EENT meds

Question 1

Group A β hemolytic streptococcal infection (GABHS)-’strep throat’

Answer 1

rapid onset
Fever >38˚
tender anterior cervical adenopathy
No cough
pharyngotonsillar exudate
3 sx-90%
1 sx unlikely
Treatment
Penicillin
Erythromycin

Question 2

bacterial vs viral pharyngitis

Answer 2

bacterial: swollen uvula, white spots, red swollen tonsils and throat, gary furry tongue
viral: red swollen tonsils and throat

Question 3

PCN for strept interactions

Answer 3

Probenecid may increase the serum concentration of Penicillins
Tetracycline Derivatives: May diminish the therapeutic effect of Penicillins
Bacteriostatic with bactericidal
Penicillin may enhance the anticoagulant effect of Vitamin K Antagonist-warfarin

Question 4

erythromycin for strept

Answer 4

Alternative to patient with Penicillin allergy
prokinetic: Abdominal pain, anorexia, diarrhea (GI disturbances)
QT prolongation
ototoxicity
Report immediately any unusual malaise, nausea, vomiting, abdominal colic, or fever; skin rash or itching; easy bruising or bleeding
no effect on CYP450

Question 5

acute laryngitis

Answer 5

usually viral
possible bacterial
treat w/erthromycin, cefuroxime, amox-clavulanate (augmentin)

Question 6

chronic group a B hemolytic strept

Answer 6

clindamycin,
amox-clavu
pcn V- rifampin
pcn g benzathine and rifampin

Question 7

Mouth/Throat: Viral-Herpes Simplex

Answer 7

inhibition of DNA synthesis and viral replication
Acyclovir
Valacyclovir: (prodrug of acyclovir) can be take daily for supression
Famciclovir (no RCTs)

Question 8

antiherpetic ADE

Answer 8

ADE: malaise, headache
bendaryll licodaine for pain
monitor urine, liver, renal, CBC
adjust if renal impairment
interactions: Acyclovir-Valacyclovir, Famciclovir may diminish the therapeutic effect of Zoster Vaccine
may enhance CNS depressant effect of HIV tx

Question 9

aphthous ulcer tx.

Answer 9

-pain managment ice, benadryll lidocaine

Question 10

candidiasis

Answer 10

Painful creamy-white curd-like patches overlying erythematous mucosa
Easily rubbed off

Question 11

candidiasis tx.

Answer 11

topical 1st line
Nystatin Suspension 1:100,000
“azole” antifungal: Fluconazole: changes cell wall permeability
Periodic liver function tests (AST, ALT, alkaline phosphatase)
Renal function tests
Potassium levels

Question 12

candidiasis tx. side effects

Answer 12

Nausea, abdominal pain, vomiting, diarrhea, dysgeusia (distortion sense of taste), dyspepsia (Indigestion)

Increased Alkaline phosphatase, ALT, AST, hepatic failure (rare), hepatitis, jaundice
angioedema (rare)

Question 13

azole interactions

Answer 13

increase conc. of statins, citalopram, proton pump inhibitors K antagonist.
dec. metabolism of benzos and losartans
can enhance CCB

Question 14

azole

Answer 14

single dose for vaginal candidiasis

Ketaconazole with food

Question 15

Conjuctivitis tx.

Answer 15

Ophthalmic antibiotics
Special population—contact wearers: Pseudomonas aeruginosa
Bacterial
Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
viral - no antibiotics

Question 16

bacterial Conjuctivitis tx

Answer 16

Antibiotics
Ophthalmic- topical
Macrolides:
Erythromycin:1st line
Azithromycin
Aminoglycosides:
Gentamicin
Tobramycin
Polymixin-Trimethoprim (Polytrim)

Question 17

blepharitis tx

Answer 17

from staph treat with erythromycin ophthalmic ointment

antiviral if suspect herpes

Question 18

preoribital (preseptal) cellulitis tx.

Answer 18

If MSSA
Amoxicillin-clavulanate
Cefpodoxime
Cefdinir
If CA-MRSA suspected
Trimethoprim-sulfamethoxazole
Clindamycin
Doxycycline

Question 19

orbital cellulitis

Answer 19

emergency*

inpatient: empiric with vanco + ceftriazone