Health Information Exam 2

Helpfulness: 0
Set Details Share
created 5 weeks ago by YaniseHurt
2 views
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

Causes of dry eye

  • Aging (postmenopausal)
  • Underlying diseases
  • Recent surgical procedure
  • Systemic Medication: Anticholinergic (decongestants, diuretics, B-Blockers)
  • Autoimmune Agents: Cyclosporine
  • Allergens + environmental conditions (heat, air conditioning)
2

Chief Complaint

  • Sandy/ Gritty eyes
  • Itchy
  • Burning
  • Feeling like something is in the eyes
  • XS tears
3

Treatment goals

  • Alleviate dryness of ocular surface  Relieve symptoms of irritation
  • Prevent corneal/ noncorneal tissue damage
4

Pharm Therapy

Ocular lubricants

5

Ocular lubricant types

  • Non-medicated ointment
  • Gels
  • Artificial tears
  • Immunomodulating Agents
  • Vitamin A Preparations
6

Non-medicated ointment:

Recommendations

Purpose

AE

  • Recommend preservative-free non-medicated ointments
  • For minor disorders
  • Can cause blurred vision
7

How to prevent blurred vision for ointment

Use ointment + artificial tears

8

Artificial tears:

Mild

Moderate

Severe

  • Mild: Low viscosity 1x-2x/ day + follow up in 1 week
  • Moderate: Low or high viscosity 3x-4x/ day + follow up in 1 week
    • More viscous = prolonged ocular contact time/ greater resistance to tear dilution
  • Severe: Preservative-free artificial tears used every hour prn + nighttime use of ointment + following up in 1 week
9

Immunomodulating Agents

Topical cyclosporine + ocular surface lubrication

10

AE of products

  • Burning, stinging, discomfort
11

Non-pharm therapy

  • Warm/ cold compresses
  • Maintaining good eyelid hygiene
  • Systemic Omega-3 FA supplement (flaxseed oil)
  • Using humidifiers
  • Avoid prolonged use of computers
  • Wearing eye protection (glasses/ sunglasses/ goggles)
  • Wearing glasses instead of contacts
  • Environmental modifications (positioning workstation away from heat/ air conditioning)
  • Eliminating topical/ systemic medications
12

Exclusion factors

  • Eye pain
  • Blurred vision not associated with ophthalmic ointment
  • Sensitivity to light
  • History of contact wearing
  • Blunt trauma to the eye
  • Chemical exposure
  • Heat exposure (excluding the sun)
  • Symptoms persistent for > 72 hours
13

Allergic Conjunctivitis

Topic

14

Causes

  • Allergens
  • Pollen
  • Dander
  • Topical eye preparations
  • Seasonal allergy rhinitis
15

CC

  • Red eye
  • Watery discharge
  • Pruritis (itching)
16

Treatment goals

  • Remove/ avoid allergen
  • Limit/ reduce the severity of the allergic reaction
  • Provide systemic relief
  • Protects the ocular surface
17

Pharm therapy first line

Artificial tears

18

Other pharm therapy

  • Antihistamine/ Mast Cell Stabilizers
  • Ketotifen Fumarate
  • Decongestants
19

Antihistamine/ Mast Cell Stabilizers

Antazoline Phosphate

20

Purpose

  • Pupillary dilation
21

Decongestants

  • Phenylephrine
  • Zolines
22

AE of decongestants

Rebound conjunctivitis hyperemia

23

Contraindication

Angle-closure glaucoma/ pregnancy

24

Non-pharm therapy

  • Remove/ avoid exposure to allergen
  • Apply a cold compress 3-4 times/ day
  • Check pollen count
  • Run air conditioning
  • Use air filters
  • Wear sunglasses to shield wind and allergens
25

Exclusion factors

  • Eye pain
  • Blurred vision not associated with ophthalmic ointment
  • Sensitivity to light
  • History of contact wearing
  • Blunt trauma to the eye
  • Chemical exposure
  • Heat exposure (excluding the sun)
  • Symptoms persistent for > 72 hours
26

Impacted Cerumen Wax

Topic

27

CC

  • Ear fullness
  • Dull pain
  • Discomfort
  • Itching
  • Hearing loss
  • Tinnitus
  • Dizziness
  • Vertigo
  • Cough
  • Hearing aid malfunction
28

Treatment goals

Remove the cerumen (wax)

29

Pharm therapy first line

Carbamide Peroxide 6.5% in Anhydrous Glycerin

30

Other pharm therapy

  • Docusate Sodium
  • Hydrogen Peroxide
  • Olive Oil (Sweet Oil)
31

How to administer

Carbamide Peroxide 6.5% in Anhydrous Glycerin

  • Aural irrigation technique
  • Hardened or impacted earwax
  • 5-10 drops in affected ear + solution should remain in the ear for 15 minutes
32

Non-pharm therapy

  • Can only be done when the wax has migrated to the outermost portion of the WAR
  • Remove wax with Curette
33

What should never be done

Do not use cotton-tipped swaps

34

Exclusion factors

  • Signs of infection
  • Pain associated with discharge
  • Bleeding/ trauma
  • Ruptured lymphatic membrane
  • Ear surgery within the last 6-weeks
  • Tubes
  • Incapable of following instructions
  • Hypersensitivity to recommended agents
  • Younger than 12 years old
35

Water Clogged ears

Topic

36

CC

  • Ear fullness
  • Localized discomfort
  • Hearing impairment
  • Swelling, skin maceration, itching, infection
    • Caused by heat and humidity
37

Treatment goal

  • Dry using safe/ effective agents
  • HCP should rule out a ruptured tympanic membrane and inner tubes
38

First-line pharm therapy

  • Isopropyl Alcohol 95% in Anhydrous Glycerin 5%
39

Minimum age

  • No minimum age
40

Application process

  • Apply 4-5 drops
  • If burning ensues, provide referral
41

Other pharm therapy

  • Acetic Acid + Water
  • Acetic Acid + Isopropyl Alcohol
42

AE of Acetic Acid + other component

Pseudomonas, Candida, and Aspergillus are susceptible to this agent

43

Non-pharm therapy

  • Earplugs
  • Head cap
44

Before applying earplugs

Cotton swabs coating “waterproofed” with petroleum jelly

45

After applying earplugs

  • Absorbs trapped water
    • Children 11 years and older (Clear Ears)
    • After 5-10 minutes of Clear Ear use blow dryer on low or tilt head
46

Exclusion factors

  • Signs of infection
  • Pain associated with discharge
  • Bleeding/ trauma
  • Ruptured lymphatic membrane
  • Ear surgery within the last 6-weeks
  • Tubes
  • Incapable of following instructions
  • Hypersensitivity to recommended agents
47

Recurrent Aphthous Stomatitis (RAS):

Topic

48

RAS disorders

Canker Sore

Aphthous Ulcer

49

Causes

  • Systemic Factors: Behcet Disease, Lupus, Neutrophil dysfunction, IBD, HIV
  • Local Factors: (smoking, chemical irritation, biting inside of mouth)
  • Immunologic
  • Genetic
  • Allergic
  • Nutritional
  • Streptococci Infectious agents
  • Varicella-Zoster virus Infectious Agent’s
50

CC

  • Epithelial ulceration on the nonkeratinized mucosal surface
  • Located on “moveable mouth”: Tongue, the floor of the mouth, soft palate, the lining of lip or cheek
  • Round/ Oval
  • Grey-yellow or grey
  • Pain
51

Treatment goals

  • Relieve symptoms
  • Cannot be cured
52

Pharm Therapy

  • Topical Oral Anesthetics
  • Oral debriding/ wound cleaning
  • Topical protectants
  • Oral rinses
  • Systemic analgesic
53

Topical Oral Anesthetics

  • Caine’s
  • Benzyl alcohol
  • Dyclonine
  • Hexylresorcinol
  • Salicylic Alcohol
54

Oral debriding/ wound cleaning

  • Hydrogen Peroxide
  • Carbamide Peroxide
55

Oral Rinses

Saline Rinses

56

Systemic analgesic

Aspirin

NSAIDs

Acetaminophen

57

Non-pharm therapy

Nutritional deficient

Allergy

Stress

Ice

58

Nutritional deficient

Allergy

Stress

Ice

Nutritional deficient: Increase consumption of foods/ supplements high in deficient nutrients

Allergy: Eliminate exposure to the allergen

Stress: Relaxations + Stress removal

Ice: Numbing effect

59

Exclusion factors

  • Lesion associated by underlying pathology
  • Lesion presented for > 14 days
  • Frequent, recurrent lesion
  • Symptoms of systemic illness
60

Herpes Simplex Labialis

Topic

61

Causes

  • UV light
  • Stress
  • Fatigue
  • Cold
  • Wind burn
  • Fever
  • Injury
  • Menstruation
  • Dental work
  • Infectious Disease
  • Factors that suppress immune system (Chemotherapy, Radiation therapy, etc.)
62

CC

  • Lip lesion (Red papules)
    • Crust on/ around lesion  Secondary bacterial infection: require antibiotics)
  • Burning/ pain
  • Pruritus (Itching)
  • Tingling + Numbness
  • Fever
  • Localized bleeding
  • Swollen lymph nodes
  • Malaise
63

Treatment goals

  • Relieve symptoms
  • Prevent secondary infection+ curtail the spread of infection
64

Pharm therapy

  • Topical skin protectants
  • Analgesics/ Anesthetics: Caine’s + Benzos
  • Topical Docosanol 10% aka Abreva (decreases duration of the outbreak)
  • Triple antibiotic ointment
65

What should not be used

NO hydrocortisone

66

Instructions for Topical skin protectant

Use 3-4 times a day after meals + avoid drinking for 30 minutes after application

67

Instructions for triple antibiotic

3-4x a days for secondary infection

68

Non-pharm therapy

  • Keep lesions clean: wash with mild soap
  • Hand washing to prevent contamination + minimize autoinoculation of virus
  • Keep skin moist
    • Dry, cracking skin can cause secondary infection
    • Sunscreen
69

Exclusion factors

  • Lesion presented for > 14 days
  • Increased frequent, recurrent lesion
  • Compromised immune system
  • Symptoms of infection: Fever, swollen glands, rash, etc.
  • No previous diagnosis of cold sore
70

Acne

Topic

71

Treatment goals

  • Elimination of visual lesions that occur during the acute phase of acne
  • Maintain treatment that prevent relapse
  • Implement adjunctive procedures that treat scarring or other complications that result from acne
72

Pharm therapy: First line

  • Adapalene gel 0.1% (Differin Gel)
73

Other pharm therapy

Benzoyl Peroxide (Most common topical acne product)

Hydroxy Acids

Sulfur precipitated or colloidal

Sulfur/ Resorcinol

74

Nodal

Refer

75

Non-nodal

Acne products

76

Cut off

6 weeks

77

Exclusion factors

  • Moderate-Severe acne
  • Exacerbation factors
    • Comedogenic drugs
    • Mechanical irritants
  • Possible Rosacea
78

First-line MOA

  • Modulate epithelial cell differentiation, keratinization, and inflammation
79

Application

  • Apply a thin layer to skin once daily
  • Increases susceptibility to sunburn (protect from sun exposure)
80

SE

Redness, scaling, dryness, itching, and burning

81

When will full therapeutic effect be noticed

8-12 weeks

82

About Benzoyl Peroxide

  • Keratolytic and antibacterial properties
  • Kills bacteria by introducing oxygen into the environment
  • More effective when used with a topical antibiotics (clindamycin or erythromycin)
  • Available in 2.5%-10% as a gel, wash, or cream
  • May cause photosensitivity = avoid sun exposure
  • Side Effects: mild erythema, and scaling allergic contact dermatitis
    • BP + Salicylic Acid ACD range for local irritation to local/ systemic hypersensitivity
83

About Hydroxy Acids

  • Keratolytic Agents (such as alpha-hydroxy acids—AHAs)
  • Another common acne product
  • Less potent and used when patients cannot tolerate other products
  • Polyhydroxy acids—fewer AE’s + better for pts with clinical sensitivities
  • Salicylic Acids—milder, less effective treatment
    • Use 1-3 times/ day prn
84

About Sulfur

  • Keratolytic and antibacterial effects
  • Side Effect: Comedogenic (blocks pores and causes blackheads)
  • AE: odor, dry skin
  • Alternative forms of sulfur (sodium thiosulfate, zinc sulfate, and zinc sulfide) are not safe/ effective
85

About Sulfur/ Resorcinol

  • Resorcinol enhances the effect of sulfur
  • Primarily used as a Keratolytic
    • Resorcinol is not effective use as a monotherapy
86

Special Populations

  • Pregnancy
  • Pediatrics
87

Non-pharm therapy

  • Cleanse face with mild soap or non-soap cleanser 2 x/day
  • Stay well hydrated
  • Appropriate use of facial toners
    • Overuse causes skin irritation
  • Alter diet by eliminating or reduce the intake of foods with a high glycemic index
88

Burns + Sunburns

Topic

89

CC Stage I

  • Epidermis only
  • Red, non-blanched, unbroken, non-blistered
  • Erythema
  • Slight dermal edema
90

CC Stage II

  • Laceration + punctures
  • Blistering, partial-thickness skin loss (involves epidermis and dermis)
  • Break in the skin, drainage from wound, pain, edema, erythema
  • Fever, vomiting, chills, weakness, shock
  • Prone to infection
  • Can be managed is only 1-2% of BSA
  • Refer: more than 10% of BSA impacted, Stage II burns in children, multiple medical issues
91

CC Stage III

  • Full thickness burns with deep lacerations + punctures
    • Damage to epidermis, dermis, and dermal appendages
92

Pharm Therapy

  • Topical antibiotics + Antiseptic preparations
    • Prevent secondary infection
93

Non-pharm therapy (Stages I + II)

  • Clean area with saline or water for irrigation
  • Mechanical cleaning with gauze
  • Soak in soap water 4 times/ day
  • Continuous cooling for the first 10 minutes
    • Dissipates heat, removes pain + delays onset and minimizes burn edema
  • Nonadherent hypoallergenic dressing
  • If chemicals get into the eye rinse and contact area poison immediately
94

What should be avioded

Ice packs

Causes numbness and intense vasoconstriction

95

Exclusion Factors

  • 2%+ of BSA
    • Use Rule of Nines
  • Superficial partial-thickness or deeper injury during initial or 24-48 assessment
  • Stage III and IV
    • Animal bites, puncture wounds, severe burns
96

Vulvovaginal Candidiasis

Topic

97

CC

  • No pH changes
  • Irritation
  • Itching
  • No odor
  • Thick, white discharge
98

Pharm Therapy

  • Imidazole (clotrimazole, miconazole, tioconazole)
    • Initial, uncomplicated VVC
99

AE

  • CYP450-I
    • Decreases the synthesis of fungal sterol ergosterol
  • Burning
  • Itching
  • Irritation
  • D-D-I
    • Warfarin = Increases bleeding by decreasing the elimination
      • Both compete for elimination via CYP2C9
100

Non-pharm therapy

  • Consuming yogurt
  • D/C drugs known to increase susceptibility
    • Low dose oral contraceptive will not cause VVC
101

Exclusion factors

  • < 12 years old
  • Pregnancy
  • Concurrent symptoms: fever, pain in the pelvic area, lower abs
  • Medication that causes VVC (Corticosteriods / antineoplastics)
  • Medical disorders that cause VVC (db, HIV)
  • Recurrent VCC (>3 per year)
102

Atrophic Vaginitis

Topic

103

Causes

  • Inflammation of the vagina related to atrophy of vaginal mucosa secondary to decreases estrogen levels
    • Post-menopause  epithelium become thin causing a decline in vaginal lubrication
    • Decrease in estrogen levels
      • Breastfeeding, recently given birth
    • GnRH agonists
    • Aromatase-I
104

CC

  • Vaginal irritation
  • Dryness
  • Burning
  • Itching
  • Leukorrhea
  • Dyspareunia
  • Thin, water (occasionally bloody), or yellow malodorous discharge
105

Treatment goals

  • Reduce/ eliminate dryness, burning, and itching
  • Eliminate dyspareunia
106

Pharm therapy

  • Water soluble lubricating products
107

Exclusion factors

  • Severe dryness, dyspareunia, or bleeding
  • Symptoms that are not localized
  • Dryness or dyspareunia not relieved by lubricants
108

Insomnia

Topic

109

Classification

  • Transient: Self-limiting + lasts less than 1 week
  • Short term: Lasts 1-3 weeks
  • Chronic/ Long-term: 3+ weeks (sometimes years)
    • Usually, a result of medical issues
110

Primary insomnia

Sleeping difficulties lasts at least 1 month + affects

111

Causes

  • Stress
  • Work schedule
  • Caffeine
  • Medications
  • Antidepressants, Antihypertensives, Sympathomimetics (pseudoprime, phenylephrine), L-Dopa
  • Drugs for recreational use
  • Last night eating or exercising
  • Psychiatric disorders
  • Alcohol use + withdrawal
112

CC

  • Difficulty falling asleep
  • Frequently waking up
  • Early morning awakening and inability to go back to sleep
  • Unusual/ troublesome dreams
113

Important to remember

  • Insomnia: inability to fall asleep within 30 minutes
  • OTC Meds: for pts who have difficulty falling asleep/ not those who wake up nightly
114

Pharm Therapy:

Transient + Short-term

  • Antihistamines
115

Pharm Therapy:

Feels rested in the morning + Functional during the day

  • Sleep Hygiene Measures + follow up in 14 days
116

Pharm Therapy:

Problem related to use of stimulants (Alcohol, Caffeine, Nicotine)

  • Cessation/ Moderation of consumption
  • Avoidance of stimulants in late evening
  • Follow up in 10 days
117

Pharm Therapy:

Problems related to lifestyle practices, poor sleep, stress

  • Sleep hygiene measures + diphenhydramine 25mg-50mg for 2-3 nights, skip a night, and re-evaluate
  • Only use agent for 10 days + if not resolved refer
118

Pharm Therapy:

Episodic Insomnia

  • Sleep hygiene measures + diphenhydramine 25mg-50mg for 2-3 nights, skip a night and re-evaluate
  • Only use agent for 10 days + if not resolved refer
119

Non-pharm therapy

  • Cognitive Behavioral Therapy for Insomnia (CBI)
  • Practicing good sleep hygiene
120

Exclusion factors

  • Less than 12 years old
  • 65 years old and older
  • Pregnant
  • Frequent nocturnal awakening/ early morning awakening
  • Chronic insomnia (> 3 weeks)
  • Sleep disturbance secondary to psychiatric/ general medical disorders
121

Special populations

  • Pregnancy + lactating
  • Children
    • Due to lifestyle issues
  • Geriatric
    • Due to anticholinergic effect
  • Angle-Closure glaucoma
    • Increases interocular pressure
  • Prostatic Hyperplasia
    • Urinary retention