EENT Medications Flashcards
Chemical messenger that mediates allergic and inflammatory reactions, gastric acid secretion, and neurotransmission in certain parts of the brain
Histamine
Histamine is primarily located in what type of cells?
Mast Cell granules
Where in the body are mast cells generally found?
nose
mouth
skin
internal body surfaces
blood vessels
Release of histamine is usually mediated by what?
Immune system
This receptor stimulates nerve endings that mediate itching, cause bronchoconstriction and increase mucus production, and increase capillary permeability leading to edema and vasodilation resulting in a decreased BP
H₁ Receptor
This receptor stimulates gastric acid secreting and increases capillary permeability and vasodilation, and slightly increases heart right and contractility
H₂ Receptor
First Generation Oral Antihistamines
Chloropheniramine (Chlor-Trimeton)
Diphenhydramine (Benadryl)
Doxylamine (Unisom)
Hydroxyzine (Vistaril)
Meclizine (Antivert)
Promethazine (Phenegran)
Second Generation Oral Antihistamines
Cetirizine (Zyrtec)
Desloratadine (Clarinex)
Fexofenadine (Allegra)
Loratadine (Claritin)
Levocetirizine (Xyzal)
What mechanism of action is used to block H₁ receptor-mediated responses to histamine in the GI tract, blood vessels, and respiratory tract?
Competitive binding
This generation of medication penetrates the CNS and causes sedation and can interact with other receptors besides H₁.
First-Generation Oral Antihistamine
This generation of medication has a minimal to negligible distribution to the CNS and is specific for H₁ receptors.
Second-Generation Oral Antihistamines
Second-generation are preferred to treat this due to less sedation and the reduction of sneezing, itching, and rhinorrhea
Allergic Rhinitis & Urticaria
These three drugs are second-generation antihistamines that are best for treating allergic rhinitis and urticaria
Loratadine (Claritin)
Desloratadine (Clarinex)
Fexofenadine (Allegra)
Doxylamine is the drug of choice and is used in combination with Vitamin B6 to treat what?
Pregnancy induced nausea and vomiting
These three drugs are used to prevent motion sickness but are less effective if it is already present
Diphenhydramine (Benadryl)
Meclizine (Antivert)
Hydroxyzine (Visatril)
These two drugs are used to treat insomnia and are commonly found it OTC sleep aids and night time cold and cough medicine. They are only intended for short-term use
Diphenhydramine (Benadryl)
Doxylamine (Unisom)
This drug can be used for its antiparkinsonism effect. It also suppresses extrapyramidal symptoms of certain antipsychotics.
Diphenhydramine (Benadryl)
Adverse drug reaction most common with first generation oral antihistamines such as diphenhydramine and hydroxyzine and seen slightly in chlorpheniramine and meclizine.
Sedation
This effect causes symptoms such as dry mouth, decreased tears and dry nasal passages, urinary retention, and tachycardia. This effect is also worse with diphenhydramine.
Anticholinergic effect
These drugs are more effective than oral agents for allergic rhinitis but are less effective than intranasal corticosteroids
Intranasal antihistamines
Adverse drug reactions of intranasal antihistamines
Bitter taste
Nasal irritation & epistaxis
Rarely sedation and anticholinergic
Examples of intranasal antihistamines
Azelastine (Astelin)
Olopatadine (Patanase)
This class of drugs reduce proinflammatory mediators, cause vasoconstriction of the nasal passage, and decrease sneezing, itching, rhinorrhea, and nasal congestion
Intranasal Corticosteroids
Adverse drug reactions of intranasal corticosteroids
Local irritation
Burning & stinging
Epistaxis
This class of drug stabilizes mast cell and eosinophil plasma membrane by preventing the degranulation of the mast cell and prevents release of histamines & leukotrienes
Mast Cell Stabilizers
These drugs are not first line for anything and are an alternative daily therapy for mild asthma. They also are not a therapy for an acute attack because they a very slow acting
Mast Cell Stabilizers
Name an example drug of a mast cell stabilizer
Cromolyn (Intal)
What are some adverse drug reactions from mast cell stabilizers?
Throat irritation & dry throat
Dysgeusia (bad taste in mouth)
Cough
What are two examples of intranasal antihistamines?
Azelastine (Astelin)
Olopatadine (Patanase)
What are some of the drug-drug interactions that can occur with oral antihistamines?
Potentiate CNS depression (including alcohol)
Potentiate anticholinergic effects
Worsen urinary retention in BPH
Decrease effectiveness of cholinesterase inhibitors in Alzheimer’s
Many are CYP2D6 and 3A4 Substrates or Inhibitors
This class of drug decreases inflammation in the airways and is 2nd line for mild intermittent disease comorbid with mild asthma. Can also be used in children as young as 6 moths
Leukotriene Receptor Antagonists
What drug is a Leukotriene Receptor Antagonist?
Montelukast (Singulair)
What are the intial treatments for acute bacterial sinusitis?
NSAIDs
Steam therapy
Saline rinse
Intranasal corticosteroid
When should you consider giving antibiotics for acute bacterial sinusitis?
Symptoms longer than 10 days
Facial or dental pain
Fever
Maxillary edema or puffiness
What drug is first line for the treatment of acute bacterial sinusitis?
Augmentin for 10 days
What drug should be given for acute bacterial sinusitis if the patient has a PCN allergy?
Clindamycin or Cefdinir
This class of drug stimulates α & β adrenergic receptors. Induce the release of norepinephrine from nerve endings and act similar to epinephrine, but much less potent
Nasal decongestants
What are some example drugs of nasal decongestants?
Pseudoephedrine (Sudafed)
Pseudoephedrine/loratadine (Claritin-D)
Phenylephrine
What are the clinical uses of nasal decongestants
Allergic rhinitis
Common cold
Sinusitis
What are some adverse effects of nasal decongestants?
↑ BP
Urinary retention
Insomnia
Tachycardia
What drug can be used for patients who are experiencing the cold or flu and have high blood pressure?
Coricidin HBP
Pseudoephedrine is a precursor to what illegal substance?
Methamphetamine
These drugs are α agonists that cause vasoconstriction in the nasal mucosa and reduce airway resistance. They have a rapid onset of action and few systemic effects with aerosols
Topical nasal decongestants
What are two examples of topical nasal decongestants?
Phenylephrine (Neo-synephrine)
Oxymetazoline (Afrin)
Clinical use of topical nasal decongestants?
Allergic Rhinitis & Common Cold etc.
Short term (3 - 5 days)
What are some adverse effects of topical nasal decongestants?
Rebound congestion (rhinitis medicamentosa)
↑ BP & Urinary retention
Insomnia
Tachycardia
What class of drugs are structurally related to codeine & depresses the medullary cough center?
Antitussives
This drug is an OTC antitussive that can be formulated alone or in combination with guaifenesin (Mucinex), phenylephrine, pseudoephedrine, or acetaminophen
Dextromethorphan
Local anesthetic used to decrease the sensitivity of the airway stretch receptors and the drive to cough after a deep breath. Must be 10 years or older. Almost no side effects.
Benzonatate (Tessalon Perles)
Moderate opioid agonist with antitussive effects. Suppresses the response of the CNS cough center at doses that don’t cause analgesia
Codeine
Side effects of Codeine
Nausea and Vomiting
Constipation
Sedation
Potential addiction
Prodrug that that needs converted to morphine by CYP2D6 to produce analgesia
Codeine
Drug that thins airway mucus (expectorant) making it easier to bring up. No antitussive effects and lack clinical efficacy data.
Guaifenesin (Mucinex)
Side effects of Guaifenesin (Mucinex)
May cause nausea and vomiting at high doses
Rarely: Uric acid nephrolithiasis (Kidney Stones)
This type of glaucoma is treated in the hospital and is a medical emergency
Closed-angle glaucoma
This type of glaucoma is a chronic disease state and is treated with eyedrops
Open-angle glaucoma
Often used as 1st line treatment for glaucoma. Works by increasing aqueous flow.
Prostaglandins
Clinical Pearls of Prostaglandins
Take at night
Cannot be administered with contact lenses
Adverse drug reactions of Prostaglandins
Changes in iris pigmentation
Eyelash growth
Eye redness, tearing, eye pain, or lid crusting
Examples of Prostaglandins
Travoprost (Travatan Z)
Bimatroprost (Lumigan)
Latanoprost (Xalatan)
Class of drugs that can be used to treat glaucoma. Works by reducing aqueous humor production.
Non-selective Beta-blockers
Examples of Non-selective Beta Blockers
Timolol
Betaxolol
Levobunolol
Carteolol
Clinical pearls of Non-selective beta blockers
Can exacerbate respiratory conditions
Timolol is typically an eye drop but can be a gel
Adverse drug reactions of non-selective beta blockers
burning, stinging, or Itching of eyes & eyelids
changes in vision
photosensitivity
Not commonly used to treat glaucoma but works by reducing aqueous humor production. Must be used 3x a day. Can produce a bitter or unusual taste.
Carbonic Anhydrase Inhibitors
Examples of Carbonic Anhydrase Inhibitors
Brinzolamide (Azopt)
Dorzolamide (Trusopt)
Lowers interocular pressure by increasing aqueous outflow. Also called Miotics.
Cholinergic Agonists
Examples of Cholinergic Agonists
Pilocarpine
Carbachol
Clinical Pearls of Cholinergic Agents
4x daily for Glaucoma
Used in acute angle closure
Use with caution of history of retinal detachment or corneal abrasion
Allergic Conjunctivitis Treatments
- Antihistamine (Ketotifen)
- Moisturize with Blink
- NSAID (Ketorolac)
- Mast Cell Stabilizer (Cromolyn)
- Steroids (Dexamethasone or Prednisolone)
Bacterial Conjunctivitis Treatments
- Polytrim (Trimethoprim & Polymyxin B)
- Fluoroquinolones (Ciprofloxacin)
- Aminoglycosides (Gentamicin)
- Macrolides (Azithromycin & Erythromycin)
Drug class that is used shortly after birth for prevention of ophthalmic neonatorum due to gonococcal infection
Macrolides
Otitis Externa Treatments
Ciprodex (Ciprofloxacin & Dexamethasone)
Neomycin
Used to treat cerumen impaction. Release hydrogen peroxide and foaming action helps soften the wax.
Carbamide peroxide (OTC)
