Integument Exam 1 Part 1

What are the main functions of the eyebrows?

Shade sunlight Prevent perspiration from dripping into

What are the functions of the palpabrae (eyelids)?

blinking to help keep eye protected and lubricated

Eyelashes main function:

Protect eyes from things entering

This is a gland assoc. w/ the eyelashes:

Ciliary glands

What is the main function of the ciliary glands?

Secreting oily secretion to keep inner part of the eye lubricated

What is a mound of tissue that contains sweat glands and oil glands
that provides secretions for the eye?


What is the colored part of the eye?


What is the black portion of the eye where light enters?


Which muscles are responsible for closing the eyelids?

Orbicularis oculi muscles

Which muscle helps to raise the eyelids?

Levator palpebrae superioris muscle

These produce a mucus-like secretion that help keep inner part of
eyelids/eye from drying out:

tarsal glands

Tarsal glands are also known as what?

Meibomian glands

This is a thin, transparent, mucus membrane that covers the surface
of the eye:


The conjuctiva contain tiny what?

blood vessels

When the blood vessels of the conjuctiva become inflammed, and the
eye turns red or pink, this is known as what?


Conjunctivitis can be caused from what?

Bacteria Virus Allergy

What occurs when the ciliary glands of the eye become inflamed or blocked?

Stye (hordeolum)

What can occur from blocked or inflamed tarsal (meibomian) glands?


If the tarsal glands are not producing an oily secretion like they
should be, then what condition can occur?

Dry eye

Which part of the eye serves as an integral function in forming tears?

Lacrimal apparatus

The Lacrimal apparatus contain what type of receptors that help with
tear secretion?


mAChR receptors that are antagonized in the lacrimal apparatus can
lead to what?

Dry eye

Tears contain what contents?

water salts mucus lysozyme

What is the function of lysozyme in tears?

Bactericidal (kills bacteria)

How many extrinsic muscles of the eye are there?

6 (4 oblique and 2 rectus)

The extrinsic muscles of the eye are used to do what?

Move the eyeball

Diplopia (double vision) can be caused by what?

weak/paralyzed extrinsic eye muscles

Which condition can be caused by weak eye muscles that are usually
congenital (at birth)?

Strabismus (wandering eye)

What is the outermost layer of the eye?

Fibrous layer

The fibrous layer contains what main 2 parts of the eye?

Sclera (whites of eyes) Cornea

List the functions of the Sclera:

Protects and shapes Anchoring site for 6 extrinsic eye
muscles Avascular (no blood vessels)

This part of the eye is where light first enters:


Is the cornea vascular or avascular?


Why are there no blood vessels (avascular) in the fibrous layer of
the eye?

To prevent scattering of light

The cornea can also represent a barrier to what?

Drug therapy

What is the middle layer of the eye known as?

Vascular (Uvea)

What main parts of the eye are found in the Uvea/vascular layer?

Choroid Ciliary body Iris (colored part of

Where is the location of the Choroid?

Posterior part of vascular layer

What are the main functions of the choroid?

Provides nutrients Absorbs light

The ciliary body is found where in the eye?

Anterior portion of vascular layer

What part of the ciliary body produces aqueous humor?

Ciliary processes

What portion of the ciliary body is responsible for holding the lens
in place?

Ciliary zonules/ suspensory ligaments

What is the main function of the ciliary muscles (ciliary muscles are
a portion of the ciliary body)?

Control the shape of the lens

The iris is found where in the eye?

Anterior portion of vascular layer

The iris is made up of what?

Smooth muscle fibers (circular muscles and radial muscles)

Circular muscles in the iris are responsible for what?

Constricting the pupil

Radial muscles in the iris are responsible for what?

Dilating the pupil

Constriction of the pupil is defined as what?


Under what circumstances might the pupils constrict (circular muscles contract)?

Bright light, close vision

The circular muscles of the iris are under what nervous system control?


Dilation of the pupil is defined as what?


Under what circumstances might mydriasis occur?

Dim light, distant vision

The radial muscles of the iris are under what nervous system control?

sympathetic (fight or flight)

What is the inner most portion of the eye known as?

Inner layer (retina)

What are the two layers of the retina?

Pigmented (outer layer) Neural (inner layer)

What are the main functions of the pigmented layer of the retina?

Absorbs light Removes photoreceptor cells
Stores vitamin A

What is the main function of the neural layer of the retina?

Phototransduction (conversion of light energy into chemical energy)

What are the 3 main cell types found in the neural layer of the retina?

photoreceptors bipolar cells ganglion

Where the optic nerve leaves the eye is known as the what?

Optic disk ("blind spot")

What part of the eye separates the anterior and posterior segment?


What portion of the eye is responsible for dividing the anterior and
posterior chamber of the anterior segment?


Describe the flow of aqueous humor in the eye

Produced in ciliary body--> flows through posterior chamber-->
flows through iris--> flows to anterior chamber--> goes through
Schlemm's canal

Where is most aqueous humor found?

Anterior chamber of eye

List the functions of aqueous humor:

Supplies nutrients and oxygen Carries away metabolic
wastes Maintains intraocular pressure (IOP)
Continually produced and drained

Blocked drainage of aqueous humor causes WHAT to rise?

intraocular pressure

Intraocular pressure rising compresses what?

retina and optic nerve (could lead to glaucoma = blindness)

What type of epithelial cells make up the lens?

cuboidal cells

What makes up the bulk of the lens?

Lens fibers

Transparent, folded proteins that form the body of lens are known as what?


Changing the lens so that it bulgy in appearance is known as what?


Accommodation occurs when focusing on an object that is what?


The clouding of the lens caused by clumping of crystallins is known
as what?

Cataracts (can affect 1 or both eyes/ can be congenital or occur with aging)

The posterior segment of the eye contains what type of humor?


List the functions of the vitreous humor:

Maintains shape of the eye Holds neural layer against
the pigmented layer Contributes to IOP, helps counteract
pulling force of extrinsic eye muscles Lasts for a

Photoreceptors allow us to detect what?


Which photoreceptors function at low light levels?


What are associated with color and high visual acuity?


What transfers signals from photoreceptors to ganglion cells?

Bipolar cells

Axons from what cells form the Optic nerve?

Ganglion cells

Ganglion cells generate what in the retina?

Action potentials

What modify signals from photoreceptors in the retina?


Which cells are interneurons that synapse with photoreceptors and
bipolar cells?

Horizontal cells

Amacrine cells are interneurons in the retina that synapse with what cells?

bipolar and ganglion cells

What is lateral to the optic disk and contains mostly cones?

Macula lutea

What is the center of the macula lutea known as?

Fovea centralis

The fovea centralis contains only what?


Macular degeneration can lead to what?

Vision loss

This occurs when cone density decreases and rod density increases:

Retina periphery

High sensitivity � respond to dim light describes what?


Low sensitivity � need bright light for activation corresponds to what?


Rods relate to a single kind of photopigment that shows what tones?

Gray tones

Cones correspond to what photopigments?

Vivid colors (1 of 3)

Light energy is converted into a graded receptor potential is known
as what?


The visual pigment in rods is known as what?


Rhodopsin is comprised of what 2 things?

Retinal Opsin

Retinal is made from what?

Vitamin A

Retinal is what kind of molecule?

Light absorbing

This is a protein that determines the wavelengths that retinal will absorb:


Describe the process of phototransduction:

Light converts 11-cis retinal to all-trans retinal, the visual
pigment (rhodopsin) becomes activated. The activated
rhodopsin activates the G-protein, transducin Transducin
activates phosphodiesterase (PDE) PDE converts cGMP into
GMP Ion channels close, results in hyperpolarization

What is the visual pigment for cones?


What is a group of conditions that causes damage to the optic nerve?


Glaucoma stems from a decreased or inadequate drainage of what?

Aqueous humor

A decrease or inadequate drainage of aqueous humor results in the
compression of what?

Retina Optic nerve

Open angle (POAG) Glaucoma is caused from what?


Closed angle (CAG) Glaucoma is caused from the physical blockage of what?

trabecular meshwork

Abnormal development of fluid outflow channels of the eye refers to
which type of Glaucoma?


Glaucoma can be caused from Secondary things such as drug use. What
are examples of drugs that have been linked to Glaucoma?

Corticosteroids (POAG) Anticholinergics (CAG)
Sympathomimetrics (CAG)

Aqueous humor is drained from the anterior chamber by what two mechanisms?

Trabecular outflow Uveoscleral outflow

Aqueous humor is formed where?

Ciliary body

What is the rate of formation for aqueous humor?

2-3 ul/min

What is the turnover for aqueous humor formation?

1.5-2 hours

What is the major drainage route for aqueous humor in the eye?

Trabecular meshwork (80%)

The mechanism of trabecular meshwork drains where?

Canal of Schlemm (scleral venous sinus)

The mechanism of Trabecular meshwork can be referred to as what?

Conventional outflow

Minor drainage for aqueous humor in the eye is via which pathway?

Uveoscleral pathway (20%)

The Uveoscleral pathway involves drainage into what location?

Suprachoroidal space into venous circulation

The Uveoscleral pathway is sometimes called the what?

Nonconventional route

What is the composition of aqueous humor?

Similar to plasma Slightly more acidic than plasma (pH
of 7.2) Less protein than plasma

What are the functions of aqueous humor in the eye?

Maintain intraocular pressure (IOP) Provide nutrients
to cornea and lens (avascular so substitutes for blood)
Remove metabolic wastes

What is the average IOP?

14-16 mm Hg

What is the range of aqueous humor?

10-21 mm Hg

What factors contribute to changes in IOP?

Pulse Blood pressure Cough
Posture Neck compression

Diurnal variation of IOP is due to changes in what?

rate of aqueous humor formation

Aqueous humor formation is highest when?

The morning (AM)

Aqueous humor formation is the lowest when?

Evening/night (PM)

True or False: IOP is used to diagnose glaucoma


Elevated IOP in glaucoma is due to what?

decreased outflow of aqueous humor

Elevated IOP in glaucoma patients increases risk of what?

visual field loss

What reduces the risk of glaucomatous progression?

Lowering IOP

IOP < 21 mm Hg but visual field loss and changes in optic disk
refers to which type of Glaucoma?

Normal tension Glaucoma

Normal tension glaucoma consists of what percent of glaucoma patients?


IOP > 21 mm Hg but no visual field loss or changes in optic disk
refers to what?

Ocular hypertension

What is the occurrence of ocular hypertension?


True or False: Patients with open-angle Glaucoma do not have symptoms

True (gradually lose peripheral vision)

Describe the pathophysiolology of open-angle glaucoma:

Drainage of aqueous humor is blocked Increased
IOP Damage to optic nerve (death of retinal ganglion

The Blockage of trabecular meshwork corresponds to which glaucoma type?

Closed angle glaucoma

When the iris blocks aqueous flow through pupil, iris blocks
trabecular meshwork this is known as what?

Pupillary block

Pupillary blocks are assoc. w/ what?


When ciliary body pushes iris forward and blocks the trabecular
meshwork this is known as what?

Plateau iris (without pupillary block)

What are the 2 major mechanisms to lower IOP?

Increase aqueous humor outflow through trabecular
meshwork through uveoscleral pathway
Decrease production of aqueous humor

Which drugs are prodrugs that are converted to their active form in
the cornea?

Prostaglandin Analogs

Prostaglandin Analogs lower IOP how?

Increasing uveoscleral outflow

What is the brand name of Latanoprost?


What is the brand name of Latanoprost + Timolol?


What is the generic of Lumigan?


This is a 20-carbon fatty acid derivative produced by metabolism of
arachidonic acid:


What is the generic of Travatan Z?


What is the brand name of Latanoprostene bunod?


What is the brand name of Tafluprost?


Prostaglandin drugs are also shown to increase what?

trabecular outflow

Which drug contains a nitric oxide donor, nitric oxide causes
relaxation of TM and SC which leads to increased outflow?

Latanoprostene bunod (Vyzulta)

Prostaglandin Analogs are analogs of what?


What is the MAJOR side effect of prostaglandin analogs?

Hyperpigmention (stimulating FP receptor stimulates melanin giving
rise to pigment)

Prostaglandin analogs increase uveoscleral outflow, because of their
increased synthesis of what?


What is the brand name of Timolol?


What is the brand name of Timolol + Brimonidine?


What is the brand name of Levobunolol?


What is the brand name of Metipranolol?


What is the generic for Cosopt?

Timolol + Dorzolamide

What is the brand name of Carteolol?


What is the generic of Betoptic?


What are the 2 classes of beta-receptor antagonists?

Nonselective Selective (Beta-1)

What is the only Beta-1 selective B receptor drug used to treat glaucoma?

Betaxolol (Betoptic)

Beta-receptor antagonists lower IOP how?

By decreasing rate of aqueous humor production

The majority of Beta receptors in the eye are what?


Which drug would be less effective than non-selective beta blockers
for the eye?


Which B-receptor antagonist has ISA (intrinsic sympathomimetic
activity) meaning it binds to but does not fully block the receptor
(partial agonist)?

Carteolol (Ocupress)

What is the brand name for Apraclonidine?


What is the brand name for Brimonidine?

Alphagan P

What is the brand name for Brimonidine + Timolol?


What is the brand name for Brimonidine + Brinzolamide?


Alpha-2 adrenergic agonists lower IOP how?

By decreasing the production of aqueous humor

What is the brand name of Brinzolamide?


What is the generic of Trusopt?


Carbonic anhydrase inhibitors lower IOP how?

Decreasing aqueous humor production

What is the brand name of Dorzolamide + Timolol?


What is the only class of drugs intended to treat glaucoma that can
be taken systemically?

Carbonic anhydrase inhibitors

List the two systemic drugs that are taken for glaucoma?

Acetazolamide (Diamox)
Methazolamide (Glauc tabs, Neptazane)

Which topical agents intended to treat glaucoma are direct-acting?


Cholinomimetics are what type of agonists?

muscarinic receptor

Cholinomimetics cause contraction of what?

Ciliary muscle

Cholinomimetics lower IOP how?

By facilitating aqueous outflow through trabecular meshwork (through
contracting ciliary muscle)

What is the brand name of Pilocarpine?


What is the generic of Miostat?


What is the brand name for Netarsudil?


Which drug class Lowers IOP by increasing trabecular outflow and
reducing aqueous humor production?

Rho Kinase Inhibitor

Rho kinase (ROCK1 and ROCK2) enzymes are involved in regulating the what?


Chronic, develops over several years, most common glaucoma type
refers to?

Open Angle

Which glaucoma type can be acute or chronic, may be undiagnosed until
routine eye exam or an acute event?

Angle Closure

Which glaucoma type relates to changes in the eye consistent with
glaucoma despite IOPs < 21 (treat as open angle unless surgery is required)

Normal tension

Which glaucoma type relates to the use of anticholinergic drugs or
long- term use of steroids (treat as open angle)?


Which glaucoma type is chronic, develops over several years, and is
the most common glaucoma type?

Open angle

Which glaucoma is acute or chronic, and may be undiagnosed until
routine eye exam or an acute event?

Angle closure

Which glaucoma type relates to changes in the eye consistent with
glaucoma despite IOPs < 21?

Normal tension

Normal tension glaucoma is treated like what glaucoma type unless
surgery is required?

Open angle

Which glaucoma type involves the use of anticholinergic drugs or
long- term use of steroids?


Secondary glaucoma should be treated as what glaucoma type?

Open angle

What is the pathophysiology of angle closure glaucoma?

Iris blocks Trabecular Network, causing a rapid increase in IOP

What are the risk factors for angle closure glaucoma?

Increased age Female gender Family
history Shallow anterior chamber causing a narrow angle
between the cornea and iris or tight contact between the iris and
lens Far-sightedness Certain medications

True or False: For acute closure glaucoma, the majority of cases are
chronic and asymptomatic until discovered during an eye exam.


What is the treatment of angle closure glaucoma?

Prophylactic iridotomy followed by the same medications used to treat
OAG if pressure remains high

List some medications that may precipitate angle closure glaucoma?

Anticholinergics = Oxybutynin (Ditropan)/Tolterodine
(Detrol) Antihistamines TCAs = Amitriptyline (most
anticholinergic of this drug class) SSRIs = Calexa
(Citalopram) Decongestant = pseudoephedrine (OTC) and
phenylephrine Typical antipsychotic = (Haloperidol)

What are the 2 main functions the ear is associated with?

Hearing Balance

What are the 3 areas of the ear?

External Middle Inner

What part of the ear is made of cartilage and what we consider the "ear"?


What are the parts of the auricle/pinna?

Helix Lobule

Which part of the auricle is the dangling flesh or is the "ear lobe"?


Which parts of the ear are solely involved in sound transmission?

External and middle

Which part of the ear is associated with balance and equilibrium?


What is the "rim of the ear'?


What is the purpose of the auricle/pinna?

To direct sound waves into the ear

Where the sounds waves hit the auricle/pinna helps the brain
determine what?

Where the sound is coming from

What directs sound waves into the ear?

External acoustic meatus (auditory canal)

What lines the auditory canal?

Hair Ceruminous glands

Ceruminous glands secrete what?

cerumen (earwax)

What is the purpose of hair and ceruminous glands in the auditory canal?

To protect against foreign objects

Which part of the ear is the site of otitis externa?

External acoustic meatus (auditory canal)

What part of the ear transfers sound to the middle ear?

Tympanic membrane (eardrum)

Sounds waves cause the eardrum to do what?


Describe the structure of the tympanic membrane:

thin and translucent

The tympanic membrane separates what 2 areas?

external ear from middle ear cavity

What are the parts of the middle ear (tympanic cavity)?

Oval (vestibular) window Round (cochlear) window
Pharyngotympanic tube (auditory or eustachian tube)

The Pharyngotympanic tube (auditory or eustachian tube) connects what parts?

middle ear to nasopharynx

Sound waves come through what part of the middle ear?

oval window

Sound waves terminate where in the middle ear?

round window

The middle ear is filled with what and lined with what?

filled with air; lined with mucosa

Inflammation of the middle ear is known as what?

Otitis media

True or False: Otitis media can be acute or chronic.


Chronic otitis media can require the insertion of what?

Ear tubes

Describe the pathophysiology of otitis media

Accumulation of fluid within middle ear Fluid can be
infected by bacteria or viruses that reach middle ear through
the auditory (eustachian) tube Eardrum may not move and
can be red and bulgy

These are tiny bones that help transmit sound waves (vibrations) into
the inner ear:

Auditory ossicles

What are the 3 auditory ossicles?

Malleus Incus Stapes

Which ossicle is connected to the eardrum?


Which ossicle is situated in the oval window?


Which ossicle is the middle bone?


The contraction of which muscles limits movement of the ossicles and
minimizes transmission of loud sound waves to the inner ear?

Tensor tympani Stapedius

Which muscle is attached to the malleus?

tensor tympani

Which muscle is attached to the stapes?


The inner ear is also called the what?


The bony (osseus) labyrinth is filled with what?


The membranous labyrinth is filled with what?


What is the function of perilymph and endolymph?

Conducting sound vibrations (allowing for hearing)
Respond to changes in head position and acceleration

Which part of the inner ear has the saccule and utricle (which are
two membranous labyrinth sacs)?


The saccule and utricle house what types of receptors?


The macule
receptors in the saccule and utricle are involved with what?

Linear acceleration and deceleration

What is the membranous labyrinth of the semicircular canals?

semicircular duct

What are the 3 semicircular canals?

anterior posterior lateral

What are the specialized swellings or regions at the ends of the
semicircular duct?


What receptors are housed in the ampulla?

crista ampullaris

Crista ampullaris receptors respond to what?

Rotational (angular) head movements

List the 3 chambers (scalae) of the cochlea:

Scala vestibuli Scala media Scala

The scala media is known as the what?

Cochlear duct

Which chamber of the cochlea is continuous with vestibule and next to
oval window?

Scala vestibuli

The scala media contains what?


What is the hearing receptor region found in the cochlear duct?

Spiral organ of Corti

Which chamber of the cochlea terminates at the round window?

Scala tympani

What is the "roof" of the cochlear duct?

Vestibular membrane

The vestibular membrane separates what 2 regions?

scala media from scala vestibuli

What is the external wall of the cochlear duct?

Stria vascularis

The stria vascularis secretes what?


What is the "floor" of the cochlear duct?

Basilar membrane

What is the basilar membrane's functions?

Involved in sound reception Vibrates in response to
movement of fluid caused by sound waves

Which drug class target the stria vascularis?

loop diuretics (furosemide, ethacrynic acid)

What is the ototoxicity associated with loop diuretics?

reversible hearing loss

List the 5 steps to hearing:

Sound waves vibrate the tympanic membrane. Auditory
ossicles vibrate. Pressure is amplified. Pressure waves
created by the stapes pushing on the oval window move through fluid
in the scala vestibuli. Sounds with frequencies below
hearing travel through the helicotrema and do not excite hair
cells. Sounds in the hearing range go through the cochlear
duct, vibrating the basilar membrane and deflecting hairs on innder
hair cells.

What Rests on the basilar membrane, involves the vibration of the
basilar membrane, and activates hair cells?

Spinal organ of Corti

What are the sensory receptor cells that are responsible for allowing
us to hear?

Hair cells

What are responsible for hearing, and cause action potentials in the
cochlear nerve?

Inner hair cells (1 row)

What Amplifies the motion of basilar membrane to increase
responsiveness of inner hair cells; �tuning�?

Outer hair cells (3 rows)

Outer hair cells decrease the motion of the basilar membrane to
protect what?

inner hair cells

Which hair cells represent the afferent division?

Inner hair cells

Which hair cells represent the efferent division?

Outer hair cells

Which drugs associated with ototoxicity target the hair cells?

Aminoglycosides, e.g., neomycin, amikacin (irreversible hearing
loss) Cisplatin (irreversible hearing loss)
Aspirin/Salicylate (tinnitus; reversible)

Motion of stapes in the oval window moves the perilymph in the
scala vestibuli and causes the what to

basilar membrane

What refers to a section of the basilar membrane vibrating at a
specific frequency that corresponds to pitch?

Resonance frequency

Short, stiff fibers of basilar membrane near oval window relate to what?

High frequency pressure waves, high pitch

Long, limber fibers of basilar membrane near apex relate to what?

Low frequency pressure waves, low pitch

Ototoxic drugs will affect what hearing first?

high frequency and high pitch

Acute Otitis Externa (AOE),is also known as what?

Swimmer's Ear

Swimmer's ear is defined as what of the external ear canal?

diffuse inflammation

AOE is caused by what?

Break in the skin or cerumen protective barrier (in the external ear canal)

90% of the time, AOE occurs how?

Unilaterally (only one ear is affected)

What are some risk factors for developing Swimmer's Ear?

Water exposure (swimming) high humidity high
temperatures maceration of skin local trauma to
ear exposure to high bacterial counts in water

Swimmer's Ear is common in all ages but frequent in what age range?

7-12 years old

Clinical response from drug treatment for Swimmer's Ear usually
occurs in how many days?

2-3 days

When should someone with Swimmer's Ear return to the water?

After completing treatment

What is the discharge with Swimmer's Ear look like?

Clear discharge

List the symptom's of Swimmer's Ear:

Rapid onset, with classic tenderness when ear lobe is
�My ear hurts� Ear feels full or clogged.
Pain (85%) skin tightly adherent to cartilage
exacerbated by chewing (pain when chewing)
Redness, Swelling, and Pruritus (66%) �itchy
ear� (sign that healing is occuring) Some discharge from
the ear canal is possible

What are the signs of AOE?

Canal with erythema, edema & exudate. Tympanic
membrane mobile Pain with movement of ear lobe

What tool is used to view the signs of AOE?


If the tympanic membrane is not moving, what ear infection would be present?

Otitis media

What are topical antibiotic ear drops used to treat bacterial otitis
externa? (the cheapest)?

Cortisporin Otic Solution (Neomycin-Polymyxin-HC)-$21.99
Cortisporin Otic Susp (Neomycin-Polymyxin-HC)- $21.99

When it comes to Cortisporin, is the solution or suspension preferred
and why?

Suspension, because it is less irritating

A formulation containing a corticosteroid might result in more rapid
resolution of symptoms by what?

one full day

What are the directions for Cortisporin?

4 gtt TID

Which component of Cortisporin is what many people have an allergy to?


People who show signs of Neomycin allergy would show what symptoms?

Signs of redness (red streak down the side of the face) --> given
that the drop had spilled out of the ear and ran down the side of the face

If patients have an allergy to Neomycin, what drugs are used for AOE?

Quinolone Preps

List drugs that are Quinolone preps

Cipro HC Otic Susp- $135 / 10 mL Floxin Otic Soln.
(ofloxacin)- generic Ciprodex Otic Susp- $142 / 7.5 mL

What are the advantages of Quinolone preps?

Twice daily dosing
Good if allergic to neomycin

Which Quinolone Preps can be used for children with tympanostomy tubes?

Floxin (ofloxacin) Ciprodex

What are a cheaper alternative to Floxin ear drops?

Floxin eye drops (can use eye in ear)

How should ear drops be heated up?

Warm between hands (DO NOT HEAT IN MICROWAVE)

List the process of instilling ear drops:

If you are administering ear drops to yourself, lie down or
tilt your head to one side. If you are administering ear drops to
someone else, have them lie down or tilt their head to one
side. Warm the drops by holding the bottle in your hands for
a few minutes. In adults, the earlobe should be held up and
back. For children, hold the earlobe down and back. Press
on your ear flap and keep your head tilted up for 3-5 minutes to
give the medicine time to coat your ear. If you are administering
ear drops to someone else, make sure they do this.

Which OTC products refer to "molecules remember"?


True or False: Homeopathic products contain an active ingredient.

False; do not contain

List some preventions for AOE:

Shaking and Jumping Blow drying Burn ear
Electrocute yourself
Avoid Q-Tips If use, use GENTLY
Auro-Dri, Ear-Dry, Swim-Ear Isopropyl Alcohol and
glycerin 5% base (ear drying) Swim cap vs. Ear Plugs

Which OTC product should be recommended for hearing loss due to ear wax?

Carbamide peroxide 6.5 % (Debrox or Murine)

List the tips for using an ear syringe:

The syringe is filled with warm water, and the tip is carefully
inserted into the ear. The bulb is squeezed gently to create a slow
stream of water, rather than forcefully to create an abrupt stream,
which could rupture the eardrum. Ear syringes should not be used if
they cause pain or dizziness, or if the patient has a perforated
eardrum, or drainage, bleeding, pain, or irritation in the ear.

True or False: Ear candling should not be recommended for earwax removal.

True (can impact wax, lead to candlewax deposits in ear, burns to the
face, hair, scalp, ear canal, eardrum, middle ear, and even puncture
of the ear drum.)

An ear syringe/ bulb used without a needle should be administered how?

With an equal flow/stream; do not pressure wash ear

What lubricates the ear canal and may provide some relief?

Glycerin (active ingredient in Similasan)

Which earache relief is gentile enough for children and strong enough
for adults?

Similasan earache relief

What are some medications used for prevention and self-care?

Auto-Dri Homemade 1:1 mixture

Auto-Dri contains what?

Isopropyl alcohol (95%) Glycerin (5%)

What ingredient of Auto-Dri will dry out ear to avoid Swimmer�s Ear?

Isopropyl alcohol

What is the formulation of the Homemade 1:1 mixture?

5% acetic acid and alcohol ( Mix equal parts of white vinegar
and alcohol and instill into the affected ear) SIG: 5 mL
into ear QID

List the functions of the integumentary system:

Protection Chemical Skin secretions,
melanin Physical Protects
against abrasions, scrapes, etc.
Biological Dendritic cells, macrophages

Body temperature regulation Heat dissipation and
conservation Cutaneous sensation
Sensory receptors Metabolism
Enzyme activity Blood Reservoir�
5% of the body�s blood volume
Excretion Sweat

How is melanin a protective barrier?

It absorbs UV light

What are the functions of the epidermis?

Prevents water loss (keeps skin hydrated) Protects
against: Chemicals, microorganisms Abrasion
UV light Produces a vitamin D

What results in the Vitamin D precursor being produced in the epidermis?

Exposure to sunlight

What are the 4 cells of the epidermis?

Keratinocytes Melanocytes Merkel cells/
tactile cells Langerhan's cells/dendritic cells

What is the insoluble protein produced from keratinocytes?


What are the functions of keratin?

resists abrasion reduce water loss (keeps skin

What is a pigment produced from Melanocytes?


Merkel cells/tactile cells connect to what?

nerve endings

What are the biologic component of the integument system (found in
the epidermis)?

Langerhan's cells/dendritic cells

What are associated with the Langerhan's cells/dendritic cells?


Keratinocytes change in structure and are dying as they move from the
bottom stratum basal layer to the top stratum corneum layer. What is
this process called?


Which layer of the epidermis is referred to as the "stratum germinativum"?

Stratum basale (called this because of active acute dividing/mitosis)

What cancer types occur in the basale layer?

Basal cell carcinoma (keratinocytes) Melanoma

Which layer of the epidermis relates to limited amount of cell division?

Stratum spinosum

Which cancer type is associated with the stratum spinosum?

Squamous cell carcinoma

The Keratohyaline and Lamellar granules are associated with which
layer of the epidermis?

Stratum granulosum

These help to form keratin, which helps protect against abrasion and penetration:

Keratohyaline granules

These contain glycolipids, which are helpful to slow water loss
(keeps skin appropriately moisturized):

Lamellar granules

Which layer of the epidermis is the layer in which the cells die?

Stratum Granulosum

Which layer of the epidermis contains clear, flat, dead keratinocytes?

Stratum lucidum

What are the components of the stratum corneum?

Outermost layer Soft Keratin Protection
Glycolipid Waterproofing
Desquamation occurs Sloughing off of skin cells
�Shedding of skin cells from stratum corneum�

All 5 layers of the epidermis refers to what?

Thick skin (ex. palms of hands, fingertips, soles of feet, areas with
no hair)

4 layers of the epidermis (no stratum lucidum) and the strata are
thinner corresponds to what?

Thin skin (areas we usually find hair)

Once melanin is produced by melanocytes they are passed to where?


UV light stimulates what process?

Melanogenesis (production of melanin)

What results from increased melanin production and darkening of
melanin already present?

A tan

Yellow to orange pigment found in some plant products, like carrots
is known as what?


Carotene is found where?

stratum corneum adipose cells of dermis and

Oxygenated hemoglobin in red blood cells is known as what?


Carotene and hemoglobin contribute to what?

Skin color

Tyrosinase deficiency is assoc. w/ what disorder that can affect skin color?


Poorly oxygenated hemoglobin is assoc w/ what disorder that can
affect skin color?


Cyanosis is associated with what?

Heart failure Severe respiratory disorders

Increased blood flow through skin that can affect skin color is known
as what?


Anemia, low blood pressure that can affect skin color is known as what?


A liver disorder, accumulation of yellow bile pigments that can
affect skin color is known as what?


Metallic appearance of skin is a sign of Addison�s disease,
hypofunctioning adrenal cortex that can affect skin color is known as what?


Masses of clotted blood beneath skin that can affect skin color are
known as what?


Bruises can lead to what?


What are the connective tissue associated with the dermis?

Collagen Elastin

Collagen and elastin give the skin what?

It's structural strength

Elastin helps the skin have what?


What non-connective tissues are associated with the dermis?

Fibroblasts macrophages mast and white blood

What does the dermis contain?

Nerve fibers Blood vessels Lymphatic

Where is the vascular system in the skin?


What are the finger-like structures of dermis that run into epidermis?

Dermal papillae

What are the two layers of the dermis?

Papillary layer (upper layer) Reticular layer (lower

The dermal papillae is found in which layer of the dermis?

Papillary layer

Dermal papillae contain what?

Capillary loops Free nerve endings: pain
receptors Meissner�s corpuscles: touch receptors

In thick skin, papillae lie atop large mounds called dermal ridges,
which give rise to what?

epidermal ridges (fingerprints)

What are the 3 components of the reticular layer?

Cutaneous plexus Cleavage lines Flexure

Dermal folds, deep skin creases are known as what?

Flexure lines

Longitudinal lines between collagen bundles are known as what?

Cleavage lines

Blood vessels between reticular layer and hypodermis is known as the what?

Cutaneous plexus

List the characteristics of the hypodermis:

Not part of skin Stores fat, insulates, absorbs
shock Anchors skin to muscles and bone

The following bullets relate to what wound type?
Broad and shallow with irregular edges Mild
(epidermis) or serious (dermis)

Abrasion (scrapes)

The following bullets relate to what wound type?
Knife-like: narrow, deep with sharp edges Blunt:
rip with jagged edges

Laceration (tears)

The following bullets relate to what wound type?
Bruising and damage to skin and underlying tissue

Crush/Contusion (compression wounds)

The following bullets relate to what wound type?
Narrow and deep with small openings


The following bullets relate to what wound type?
Tissue has been torn out


Burns can be caused by what?

Heat or chemicals

Which burn is superficial (epidermis), red?

1st degree

Which burn is deeper than dermis, dry, dead tissue?

3rd degree

Which burn relates to damage to epidermis and dermis, blisters?

2nd degree

Ulcers can be caused by what?

Innate processes External forces
Pressure Shearing Friction

Formal closure of wound (ex. Suture, stapled) relates to which
category of wound healing?


Which category of wound healing relates to Initial debridement of
wound then Formal closure?

Tertiary (delayed primary closure)

Which category of wound healing relates to no formal wound closure
(ex. Heals on its own)?


Which phase of wound healing relates to thrombus and inflammation?

Phase 1

Which phase of wound healing relates to tissue remodeling (scar formation)?

Phase 3

Which phase of wound healing relates to proliferation (including
angiogenesis/ granulation tissue formation and re-epithelialization)?

Phase 2

The formation of a blood clot is known as what?


Thrombosis establishes what?

Hemostasis (stopping bleeding)

Hemostasis leads to what?

Provisional matrix for cell migration

What involves the generation of vasoactive mediators and chemotactic
factors that attract inflammatory cells and other cells?


What is the result of inflammation?

Cleansing of wound Initiation of angiogenesis
Making new blood vessels

What clear bacteria and foreign particles during inflammation?


Angiogenesis/granulation tissue formation relates to what?


Proliferation involves what cells that are important in wound healing?


Fibroblasts make and deposit what?


What is the result of proliferation?

New circulation to support the healing wound
Granulation tissue: fibrous, connective tissue that replaces the
fibrin clot

Which part of proliferation relates to covering the would with epithelium?


Re-epithelialization is mediated by what?

Growth factors

Re-epithelialization involves what?

Migration of epithelial cells across wound Coating of
granulation tissue and provisional ECM

What is the result of re-epithelialization?

Epithelial cover is re-established

Tissue remodeling involves what?

Wound contraction Deposition of collagen

Wound contraction is mediated by what?

Fibroblasts: myofibroblasts

Myofibroblasts do what?

Reduce the size of the wound

The deposition of collagen results in what?

Replaces provisional ECM and granulation tissue
Increases strength of the wound

What is the result of tissue remodeling?

Formation of a scar <80% strength of original,
uninjured skin

Tissue remodeling can last how long?

Days, weeks, or even monthsLi

List the different types of skin lesions:

Papule Nodule Vesicle Bulla
Pustule Macule Plaque Wheal

List the appendages of the skin:

Sweat glands Oil glands Hair

What are the sudoriferous (sweat) glands of the skin?

Eccrine/Merocrine Apocrine

Which sudoriferous glands are found on the palms, forehead, and the
soles of feet?


Eccrine/Merocrine glands release their contents where?

Surface of the skin

Eccrine/Merocrine glands secrete what kind of fluid?

Thin, watery fluid

Apocrine glands secrete what kind of fluid?

Milky, viscous fluid

True or False: Eccrine/Merocrine glands are more numerous than
Apocrine glands.


Apocrine glands are found where?

Axillary and anogenital areas

Which sweat glands are under hormonal control (begin to function at puberty)?


List modified apocrine glands:

Ceruminous glands Earwax Mammary
glands Milk

Apocrine glands empty their contents where?

Hair follicle

Sebaceous (oil) glands secrete what?


What are the functions of sebaceous glands?

Lubricate skin and hair slow water loss

What is associated with sebaceous glands?


Sebum is secreted where?

Hair follicles

What is the inflammation of sebaceous glands known as what?


Short, fine and usually unpigmented hair is known as what?

Vellus hair

Vellus hair replaces what?

Lanugo hair (baby hair) - everywhere except terminal hair

Long, coarse and pigmented hair refers to what?

Terminal hair

Terminal hair replaces lanugo of what locations?

scalp eyelids eyebrows

Terminal hair replaces vellus hair in what locations?

Pubic and axillary regions (at puberty)

Hair contains mostly what?

Hard keratin

What are the 2 parts of the hair?

Hair shaft Hair root Hair bulb

What are the 3 portions of the hair bulb?

Hair follicle receptor/root hair plexus Hair
papilla Hair matrix

Hair follicles stand on end due to contraction of these muscles:

Arrector pili

The hair papilla help nourish what?

Hair matrix

What are a modification of the epidermis?


Nails contain what?

hard keratin

What are the different components of the nails?

Free edge Body Root Nail bed

Which part of the nail is responsible for nail growth?

Nail matrix

Which vitamin has growth promoting activity and effects on various tissues/functions?

Vitamin A

Is vitamin A a fat soluble or water soluble vitamin?

fat soluble

Where do we get Vitamin A from?

Outside resources (food)

Any molecule that, by itself or through metabolic conversion, binds
to and activates the retinoic acid receptors are known as what?


Biologically active retinoids are found where?

Foods of animal origin

Our body converts retinyl esters from animal sources into what?


List some examples of retinyl esters from animals:

Palmitic acid Myristic acid Dodecanoic

The highest sources biologically active retinoids are found where?

Fish liver oils (Also in: animal livers, milk, and eggs)

What is the nomenclature of alcoholic retinoids?


What is the nomenclature of Aldehyde retinols?


What is the nomenclature of carboxylic acid retinoids?

Retinoic acid

What is the nomenclature of ester retinoids?

Retinyl esters

Which retinoid is a Vitamin A and precursor for the active forms?


Which retinoids are active form in the eye?


Which retinoids are the active form in the body (not including the eye)?

Retinoic acid

Which retinoids are from animal sources and is the storage form in
the body?

Retinyl esters

Provitamin A Carotenoids are obtained from where?

Plant sources

What is the most abundant (most common) Provitamin A Carotenoid that
our body absorbs?


What are the functions of retinoids?

Vision (active form is retinal) Growth and development
of tissues Regulation of epithelial cells Bone
growth Reproduction and embryonic development
Immune defense

Systemic administration of retinoids for drug therapy can cause what?

Birth defects (can also be caused by large amounts of vitamin A consumed)

Which Provitamin A carotenoids is relatively not toxic and therefore
not associated with being teratogenic?


What are the 2 retinoic acid receptors?

Retinoic Acid Receptors (RARs) Retinoic Acid X
Receptors (RXRs)

What kind of receptors are the retinoic acid receptors?


Retinoic acid receptors regulate what?

Gene expression

What are the subtypes of RARs and RXRs?

alpha beta gamma

Which subtypes of RAR are found in the body?

alpha gamma

Which subtypes of RXRs are found in the body?

alpha beta

Retinoids that target RARs predominantly affect what?

cellular differentiation and proliferation

Retinoids that target RARs are useful for what?

Acne Psoriasis Aging

Retinoids that target RXRs predominantly induce what?


Retinoids that target RXRs are useful for what?

Malignancy (tumors)

Retinol is converted into retinoic acid by sequential action of what
2 enzymes?

Retinol dehydrogenase (rate-limiting) Retinal

Which retinoid form usually doesn't get excreted from the body?


Which retinoid form usually does get excreted (in urine and feces)?

Retinoic acid

What 4 components are associated with acne?

Follicular hyperkeratinization (over production of
keratin) Sebum production (over produced- can block hair
follicle) Inflammation
Propionibacterium acnes

P acnes is a resident where?

Epidermis/hair follicle

Enlarged and plugged hair follicles are known as what?


Closed comedones are known as what?


Open comedones are known as what?


Which retinoids lack receptor specificity, significant side effects?

First Generation

Which retinoids are designed to optimize receptor selective binding?

Third Generation (Arotinoids)

Which retinoids lack receptor specificity, but have improved side effects?

Second Generation

List some first generation retinoids:

Retinol Tretinoin Isotretinoin

List some second generation retinoids:

Etretinate Acitretin

List some third generation retinoids:

Tazaroten Bexaroten Adapalene

Which drug reduces the hyperkeratinization that leads to comedone formation?


Tretinoin comes in what form?


Topical steroids are indicated for relief of what?

inflammatory and pruritic (itching) manifestations

Nonprescription products are indicated for temporary relief of
itching associated with what?

Minor skin irritations

Potency of topical steroids is based on their what?

Skin vasoconstricting ability

Which topical steroids are associated with group 1/ very high potency?

Augmented betamethasone dipropionate GEL/OINT 0.05%
Clobetasol propionate CR/Oint 0.05%

Which topical steroids are associated with group 2/ high potency?

Fluocinonide CR 0.05% Augmented betamethasone
dipropionate CR/LOT0.05% Triamcinolone acetonide CR

Which topical steroids are associated with group 3-5/ medium potency?

Betamethasone valerate cream 0.1% Desoximetasone cream
0.05% Fluocinolone acetonide Cr/Sol 0.025%
Hydrocortisone butyrate 0.1% Hydrocortisone valerate CR
0.2% Triamcinolone acetonide creams, 0.1%, and 0.025%

Which topical steroids are associated with group 6-7/ low potency?

Flucinolone acetonide cr/sol 0.01%
Hydrocortisone 2.5% (any)
Hydrocortisone 1.0% (any)(OTC) Desonide cream

Which steroids are reserved for children, milder conditions
or thin skin areas such as face, groin, skin folds, and armpits?

Low potency

Medium potency steroids are used on what areas of the body?

trunk arms legs

Which steroids are used for severe inflammation and thicker skin such
as the palms of hands and soles of the feet?

Very high potency steroids

Treatment with very high potency steroids should not exceed how long?

2 weeks

Continuous use of highly potent steroids can cause what?

Adrenal suppression

Augmented betamethasone dipropionate (Diprolene, etc) is
more potent than the regular version why?

the vehicle in the augmented version increases
penetration .

Which agent is used to increase absorption?

Propylene glycol

What are some measures used to increase absorption?

Wrap with saran wrap Put on gloves if have hand

List the order of potency among lotions, creams, and ointments?

Ointments > Creams > Lotions

Ointments are good for what?

thick or dry skin

Lotions, gels, foams are good for what areas?

Hairy areas

Which formulations can be used in any location?


What is the most common dosing for topical steroids?


Which conditions are treated with very high/high potency (Group 1 and
2) steroids?

Atopic dermatitis (resistant)- Eczema Discoid
lupus Poison ivy (severe) Psoriasis Severe
hand eczema

Which conditions are treated with medium potency (Groups 3-5) steroids?

Anal inflammation (severe) Atopic dermatitis
(moderate)-Eczema Scabies (after scabicide)
Seborrheic dermatitis Severe dermatitis

Which conditions are treated with low potency (Group 6 and 7) steroids?

Dermatitis (diaper) Dermatitis (eyelids)
Dermatitis (face) Perianal inflammation Insect
bites Sunburn (first & second degree) Contact
dermatitis Atopic dermatitis (children) Atopic
dermatitis (mild adult)

To avoid adverse effects, continuous use of low potency to high
potency topical agents should not exceed how long?

3 months

List the adverse affects (cutaneous rxns) associated with chronic use
or overuse of topical steroids?

Bruising Increased fragility (skin could tear)
Atrophy(stetch marks) Striae (stretch marks)
Telangiectasia (spider veins)

List some others adverse effects associated with topical steroids:

Increase risk of infection (initially) Delayed wound
healing.(initially) Hyperpigmentation

Why should highly potent topical steroids be avoided in facial areas
and genital areas?

Increased absorption (great risk for adverse events)

What systemic effective ADR can occur with topical steroids of high
to very high potency?

Hypothalamic-pituitary-adrenal suppression

Which patients are more susceptible to HPA axis suppression due to a
greater surface area to body weight ratio?


Suppressing the Adrenal glands can lead to what?

Cushing's Syndrome

The signs and symptoms of Cushing's Syndrome include:

Upper body weight gain High blood pressure
Skin change Acute adrenal insufficiency can even be

What are some other potential ADR with High and Very High Potency
topical steroids?

Glaucoma/Cateracs Hyperglycemia

What is an easy estimate for patients to measure out topical steroids?

Fingertip method (500 mg of drug in fingertip)

1 fingertip unit covers what?

both sides of adult hand

Which fingertip units will cover one adult foot?

2 fingertip units

How many fingertip units cover an adult face and neck?


How many fingertip units cover one adult arm?


How many fingertip units cover one adult leg?


How many fingertip units cover adult trunk (front or back)?


Occlusive dressings she be avoided using more than how long?

12 hours/day

Treating skin infections with topical corticosteroids can do what?

Worsen infection

In the presence of an infection, institute therapy with what?

Antifungal or antibacterial agent

What drug is a combination of a steroid and an antifungal?


What leave the skin mostly intact, are not deep such as scratches?


Which wounds include several layers of fat or muscle and take several
days to heal�.. a cut that is jagged or irregular?


Surgical wounds, which are usually made by a scalpel. These are
similar to lacerations, but have very smooth edges are known as what?


Lacerations tear through the skin, while these go in and come back
out like a nail, animal bite or tack are known as what?


What two wound types might be hard to distinguish from each other?

Lacerations and punctures

What wound types are hard to treat?


What is the ideal time for infection to set into a laceration,
puncture, or incision (wounds that require suturing)?

8 hours

What is the optimal time for suture removal for the face?

3-5 days

What is the optimal time for suture removal for the chest and extremities?

8-10 days

What is the optimal time for suture removal for High tension (joints, hands)

10-14 days

What is the optimal time for suture removal for the scalp?

7 days

What is the optimal time for suture removal for the back?

10-14 days

When an injured area is bleeding it should be elevated above the what?


What should continue to be added to try and stop bleeding?


What can be used to stop bleeding for light to moderate blood flow?

Primary dressing

Moderate to heavy blood flow should be treated with what?

Secondary dressing

Irrigation of a wound should be with what?

clean water or normal saline

List some products that can be used to clean skin around the wound:

Povidone-iodine, 10%, Topical Solution (Betadine)
Hydrogen Peroxide (3%) (Dilute with water 50%)
Chlorhexidine Gluconate (4%) (Hibiclens) Soap and

What is added to ethyl alcohol to deter the ingestion of the
antiseptic (hand-sanitizer)?


What works slightly better than ethyl alcohol as an antiseptic but
it's more drying and irritating to the skin?

isopropyl alcohol

What refers to a mixture of water and either isopropyl or ethyl
alcohol for topical use?

Rubbing alcohol

What percent of rubbing alcohol is recommended to use as a
disinfectant on surfaces or on the skin as an antiseptic?


What is known as total clean formula and is the antibacterial agent
in hand soap?

Benzethonium chloride 0.1% (NO ONE IS ALLERGIC TO THIS)

What are 3 topical OTC antibiotics?

Bacitracin Zinc (500 units) Bacitracin Zinc +
Polymyxin B Sulfate 10,000 units (POLYSPORIN) Bacitracin
Zinc +Polymyxin B Sulfate + Neomycin Sulfate (Triple Antibotic)

Dermatologic Hypersensitivity rxns result in what effects?

Reddening Allergic contact dermatitis

What is the incidence of allergic reactions in Neomycin?


What is the incidence of allergic reactions in Bacitracin?


What antiseptic can be used for a patient who has an allergy?

Benzalkonium Chloride (0.13%). (Bactine--> also contains Lidocaine)

Bactine is best stored where?

Refrigerator (feels good when cold and easy to find)

Which drug is used for the treatment of skin lesions caused by
susceptible strains of S. aureus and
Streptococcus pyogenes?

Mupirocin Ointment (Bactroban)

Which antibiotic is used as a protection against anaerobes?

Cleocin (Clindamycin)

What antibiotic is used to prevent Community MRSA?

Bactrim (Sulfamethoxazole-Trimethoprim)

Why should non-stick pads not be used?

Pulling off skin and scab

Tapes and dressings/gauze are used for what type of bleeding?

Light to moderate (primary)

Which type of tape should not be used?

Paper (comes off easily)

What are some examples of secondary dressings that are used for
moderate to heavy drainage?

Abdominal pads (ABD) Kling rolls Tampax

Hydrophilic Polymer and Potassium Ferrate acts as a wound sealer or
artificial scab refers to which drug?

Wound Seal

Why should a wound be washed out prior to the use of WoundSeal?

Contamination would stay in wound

What should be used when you have a laceration that you don�t think
needs stitches?

Steri-strips (butterfly strip)

Steri-strips can be used in the ER for what?

Extra support on top of stitches

What are the tips for using steri-strips?

Apply to dry, clean skin without tension. Can stay in
place until they fall off or 7-10 days. Showering okay,
after 24 hours

What is a tissue adhesive (that is like extra strength superglue)?

Dermabond (clean out wound prior to use

List how Dermabond is used:

Good for small areas such as face/scalp Peels off in
5-10 days. Crush Dermabond vial and invert. Gently
brush adhesive over laceration. Avoid pushing adhesive into
wound. Apply three layers of adhesive.

List the contraindications associated with Dermabond:

Jagged lacerations Bites, punctures or crush
wounds Contaminated wounds Mucosal surfaces
high-moisture areas Hands, feet and joints, unless kept

Neosporin wound cleaner has what active ingredient?

Benzalkonium Cl (Alternative to people with Neo allergy)

Neo to Go has what active ingredients?

Benzalkonium Cl and Pramoxine (Alternative for those with Neo
allergy; pramoxine for pain and itch)

Any symptoms of eye problems persisting for more than how long
require a referral to an MD?

>72 hours

What are the signs and symptoms of Dry Eye Disease?

White or mildly red eye Sandy, gritty feeling
�Foreign object� in eye feeling Decreased or
paradoxical increased tear production Blurred vision
Itching Photophobia

What are complications associated with Dry Eye Disease?

Causes irritation/inflammation that won�t go away
Aching in eye/painful Potential damage to cornea if not

A very rapid increase in intraocular pressure (IOP) refers to which
glaucoma type?

Acute angle closure glaucoma

What are the symptoms of acute angle closure glaucoma?

Blurred vision Halos around eyes Eye
redness Severe eye pain Headache

Which glaucoma type is the most common?

Open angle glaucoma

What is the specific cause of open angle glaucoma?


What are the symptoms of open angle glaucoma?

No symptoms

What has been shown to reduce the disease progression of open angle glaucoma?

Lowering IOP

An IOP greater than what value is a risk factor for developing OAG?

>21 mmHg

At what age should yearly eye exams be performed for glaucoma screens?


Is family history a risk factor for open angle glaucoma?

Yes. If mother/father had it then exams need to be done before age 40

Which ethnicities are more prone to OAG?

African American/Hispanic

What are some risk factors for OAG?

Hypotension Corticosteroid use long term (especially
ocular steroids prednisone eye drops) Severe Myopia
(near-sightedness) Ocular trauma, optic nerve damage, optic
disk hemorrhage Reduced blood flow to the optic nerve

General IOP % decrease goal � decrease IOP by what % from baseline
IOP at diagnosis?

20-30% from baseline

What are the main two ways to increase ocular absorption and decrease
systemic effects in patients who administer eye drops?

Nasolacrimal occlusion Eyelid closure technique

Nasolacrimal occlusion should last how long?

1-2 minutes

Describe the process of the eyelid closure technique?

Gently close eyelid and keep head tilted back Do NOT
immediately look down or squeeze eyes shut as in 2nd, 3rd

List the pharmacotherapy plan for OAG?

Initiate therapy with one ocular agent, usually a
prostaglandin analogue or a beta-blocker and Monitor IOP
in 4-6 weeks
THEN: A) � if IOP reduced, but not at
goal, increase sol. strength (if possible) of existing
medication or consider substituting a different medication from
the same class or consider adding an additional agent from
another class, depending on the patient OR
B) if IOP does not decrease with 1st agent, DC first agent
and try an agent from a different class
NOTE: As the years progress, most patients will
require 2 to 3 medications; combination products could be considered
for these patients

What are the first line medications for OAG?

Ocular Prostaglandin analogues Ocular

What are the second line medications for OAG?

Ocular Alpha 2 adrenergic agonist Brimonidine Ocular
Carbonic anhydrase inhibitors

What are used as third line treatments in OAG?

Combination products

What are the 4th line medications used (RARELY USED) for OAG?

Ocular Cholinergic (Miotic) agents Systemic carbonic
anhydrase inhibitor

The fourth line medications used for OAG are used often in what?

acute angle glaucoma to rapidly decrease IOP

Which drugs improve uveoscleral outflow, and to a lesser amount,
trabecular outflow, of aqueous humor to reduce IOP by 25-35%?


Do PA have better or worse control of nocturnal IOP compared to Beta Blockers?


Do PA have more or fewer side effects than Beta blockers?


Which drug may increase outflow thru the trabecular network and may
be slightly more effective than the other Prostaglandin Analogues (PAs)?


What are the directions for the prostaglandin analogs?

One drop at bedtime (1 gtt OU QHS)

What is the generic of Xalatan?


What is the generic for Lumigan?


What is the generic for Travatan Z?


What is the generic for Zioptan?


Which drug is the modified prostaglandin analog?

Latanoprostene bunod (Vyzulta)

Which PAs are available in generics and therefore less expensive?

Xalatan (Lantanoprost) Lumigan (Bimatoprost)
Travatan Z (Travoprost)

Which PA is available as preservative free?

Zioptan (Tafluprost)

What are the side effects of PAs?

Eyelid skin darkening and redness Ocular inflammation
and edema Stinging and Foreign body sensation upon
administration Loss of periorbital fat- not reversible
Dry eye, especially if using > 1 eye drop medication
Allergic conjunctivitis Iris pigmentation � increase or
decrease? Increase- not reversible Eyelash darkening or
lightening? darkening Eyelash over-growth (hypertrichosis)
or slowed growth? Over-growth

Which drugs reduce IOP by reducing aqueous humor production by the
ciliary body to reduce IOP but 20-30%?

Ocular beta blockers

What is the generic of Timoptic?

Timolol maleate

What is the generic for Betagan?


What is the generic for Optipranolol?


What is the dosing for Timoptic?

one drop twice a day or daily

What is the dosing for Timoptic XE?

one drop daily

What is the dosing for all other ocular beta-blockers?

One drop twice a day

What is the generic of Betoptic?

Betaxolol (comes in sol. and susp.)

Betoptic is what?

Beta-1 cardioselective

What are the systemic side effects of ocular beta blockers if there
is systemic absorption?

Asthma, COPD, bronchospasm, respiratory depression
Bradycardia, hypotension, heart block Masks signs of
hypoglycemia in diabetes

What are the contraindications of ocular beta blockers?

Asthma, COPD, bronchospasm Bradycardia, Heart Failure,
Heart block, Atherosclerosis Diabetes Myasthenia

If a patient does not use proper administration technique while using
timolol 0.5% in each eye this could be equivalent to how much oral timolol?

10 mg

What are the local side effects of ocular beta blockers?

Stinging upon administration Dry eye, especially if
using >1 eye drop medication Ocular irritation
Allergic conjunctivitis (very rare) Blurred vision upon

Which drugs reduce aqueous humor production?

Ocular alpha-2 adrenergic agonists

What is the generic of Alphagan P?


What is the drug class of Alphagan P?

Alpha-2 adrenergic agonist

What is the dosing of Alphagan P?

one drop twice a day or three times a day

What is the generic of Iopidine?


What is the dosing of Iopidine?

one drop 2-3 times a day

Iopidine is used for what?

Post eye surgery (not indicated for glaucoma)

What causes fewer local side-effects than the preservative
benzalkonium chloride?

Purite preservative

Purite preservative is used in which drugs?

Alpha-2 adrenergic agonits

What are the local side effects of Alpha-2 adrenergic agonists?

Eye irritation, eye itching, ocular edema Allergic
conjunctivitis Foreign body sensation in eye Dry
eye, especially if using > 1 eye drop medication Dry

What are the systemic side effects of alpha-2 adrenergic agonists (if
no or poor NLO or ELC)?

Dizziness Fatigue and Somnolence Dry
mouth Dry nose Headache Bradycardia,

Alpha-2 adrenergic agonists should be used in caution with patients
of what conditions?

Cardiovascular conditions Cerebrovascular disease
Impaired Renal Function Diabetes

30% of patients experience allergic conjunctivitis with which drug?

Apriclonidine (Iopidine)

What are ocular carbonic anhydrase inhibitors used for OAG?

Dorzolamide Brinzolamide

What is generic of Azopt?


What is the generic of Trusopt?


Which drugs decrease IOP approx. 20-25% at peak effect 5 hours after administration

Alpha-2 adrenergic agonists

What is the dosing of carbonic anhydrase inhibitors?

one drop 2-3 times daily

Which drugs decrease aqueous humor production to reduce IOP?

Carbonic anhydrase inhibitors

Carbonic anhydrase inhibitors reduce IOP by what %?


What are the local side effects of CAIs?

Ocular burning and stinging - common Dry eye
Transient blurred
vision; Tearing Allergic conjunctivitis (common
SE)- varies� definitely over 10%
Rare � severe
conjunctivitis, allergic dermatitis of the lids, corneal edema,

True or False: Systemic side effects are rare with CAIs.


What is the systemic side effect exception to CAIs?

Metallic taste in mouth

Which drugs are orally used in short term in angle closure glaucoma?

Systemic CAIs

What are some oral CAIs?

Acetazolamide Methazolamide

Why aren't systemic oral CAIs used for OAG?

Potential serious side effects

Systemic (oral) CAIs have a relative contraindication with what allergy?


Which drug type increases aqueous humor outflow?

Rho kinase inhibitors

What is the generic of Rhopressa?


What is the drug class of Rhopressa?

Rho Kinase inhibitor

What is the dosing for Rho kinase inhibitors?

1 drop at bedtime

True or False: Rhopressa is considered an addition to first line therapy


What are the side effects of Rho kinase inhibitors?

Pain when instilled in eye
Hemorrhages in

What is the generic of Cosopt and Cosopt PF?

Timolol and Dorzolamide

What is the dosing of Cosopt?

1 drop BID

What is the generic of Combigan?

Timolol and Brimonidine

What is the dosing of Combigan?

1 drop BID

What is the generic of Xalacom?

Timolol and Latanoprost (not available in US)

What is the dosing of Xalacom?

1 drop QD

What is the generic of Simbrinza?

Brinzolamide and Brimonidine

What is the dosing of Simbrinza?

1 drop TID

Patients with active Respiratory distress, Bronchospasm should avoid
which ocular glaucoma medications?


Patients with advanced heart disease, Bradycardia should avoid which
ocular glaucoma medications?


Patients with sulfa allergies should avoid which ocular glaucoma medications?

Systemic CAIs (caution- ocular CAIs)

Patients with a history of kidney stones should avoid which ocular
glaucoma medications?

Systemic CAIs

Retinal detachment can be associated with which glaucoma medications?

Cholinergic agents (Pilocarpine)

Patients with hypersensitivity to product components should avoid
which glaucoma medications?

Prostaglandin analogues, Vyzulta

Patient with blue or green eyes that does not want darkened eye
pigmentation should avoid which ocular glaucoma medications?

Prostaglandin analogues, Vyzulta

What are some other combination products not available in the US?

Travoprost/Timolol Timolol/Brinzolamide

If more than one drop needs to be instilled into the same eye, how
long should the interval be between drops?

5 minutes

Conjunctivitis can be caused from what etiologies?

Allergic (most common) Viral Bacterial

List some potential irritants/allergens that can cause allergic conjunctivitis:

Pollen; Ragweed Dust Pollution
Animal dander Cigarette smoke

What are the signs/symptoms of allergic conjunctivitis?

�Pruritis (itch) �Redness
�Stinging/Burning �Watery eyes �Photophobia
�Glassy appearance

Is allergic conjunctivitis seasonal or year-round?

Can be either one

Is allergic conjunctivitis always combined with allergic rhinitis?


What are some non-pharmacologic recommendations for allergic conjunctivitis?

�Change pillowcases �shower at night �more
resistant pillowcase covers �clean wash cloths
�towels, etc. when washing �Cold compress,
�Artificial tears to rinse eye out at bedtime

Most OTC medications indicated for allergic conjunctivitis should not
be used for how long?

NMT 3 days

What are the trade names for olopatadine?

Pazeo Pataday Patanol

What is the drug class of olopatadine?

Antihistamine with mast cell stabilizing effects

What is the dosing of Pataday and Pazeo?

1 gtt OU QD

What is the dosing of Patanol?

2 gtt(s) OU BID

What are the trade names of Ketotifen ophthalmic?

Alaway Zaditor

What is the drug class of ketotifen ophthalmic?

Antihistamine with mast cell stabilizing properties

What is the dosing of ketotifen ophthalmic?

1 gtt OU BID

What is the generic name of Alocril?


What drug class is Alocril?

Mast cell stabilizer (does not have antihistamine)

Why is Alocril considered a second line treatment?

Takes several weeks to be effective

What are the trade names of pheniramine and naphazoline?

Naphcon-A Visine-A Opcon-A

Pheniramine is what drug class?


Naphazoline is what drug class?


What is the dosing for pheniramine and naphazoline?

1-2 gtt(s) OU up to 4 times a day

Antihistamine/decongestant combinations should not be used longer
than 3 days. Why?

Rebound congestion

Antihistamine/decongestant combinations increase the risk of what?

acute angle glaucoma

What are some other decongestants in eye drops?

Phenylephrine Tetrahydralazine

Ophthalmic corticosteroids are not intended for long term use why?

increased risk of side effects

When are ophthalmic corticosteroids used for allergic conjunctivitis?

Severe cases

Ophthalmic corticosteroids with what functional group are associated
with fewer ocular side-effects?


Ophthalmic corticosteroids with what functional group are associated
with more ocular side-effects?


What are the brand names for Loteprednol?

Lotemax Alrex

What is the dosing for Lotemax?

1 gtt OU QID

What kind of corticosteroid is lotemax?


What are some ketone corticosteroids?

�Prednisolone (Pred Forte�)
�Fluorometholone (FML�)

What is the patient counseling for Lotemax?

may find relief within 6 hours

What are the side effects for Lotemax?

blurred vision increased risk of eye infection and dry
eye shake suspension well before using

What is the generic for Claritin?


What is the generic for Zyrtec?


What is the dosing regimen for Claritin?

10 mg QD

Zyrtec and Claritin are what drug class?

second generation oral antihistamines

Second generation oral antihistamines are used for treatment of what?

allergic rhinitis

Patient presentation: acute onset of ocular watery mucous discharge,
red eye, itchy eye and lid edema in one eye; may spread to other eye
relates to what?

Viral conjunctivitis

What is the most common cause of viral conjunctivitis?

Adenovirus (common cold)

Viral conjunctivitis is known as what?

Pink eye

What is the generic name of Viroptic?


Viroptic is used for what?

Herpes simplex viral conjunctivitis

What is similar to viral conjunctivitis but eye discharge is
mucopurulent and eyes are �glued shut� (matted) in the morning?

Bacterial conjunctivitis

What are fluoroquinolone ocular products used for bacterial conjunctivitis?

Ciprofloxacin Moxifloxacin

What is the trade name for Moxifloxacin?


What is the dosing regimen for Vigamox?

1 gtt TID for 7 days

What is the patient counseling for fluoroquinolone ocular products?

May feel stinging and burning on admin

What are the ocular related side effects associated with Hydroxychloroquine?

blurred vision intolerance corneal
deposits retinopathy

What are the ocular related side effects associated with corticosteroids?

Increase risk for Cataracts Increase IOP

What are the ocular side effects associated with Tamsulosin (Flomax)?

blurred vision eye pain
floppy iris syndrome
(reduced muscle tone in iris)

What drug class is Flomax?


If a patient is taking Flomax and is going to have eye surgery soon,
then what counseling should be done?

discard medicine prior to eye surgery

What are the ocular side effects associated with amiodarone?

Corneal deposits optic neuritis and neuropathy

What are the ocular side effects associated with Digoxin?

yellow/green halos (reversible)

What are the ocular side effects associated with Tamoxifen?

cataracts corneal opacities decreased color
perception retinopathy

What are the ocular side effects associated with Isotretinoin?

decreased night vision photophobia corneal
opacities and dry eye

What are the ocular side effects associated with fluoroquinolones
(ex. Ciprofloxacin and Levofloxacin)?

Retinal detachment � Medical emergency (not reversible)