CH 4 EENT Flashcards
does acute bacterial rhinsinusitis (ABRS), aka URI that is secondary infection of the sinuses after a viral URI, need antibiotics?
NO! <3% of viral URI are complicated in ABRS and resolve without antimicrobial therapy
number 1 organism leading cause of acute bacterial rhinusitis
Strep pneumoniae
Diseases caused by Strep pneumoniae:
COMPS
Conjunctivitis
Otitis media
Meningitis
Pneumonia
Sinusitis
Diseases caused by H. influenzae:
COMPS
Conjunctivitis
Otitis media
Meningitis (Type B)
Pneumonia
Sinusitis
what is the 2nd most causative organism for ABRS
gram negative bacillus: H influenzae
what is the 3rd most causative organism for ABRS
M. catarrhalis (gram negative coccus)
acute bacterial rhinosinusitis/URI signs and sx’s:
fever & sx > 10 days
maxillary toothache
initial sx improvement then sudden worsening of sx
cacosmia (sense of bad odor in nose)
unilateral facial pain
bacterial URI need at least 1 of these to dx (compared to viral):
a) not improving 10 or more days
b) severe fever >102, purulent nasal discharge/facial pain for 3 + days
c) worsening or “double sickening” usu per 5-6 days of illness
if dx of ABRS, analyze for antibiotic resistance!
most common risk:
age < 2 or >65
day care attendance
use of antibiotics in past month
if there is NO/worsening improvement after 3-5 days with antimicrobial class, broaden or switch to different antimicrobial class, if worsening/no improvement after 3-5 days, get
CT or MRI to investigate non infectious causes
sinus or meteal cultures
if there is a risk for resistance present, use
2nd line therapy, should improve after 3-5 days
complete therapy in 7-10 days
antimicrobial therapy for acute bacterial rhinusitis days?
5-7 days
what antimicrobials are NOT recommended in ABRS treatment due to rising resistance rates and tx failure?
macrolides (azithromycin, clarithromyin, erythromycin) and bactrim/ TMP-SMX
first line antib for acute bacterial rhinosinusitis in adults?
amoxicillin 500 TID or 875 mg PO BID
OR
Amoxicillin clavulanate 1000mg/62.5 mg PO BID (take with food)
when someone is penicillin allergy, ask…
what happens when you take penicillin?
“idk”,
if no compromise in breathing, BP, no hives, no anaphlyaxis history
Antib for beta lactam allergy to ABRS, depends on anaphylaxis history. If no hx, then give:
If have anaphylaxis hx, give:
No hx:
- Cefdinir 600 mg/day q 12 hrs
OR
- Cefpodoxime 200 mg PO BID
OR
Cefuroxime 500 mg PO BID
if hx:
- levofloxacin 750 mg PO QD
OR
- moxifloxacin 400 mg PO QD
OR
- doxycycline 100 mg PO BID
**give doxy over -floxacin, but NO pregnant women*
if treatment failure after 3-5 days of therapy of ABRS:
mild/moderate symptoms:
amoxicillin-clavulanate 2000mg/125mg PO BID
OR
2nd or 3rd generation cephalosporin (Cefpodoxime, cefprozil, cefdinir)
severe symptoms:
levofloxacin 750mg PO QD
OR
Moxifloxacin
limit what antibiotic use in treating ABRS?
fluroquinolones (-floxacins)
substrate and example
a medication that is biotransformed by the isoenzyme, utilizing this enzme in order to be modified so it can reach drug site of action and/or be eliminated
CYP450 3A4 substrate: Sildenafil, atorvastatin, simvastatin, alprazolam
inhibitor and examples
drug that blocks isoenzyme activity, limiting substrate excretion, allowing increased in substrate lvls, possible risk of toxicity
erythromycin
if use any CYP450 drug is used with an inhibitor drug,
increases substrate levels
ex: clarithromycin + alprazolam = increased sedation, fall risk
inducer
accelerates lvl of isoenzyme so substrate pushed out, and decreases substrate level
ex: St johns wort + 3A4 substrate (COC use) lead to spotting, potential contraceptive failure
allergic rhinitis patho
inflammatory, IgE dz due to genetic and environmental interactions with nasal congestion, rhinorrhea, sneezing, intraocular and/or nasal itching
huge difference with allergic rhinitis and covid/flu/cold is
itch! eyes, nose, throat
first line for allergic disorder
avoid allergen
What controller therapy to prevent sx by preventing formation of inflammatory mediators in allergic rhinitis?
First line: intranasal corticosteroids
- fluticasone proprionate (Flonase), Itramcinolone (Nasacort)
educate takes 1 week to work
Intranasal antihistamine
- Azelastine (Astelin); rapid sx relief
What reliever therapy to relieve acute sx’s by blocking action of histamine?
2nd gen oral antihistamine:
- loratadine (Claritin), cetirizine (ZYrtec), levocetrizine (Xyzal)
[NO 1st gen antihistamine use [diphenhydramine/benadryl] bc sedation
ocular histamine for allergic conjunctivitis:
- olopatadine, azelastine, bepotastine
which 2nd gen antihistamine most potent to give for allergic rhinitis?
levocetrizine (Xyzal)
for allergic rhinitis, meds NOT routinely advised to give?
leukotriene modifier
- montelukast (Singulair) bc SE of agitation, depression, suicidal thoughts, sleep disturbances
systemic corticosteroids
- long acting or oral systemic causes risk of adrenal suppression, neg impact of bone density, and gastropathy
-takes days to work
always get what when someone presents with eye complaint?
always get vision screen with anyone presenting with eye complaint
painful
aphthous stomatitis
painful, self resolving
painless oral lesion
squamous cell carcinoma
persistent PAINLESS oral lesion (poke with tongue blade and won’t hurt)
encourage HPV vaccine (gardasil)
painless
syphilic chancre (but usu appears on genitals)
95% of oral cancers are what type of cell?
squamous cell carcinoma (SCC)
risk factors and risk factor reduction of oral cancer
longstanding HPV infectio (HPV16)
tobacco
alcohol misuse
>55 yrs
get HPV vaccine! avoid tob/alcohol
oral cancer presentation
painLESS, ulcerating oral lesions x months
adjacent lymphadenopathy, immobile NONtender nodes usually >1cm
refer for bx
when is a referral to an eye specialist?
sig change from baseline/new onset
red eye, painful, new onset vision change
gradual PERIPHERAL vision loss
open-angle glaucoma
painless, gradual onset of increased intraocular pressure = optic atrophy which can loss peripheral vision if no intervention
> 80% of all glaucoma
tx: topical miotics, beta-blockers
gradual onset blurring of near vision
presbyopia
central vision loss
macular degeneration
- From age; thickening slcerotic changes in retinal basement membrane complex
-pain LESS vision changes, distorted central vision
check Amsler grid test (early sign if abnormal)
presbycusis
-difficulty hearing conversation in a noisy environment
- accelerated by noisy environments, ototoxic meds (uncommon)
Group A beta hemolytic strep (GABS)/strep diagnosis and when to treat?
CENTOR Score:
-COUGH absent 1+
-Exudates (patchy tonsilar exudates) 1+
-NODES swollen 1+
-feveR 1+
-15 or younger is 1+
45 or older is - 1
treat if 4 or more points
-SUDDEN sore throat (next day)
-frontal headache (NO body aches)
Viral pharyngitis sx’s
-running nose THEN sore throat
-cough
-clear nasal discharge
-hoarseness
-scattered small vesicles on soft palate and tonsils
-generalized body aches
GABHS treatment
oral penicillin or amoxicillin
sudden increase in intraocular pressure
angle closure glaucoma
usu unilateral, acutely red, painful eye with vision change (halos around light)
refer!
conjunctivitis (non-gonococcal, non chlamydia) treatment
optic cipro soln or polymyxin B with trimethoprim ophthalmic soln
OR
Azithromycin ophthalmic soln
