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Fall 2024 > Ear pharm > Flashcards

Ear pharm Flashcards

1
Q

FDA approved OTC for cerumen impaction

A

Carbamide Peroxide Solution 6.5%; >12 years of age

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2
Q

Carbamide peroxide names

A

Debrox
Mack’s Wax away
Murine for ear wax

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3
Q

Carbamide peroxide MOA

A

Urea and Hydrogen peroxide release oxygen which results in softening and removal of cerumen; weak antibacterial effects

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4
Q

When should carbamide peroxide be avoided?

A

Ear drainage/discharge
Ear pain
Rash/irritation in the ear
Injury/Perforation of the eardrum
Recent ear surgery
Dizziness

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5
Q

Carbamide peroxide instructions

A

Lie on bed, impacted ear upward, 5-10 drops, allow to remain several minutes, gently wash ear with warm water in syringe
*may need to repeat twice daily up to 4 days if needed

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6
Q

What should be avoided vs what can be used if ruptured TM

A

Avoid OTC otic preps
Avoid antibiotic drops except Fluoroquinolones +/- corticosteroids

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7
Q

First step to treat otitis externa

A
  1. Clean ear canal
    - if intact TM: 3% hydrogen peroxide solution with water at room temp.
    - if ruptured TM or unable to visualize: refer to otolaryngologist
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8
Q

Treat mild otitis externa

A

Topical acetic acid/hydrocortisone combination

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9
Q

Treat moderate otitis externa

A

First-line: Ciprofloxacin/hydrocortisone (Cipro HC) and Neomycin-polymyxin B-hydrocortisone (cortisporin)

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10
Q

Treatment of severe otitis externa

A

Topical antibiotic + antiseptic + glucocorticoid (same as moderate) and wick placement

If deep tissue infection - oral antibiotics + topical antibiotics

Oral agents - Ciprofloxacin 500mg BID or 10mg/kg/day, 2 doses, max 500mg for children

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11
Q

Treatment of otitis externa if patient is immunocompromised

A

Oral Ab + Topical Ab + Wick placement

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12
Q

Otitis externa patient education for drops

A

Tilt head toward opposite shoulder, pull auricle upward, fill ear canal with drops, lie on side 3-5 minutes or place cotton swab 20 minutes, typically 3-4 times per day for 7-14 days

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13
Q

What is the preferred topical agent for otitis externa

A

Topical fluoroquinolone
- better antimicrobial spectrum
- anti-inflammatory
- no ototoxicity
- Downside: cost, local irritation

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14
Q

Use of topical corticosteroids in otitis externa

A

Decrease inflammation/pain/pruritus
- hydrocortisone
- dexamethasone
- prednisolone
Use with antibiotic drops

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15
Q

Antiseptic and acidifying solutions for otitis externa

A

Bacteriostatic
Alcohol and acetic acid often used
Disadvantages: local irritation/burning/stinging
*DO NOT use with tympanic membrane perforation

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16
Q

What should be done if there is no response to treatment for otitis externa

A

Obtain culture
Consider referral to otolaryngologist
Consider CA-MRSA
Question Compliance/Water exposure

17
Q

Relationship between otic drops and eye drops

A

Sometimes eye drops can be used in ear, Ear drops should NOT be used in the eye

18
Q

What is the most common etiology of AOM

A

Strep pneumoniae
H. influenzae
M. cat

19
Q

When does antibiotic treatment need to be used for AOM

A

<6 months of age
<24 months and bilateral AOM
>6 months if certain diagnosis AND moderate to severe otalgia

20
Q

When should AOM be observed and not treated with antibiotics

A
  1. 6 months - 2 years if uncertain diagnosis and non-severe signs and symptoms
  2. > 2 years old without severe signs and symptoms
21
Q

Antimicrobial treatment for AOM - children

A

Amoxicillin 80-90mg/kg/day
Augmentin 90mg/kg/day, 6.4mg/kg/day
If S. pneumoniae: Clindamycin alone
If S. pneumoniae + H. influenzae: add cephalosporin

22
Q

When should tympanostomy tubes be considered - children

A

3 episodes in 6 months or 4 episodes in one year

23
Q

What is the pathogenesis of AOM in adults

A
  1. Eustachian tube dysfunction
  2. Seasonal allergic rhinitis
  3. URI
24
Q

What is often mistaken for AOM

A

Otitis media with effusion

25
Q

What should be used to manage otitis media with effusion

A

Antihistamines, oral decongestants, nasal corticosteroids

26
Q

First line treatment for AOM in adults

A

Amoxicillin/clavulanate 875/125mg BID
*higher doses if high risk for sever infection or resistant pathogens
Mild penicillin allergy - cephalosporin
Severe penicillin allergy - Doxycycline

27
Q

When to refer AOM in adults

A

Recurrent AOM - >2 in 6 months
Persistent hearing loss following AOM
Chronic TM perforation following AOM >12 weeks

28
Q

What 3 drug classes can cause ototoxicity

A
  1. Aminoglycosides - high frequency loss + dizziness
  2. Platinum compounds - high frequency loss + tinnitus
  3. Loop diuretics - sudden progressive SN loss, transient or permanent, dizziness

Fall 2024 (34 decks)

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