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EENT Flashcards

1
Q

Bacterial Pharyngitis

A

GABHS
aka strep throat

fever
anterior cervical adenopathy
cough absent
exudate

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2
Q

Bacterial Pharyngitis: treatment

A

PCN, cephalosporin (1st generation)

PCN allergic alternative:
erythromycin/macrolide

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3
Q

Bacterial Pharyngitis: Penicillins: ADEs

A

hypersensitivity

mild diarrhea, vomiting, nausea, oral candidiasis

monitor for:

  • anaphylaxis
  • opportunistic infection
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4
Q

Bacterial Pharyngitis: Penicillins: drug interactions

A

probenecid (inc PCN serum concentration)

tetracycline derivatives (diminish therapeutic effect)

may enhance anticoagulant effect of warfarin (vitamin K antagonist)

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5
Q

Bacterial Pharyngitis: Erythromycin (& Macrolides): ADEs

A

hypersensitivity

abdominal pain, anorexia, diarrhea

QTc prolongation

pruritus, rash

ototoxicity

cholestatic jaundice

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6
Q

Bacterial Pharyngitis: Erythromycin (& Macrolides): interactions

A

effects on CYP450

  • substrate of CYP2B6, CYP3A4
  • inhibits CYP3A4
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7
Q

Bacterial Pharyngitis: Erythromycin (& Macrolides): off label use

A

GI prokinetic

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8
Q

Antibiotics for GABHS Chronic Carriers

A

clindamycin
amoxicillin-clavulanate
PCN V+rifampin
PCN G benzathine+rifampin

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9
Q

Acute Laryngitis

A

usually viral (can be bacterial)

  • M catarrhalis
  • H influenzae

treatment:

  • erythromycin (macrolide)
  • cefuroxime
  • amoxicillin-clavulanate
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10
Q

Herpes Simplex Virus: treatments

A

antivirals “off label”

acyclovir
valacyclovir
famciclovir (no RCT)

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11
Q

Herpes Simplex Virus: management

A

ice, popsicles

diphenhydramine + magnesia aluminum every 2 hours

topical lidocaine

fluids as tolerated

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12
Q

Herpes Simplex Virus: ADEs

A

malaise
HA
nausea, vomiting, diarrhea

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13
Q

Herpes Simplex Virus: interactions

A

diminish therapeutic effect of zoster vaccine (discontinue 24 hours before, 14 days after)

enhances CNS depressant effect of zidovudine

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14
Q

Aphthous Ulcer: treatment

A

ice, popsicles

diphenhydramine + magnesia aluminum every 2 hours

topical lidocaine

tiamcinolone in orabase

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15
Q

Oral Candidiasis

A

fungal infections

painful creamy white curd like patches overlying erythematous mucosa

easily rubbed off

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16
Q

Oral Candidiasis: treatment

A

first line: topicals

  • nystatin susprension 1:100,000 (1st line)
  • clotrimazole troches
  • itraconazole suspension

oral prototype: fluconazole

pregnancy category C/D

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17
Q

Oral Candidiasis: ADEs

A

anaphylactic reactions
angioedema
HA, dizziness
rash
nausea, abdominal pain, vomiting, diarrhea, dysgeusia, dyspepsia
increased alkaline phosphatase, ALT, AST, hepatic failure, hepatitis, jaundice

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18
Q

Oral Candidiasis: efficacy/monitory

A

periodic LFTs
renal function tests (baseline SrCr, K levels)
QT prolongation

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19
Q

Oral Candidiasis: interactions

A

inhibits CYP1A2, CYP2C19, CYP2C9, CYP3A4

  • inc serum concentration
  • decrease metabolism
  • enhance ADE

etc, etc, etc

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20
Q

Conjunctivitis

A

allergic

viral (adenovirus)

bacterial (S. aureus, S. pneumoniae, H. influenzae, M. catarrhalis) (contact wearers: pseudomonas aeruginosa)

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21
Q

Bacterial Conjunctivitis: treatment

A

topical ophthalmic

  • macrolide
  • trimethoprim polymyxin
  • bacitracin polymyxin
  • bacitracin
  • fluoroquinolone

respond in 1-2 days

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22
Q

Blepharitis

A

inflammation of the lid margin

S. aureus

treatment:
- acute: warm compress, baby shampoo, erythromycin or bacitracin ointment
- posterior: doxycycline, TCN, azithromycin

if herpetic –> antivirals

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23
Q

Preseptal Cellulitis

A

infection of the eyelid and surrounding anterior of the orbital septum

S. aureus, S. pneumoniae, anaerobes

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24
Q

Preseptal Cellulitis : treatment (MSSA)

A

amoxicillin/amoxicillin clavulanate

cefpodoxime

cefdinir

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25
Preseptal Cellulitis : treatment (MRSA)
trimethoprim sulfamethoxazole clindamycin doxycycline
26
Orbital Cellulitis
emergency inpatient treatment: empiric with vancomycin plus ceftriaxone or cefotaxime
27
Corneal Abrasion
pain, injection, photophobia, FB sensation treatment: - erythromycin ointment - sulfacetamide - polymixin/trimethoprim - ciprofloxacin/ofloxacin +topical NSAIDS (ketorolac) NO aminoglycosides, steroids
28
Corneal Ulcer
ASAP referral infection from contact lens treatment: ophthalmic fluoroquinolones
29
HSV Keratitis
ASAP referral dendritic lesion, pain, injection treatment: - topical antivirals - corticosteroids (ophthamologist only)
30
Herpes Zoster
ASAP referral pain, tearing, photophobia, injection, pseudodendrite treatment: - ophthalmic antivirals, antibiotics - corticosteroids (ophthamologist only)
31
Viral Conjunctivitis
symptomatic relief: - topical antihistamine/decongestants - lubricating agents
32
Eye: erythromycin/azithromycin
mechanism: inhibits RNA dependent protein synthesis at the chain elongation step ADEs - hypersensitivity -minor ocular irritation - redness
33
Eye: sulfacetamide
mechanism: inhibits bacterial folic acid synthesis ADEs - irritation - burning - stinging
34
Polymixin Trimethoprim
mechanism: - binds to lipids - inhibits folic acid reduction ``` ADEs burning itching edema rash redness stinging tearing ```
35
Fluoroquinolones
mechanism: DNA gyrase inhibitor ``` ADEs: blurred vision, burning, discomfort, dryness, edema, eye pain FB sensation itching photophobia, redness stinging, tearing hypersensitivity ```
36
Aminoglycosides
indicated in contact wearers with abrasion (risk of pseudomonas infection) ADEs: burning irritation
37
Topical NSAIDs
ketorolac Only agent with indication other than treatment for postoperative inflammation following cataract surgery and/or laser corneal surgery ``` ADEs: ocular inflammation irritation pain ocular pressure tearing ```
38
Antivirals: ganciclovir
mechanism: inhibition of viral DNA synthesis ADEs: blurred vision irritation
39
Antivirals: trifluridine
mechanism: interferes with viral replication by inhibiting thymidylate synthetase ADEs: mild local irritation
40
Corticosteroids
decrease inflammation may mask infection ADEs: cataract formation glaucoma perforation of globe secondary infections stinging VA/VF defects
41
Otitis Externa
painful erythema and edema of the ear canal skin + purulent exudate causes: - water exposure - mechanical trauma - infections (pseudomonas, proteus, aspergillus)
42
Otitis Externa: treatment
decrease excessive moisture -acetic acid (vosol) otic +/- hydrocortisone treat infection: TOPICAL -aminoglycoside (neomycin/polymyxin/HC, gentamicin/tobramycin +/- corticosteroids) -fluoroquinolone (ciprofloxacin) (1st line) ORAL -fluoroquinolone ciprofloxacin
43
VoSol HC
acetic acid, propylene glycol diacetate, hydrocortisone ADEs: transient burning or stinging
44
Neomycin sulfate, Polymyxin Sulfate and Hydrocortisone
mixed antibiotic product with corticosteroid interferes with bacterial protein synthesis by binding to 30S be careful of TM perforation
45
Fluoroquinolones
ciprofloxacin otic ADEs: pain fungal superinfection pruritus
46
Aminoglycosides
gentamicin or tobramycin +/- hydrocortisone vestibular ototoxicity TM perforation
47
Acute Otitis Media
otalgia, erythema, TM hypomobility precipitated by URI S. pneumoniae, H influenza
48
Acute Otitis Media: treatment (pediatrics)
1st line: high dose amoxicillin PCN allergy: - erythromycin + sulfonamide - cefaclor amoxicillin clavulanate
49
Cephalosporins to use with a true PCN allergy
cefdinir cefpodoxime cefuroxime ceftriaxone (IM)
50
Otitis Media: cephalosporins
ADEs: rash, diarrhea, increased transaminases vaginitis dose adjustment with renal impairment
51
Otitis Media: treatment (adults)
1st line: amoxicillin clavulanate PCN allergy (no severe reaction): - cefdinir - cefpodoxime - cefuroxime - ceftriaxone PCN allergy (severe reaction): - doxycycline - azithromycin - clarithromycin
52
Resistance
S pneumoniae - macrolides trimethoprim sulfamethoxazole - H influenza, S pneumoniae, GABHS clindamycin - H influenzae
53
AOM treatment duration: <2 years
TM perforation Hx of reccurent AOM 10 days
54
AOM treatment duration: >2 years
no TM perforation no hx of recurrent AOM 5-7 days
55
Bacterial Sinusitis
mostly viral inflammation of sinuses (maxillary MC) S pneumoniae > H influenza > M catarrhalis
56
Bacterial Sinusitis: treatment
fluids humidity irrigation allergy meds antibiotics if: - worsen after 5-7d - persist > 10-14d 1st line: amoxicillin clavulanate 2nd line: doxycycline
57
Sinusitis: TMP-SMX
folate antagonist anti-infectives ``` ADEs: nausea, vomiting, anorexia rash, urticaria steven johnson syndrome sore throat, fever, arthralgia, pallor, purpura, jaundice ```
58
Sinusitis: doxycycline
inhibits protein synthesis ``` ADEs: photosensitivity, rash, skin hyperpigmentation, Stevens-Johnson syndrome, urticaria anorexia, diarrhea, vomiting tooth discoloration hepatotoxicity BUN increased ``` interactions: - antacids/vitamins decrease absorption - carbamazepine decreases serum concentration
59
Sinusitis: fluoroquinolones
ADEs: nausea, diarrhea, constipation, abdominal pain, dyspepsia, vomiting headache, insomnia, dizziness
60
Glaucoma: primary open angle
MC insidious, peripheral vision loss cupping and pallor of optic disk inc intraocular pressure reduced drainage of aqueous fluid through trabecular meshwork
61
Glaucoma: primary angle closure
acute eye pain/blurriness closure of preexisting narrow anterior chamber angle emergency
62
Glaucoma: primary open angle: treatment
decrease IOP increase aqueous drainage: - prostaglandin analogues (lantanoprost, bimatoprost)(1st line) - topical alpha adrenergics (alphagan) decrease aqueous production: - topical beta blockers (timolol)(1st line) - topical/oral carbonic anhydrase inhibitor (cosopt, diamox) surgery
63
Prostaglandin Analogues
F2 alpha analog - inc outflow ``` ADEs: inc pigmentation of iris abnormal hair growth blurred vision burning, stinging conjunctival hyperemia FB sensation itching ``` half life: 17 minutes
64
Topical alpha adrenergics
brimonidine selective agonist for alpha 2 receptors ``` ADEs: allergic conjunctivitis, conjunctival hyperemia, eye pruritus somnolence HT, hypotension hypercholesterolemia ```
65
Topical Cholinergics
directly stimulates cholinergic receptors causing eye miosis, loss of accommodation, lowering of IOP ADEs: Hypertension, tachycardia Diarrhea, nausea, salivation, vomiting Ocular: Burning, ciliary spasm, conjunctival vascular congestion, corneal granularity, lacrimation, lens opacity, myopia, retinal detachment, supraorbital or temporal headache, visual acuity decreased Bronchial spasm, pulmonary edema Diaphoresis May cause decreased visual acuity, especially at night or with reduced lighting
66
Topical Beta Blockers
blocks B1 and B2 receptors - reduces production lots of ADEs
67
Topical/Oral Carbonic Anhydrase Inhibitors
dec aqueous humor secretion and IOP ADEs: taste perversion abdominal pain, dyspepsia, nausea

PHA 550 (26 decks)

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