Eye and ear

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Slide 1: 

Drugs for the Ears and Eyes

Objectives-Ear : 

Objectives-Ear Compare and contrast acute otitis media (AOM), otitis media with effusion (OME), and antibiotic-resistant otitis media, in terms of the most common pathogenic causes (epidemiology), typical signs and symptoms, and treatment. Comment on the pros and cons of routinely treating all (or even most) causes of acute otitis media with antibiotics, as opposed to holding off with antibiotic therapy for a short time and seeing whether the signs and symptoms of the condition resolve spontaneously (“prescribe and wait”). Comment on the use of antibiotic prophylaxis for recurrent otitis media in children. Imagine talking to a mother who has brought her daughter into the pediatrics office three times in the last year with an ear infection; she wants a prescription for antibiotics to prevent another infection.

Figure 105-1 Anatomy of the ear. : 

Figure 105-1 Anatomy of the ear.

Treatment of Otitis Media : 

Treatment of Otitis Media Acute otitis media Amoxicillin Antibiotic-resistant otitis media High dose amoxicillin-clavulanate Recurrent otitis media Prevention Vaccination

Otitis Externa : 

Otitis Externa Acute otitis externa Topical treatment Oral treatment Ciprofloxacin, fluoroquinolones Prevention

Objectives-Eye : 

Objectives-Eye Compare and contrast open-angle glaucoma and angle-closure glaucoma in terms of etiologies, prevalence (including demographic/ethnic factors), and management. Summarize how the sympathetic and parasympathetic branches of the autonomic nervous system control pupil size, and explain why pupil size is important for narrow-angle glaucoma; state the classes of autonomic drugs that cause miosis and mydriasis; explain whether the effects of these drugs are beneficial or harmful for glaucoma, and why.   State the very simple, fundamental mechanism by which all drugs that have been shown to be effective for managing glaucoma, regardless of their mechanism of action or class, are beneficial for this eye disorder.

Objectives-Eye : 

Objectives-Eye Give a general and accurate description of how the following may help lessen intraocular pressure (IOP): adrenergic agonists; muscarinic agonists; acetylcholinesterase inhibitors; carbonic anhydrase inhibitors, and PGF2 alpha or its analogs.   State comorbidities that might be aggravated by stated drugs or drug groups that are suitable for managing glaucoma. Conversely, name some drugs or drug classes and the main indications for their use that might raise IOP and aggravate glaucoma.   State whether topical ophthalmic administration of drugs for glaucoma (as opposed to administering by, say, the oral route) will ensure that no systemic side effects occur, and explain why; identify what administration techniques

Figure 103-1 Anatomy of the normal eye. : 

Figure 103-1 Anatomy of the normal eye.

Drugs for the Eye : 

Drugs for the Eye Glaucoma—visual field loss secondary to optic nerve damage Forms Primary open-angle glaucoma (POAG) Acute angle-closure glaucoma

Figure 103-2 Comparative anatomy of the eye in open-angle and angle-closure glaucoma. : 

Figure 103-2 Comparative anatomy of the eye in open-angle and angle-closure glaucoma.

Primary Open-Angle Glaucoma : 

Primary Open-Angle Glaucoma Risk factors Elevation of intraocular pressure (IOP) African American Family history of POAG Advancing age

Drug Therapy for Glaucoma : 

Drug Therapy for Glaucoma Drugs that lower IOP by either – Facilitating aqueous humor outflow – Reducing aqueous humor production Beta-adrenergic blocking agents Alpha2-adrenergic agonists Brimonidine [Alphagan] Cholinergic agonists Prostaglandin analogs Latanoprost [Xalatan] Carbonic anhydrase inhibitors

Cycloplegics and Mydriatics : 

Cycloplegics and Mydriatics Cycloplegics—paralyze ciliary muscles Mydriatics—dilate the pupil Uses Intraocular examination Intraocular surgery Treatment of anterior uveitis Miotics constrict pupil

Age-Related Macular Degeneration (AMD) : 

Age-Related Macular Degeneration (AMD) Painless, progressive disease that blurs central vision and limits perception of fine detail AMD is the leading cause of blindness in older Americans: about 15 million have the disease Stages Early Intermediate Advanced Management and treatment Laser therapy Photodynamic therapy

Drugs for Age-Related Macular Degeneration : 

Drugs for Age-Related Macular Degeneration Demulcents [Artificial Tears] Ocular decongestants Glucocorticoids Dyes Antiviral agents

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