Ear, nose drugs

Question 1

First generation antihistamines

Answer 1

Diphenhydramine (Benadryl), Brompheniramine (Dimetane), Chlorpheniramine (ChloroTrimeton), Promethazine (Phenergan), many times daily

Question 2

Second generation antihistamines

Answer 2

Loratadine (Claritin), Fexofenadine (Allegra), Cetirizine (Zyrtec), Desloratadine (Clarinex), Levocetirizine (Xyzal), once daily

Question 3

Combo products

Answer 3

Loratadine/Pseudoephedrine (Claritin-D), Fexofenadine/pseudoephedrine (Allegra-D), MANY

Question 4

Antihistamine MOA

Answer 4

blocks histamine receptor to suppress itching, sneezing, rhinorrhea, and ocular symptoms

Question 5

Antihistamine ADR

Answer 5

Sedation, anticholinergic side effects, cog dysfunction

Question 6

Pearls for antihistamines

Answer 6

best for prevention of sx, start routine admin in March, don’t wait for symptoms, take additional if mowing, use combo products, very safe for long term use, caution with alzheimer’s, BPH and glaucoma

Question 7

Which antihistamines are good for peds

Answer 7

Zyrtec and claritin, not so much with benadryl

Question 8

Azelastine (Astelin)

Answer 8

nasal spray antihistamine, helps with ocular sx, can cause drowsiness, nasal irritation, $$$

Question 9

Dymista

Answer 9

Azelastine+fluticasone, nasal antihistamine combo, $$$$$$

Question 10

Decongestants

Answer 10

Pseudoephedrine (Sudafed), Phenylephrine (Sudafed PE tablets and Neo-synephrine Nasal spray), Oxymetazoline (afrin, nasal), Sodium chloride (Ocean spray, increases humidity)

Question 11

Decongestant use and ADR

Answer 11

focus in nasal congestion, insomnia, tachy, HTN (in uncontrolled); overall safe but shouldn’t be used long term

Question 12

Nasal corticosteroids

Answer 12

Budesonide (Rhinocort), Flunisolide (Nasarel), Fluticasone (Flonase and Veramyst), Mometasone (Nasonex), Triamcinolone (Nasacort)

Question 13

Nasal corticosteroids Pearls

Answer 13

not for short term use, does not have immediate results, not first line, usually combo, can cause oral thrush, nasal irritation, sore throat, sneezing

Question 14

Anticholinergics

Answer 14

Ipratropium (atrovent), spray decreases rhinorrhea, best for non allergic rhinitis, limited use

Question 15

Montelukast (Singulair)

Answer 15

leukotriene receptor blocker, ideal pt w/ asthma, once daily, approved for children, never first line, safe but efficacy?

Question 16

Immunotherapy for nose

Answer 16

sub-cutaneous injections of antigens weekly with slow transition with increased dose, reserved for pt that do not respond

Question 17

Pathogens of acute otitis externa

Answer 17

pseuromonas aeruginosa, staph aureus

Question 18

approaches to treating AOE

Answer 18

acidifying agents (acetic, boric acid), astringents (aluminum acetate), analgesic/anesthetic (antiprene/benzocaine), anti-inflammatory (hydrocortisone, dexamethasone), antibiotics

Question 19

Antibacterials used for mild to moderate infection

Answer 19

neomycin/colistin/hydrocortisone (Coly-Mycin Otic), Neomycin/polymixin B/hydrocortisone (Cortisporin Otic)

Question 20

antibacterials for Severe infections

Answer 20

Ofloxacin (Floxin), Ciprofloxacin/hydrocortisone (cipro HC otic), Ciprofloxacin/dexamethasone (ciprodex otic)

Question 21

Antipyrene/Benzocaine (AB otic, AUrodex)

Answer 21

for ear pain and swelling, 3-4 drops every few hours, safe, onset 30 mins, cheap

Question 22

Acetic acid (VoSol HC Otic, Vosol Otic)

Answer 22

use limited, helps inhibit bacterial growth

Question 23

Acetic acid/aluminum acetate (Domeboro)

Answer 23

good if pt has breakdown of ear canal

Question 24

Ear Hygiene option

Answer 24

Swim ear-Isopropyl alcohol, anhydrous glycerin, efficacy?, Dri ear- boric acid, isopropyl alcohol; Debrox- carbamide peroxide, glycerin, propylene glycol (helps w/ear wax); 50/50 H2O2/H2O