EENT 2 Flashcards
a medication or enzyme that is metabolized by the isoenzyme, utilizing this enzyme in order to be modified so it can reach drug site of action and/or be eliminated.
Substrate
clnical ex: CYP450 3A-4 substrates (sildenifil, simvastatin, atorvastatin, and xanax)
Blocks the activity of the isoenzyme, limiting substrate excretion, allowing an increase in substrate levels, and possible risk of substrate-induced toxicity.
Inhibitor
Clinical ex: Erythro/clarythromycin are cyp450 3A-4 inhibitors. When taken in conjunction with CYP450 3A-4 substrates (sildenifil, simvastatin, atorvastatin, and xanax) leads to an increase in substrate levels and possible toxicity
accelerates the activity of the isoenzyme so that the substrate is pushed out the exit pathway, leading to a reduction in substrate level.
Inducer
A clinical ex: St. john’s wort (an inducer of cyp450) used in combination with COC or cyclosporine reduces target drug levels
When would you choose a respiratory fluoroquinolone (levo or moxi) over doxycycline for ARBS (acute rhino bacterial sinusitis)?
If there was an initial failed treatment with Amox/with clav. since it doesn’t fight against drug-resistant S. Pneumo
Number one abx for acute bacterial sinusitis?
Amox with clav.
True or false
Clarithromycin taken concomitantly with simvastatin can increase the drug levels of simvastatin by 10 fold increasing the risk of rhadmo.
True
True or false
Clarithromycin combined with Xanax increases sedation and fall risk
True
True or false
St. johns wart used in combination with COC may lead to spotting and contraceptive failure
True
(T/F) The U.S. FDA advises that the adverse effects associated with fluoroquinolones (cipro-, levo-, moxifloxacin [-floxacin suffix]) generally outweigh the benefits for patients with acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections who have other treatment options
true
You see a 47-year-old man in for an urgent care visit who has hypertension, dyslipidemia, and depression. He states, “I am on a big list of medications but I am not sure of all the names.” He also has a history of penicillin allergy with a hive-form reaction. He has not taken a systemic antimicrobial in more than a year and denies recent hospitalization. When developing a treatment plan for acute bacterial rhinosinusitis, you consider prescribing the following course of an oral antimicrobial:
A 5-day course of clarithromycin.
A 7-day course of doxycycline.
A 10-day course of amoxicillin-clavulanate.
A 7-day course of moxifloxacin.
Correct answer is doxycycline
clarithromycin is a CYP450 inhibitor that may interact with his other medications
Amox-clav. is contraindicated with his allergy
Moxi is reserved for suspected DR s. pneumo
Sandra is a 45-year-old well woman diagnosed with a left-sided unilateral acute otitis media 10 days ago and treated with an antimicrobial. She is seen today with a report of resolution of ear pain, but with persistent sensation of ear fullness and diminished ability to discriminate speech in the affected ear.
Erythema of the ear canal.
Weber test lateralizing to the affected ear.
Discomfort on tragus pull.
Anterior cervical lymphadenopathy on the affected side.
Weber test lateralizing to the affected ear.
Effusion is an expected side effect of AOM and may cause a feeling of fullness
Hank is a 58-year-old man who presents with a chief complaint of bilateral itchy eyes occurring intermittently throughout the year. Exam reveals 20/30 vision OD (right eye), OS (left eye), OU (both eyes) with corrective lenses, bilateral hyperemic bulbar and palpebral conjunctiva, and a small amount of rope-like pale yellow discharge.
Bacterial conjunctivitis.
Blepharoconjunctivitis.
Allergic conjunctivitis.
Angle-closure glaucoma.
Allergic conjunctivitis characterized by ITCHING and rope-like discharge
Appropriate pharmacologic management options for allergic rhinitis in a 29-year-old woman who is a home daycare provider includes all of the following except:
Short-term use of a decongestant nasal spray.
Oral chlorpheniramine.
Flunisolide nasal spray.
Oral loratadine.
Oral chlorpheniramine. this is a first generation antihistamine that induces drowsiness.
The other medications are indicated
Edgar is a 75-year-old man with a 60 pack-year history of cigarette smoking and COPD who presents with a chief complaint of a “sore” on the base of his tongue. This lesion has been present for a number of months, remaining relatively stable in size and is not painful. Physical examination reveals a painless ulcerated lesion with indurated margin and is accompanied by a firm, nontender submandibular node. His current medications include inhaled corticosteroids with a long-acting beta2-agonist
This clinical scenario is most consistent with:
Syphilitic chancre.
Aphthous stomatitis.
Squamous cell carcinoma.
Oral candidiasis.
squamous cell carcinoma
he needs to be referred for a biopsy
What cranial nerve is being tested?
Puff out your cheeks.
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