EENT Medications Flashcards by Dylan Null

Chemical messenger that mediates allergic and inflammatory reactions, gastric acid secretion, and neurotransmission in certain parts of the brain

Histamine

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Histamine is primarily located in what type of cells?

Mast Cell granules

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Where in the body are mast cells generally found?

nose
mouth
skin
internal body surfaces
blood vessels

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Release of histamine is usually mediated by what?

Immune system

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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

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This receptor stimulates gastric acid secreting and increases capillary permeability and vasodilation, and slightly increases heart right and contractility

H₂ Receptor

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First Generation Oral Antihistamines

Chloropheniramine (Chlor-Trimeton)
Diphenhydramine (Benadryl)
Doxylamine (Unisom)
Hydroxyzine (Vistaril)
Meclizine (Antivert)
Promethazine (Phenegran)

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Second Generation Oral Antihistamines

Cetirizine (Zyrtec)
Desloratadine (Clarinex)
Fexofenadine (Allegra)
Loratadine (Claritin)
Levocetirizine (Xyzal)

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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

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This generation of medication penetrates the CNS and causes sedation and can interact with other receptors besides H₁.

First-Generation Oral Antihistamine

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This generation of medication has a minimal to negligible distribution to the CNS and is specific for H₁ receptors.

Second-Generation Oral Antihistamines

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Second-generation are preferred to treat this due to less sedation and the reduction of sneezing, itching, and rhinorrhea

Allergic Rhinitis & Urticaria

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These three drugs are second-generation antihistamines that are best for treating allergic rhinitis and urticaria

Loratadine (Claritin)
Desloratadine (Clarinex)
Fexofenadine (Allegra)

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Doxylamine is the drug of choice and is used in combination with Vitamin B6 to treat what?

Pregnancy induced nausea and vomiting

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These three drugs are used to prevent motion sickness but are less effective if it is already present

Diphenhydramine (Benadryl)
Meclizine (Antivert)
Hydroxyzine (Visatril)

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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)

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This drug can be used for its antiparkinsonism effect. It also suppresses extrapyramidal symptoms of certain antipsychotics.

Diphenhydramine (Benadryl)

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Adverse drug reaction most common with first generation oral antihistamines such as diphenhydramine and hydroxyzine and seen slightly in chlorpheniramine and meclizine.

Sedation

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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

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These drugs are more effective than oral agents for allergic rhinitis but are less effective than intranasal corticosteroids

Intranasal antihistamines

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Adverse drug reactions of intranasal antihistamines

Bitter taste
Nasal irritation & epistaxis
Rarely sedation and anticholinergic

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Examples of intranasal antihistamines

Azelastine (Astelin)
Olopatadine (Patanase)

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This class of drugs reduce proinflammatory mediators, cause vasoconstriction of the nasal passage, and decrease sneezing, itching, rhinorrhea, and nasal congestion

Intranasal Corticosteroids

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Adverse drug reactions of intranasal corticosteroids

Local irritation
Burning & stinging
Epistaxis

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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)