic prophylaxis previously used in children with more than 3 episodes in 6 months or ≥4 episodes in a year
Amoxicillin 20-30 mg/kg/day given QHS or split q 12 h
No longer recommended for otitis-prone children due to increasing resistance
Tympanostomy tubes
Influenza vaccine
More effective in preventing AOM in children >2yrs
Pneumococcal vaccine
Protective against infection by vaccine serotypes only with limited overall benefit for AOM |
|
|
Term
|
Definition
Infection & inflammation of external auditory canal
Microbiology
-Staphylococcus aureus
-Group A strep
-Pseudomonas aeruginosa
-Aspergillus |
|
|
Term
| What are the categories of otitis externa? |
|
Definition
Acute localized
-Most common
-Similar to staphylococcal infections of skin & hair follicles
-Intense pain & tenderness, local erythema, heat
Acute diffuse
-“swimmer’s ear” (water gets under wax-great media)
-Acute infection, usually secondary to S.aureus
-Usually gram negative organisms: Proteus sp., Enterobacteriaceae, Pseudomonas aeruginosa. can be fungal (rare)
-Hot, humid climates, contaminated hot tubes
-Canal erythematous, edematous, severe cases hemorrhagic
Chronic
-Complication of persistent chronic otitis media and drainage into the external ear canal causing chronic irritation
-Itching is main symptom, usually secondary to seborrhea (dandruff)
Malignant or invasive
-Severe necrotizing infection with invasion into surrounding tissues including cartilage & bone
-Psuedomonas aeuroginosa is most common cause (>90%)
-Groups at risk: immunocompromised, elderly , & diabetics |
|
|
Term
| What is the tx for otitis externa? |
|
Definition
Gentle cleansing
-Irrigation with hypertonic (3%) saline and cleansing with alcohol and acetic acid mixed 1:1
-For chronic and swimmers ear [also use dandruff shampoo for chronic when dandruff is present]
Topical: Cortisporin® eardrops (neomycin/polymyxin B/hydrocortisone) QID
-For chronic and swimmers ear
Quinolone eardrops: ofloxacin 0.3% BID or Cortisporin® drops QID
-Swimmers ear
-IV imipenem, IV meropenem or IV Cipro
-Malignant otitis externa in high risk groups
-Debridement usually required, Rule/out osteomyelitis (if bone involved – tx for 4-6 weeks) |
|
|
Term
|
Definition
-Acute sore throat infection caused by viruses or bacteria
-In US, 15 million pts/yr seek care for sore throat
-Inflammation of pharynx and surrounding lymphoid tissue
-Most self-limited 2-7 days |
|
|
Term
| When pharyngitis is a part of a URI, what are the causes? What are the bacterial causes? |
|
Definition
Component of URI caused by:
Parainfluenza virus
Epstein-Barr virus
Coronavirus
Adenovirus
Influenza virus
Rhinovirus
Bacterial-Group A B-hemolytic streptococci (GAS)
--Streptococcus pyogenes
--Most common bacterial cause |
|
|
Term
| How is GAS pharyngitis presented? |
|
Definition
Sore throat with dysphagia
Fever
Red throat
Enlarged tonsils
Tonsillar exudates & vesicles possible
Cervical lymph nodes
Scarlet rash
Rheumatic fever
Acute Glomerulonephritis |
|
|
Term
| What other conditions can cause sore throat? |
|
Definition
GERD
Postnasal drop
Allergies
-these are not infectious |
|
|
Term
| What can make the diagnosis of streptococcal pharyngitis diagnosis? |
|
Definition
Rapid antigen detection test (RADT)
-80-90% sensitivity, results in minutes
Throat swab & culture “Gold Standard”
-results in 24-48 hours
-Perform on negative RADTs in pts with significant pediatric contact
Perform these tests only if there’s a clinical suspicion of streptococcal pharyngitis
Pharyngeal carriage of group A streptococci is 5-20% in children
-Risk factor for developing streptococcal pharyngitis after a break in mucosal integrity |
|
|
Term
| Who should have a throat culture?*** |
|
Definition
****Children aged 4-15 yrs with elevated temp & sore throat as primary complaint
Close contact with strep pharyngitis
History of rheumatic fever or heart disease
Epidemic of GAS or Corynebacterium diptheria |
|
|
Term
| What else do adults have when they present with pharyngitis? |
|
Definition
Fever over 38 c (101 F)
Tonsillar exudate
Absence of cough
Swollen, tender, anterior cervical lymph nodes |
|
|
Term
| In pharyngitis, what are the goals of tx? |
|
Definition
Resolve symptoms
Limit spread of infection
Prevent complications
Untreated or inappropriately treated disease caused acute rheumatic fever, potential permanent heart valve damage, and infectious complications |
|
|
Term
|
Definition
Autoimmune disorder
Destruction of heart valves
Polyarthritis
chorea |
|
|
Term
| How does Scarlet fever present? |
|
Definition
Strep toxic shock-like syndrome
Toxin mediated complication
Hypotension, multiorgan failure, erythematous rash, desquamation |
|
|
Term
| With what antibiotics should you treat GAS in pharyngitis? |
|
Definition
Shortens course of disease
Prevents rheumatic fever
Reduces period of contagiousness to 24 hrs
Limits spread of infection
Reduces complications |
|
|
Term
| How long can tx be delayed, and still prevent rheumatic fever? |
|
Definition
|
|
Term
| What is the tx of pharyngitis? |
|
Definition
Analgesics
Fluids
Lozenges
Saltwater gargle
Antibiotics |
|
|
Term
| What is the first line tx of pharyngitis? What about in penicillin allergic pts? |
|
Definition
Penicillin VK
-50 mg/kg/day divided q 8 hrs (child)
-Penicillin V 500 mg q 8 hrs (adult)
Amoxicillin
-40 mg/kg/day divided q 8 hrs (child)
-500 mg q 8 hrs (adult)
If Penicillin allergic pts:
1st gen cephalosporin (Keflex)
Erythromycin
Clarithromycin
Azithromycin
Treat x 10 days (except azithro x 5) |
|
|
Term
| Why are sulfonamides not used in pharyngitis? |
|
Definition
| even with susceptible strains, does not prevent rheumatic fever |
|
|
Term
| How does sinusitis most commonly develop? How many develop into bacterial infections? |
|
Definition
-as a complication of a viral infection
-0.5-2% |
|
|
Term
|
Definition
| caused by mucosal inflammation and local damage to mucociliary clearance mechanisms from viral infection or allergy |
|
|
Term
| What is the pathophys on sinusitis? What is this blockage ideal for? |
|
Definition
-Reduced mucus clearance – leads to blockage of opening of sinuses to the upper airway
-Ideal for bacterial growth, promotes cycle of mucosal injury and local inflammatory response |
|
|
Term
|
Definition
Nose blowing
Viral virulence
Pharyngeal colonization with bacteria
Reduced local immunity |
|
|
Term
| How long does an acute sinus infection last? subacute? chronic? |
|
Definition
2-4 wks
4-8 wks
>8 wks, >3-4 episodes/ yr, and repeated failure to respond to therapy |
|
|
Term
| How does sinusitis present? |
|
Definition
Mucopurulent nasal discharge
Nasal congestion/postnasal drainage
Facial pain/sinus tenderness/pressure
Maxillary toothache
Fever
Headache
Cough
Sore throat
Halitosis, malaise fever, chills, periorbital swelling
many pts with common cold have radiographic evidence of sinusitis by day 7. |
|
|
Term
| How is sinusitis diagnosed? |
|
Definition
Transillumination of the maxillary sinuses
CT or MRI
Sinus puncture w/ aspiration & culture
>105 colony forming units/ml |
|
|
Term
| What are the tx goals of sinusitis? |
|
Definition
Symptom relief
Restore sinus function
Prevent intracranial complications
-Periorbital cellulitis
-Meningitis
-Facial osteomyelitis
Prevent progression to chronic sinusitis
Eradicate pathogens |
|
|
Term
| What is the tx of sinusitis? What if they are penicillin resistant? How long should this last? |
|
Definition
Amoxicillin
-Children: 90 mg/kg/day in 2 doses
-Adults: 500 mg tid
Amoxicillin -clavulanate
-Children: 90 mg/kg/day in 2 doses
-Adults: 875 mg bid
Cefdinir
-Children: 14 mg/kg/day in 1-2 doses
-Adults: 600 mg/day in 2 doses
Penicillin allergic
-Clarithromycin or azithromycin
-Trimethoprim-sulfamethoxazole
-Doxycycline (if pt is >18yrs)
Treat for 10 -14 days (except azithromycin x 5) |
|
|
Term
| What is the primary treatment for sinusotos patients who are unresponsive in 48-72 hrs? secondary? |
|
Definition
Amoxicillin-clavulanate
Beta-lactamase stable cephalosporin active against S. Pneumo (cefuroxime, cefpodoxime)
Azithromycin, clarithromycin
Fluroquinolone (levofloxacin, gatifloxicin, moxifloxacin)
TMP-SMX |
|
|
Term
| What is some adjunctive therapy of treatment? |
|
Definition
Topical & systemic decongestants
-Phenylephrine or oxymetazoline
-pseudoephedrine
Intranasal steroids
*Try to avoid antihistamines |
|
|
