Initial Post In your initial post, answer all the questions and provide rational

Initial Post
In your initial post, answer all the questions and provide rationales for your answers with supporting evidence using APA formatting. Integrate two evidence-based resources to include clinical practice guidelines as well as the course textbook.
Read the scenario and answer the following questions:
Ophthalmic DisordersV.S., age 12 Hispanic male, presents with a feeling that there is sand in his eye. He had a cold a week ago and woke up this morning with his left eye crusted with yellowish drainage. On physical examination, he has injected conjunctiva on the left side, no adenopathy, and no vision changes. His vision is 20/20. Fluorescein staining reveals no abrasion. He is allergic to sulfa.
Diagnosis: Conjunctivitis
List specific goals of treatment for V.S.
What drug therapy would you prescribe? Why?
What are the parameters for monitoring the success of the therapy?
Discuss the education you would give to the parents regarding drug therapy.
List one or two adverse reactions for the selected agent that would cause you to change therapy.
What would be the choice for second-line therapy?
What over-the-counter or alternative medications would be appropriate for V.S.?
What dietary and lifestyle changes should be recommended for V.S.?
Describe one or two drug–drug or drug–food interactions for the selected agent.
Reply Posts
Reply to at least two of your classmates, in a well-developed paragraph (300–350 words) to each peer integrating an evidence-based resource that is different than the one you used for the initial post.
Respectfully agree and disagree with your peers’ responses and explain your reasoning by including your rationales in your explanation.
please respond to Samantha:
List specific goals of treatment for V.S.
Inflammation of the conjunctiva, conjunctivitis, can occur from bacterial, viral, or allergic causes. Allergic conjunctivitis typically presents with nasal congestion, sneezing, and/or wheezing, itching of the eye being the primary complaint along with a grittiness, burning, or irritating description, watery discharge, and a pink conjunctiva that may be puffy or bumpy in appearance (Jacobs, 2022a). Viral conjunctivitis typically occurs following a viral episode with adenopathy, fever, an upper respiratory infection, or pharyngitis with limited pruritis if any, a primary complaint of ocular grittiness, burning or irritation, watery discharge with mucosal strands, and a conjunctiva pink to red in color with a bumpy appearance (Jacobs, 2022a). Bacterial conjunctivitis most often has no systemic symptoms, little to no pruritis, a conjunctiva that is pink to red in color, is unilateral, and drainage that is purulent with color variations of yellow, white, or green that continues to redevelop quickly after clearance (Jacobs, 2022a). Based on this information and the presentation of V.S., he most likely has bacterial conjunctivitis. Specific goals of treatment for V.S. and his bacterial conjunctivitis are resolution of sensation of sand in the eye and ocular discharge to increase patient comfort, reduce the course of infection, prevention of community transmission, and prevention of conjunctivitis complications including vision loss, corneal abrasion, corneal perforation, and keratitis (Pippin & Le, 2023). What drug therapy would you prescribe? Why?
Most patients with bacterial conjunctivitis don’t require antibiotics, but some situations may warrant them in order to shorten the course of infection when it comes to a patient’s preference to return to work or school quicker (Jacobs, 2022a). V.S. is most likely in school as a 12-year-old male and shortening the course could help him return to classes sooner, thus I would prescribe Erythromycin ophthalmic ointment 1 centimeter instilled to the affect eye’s lower lid 4 times a day for 7 days (Jacobs, 2022a, Lexicomp, n.d.). This drug is recommended as it is typically inexpensive, non-toxic, readily available, and has low rates of hypersensitivity (Jacobs, 2022a). Another first-line treatment option is sulfacetamide sodium, but this would be contraindicated with V.S.’s allergy (Woo & Robinson, 2020). What are the parameters for monitoring the success of the therapy?
The parameters for monitoring success of this therapy include resolution of ocular discharge and sand in the eye sensation, increased patient comfort, infection course reduction, prevention of community transmission including those in V.S.’s household and classroom, and prevention of conjunctivitis complications including vision loss, corneal abrasion, corneal perforation, and keratitis (Pippin & Le, 2023). Discuss the education you would give to the parents regarding drug therapy.
Specific education to V.S.’s parents about his erythromycin therapy would include minor ocular irritation and redness are normal side effects of this drug (Lexicomp, n.d.), proper hand hygiene before and after administration, do not touch the unaffected eye after instilling the affected eye, do not touch the end of the ointment tube to the affected eye and then touch it to the unaffected eye (UpToDate Doctors and Editors, n.d.). After placing the ointment inside the lower lid, the parents should instruct V.S. to close his affected eye for 1-2 minutes and roll her eyeball around inside (Lexicomp, n.d.). Vision may be blurred for up to 20 minutes after ointment administration (Jacobs, 2022b). Take missed doses as soon as remembered unless it is too close to next dose, don’t double on doses, stop taking drug if serious allergic reaction occurs, and report any signs of allergic reaction immediately (Lexicomp, n.d.). V.S.’s parents should check with their school and/or daycare’s rules regarding return after conjunctivitis, but he should stay home until resolution of symptoms or until 24 hours after antibiotic initiation (UpToDate Doctors and Editors, n.d.). List one or two adverse reactions for the selected agent that would cause you to change therapy.
Adverse reactions indicating an allergic reaction such as rash, hives, pruritis, changes in eyesight, ocular pain, sever eye irritation, wheezing, throat tightness, difficulty swallowing or talking, swelling of the mouth, lips, face and throat need to be immediately reported and a change in therapy is required (Lexicomp, n.d.). What would be the choice for second-line therapy?
A second-line therapy option for V.S. would be 1-2 drops of trimethoprim-polymyxin B four times daily for 5-7 days to the affected eye (Jacobs, 2022a). This drug is also recommended as it is typically inexpensive, non-toxic, readily available, and has low rates of hypersensitivity (Jacobs, 2022a).
What over-the-counter or alternative medications would be appropriate for V.S.?
One over-the-counter medication that could help V.S. with his case of bacterial conjunctivitis is an ocular lubricant, which will help with the symptom of dry eye (Jacobs, 2022b). A few examples of ocular lubricants include sterile eye drops and artificial tears. V.S. can also use warm or cool compresses to help with swelling and pain as needed (Jacobs, 2022b). What dietary and lifestyle changes should be recommended for V.S.?
A major lifestyle modification that should be reinforced to V.S. and his parents is hand hygiene. Hand hygiene should consist of 15-30 seconds of hand friction using soap and water and should be performed before and after eating, after using the bathroom, and after touching the eyes, sneezing, or coughing (Jacobs, 2022b). Hand hygiene should also be done after interaction or close contact with a sick individual if it is not possible to isolate form them. Hand sanitizers can also be used. The sharing of linen including towels, handkerchiefs, tissues, pillows, bedsheets, and cosmetics should not occur, especially among infected to uninfected family or friends (Jacobs, 2022b). V.S. should ensure hygiene practices in social settings like school and daycare, and inform his friends. Eating a diet rich in vitamin C, E, beta-carotene, zinc, and copper provides antioxidants and minerals that are beneficial for ocular health (Lawrenson & Downie, 2019). Describe one or two drug–drug or drug–food interactions for the selected agent.
No drug-drug or drug-food interactions were found for ophthalmic erythromycin. Please respond to Kenneth:
Diagnosis: Conjunctivitis List specific goals of treatment for V.S. I would diagnose V.S. with viral conjunctivitis based upon reported symptoms and review of past medical history leading up to this office visit. Viral conjunctivitis can often be present when viral upper respiratory infections are present. Symptoms include itching or feeling of grittiness in the eye and crusting around the eye upon first wake-up in the morning that then changes to a watery discharge (Jacobs, 2022). V.S. reported having a cold approximately seven days ago and with reported subjective symptoms at home as well symptoms noted on physical examination are indicative of viral conjunctivitis. Viral conjunctivitis is highly contagious and likely spreads to both eyes which can be misconstrued as bacterial. Symptoms peak days three to five with viral conjunctivitis to run its course in two to three weeks. Treatment goal is to monitor symptoms for deterioration and treat symptoms to provide therapeutic relief (Jacobs, 2022). What drug therapy would you prescribe? Why? I would prescribe naphazoline and pheniramine which is an OTC medication known by its brand name of Visine. This medication would be administered up to four times a day by instilling one to two drops into the eye to provide symptom relief of itching and irritation for viral conjunctivitis (Lexicomp, n.d.a). What are the parameters for monitoring the success of the therapy? This medication therapy is prescribed to provide symptom relief of itching or redness that may be present (Lexicomp, n.d.a). The goal of this therapy is to alleviate the feeling of sand in V.S. eye as reported, which is a common manifestation of viral conjunctivitis (Jacobs, 2022). Discuss the education you would give to the parents regarding drug therapy. For naphazoline and pheniramine there are no listed adverse reactions for this medication. Rather education is focused on administration. If contacts are worn, then it is recommended to remove these prior to installation and for safety it is instructed not to allow the tip of the dispenser to contact the eye or any surrounding structures (Lexicomp, n.d.a). List one or two adverse reactions for the selected agent that would cause you to change therapy. For patients taking naphazoline and pheniramine there are no noted adverse reactions to monitor for but there are some warnings while on this therapy which could be inconvenient or irritating to V.S. Some patients have reported sensitivity to lights which occur when the pupils become enlarged. Also, slight irritation or tingling that occurs for a short period following instillation. The tip of multi-dose bottles must be kept clean in order to prevent the risk of a bacterial infection (Lexicomp, n.d.a). What would be the choice for second-line therapy? If V.S. does not receive adequate symptom relief from naphazoline and pheniramine or has irritation with this treatment then I would prescribe V.S. to begin taking olopatadine (Jacobs, 2022). Olopatadine is an H1 antagonist antihistamine which can be taken as eye drops as well to provide therapeutic relief for viral conjunctivitis (Lexicomp, n.d.b.). If V.S. was to become diagnosed with bacterial conjunctivitis that came from an opportunistic pathogen from a contaminated eye drop container for instance, then ophthalmic azithromycin would be started to treat what is now bacterial conjunctivitis which is marked by purulent discharge (Jacobs, 2022). This medication is appropriate for V.S. based on the noted sulfa allergy in treatment for bacterial conjunctivitis. Azithromycin would be administered by instilling one drop to the affected eye twice daily for two days then decreased to once daily for the following five days (Lexicomp, n.d.c). What over-the-counter or alternative medications would be appropriate for V.S.? I would educate V.S. on remedies that can assist in decreasing the severity of symptoms associated with viral conjunctivitis. These would include the use of either cool or warm compresses to decrease eye irritation. This can be done completely at the preference to what is more comfortable and symptom relieving for the patient (Jacobs, 2022). What dietary and lifestyle changes should be recommended for V.S.? I would first educate V.S. and his parents on how highly contagious both viral and bacterial conjunctivitis is. Due to this, items that come into contact with the eye should be cleaned and not shared between people within the household. Proper hand hygiene should be emphasized. I would also educate the household that viral conjunctivitis can remain highly contagious even after symptoms begin to improve and that if diagnosed with bacterial conjunctivitis the window for being contagious is closed when either drainage has resolved or treatment has been used for greater than 24 hours (Jacobs, 2022.). Describe one or two drug–drug or drug–food interactions for the selected agent. The OTC medication naphazoline and pheniramine that I first prescribed to treat viral conjunctivitis can interact with atomoxetine. This medication can be used to treat ADHD and can place an increased risk for increased heart rate or blood pressure with naphazoline and pheniramine. This interaction risk category is a C rating and should be monitored while on these therapies (Lexicomp, n.d.a).