EENT Meds Flashcards by Mary Schoolcraft

What antibtx can be used to treat sinusitis?

Penicillin (Extended Spectrum)
Cephalosporins (2nd generation)
Cephalosporins (3rd generation)

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Name an extended spectrum antibiotic (PCN):

amoxicillin/clavulanate (Augmentin)

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Name some examples of 2nd generation Cephalosporins?

cefprozil (Cefzil)
cefuroxime (Ceftin)
cefaclor (Ceclor)

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Name some examples of 3rd generation Cephalosporins?

cefixime (Suprax)
ceftibuten (Cedax)
cefpodoxime (Vantin)

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What oral decongestants can be used to treat sinusitis?

pseudoephedrine (Sudafed)

phenelephrine (Endal)

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What topical nasal decongestants can be used to treat sinusitis?

oxymetazoline (Afrin)

phenylephrine (Neo-Synephrine)

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What topical nasal steroids can be used to treat allergic rhinitis?

budesonide (Rhinocort)
fluticasone (Flonase)
mometasone (Nasonex)
triamcinolone (Nasacort)

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What OTC antihistamines (2nd generation) can be used to treat allergic rhinitis?

cetirizine (Zyrtec)
fexofenadine (Allegra)
loratadine (Claritin)

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What antihistamines (1st generation) can be used to treat allergic rhinitis?

diphenhydramine (Benadryl)

hydroxyzine (Atarax, Vistaril)

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Name some examples of PCN used to treat OM?

amoxicillin (Amoxil)

amoxicillin/clavulanate suspension (Augmentin ES)

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What macrolides (extended spectrum) can be used to treat OM?

azithromycin (Zithromax)

clarithromycin (Biaxin)

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What 2nd generation cephalosporin(s) can be used to treat OM?

cefprozil (Cefzil)
cefuroxime (Ceftin)
cefaclor (Ceclor)

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What 3rd generation cephalosporin(s) can be used to treat OM?

cefixime (Suprax)
ceftibuten (Cedax)
cefpodoxime (Vantin)

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What is the action of amoxicillin/clavulanate (Augmentin) a PCN, on sinusitis?

It inhibits cell wall synthesis of gram + (staph, strep) bacterial, but addition of calculate extends antimicrobial spectrum (covers many gram (-) organisms too) and protects beta lactic ring from beta lactamase

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What should you know about amoxicillin/clavulanate when treating for sinusitis?

Considered 1st line for treatment of acute sinusitis
Monitor for PCN hypersensitivity
Clavulanate associated with diarrhea

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What is the action of 2nd generation cephalosporins (cefprozil, cefuroxime, cefaclor) on sinusitis?

Inhibits cell wall synthesis of bacteria
Contains beta lactam ring like PCN
Provides coverage of many gram (+) and gram (-) bacteria, but not those organisms that produce beta lactimase

What should you know about 2nd generation cephalosporins when treating for sinusitis?

Well tolerated
Cross sensitivity (approx. 2-10%) with the PCN
Do NOT administer if pt has had anaphylaxis or hives with PCN

What is the action of 3rd generation cephalosporins when treating sinusitis?

Exactly as for 2nd generation cephalosporins, but covers many more gram (-) organisms; and if organism produces beta-lactamase, the antibiotic remains effective

What should you know about 3rd generation cephalosporins when treating for sinusitis?

Well tolerated; can be given once daily
Cross sensitivity (approx. 2-10%) with the PCN
Do NOT administer if pt has had anaphylaxis or hives with PCN

What is the action of oral decongestants in treating sinusitis?

Act on adrenergic receptors affecting sympathetic tone of the blood vessels and causing vasoconstriction
This results in mucous membrane shrinkage and improved ventilation

What should you know about oral decongestants when treating for sinusitis?

Do not use in pts with HTN, arrythmias, mitral valve prolapse
Cautious use in pts with thyroid disease, CAD, PAD, arrhythmias, prostate disease and glaucoma

What is the action of topical nasal decongestants in sinusitis?

Act on adrenergic receptors affecting sympathetic tone of the blood vessels and causing vasoconstriction, but effect is local or minimally systemic

What should you know about topical nasal decongestants in treating sinusitis?

Topical agents work faster but are more likely to bring about rhinitis medicomentosa if used >4 days
May produce burning, stinging especially when sprayed on irritated mucous membranes

What is the action of topical nasal steroids when treating allergic rhinitis?

Exert glucocorticoid activity on the nasal mucosa and thus have local anti-inflammatory effects

What should you know about topical nasal steroids when treating allergic rhinitis?

- Considered the "gold standard" in treatment of allergic rhinitis - Minimal systemic absorption - Can produce drying of nasal mucosa and bleeding can result - Can contribute to fungal nasal infections (rare)

What is the action of 2nd generation antihistamines (cetirizine, fexofenadine, loratadine) when treating allergic rhinitis?

Selectively block peripheral histamine binding sites

What should you know about 2nd generation antihistamines (cetirizine, fexofenadine, loratadine) when treating allergic rhinitis?

- Advantage is lack of sedation for all but cetirizine (Zyrtec) - Once daily dosing improves compliance - Generally well tolerated

What is the action of 1st generation antihistamines (diphenhydramine, hydroxyzine) when treating allergic rhinitis?

Non-selectively block histamine binding sites in the brain (centrally) and peripherally

What should you know about 1st generation antihistamines (diphenhydramine, hydroxyzine) when treating allergic rhinitis?

- Monitor additive effects with ETOH, other sedative drugs - Cautious use in elderly where exaggerated effects may produce excessive sedation, dizziness, confusion, hypotension, urinary retention, dry mouth - Many available OTC

What is the action of PCN (amoxicillin, amoxicillin/clavulanate suspension) in treating otitis media?

- PCNs inhibit bacterial cell wall synthesis - Clavulanate broadens spectrum of coverage - Amoxicillin not effective in presence of beta lactase producing organisms

What should you know about PCN (amoxicillin, amoxicillin/clavulanate suspension) when treating OM?

- Given in divided doses | - Consider amoxicillin/clavulanate first line if pt has severe illness, has had recent antibx exposure

What is the action of macrolides (azithromycin, clarithyromycin) in treating OM?

- Inhibit protein synthesis by binding to the 50S ribosomal subunit

What should you know about using macrolides (azithromycin, clarithromycin) in treating OM?

- First line for PCN allergic (Type I allergic reaction) | - Consider clindamycin, if failure after 48-72 hours

What is the action of 2nd generation cephalosporins (cefprozil, cefuroxime, cefaclor) in treating OM?

- Inhibit cell wall synthesis | - Cefuroxime (Ceftin) is more stable in presence of beta lactase producers than other 2nd generation agents

What should you know about using 2nd generation cephalosporins (cefprozil, cefuroxime, cefaclor) when treating OM?

- Do not use if pt has PCN allergic (hives or anaphylaxis) | - Consider ceftriaxone (Rocephin) if failure after 48-72 hours with 2nd generation cephalosporin

What is the action of 3rd generation cephalosporins (cefixime, ceftibuten, cefpodoxime) in treating OM?

- Inhibit cell wall synthesis | - Stable in the presence of beta lactamase producers

What should you know about using 3rd generation cephalosporins (cefixime, ceftibuten, cefpodoxime) in treating OM?

- Well tolerated - Consider ceftriaxone (Rocephin) if failure after 48-72 hours - Do not administer if pt has had anaphylaxis or hives with PCN