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Erica Pharm 2 Exam > EENT > Flashcards

EENT Flashcards

1
Q

What are the 3 mechanisms of action of an antibiotic?

A
  • Cell wall synthesis
  • nucleic acid synthesis
  • protein synthesis
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2
Q

What are classic sxs of GABHS, or sore throat?

A
  • fever > 38deg
  • TTP anterior cervical adenopathy
  • NO cough
  • pharyngotonsillar exudate
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3
Q

Treatment for sore throat.

A
  • Penicillin

- Erythromycin

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4
Q

Distinguish between bacterial and viral pharyngitis on clinical presentation.

A

Both: red, swollen tonsils and throat redness

Bacterial: swollen uvula, whitish spots, gray furry tongue

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5
Q

MOA of Penicillin

A

Inhibits bacterial cell wall synthesis (Beta-Lactam)

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6
Q

Adverse events/side effects of Penicillins (beta-lactams)

A
  • Hypersensitivity (i.e. hives, swelling to lips, tongue, mouth, or throat)
  • Mild N/V/D
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7
Q

What do you want to monitor when prescribing Penicillin?

A
  • opportunistic infection (i.e. unhealed sores, white plaques, purulent vaginal dc)
  • Signs of anaphylaxis during 1st dose
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8
Q

What are the different ways you can give Penicillin? When should you adjust the dose?

A

Orally - Penicillin VK x10 days or Amoxicillin

IM - Penicillin G Benzathine (Bicillin Long Acting or Crystal Repository)

  • adjust does in renal impairment
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9
Q

What are the drug interactions for Penicillin?

A

May enhance anticoagulant effect of Warfarin (Vitamin K antagonist)

Tetracycline derivatives- diminish therapeutic effect (bacteriostatic w/bactericidal)

Probenecid - increase serum concentration

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10
Q

MOA of Erythromycin

A

inhibitor of translation and transcription

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11
Q

What med can you give a patient for bacterial pharyngitis w/ a PCN allergy? and what are possible side effects?

A

Erythromycin (macrolide):

  • GI disturbances
  • QTc prolongation
  • ototoxicity (hearing loss)
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12
Q

What should you monitor in Erythromycin?

A

Report immediately –> unusual malaise, N/V, abd pain, Fv, rash/itching, easy bruising or bleeding

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13
Q

Erythromycin: adult dosage and interaction

A

Erythromycin Base
Erythromycin Ethylsuccinate
Azithromycin

Interaction = effects on CYP450

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14
Q

What is the cause and treatment for acute laryngitis?

A

Usu. viral –> M. catarrhalis & H. influenzae

Tx: Erythromycin (macrolide), Cefuroxime, Amoxicillin-clavulanate (Augmentin)

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15
Q

What is characteristic of HSV 1 or 2 and what 2 drugs can you treat it with?

A
  • Prodrome of burning, pain, tingling
  • Burning erythematous papules –> vesicles that rupture –> superficial ulcers –> scabs

Acyclovir and Valacyclovir

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16
Q

What can you recommend for pain and fluid management for a pt w/ Viral-Herpes Simplex?

A
  • rinse and spit every 2 hrs w/ diphenhydramine mixed w/ Magnesium-Aluminum 1:1
  • Topical lidocaine
  • ice, popsicles
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17
Q

Side effects of antiherpetic drug?

A

Malaise and headache

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18
Q

What should you monitor when giving anti-herpetic drugs?

A

Labs: UA, BUN, serum Cr, liver enzymes, CBC

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19
Q

What are the drug interactions of Acyclovir-Valacyclovir and Famciclovir?

A

Hold antiviral meds for at least 24 hrs prior

and 14 days after live attenuated Zoster vaccine bc it may diminish therapeutic effect

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20
Q

What is the treatment for Fungal-Oral Candidiasis?

A

1st line = topicals
* Nystatin Suspension
Clotrimazoles troches
Itraconazole susp.

2nd line = oral
Fluconazole (prototype)

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21
Q

MOA of oral Fluconazole

A

binds to sterols in fungal cell membrane –> changes cell wall permeability –> leakage of cellular contents

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22
Q

What are adverse/side effects to giving oral Fluconazole?

A

Increased Alk phos, ALT, AST, hepatic failure, hepatitis, jaundice

  • monitor labs periodically and adjust for renal impairment
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23
Q

What are the drug interactions of oral Fluconazole?

A

Inhibits CYP1A2 (weak), CYP2C19 (strong, CYP2c9 (strong), CYP3A4 (mod)

  • incr. serum concentration
  • dec. metabolism
  • enhance adverse/toxic effect

– Do an interaction check! –

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24
Q

What is the treatment for viral conjunctivitis?

A

topical antihistamine/decongestants
lubricating agents
cool compresses
hygiene awareness

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25
Q

Most common bacterial causes of conjunctivitis? adults? in contact wearers?

A

“her majesties secret service”
- H. influ, M. catarrhalis, S. aureus, St. pneumo

Adults = S. aureus
Contact lenses = Pseudomonas aerusginosa

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26
Q

What is the Tx for bacterial conjunctivitis?

A

Ophthalmic- topical abx’s

  • Macrolides - Erythro/Azithromycin
  • Aminoglycosides - Gentamicin, Tobramycin (best for psuedomonas)
  • Polymixin-Trimethoprim (polytrim)
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27
Q

What is the Tx for blepharitis?

A

warm compresses, baby shampoo

Abx- Erythromycin ophtho ointment

If susp. viral cause - Acyclovir, Valacyclovir, Famciclovir

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28
Q

What is the Tx for Preseptal cellulitis aka periorbital cellulitis?

A

If MSSA (sensitive)–> Amoxicillin-clavulanate, Cefpodoxime, Cefdinir

If CA-MRSA susp –> Trimethoprim-sulfamethoxazole, Clindamycin, Doxycycline

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29
Q

What is the Tx for Orbital Cellulitis?

A

Inpatient tx w/empiric Vancomycin + Ceftriaxone

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30
Q

What is the Tx for Corneal abrasion? What med is contraindicated?

A

Tx: Ophthalmic antibiotics: Erythromycin ointment, Ciprofloxacin
and
Topical NSAIDs
** aminoglycosides if contact wearer

CI’s: Steroids bc they slow healing

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31
Q

What is the Tx for corneal ulcer?

A

STAT ophtho referral

Ophthalmic Fluoroquinolones

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32
Q

What is the Tx for HSV keratitis?

A 
STAT ophtho referral 
Topical antivirals (ganciclovir gel, trifluridine sol'n)
  • corticosteroids given ONLY by ophto
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33
Q

What is the Tx for eye infection caused by Herpes Zoster?

A

Ophthalmic antivirals and abx
Corticosteroids ONLY by ophtho

FYI - p/w pain despite local anesthetic and psuedodendrite

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34
Q

What is a common side effect of ophthalmic ointments given for bacterial conjunctivitis?

A

blurry vision for 20 mins after dose is administered

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35
Q

In how many days should a patient respond to abx treatment for bacterial conjunctivitis?

A

1 to 2 days and if not… OPTHO

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36
Q

Primary care clinicians should NOT prescribe ____ for acute conjunctivitis?

A

Glucocorticoids

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37
Q

True or false. You should not prescribe an abx for nonbacterial conjunctivitis, even if it is required for a patient to return to school or daycare.

A

FALSE.

low cost topical abx = erythromycin or sulfa

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38
Q

MOA and side effects for Erythromycin Ophth ointment and Azithromycin Ophth sol’n

A

MOA: inhibit RNA-dependent protein synthesis at the chain elongation step

ADE’s: hypersensitivity, minor ocular irritation, redness

39
Q

MOA and side effects of Sulfacetamide 10% eye sol’n

A

MOA: inhibits bacterial folic acid synthesis, which interferes w/bacterial growth

ADE’s: irritation, burning, stinging

40
Q

MOA and side effects of Polymixin-Trimethoprim ophth sol’n

A

MOA’s

  1. binds to phospholipids –> alters permeability and permits leakage
  2. inhibits folic acid reduction –> inhibits microbial growth

ADE’s: burning, itching, edema, rash, redness, stinging, tearing

41
Q

MOA and side effects of Fluoroquinolones for eye infections

A

i.e. Ofloxacin, Cipro, Moxi, Levo

MOA: DNA gyrase inhibitor

ADE’s: FB sensation, itchy, photophobia, hypersensitivity

42
Q

What is unique about dosage for fluoroquinolones for eye infections?

A

Level of severity (i.e. conjunctivitis vs. corneal ulcer) determines how much to front-load

43
Q

When are aminoglycosides for eye complaints indicated?

A

i.e. Gentamicin, Tobramycin

Contact lens wearers w/an abrasion d/t risk of pseudomonas infection

44
Q

When is Ketorolac 0.5% ophth sol’n (NSAID) use indicated?

A

sol’n for post-op inflammation following cataract surgery and/or laser corneal surgery

allergic eye dz

45
Q

What is the MOA of Ketorolac 0.5% ophth sol’n (NSAID)?

A

reversibly inhibits cyclooxygenase-1 and 2 –> decreased formation of prostaglandin precursors

46
Q

What are the side effects of Ketorolac 0.5% ophth sol’n (NSAID)?

A

ocular inflammation, irritation, pain, ocular pressure, increased tearing

47
Q

MOA and side effects of Ganciclovir 0.15% ophth gel (antiviral)

A

inhibition of viral DNA synthesis - competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase

ADE’s: blurred vision and irritation

48
Q

MOA and side effects of Trifluridine 1% ophth sol’n

A

MOA: interferes w/viral replication by inhibiting thymidylate synthetase

ADE’s: mild local irritation of conjunctiva and cornea

49
Q

Who prescribes corticosteroids for eye infections and why? What are the side effects?

A

Ophthalmologist

  • decrease inflammation by suppressing normal immune response
  • steroids may mask infection or enhance existing ocular infection

ADE’s: cataract formation, glaucoma, globe perforation

50
Q

What are examples of corticosteroids?

A

Hydrocortisone, dexamethasone, prednisolone

51
Q

What is the Tx for otitis externa?

A

Decrease excessive moisture w/ acetic acid (VoSol) or 50/50 mixture of isopropyl alcohol/vinegar

Antibacterial/fungal solutions:

  • Fuoroquinolones (Ciprofloxacin)
  • Aminoglycosides (Neomycin/Polymxin/HC or Genta/Tobramycin +/- corticosteroids)
52
Q

What can you treat with VoSol HC otic? and what are its side effects?

A

otitis externa

transient burning or stinging after instillation in the acutely inflamed ear

53
Q

List examples of medications that are mixed antibiotic products with corticosteroids used to treat otitis externa. MOA?

A

Neomycin sulfate
Polymyxin sulfate
Hydrocortisone Otic Sol’n/Susp’n

MOA: interferes w/bacterial protein synthesis by binding to 30S ribosomal subunits

54
Q

What are the side effects of fluoroquinolones used to treat OE?

A

pain, fungal superinfection, pruritis

55
Q

What med should you not give if you cannot visualize the TM?

A

Aminoglycosides ophth sol’n because of irreversible ototoxicity if TM is perforated

i.e. Gentamicin or Tobramycin

56
Q

What is the Tx for Acute OM?

A

1st line = HIGH dose Amoxicillin
Erythromycin plus sulfonamide
Cefaclor
Amoxicillin-clavulanate

57
Q

If a pt being treated for AOM has a Penicillin allergy but did NOT experience an immediate type 1 hypersensitivity reaction what drugs would you consider?

A

Cephalosporins:

  • cefdinir
  • cefpodoxime
  • cefuroxime
  • ceftriaxone
58
Q

MOA and side effects of Cephalosporins

A

Inhibits bacterial cell wall synthesis

ADE’s: rash, diarrhea, increased transaminases, vaginitis

59
Q

If a pt being treated for AOM has a Penicillin allergy and experienced an immediate type 1 hypersensitivity reaction what drugs would you consider?

A

Macrolide or lincosamide abx’s:

  • Azithromycin
  • Clarithromycin
  • Erythromycin-sulfisoxazole
60
Q

T or F: Increasing the dose of macrolide abx overcomes macrolide resistance among pneumococcal isolates as with beta-lactam drugs.

A

False.

increasing dose for macrolides –> does NOT overcome resistance

Increasing dose for beta-lactam drugs –> does overcome resistance

61
Q

How many days should you prescribe medication for AOM in pediatric patients?

A

Children <2 y/o: w/AOM + TM perf & pt’s with h/o recurrent AOM = 10 days

Children >2 y/o: w/out TM perf or a hx of recurrent AOM = 5-7 days

62
Q

What is the first line Tx for AOM in pediatric patients at initial dx and after failure at 48-72 hours?

A

Amoxicillin

Amoxicillin-clavulanate (Augmentin)

63
Q

What is the most common cause of sinusitis?

A

*Most sinusitis is VIRAL

Bacteral: S. pneumoniae, H. influenza, M. catarrhalis

64
Q

When should you prescribe an antibiotic for sinusitis?

A

Only if sxs worsen after 5-7 days or if sxs persist >10-14 days

65
Q

What is the 1st line/2nd line Tx for Sinusitis and how many days should you give the medication to begin working?

A

1st line: Amoxicillin, TMP-SMX, Doxycycline,

2nd line: Amox-Clav INI after 3 days on 1st line

66
Q

What medication should you give to a pt who suffered a recent (4-6 weeks) previous infection of sinusitis?

A

Levfloxacin or Amoxicillin-clavulanate

67
Q

What is the MOA of TMP-SMX (trimethoprim-sulfamethoxazole)?

A

MOA: sulfamethoxazole and trimethoprim are folate antagonist anti-infectives

68
Q

What are the adverse/side effects of TMP-SMX (trimethoprim-sulfamethoxazole)?

A
  • N/V, anorexia, rash, Stevens-Johnson syndrome

- Fv, arthralgia, pallor, purpura, or jaundice may indicate serious reactions

69
Q

What should you monitor in a patient on TMP-SMX (trimethoprim-sulfamethoxazole)?

A
  • Use cation if severe allergy or bronchial asthma
  • Hemolysis if pt has G6PD deficiency
  • Caution w/impaired hepatic function
  • Adjust dose in renal impairment
70
Q

What are the drug interactions for TMP-SMX (trimethoprim-sulfamethoxazole)?

A
  • Inhibition of warfarin clearance
  • Increased digoxin concentrations
  • decreased efficacy of the tricyclic antidepressant
71
Q

What should you tell patients to take with Doxycycline? What are the side effects?

A

Cola

SE’s: Photosensitivity, rash, vomiting, tooth discoloration in children

(do not use in pregnancy and up to age 8)

72
Q

What are the drug interactions of Doxycycline?

A

Antacids/vitamins - may decrease absorption of Tetracycline

Carbamazepine - may dec. serum concentration of doxy

73
Q

What is the MOA of Fluoroquinolones?

A

DNA gyrase inhibitor (inhibits DNA syntesis and integrity)

74
Q

What are examples of Fluoroquinolones? What are the adverse/side effects?

A

N/V/D, constipation, abd pain, dyspepsia, HA, insomnia

75
Q

What is considered first line empirical therapy for acute bacterial rhinosinusitis in pediatric patients?

A

Amoxicillin-clavulanate

76
Q

What medications could you give for a pediatric patient with a Penicillin allergy suffering from acute bacterial rhinosinusitis?

A

Clindamycin + cefixime or cefpodoxime
or
Levofloxacin

77
Q

T or F: Most upper respiratory tract infections have a bacterial etiology and tend to resolve spontaneously w/out pharmacologic therapy.

A

FALSE.

VIRAL cause

78
Q

What are the most common bacterial causes for… Acute otitis media? acute sinusitis? acute pharyngitis?

A

AOM and acute sinusitis = Strep pneumoniae

acute pharyngitis = group A beta-hemolytic Strep

79
Q

Vaccination against influenza and pneumococcus may decrease the risk of…?

A

Acute otitis media

80
Q

What are the empiric medications of choice for acute otitis media, acute sinusitis, and acute pharyngitis?

A

AOM and acute sinusitis = Amoxicillin

acute pharyngitis = Penicillin

81
Q

What medication is recommended for otitis media in a patient who is at high risk for a penicillin-resistant pneumococcal infection?

A

high-dose amoxicillin (80-90mg/kg/day)

82
Q

What are the goals of Tx for primary open-angle glaucoma?

A

Goal is to decrease IOP.

  1. increase aqueous drainage
  2. decrease aqueous production
  3. surgery if unresponsive to meds
83
Q

What meds can be given for primary open-angle glaucoma in order to increase aqueous drainage?

A

1st line = prostaglandin analogues (Lantanoprost, bimatoprost)

2nd line = topical alpha adrenergics (alphagan)

3rd line = topical cholinergics (pilocarpine)

84
Q

What meds can be given for primary open-angle glaucoma in order to decrease aqueous production?

A

1st line = topical BB’s (timolol)

2nd/3rd line = topical/oral carbonic anhydrase inhibitor (cosopt, diamox)

85
Q

What is the MOA of prostaglandin analogues?

A

prostaglandin F2-alpha analog reduces IOP by increaing outflow of aqueous drainage

86
Q

What are the adverse drug events of prostaglandin analogues?

A

blurry vision, burning, stinging, conjunctival hyperemia, FB sensation, increased pigmentation of the iris, and abnormal hair growth

87
Q

What is the half-life of prostaglandin analogues?

A

17 mins

88
Q

MOA of topical alpha adrenergics (Brimonidine)

A

selective agonist for alpha2 receptors –> reduction of aqueous humor formation and increased uveo-scleral outflow by prevention of vasoconstriction

89
Q

What are the ADE’s for topical alpha adrenergics (Brimonidine)?

A
  • Allergic conjunctivitis, conjunctival hyperemmia, eye prurits
  • Somnolence
  • HTN < hypotension
  • hypercholesterolemia
90
Q

MOA of topical cholinergics (Pilocarpine)

A

directly stimulates cholinergic receptors in the eye causing miosis

91
Q

ADE’s of topical cholinergics (Pilocarpine)

A

“SLUDGE”
salivation, lacrimation, urination, defecation, gastric, emesis

  • HTN, tachycardia, diaphoresis
  • Ocular: burning, ciliary spasm, conjunctival vascular congestion, corneal granularity, lacrimation, lens opacity, myopia, rential detachment, supraorbital or temporal HA, visual acuity dec.
  • bronchial spasms and pulmonary edema
  • dec. visual acuity at night
92
Q

What is the MOA of Topical Beta-blocker Timolol? and what are some ADE’s?

A

blocks both beta1 and beta2, reduces IOP by reducing aqueous production

ADE’s: decreased HR, contractility, hypotension, bronchospasm

93
Q

What are examples of a topical and oral carbonic anhydrase inhibitor? and what is the MOA?

A

Cosoft-dorzolamide (w/timolol), Diamox

MOA of dorzolamide: inhibits carbonic anhydrase in the ciliary processes of the eye -
- decreases aqueous production

Erica Pharm 2 Exam (3 decks)

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