Respiratory/renal Allergies And Asthma Test 2 Set2

Front 1

Etiology of...
a)acute cough (2)
b)subacute cough (3)
c)chronic cough (4)

Back 1

a)3 weeks or less, viral upper respiratory infexn

b)post infectious cough, bacterial sinusitis, asthma

c)post nasal drip, asthma, GERD, meds

Front 2

Pathophysiology of Cough Reflex (3)

Back 2

1)defensive respiratory tract reflex
2)deep inspiration followed by closure of glottis and forceful contraction of chest
3)mucus, cell debris, foreign stuff propelled out

Front 3

Productive Cough? (5)

Back 3

1)wet/chesty cough
2)Secretions may be clear,
3)purulent
4)discolored
5)malodorous

Front 4

Non-productive Cough (5)

Back 4

1)dry/hacking cough
2)caused by viral respiratory infexn
3)GERD
4)cardiac disease
5)meds (ACEI, BB)

Front 5

Common complications of Cough (5)

Less common complications of cough (4)

Back 5

a1)fatigue/insomnia
a2)hoarsness
a3)muscle pain
a4)excessive perspiration
a5)urinary incontinence

b1)cardiac dysrhythmias
b2)syncope
b3)stroke
b4)rib fractures

Front 6

Cough exclusions to self-treatment (10)******

Back 6

1)cough w/ thick yellow sputum or green phlegm
2)fever over 101.5
3)unintended wt loss
4)night sweats
5)hemoptysis (blood in cough)
6)chronic underlying disease associated w/ cough
7)foreign object aspiration
8)possible drug associated cough
9)cough over 7d
10)cough that worsens during self-treatment or new sx

Front 7

Goals of cough treatment (3)

Back 7

1)reduce #/severity of episodes
2)prevent complications
3)Tx is symptomatic; underlying disorder must be treated for resolution

Front 8

Nonpharmacologic treatment of cough (3)

Back 8

1)cool mist humidifiers
2)non-medicated lozenges/hard candy
3)incr hydration

Front 9

Pharmacologic therapy of cough involves.... (4)

Back 9

1)systemic antitussives
2)diphenhydramine
3)expectorants
4)topical antitussives

Front 10

Systemic Antitussives use in cough (3) and 3 products

Back 10

1)drugs of choice for NON-PRODUCTIVE COUGH
2)no use in productive cough unless absolutely necessary
3)retention of lower respiratory secretions may lead to adverse consequences

1)codeine
2)DXM
3)diphenhydramine

Front 11

Codeine
a)MOA
b)ADR's (3)
c)drug interactions

Back 11

a)acts centrally on respiratory center in medulla to INCR COUGH THRESHOLD
b1)sedation
b2)n/v
b3)constipation w/ chronic use
c)CNS depressants

Front 12

DXM
a)mechanism
b)ADRs (3)

Back 12

a)non-opoid antitussive w/ same mechanism as codeine
b1)possible drowsy
b2)n/v
b3)constipation

Front 13

When to use DXM w/ productive cough?

Back 13

if can't sleep

Front 14

Diphenhydramine
a)MOA
b)drug interactions (2)

Back 14

a)incr cough threshold (NOT FIRST LINE)

b1)incr depressant effects of narcotics, bzd's, alcohol
b2)incr anticholinergic effects of antimuscarinics

Front 15

Dosing of Antitussives
a)codeine
b)DXM
c)diphenhydramine
in adults

Back 15

a)10-20mg q4-6h (max 120mg/d)
b)10-20mg q4-8h OR 30mg q8h (max 120mg/d)
c)25mg q4-6h (max 150mg/d)

Front 16

Only FDA approved expectorant indicated for symptomatic relief of ACUTE, PRODUCTIVE COUGH and mechanism (3)

Back 16

guaifenesin

1)loosens and thins lower respiratory tract secretion
2)few data support its efficacy
3)incr water intake necessary to see effect

Front 17

Guaifenesin available in... (3)

Back 17

1)XR tablets (mucinex)
2)oral solutions/syrups (robitussin)
3)combo products (robitussin DM, tussi-bid)

Front 18

Guaifenesin dosages
a)adults
b)kids 6-12yo
c)kids 2-6yo
d)ADR's (4)

Back 18

a)200-400mg q4h (max 2400mg/d)
b)100-200mg q4h (max 1200mg/d)
c)50-100mg q4h (max 600mg/d)

d1)n/v/diarrhea
d2)dizzy/drowsy
d3)HA
d4)rash

Front 19

Topical Antitussives
a)2 approved
b)dosage forms of em (4)
c)MOA

Back 19

a)Camphor and Menthol

b1)ointments
b2)steam inhalants
b3)patches
b4)lozenges

c)inhaled vapors stim sensory nerves in nose and mucosa creating anesthetic sensation and improved airflow

Front 20

Topical Antitussives
a)ADR (7)

Back 20

1)ointments, solutions, patches are TOXIC IF INGESTED
2)toxicities include burning
3)n/v
4)restlessness
5)seizure
6)death
7)NOT DRUG OF CHOICE IN KIDS

Front 21

Admin guidelines of Topical Antitussives
a)ointments
b)lozenges
c)steam inhalation

Back 21

a)rub thick layer on chest/throat (may repeat TID)

b)allow to dissolve slowly in mouth (may repeat hourly)

c)add 1 tbsp of solution per quart of water in hot steam vaporizer (may repeat TID)

Front 22

Final counseling tips for Cough/cold (6)

Back 22

1)determine if pt has any exclusions for self treatment
2)determine what pt primary complaint is (goal is to treat only sx the pt is experiencing)
3)is cough productive or not
4)inquire about other meds (OTC and Rx)
5)choose product best suits pt and counsel proper use
6)refer if necessary

Front 23

Where does a Chalazion occur?

Back 23

Melbomian glands

Front 24

___ produces aqueous humor
___ changes lens shape to focus

Back 24

a)ciliary body
b)ciliary zonules

Front 25

___ vascular layer (feeds blood to retina)

Back 25

choroid

Front 26

_____ has to do w/ open/closed angle glacoma

Back 26

anterior chamber

Front 27

_____ is the beginning of drainage canal to nasal cavity

Back 27

superior/inferior punctum

Front 28

2 major fxns of eyelid

Back 28

1)protect the front surface of the eye from trauma by reflex neural mechanisms
2)spread secretions from glandular tissues found within the eye

Front 29

3 layers and desc of eyelid

Back 29

a)outer layer- composed of skin
b)inner layer- thin mucocutaneous epithelial layer, termed the palpebral conjunctiva
c)intermediate lyaer- muscles that open/close eye (also has sebaceous/lacrimal glands)

Front 30

Sebaceous glands
a)3 of em
b)location
c)fxn

Back 30

a)meibomian, Zeis, Moll
b)openings of which are located near the eyelashes (cilia)
c)produce secretions present in lipid layer of tears

Front 31

Lacrimal glands
a)2 of em
b)location
c)fxn

Back 31

a)Krause, Wolfring
b)openings are deep within palpebral conjunctiva, toward the outer region of inner eyelids near jxn of eyeball
c)produce watery secretions present in aqueous layer of tears

Front 32

Tear fxns (3)

Back 32

1)keep ocular surface lubricated
2)provide medium to remove debris that gets in eye
3)carry antimicrobial agents (enzymes/Ig) which protect against infexn

Front 33

Tear film compositions (3 layers and desc)

Back 33

a)inner layer- allows middle and outer mlayers to have constant adhestion across eye surface (mucinous in nature)
b)middle layer- wetting properties of tear film (aqueous in nature)
c)outer layer- retards evaporation of middle layer (lipid in nature)

Front 34

Tear production
a)normal volume
b)turnover?
c)when incr?
d)tear DYNAMICS contribute to...

Back 34

a)1-2microliters per minute (total eye volume 7-10microliters)
b)16% of the total eye volume per minute
c)up to 300% w/ irritation due to reflex tearing
d)difficulty of maintaining a constant drug [] in eye (90% of dose may be lost)

Front 35

Normal tear drainage path (5)

Back 35

1)outer portion of eyelids
2)diagonally toward nose to inferior/superior punctum
3)then to lacrimal sac
4)inferior rubinate
5)highly vascularized epithelium (this is where systemic absorption of eyedrops occurs)

Front 36

Sclera
a)what is it?
b)2 parts
c)other

Back 36

a)collagen layer that supports globe (eyeball) and contains the internal eye components
b)Episclera, bulbar conjunctiva
c)the 2 parts are source of visible redness in external eye

Front 37

Episclera?

Back 37

overlies the sclera

Front 38

Bulbar Conjunctiva (3)

Back 38

1)layer on top of episclera
2)which is continuous w/ palpebral conjunctiva @ jxn of eyelid and ocular surface
3)intersection known as fornix

Front 39

Cornea
a)def
b)5 layers

Back 39

a)aspheric, avascular that is the first light refractive element of the eye

b1)Epithelium
b2)Bauman's layer
b3)Descemet's membrane
b4)Stroma
b5)Endothelium

Front 40

Desc of...
a)Epithelium
b)Bauman's layer
c)Descemet's membrane
d)Stroma
e)Endothelium

Back 40

a)lipophilic and maintains corneal hy
b)protective
c)protective
d)hydrophilic
e)lipophilic and maintains corneal hydration

Front 41

Cornea effects on drugs (2)

Back 41

1)it is biphasic so eye drugs must have hydrophilic and lipophilic properties
2)damage to corneal epithelium can alter drug absorption rates

Front 42

Anterior chamber of eye characteristics (3)

Back 42

1)directly behind cornea and filled w/ aq. humor
2)aq humor made by ciliary body and drained by meshwork thru Schlemm
3)aq humor maintains constant internal eye pressure and provides nutrients

Front 43

Iris (3)

Back 43

1)@ back of anterior chamber
2)regulates light passage thru cornea
3)size controlled by sphincter and dilator muscles

Front 44

Posterior chamber, lens, ciliary body (3)

Back 44

1)b/w iris and lens is the posterior chamber

2)lens is crystalline biconvex structure which alters its shape to focus light onto retina

3)ciliary body changes the shape of the lens

Front 45

Vitreous body, choroid, retina

Back 45

1)vitreous body is behind the lens (80% of eye volume) and contains vitreous humor

2)choroid vasular layer inside sclera that supplies blood to retinal layers above it

3)neural tissue lining interior of globe within vitreous body, has rods and cones

Front 46

Uveal tract (3)

Back 46

Composed of...
1)choroid
2)ciliary body
3)iris

Front 47

RED LIGHT EYE SYMPTOMS****** (4 w/ each having 3,3,2,2)

Back 47

1)pain (can by symptom of uveal tract inflammation, corneal abrasion, close glaucoma)

2)blurred vision (can be due to corneal abrasion, closed glaucoma, corneal edema or inflammation/paralysis of ciliary body)

3)photophobia (can be due to inflammation of uveal tract or corneal abrasion)

4)visual loss (can be due to closed glacoma or corneal involvement)

Front 48

General Rules of Ocular disorders (5)

Back 48

1)self-medication for no more than 72h
2)refer if condition is not determined to be simple external irritation
3)refer if pt has red light symptoms
4)contact lens wearers should probably be refered
5)pts taking Rx eye drugs should see Dr before taking OTC eye products

Front 49

FDA ruling that self treatment MAY BE INDICATED FOR: (3)

Back 49

1)tear insufficiency
2)corneal edema (diagnosed)
3)external inflammation or irritation

Front 50

FDA ruling that self treatment MAY BE EFFECTIVE FOR: (3)

Back 50

1)hordeolum (stye)
2)blepharitis
3)conjunctivitis

Front 51

Referral is mandatory for: (6)

Back 51

1)embedded foreign object
2)uveitis
3)infected tear duct gland
4)corneal ulcer
5)glaucoma
6)acid/alkali exposure or flash burns

Front 52

Conditions of eyelid (w/o nodule) algorithm (just know big stuff) (4)

Back 52

.

Front 53

Blunt Trauma
a)what is it
b)3 recommendations

Back 53

a)rupture of blood vessels into tissue space

b1)REFERRAL
b2)cold compress for 24h
b3)OTC analgesic

Front 54

Contact Dermatitis
a)what is it
b)other symptoms
c)3 recommendations
d)how long til improvement

Back 54

a)hypersensitivity rxn
b)scaling, redness of eyelid marings

c1)dc new product
c2)use cold compress
c3)oral OTC antihistamines
d)improvement seen within few day (up to 2wks)

Front 55

Eyelid Infestation
a)what is it
b)characteristics of it
c)recommendations
d)prevention measures (2)

Back 55

a)usually acute (but can be chronic) crab louse or head louse
b)other areas of body and family members often affected
c)white petrolatum to eyelid margins qd-bid for 7-10days

d1)treat all affected bodily areas
d2)launder all clothes/linens in hot water

Front 56

Blepharitis
a)organisms that cause it (3)
b)characteristics of it (3)
c)goals
d)when to refer

Back 56

a)S.epidermis, S.aureus, seborrheic dermatitis

b1)chronic recurring conidtion
b2)sometimes eyelid margin changes (loss of eyelashes)
b3)will have other manifestations of seborrhea (oily skin/patchy dermatitis)

c)control symptoms and minimize secondary complications (scarring)

d)no improvement after a few days

Front 57

Treatment algorith for conditions of the eyelid WITH NODULE (know big stuff) (3)

Back 57

.

Front 58

External Hordeolum (stye)
a)what is it
b)characteristics of it
c)treatment recommendation
d)when to refer (2)
e)prevention

Back 58

a)acute inflammation of gland of Zeis from staphylococcal infexn
b)palpable, tender nodule coexisting w/ blepharitis
c)warm compress for 5-10min tid-qid

d1)if no relief in 3d, TOPICAL abx will speed resolution
d2)if same nodule has been treated before
e)nightly eyelid scrubs

Front 59

Internal Hordeolum (stye)
a)what is it
b)characteristics of it
c)treatment recommendation
d)when to refer (2)
e)prevention

Back 59

a)acute inflammation of gland of MEIBOMIAN from staphylococcal infexn
b)palpable, tender nodule coexisting w/ blepharitis
c)warm compress for 5-10min tid-qid

d1)if no relief in 3d, ORAL abx will speed resolution
d2)if same nodule has been treated before
e)nightly eyelid scrubs

Front 60

Chalazion
a)what is it
b)treatment
c)when to refer (2)
d)prevention

Back 60

a)granulomatous rxn from extravasated secretion in a meibomian gland (non-infexous, non-tender nodule)
b)warm compress 5-10min tid-qid

c1)if no relief in 3d, recalcitrant nodules need intralesional steroid injexn
c2)if same nodule has been treated previously
d)nightly use of eye scrubs

Front 61

Recalcitrant nodules?

Back 61

those that do not improve with treatment OR those that do improve only to recur in same area of eye

Front 62

Pts w/ co-existing blepharitis are...

Back 62

@ risk for recurrent sytes and should use nightly eyelid hygiene

Front 63

Treatment algorith for ocular surface conditions (red eyes) (know big things) (7)

Back 63

.

Front 64

Foreign body?
a)when to refer
b)____ incr risk of infexns

Back 64

a)continuing sensation following irrigation
b)corneal or conjunctival abrasion

Front 65

Chemical Exposure (acid/alkali) (3)

Back 65

1)immediate referal following 10min of continuous irrigation
2)red light items are dishwash stuff, ammonia cleaners
3)risk of corneal or interal eye damage

Front 66

Thermal exposure (2)

Back 66

1)Welder's arc= immediate refer
2)UV exposure= refer if no relief from artificial tears in 24h

Front 67

Simple external irritation (smoke/wind) (treatment)

Back 67

1)cool compress +/- topical decongestant

Front 68

Bacterial Conjunctivitis
a)what is it caused by
b)presentation (2)
c)treatment

Back 68

a)gram(+) mostly, some gram(-)
b1)bilateral mostly w/ purulent discharge
b2)matted eyelids on waking***
c)refer for topical Abx

Front 69

Viral conjunctivitis
a)what is it
b)presentation (2)
c)treatment (3)
d)counsel

Back 69

a)most common cause of red eye, often w/ recent illness/exposure

b1)starts unilateral and goes bilateral
b2)low fever/swollen lymph nodes

c1)self-limiting w/ resolution over 1-3wks
c2)artifical tears for symptoms relief
c3)ocular decongestants too

d)can spread to contacts

Front 70

Allergic Conjunctivitis
a)what is it
b)presentation (3)
c)treatment (3)
d)prevention

Back 70

a)airborne allergens cause conjunctival and nasal mast cell degranulation w/ histamine release

b1)ALWAYS BILATERAL
b2)sneezing/rhinorrhea
b3)itching, seasonality, recurrence*****

c1)cold compress
c2)topical decongestant/AH
c3)oral AH

d)avoid offending allergen

Front 71

Etiologies of dry eye (4)

Back 71

1)aging
2)eyelid defects
3)systemic inflammatory conditions (like RA)
4)meds (BB, AH)

Front 72

Presentation of dry eye (3)

Back 72

1)white/mildly red eyes w/ sandy or gritty sensation
2)excessive tearing due to...
3)abnormalities in tear layers causing inadequate lubrication and over production of ineffective tears

Front 73

General treatment of dry eye

Back 73

1)avoid siutations which cause tear evaporation (dry, dusty, central heat&air)

Front 74

MILD SYMPTOMS of dry eye use...

Back 74

low-viscosity preserved artificial tears 1-2x/day

Front 75

MODERATE SYMPTOMS of dry eye use... (3)

Back 75

1)NON-preserved low viscosity aritificial tears 3-4x/day
2)low viscosity agent w/ low toxicity perservative (chlorobutanol) 3-4x/day
3)med-high viscosity solution 1-4x/day BUT if using more than 2x/day use non-preserved or low toxicity preservative (purite/Na perborate)

Front 76

Which is best for INTERMITTENT but moderate symptoms

Back 76

low viscosity agent w/ low toxicity preservative (chlorobutanol) 3-4x/day

Front 77

SEVERE SYMPTOMS of dry eye use... (2)

Back 77

1)high viscosity, non preserved tear solution (or w/ purite/Na perborate) as needed
2)ADD bedtime use of NON-preserved ointment

Front 78

When to use PRESERVED eye ointment

Back 78

ONLY in pts who infrequently need to use it at HS

Front 79

Corneal edema etiology (2) and...

Back 79

1)ocular surgery
2)over wear of contacts

MUST BE DX BY A QUALIFIED PRACTICIONER

Front 80

Presentation of corneal edema

Back 80

distorted optical properties w/ halos/starburts around light sources

Front 81

Treatment of corneal edema

Back 81

1)dehydrate cornea w/ hyperosmotics (2/5% NaCl solution)

Front 82

MORE Eye conditions w/ mandatory referral (6)

Back 82

1)keratitis
2)iritis
3)vitritis
4)primary open angle glaucoma
5)primary closed/narrow glaucoma
6)secondary acute close glaucoma

Front 83

Keratitis (3)

Back 83

1)inflammation of cornea due to viral/bacteria infexn
2)blurred vision/photophobia
3)BEWARE OF CONTACT LENS WEARERS

Front 84

Iritis (4)

Back 84

1)inflammation of the iris
2)conjunctivitis
3)pain
4)blurred vision/photophobia

Front 85

Vitritis (4)

Back 85

1)inflammation of choir AND/OR ciliary body
2)conjunctivitis
3)pain
4)blurred vision/photophobia

Front 86

Secondary acute angle closure glaucoma (7) (and what eye drop can cause this)

Back 86

1)MEDICAL EMERGENCY
2)can be caused by mydriasis or adrenergic stimulation
3)red eyes
4)HA @ or above eyebrows
5)blurred vision
6)pain
7)n/v

OTC ocular decongestants

Front 87

Optical decongestants
a)ones available (4 and which is most favorable)
b)dosage
c)most rebound congestion w/...
d)indications

Back 87

a)naphazoline****, oxymetazoline, tetrahydrozoline, PE
b)1-2 drops qid
c)PE b/c short acting
d)relief of redness due to minor irritations

Front 88

Optic Decongestants SE's (5)

Back 88

1)burning/stinging/discomfort
2)short term lacrimation
3)mydriasis (more often in contact wearers and incr use)
4)rebound congestion (incr redness) (due to down regualtion of alpha1)
5)epithelial xerosis (dryness)

Front 89

Optic Decongestants
a)CI (2)
b)Warnings (3)
c)Precautions (3)

Back 89

a)hypersensitivity; narrow/closed glaucoma

b1)over 3d of use = rebound congestion
b2)pregnancy category C (and safety not established for breast feeding)
b3)dangerous to young children if mistakenly ingested

c1)CV disease
c2)DM
c3)hyperthyroidism

Front 90

Optic Decongestants
a)drug interactions
b)summary

Back 90

a1)BB, MAOI incr pressor effects

b1)0.02% naphazoline works as well as higher strengths and provides greater blanching compared to 0.5% tetrahydrozoline or 0.12% PE

Front 91

Optic antihistamine/decongestants combos
a)which available
b)indications
c)dosage
d)ADR's (3)

Back 91

a)antazoline or pheniramine w/ naphazoline
b)seasonal or atopic conjunctivitis
c)1-2 drops q3-4h prn

d1)burn/sting/discomfort
d2)lacrimation
d3)blurred vision due to anticholinergic properties

Front 92

Optic antihistamine/decongestants combos
a)CI
b)Warnings
c)Precautions
d)drug interactions

Back 92

a)same as w/ decongestants plus antazoline no use w/ contancts
b)same as w/ decongestants plus topical AH may cause local hypersensitivity rxn
c)same as w/ decongestants plus BPH
d)same as w/ decongestants

Front 93

Optic antihistamine and MAST CELL STABILIZER combos
a)available agents
b)indications
c)dosage
d)ADV

Back 93

a)ketotifen fumarate (Alaway, Zaditor)
b)temp relief of itchy eyes
c)1 drop q8-12h
d)can be used long term

Front 94

Optic antihistamine and MAST CELL STABILIZER combos
a)ADR's (3)
b)CI
c)Warning/precauctions (3)
d)drug interactions

Back 94

a1)burn/sting
a2)HA
a3)rhinitis

b)hypersensitivity

c1)only for over 3yo
c2)pregnancy category C
c3)insert contacts over 10min after dose

d)none reported

Front 95

Hyperosmotics drops
a)available agents (2)
b)indication
c)ADR's
d)CI's

Back 95

a)NaCl 2%/5% solutions & NaCl 5% ointment
b)relief of discomfort and improvement of vision in pts w/ corneal epithelial edema
c)burn/sting
d)edema due to traumatized corneal epithelium

Front 96

Hyperosmotics drops dosing (4)

Back 96

1-2 drops q3-4h; fraction of inch of ointment hs

1)begin w/ NaCl 2% solution 1-2 drops 4x daily (if little relief after 24h)
2)add NaCl 5% ointment hs (if little relief after 24h)
3)switch to 5% solution 4x daily plus 5% ointment hs (if little relief after 24h)
4)refer back to opthamologist

Front 97

Optical lubricants
a)available agents (2)
b)indications
c)dosage
d)ADR's (2)

Back 97

a)artificial tear solutions or demulcents
b)symptoms relief of dry eye
c)1-2 drops 3-4x daily

d1)blurred vision
d2)uncomfortable sensations

Front 98

Optical lubricants and preservatives (4)

Back 98

1)preservatives improve shelf-life
2)but can cause hypersensitivity rxns
3)non-preserved products should be discarded 12h after opening
4)preserved solution should be discarded 30d after opening

Front 99

Emollients/ointments
a)avilable agents
b)indications (2)
c)dosage
d)precautions

Back 99

a)blend of 60% petrolatum and 40% mineral oil

b1)symptom relief and treatment of dry eye
b2)vehicle to incr ocular contact time of instilled product

c)fraction of an inch strip/ribbon 1-2x daily
d)better to recommend preservative free ointments b/c of contact allergy w/ preserved ones

Front 100

Eyelid Scrubs
a)2ex
b)indications (2)
c)administration
d)precautions

Back 100

a)Eye Scrub, OcuSOFT
b)general eyelid hygiene; non-infectious blepharitis

c)apply warm compress to eyelid 5-10min 2-4x daily, followed by eyelid scrub

d)if no improvement within few days it could be infectious and pt should be referred