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PHA 550 > EENT > Flashcards

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
Q

Preseptal Cellulitis : treatment (MRSA)

A

trimethoprim sulfamethoxazole

clindamycin

doxycycline

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26
Q

Orbital Cellulitis

A

emergency

inpatient treatment:
empiric with vancomycin plus ceftriaxone or cefotaxime

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27
Q

Corneal Abrasion

A

pain, injection, photophobia, FB sensation

treatment:

  • erythromycin ointment
  • sulfacetamide
  • polymixin/trimethoprim
  • ciprofloxacin/ofloxacin

+topical NSAIDS (ketorolac)

NO aminoglycosides, steroids

28
Q

Corneal Ulcer

A

ASAP referral

infection from contact lens

treatment: ophthalmic fluoroquinolones

29
Q

HSV Keratitis

A

ASAP referral

dendritic lesion, pain, injection

treatment:
- topical antivirals
- corticosteroids (ophthamologist only)

30
Q

Herpes Zoster

A

ASAP referral

pain, tearing, photophobia, injection, pseudodendrite

treatment:
- ophthalmic antivirals, antibiotics
- corticosteroids (ophthamologist only)

31
Q

Viral Conjunctivitis

A

symptomatic relief:

  • topical antihistamine/decongestants
  • lubricating agents
32
Q

Eye: erythromycin/azithromycin

A

mechanism:
inhibits RNA dependent protein synthesis at the chain elongation step

ADEs

  • hypersensitivity -minor ocular irritation
  • redness
33
Q

Eye: sulfacetamide

A

mechanism: inhibits bacterial folic acid synthesis

ADEs

  • irritation
  • burning
  • stinging
34
Q

Polymixin Trimethoprim

A

mechanism:

  • binds to lipids
  • inhibits folic acid reduction
ADEs
burning
itching
edema
rash
redness 
stinging 
tearing
35
Q

Fluoroquinolones

A

mechanism:
DNA gyrase inhibitor

ADEs:
blurred vision, burning, discomfort, dryness, edema, eye pain
FB sensation
itching
photophobia, redness
stinging, tearing
hypersensitivity
36
Q

Aminoglycosides

A

indicated in contact wearers with abrasion (risk of pseudomonas infection)

ADEs:
burning
irritation

37
Q

Topical NSAIDs

A

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
Q

Antivirals: ganciclovir

A

mechanism:
inhibition of viral DNA synthesis

ADEs:
blurred vision
irritation

39
Q

Antivirals: trifluridine

A

mechanism:
interferes with viral replication by inhibiting thymidylate synthetase

ADEs:
mild local irritation

40
Q

Corticosteroids

A

decrease inflammation

may mask infection

ADEs:
cataract formation
glaucoma

perforation of globe
secondary infections
stinging
VA/VF defects

41
Q

Otitis Externa

A

painful erythema and edema of the ear canal skin + purulent exudate

causes:

  • water exposure
  • mechanical trauma
  • infections (pseudomonas, proteus, aspergillus)
42
Q

Otitis Externa: treatment

A

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
Q

VoSol HC

A

acetic acid, propylene glycol diacetate, hydrocortisone

ADEs:
transient burning or stinging

44
Q

Neomycin sulfate, Polymyxin Sulfate and Hydrocortisone

A

mixed antibiotic product with corticosteroid

interferes with bacterial protein synthesis by binding to 30S

be careful of TM perforation

45
Q

Fluoroquinolones

A

ciprofloxacin otic

ADEs:
pain
fungal superinfection
pruritus

46
Q

Aminoglycosides

A

gentamicin or tobramycin +/- hydrocortisone

vestibular ototoxicity TM perforation

47
Q

Acute Otitis Media

A

otalgia, erythema, TM hypomobility

precipitated by URI

S. pneumoniae, H influenza

48
Q

Acute Otitis Media: treatment (pediatrics)

A

1st line: high dose amoxicillin

PCN allergy:

  • erythromycin + sulfonamide
  • cefaclor

amoxicillin clavulanate

49
Q

Cephalosporins to use with a true PCN allergy

A

cefdinir

cefpodoxime

cefuroxime

ceftriaxone (IM)

50
Q

Otitis Media: cephalosporins

A

ADEs:
rash, diarrhea, increased transaminases
vaginitis

dose adjustment with renal impairment

51
Q

Otitis Media: treatment (adults)

A

1st line: amoxicillin clavulanate

PCN allergy (no severe reaction):

  • cefdinir
  • cefpodoxime
  • cefuroxime
  • ceftriaxone

PCN allergy (severe reaction):

  • doxycycline
  • azithromycin
  • clarithromycin
52
Q

Resistance

A

S pneumoniae - macrolides

trimethoprim sulfamethoxazole - H influenza, S pneumoniae, GABHS

clindamycin - H influenzae

53
Q

AOM treatment duration: <2 years

A

TM perforation
Hx of reccurent AOM

10 days

54
Q

AOM treatment duration: >2 years

A

no TM perforation
no hx of recurrent AOM

5-7 days

55
Q

Bacterial Sinusitis

A

mostly viral

inflammation of sinuses (maxillary MC)

S pneumoniae > H influenza > M catarrhalis

56
Q

Bacterial Sinusitis: treatment

A

fluids
humidity
irrigation
allergy meds

antibiotics if:

  • worsen after 5-7d
  • persist > 10-14d

1st line: amoxicillin clavulanate
2nd line: doxycycline

57
Q

Sinusitis: TMP-SMX

A

folate antagonist anti-infectives

ADEs:
nausea, vomiting, anorexia
rash, urticaria
steven johnson syndrome
sore throat, fever, arthralgia, pallor, purpura, jaundice
58
Q

Sinusitis: doxycycline

A

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
Q

Sinusitis: fluoroquinolones

A

ADEs:
nausea, diarrhea, constipation, abdominal pain, dyspepsia, vomiting
headache, insomnia, dizziness

60
Q

Glaucoma: primary open angle

A

MC

insidious, peripheral vision loss
cupping and pallor of optic disk
inc intraocular pressure
reduced drainage of aqueous fluid through trabecular meshwork

61
Q

Glaucoma: primary angle closure

A

acute eye pain/blurriness

closure of preexisting narrow anterior chamber angle

emergency

62
Q

Glaucoma: primary open angle: treatment

A

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
Q

Prostaglandin Analogues

A

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
Q

Topical alpha adrenergics

A

brimonidine

selective agonist for alpha 2 receptors

ADEs:
allergic conjunctivitis, conjunctival hyperemia, eye pruritus
somnolence
HT, hypotension
hypercholesterolemia
65
Q

Topical Cholinergics

A

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
Q

Topical Beta Blockers

A

blocks B1 and B2 receptors - reduces production

lots of ADEs

67
Q

Topical/Oral Carbonic Anhydrase Inhibitors

A

dec aqueous humor secretion and IOP

ADEs:
taste perversion
abdominal pain, dyspepsia, nausea

PHA 550 (26 decks)

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