EENT- Nasal infections Flashcards
What is the most common cause of sinusitis?
Viral!
–Inflammation of > 1 of the paired paranasal sinuses—maxillary most common
Sinusitis
–Pathogen
- S pneumoniae > H influenzae > M catarrhalis
Most common pathogens responsible for bacterial sinusitis
–Treatment for sxs:
- fluids
- humidity
- nasal saline/irrigation
Treatment for Bacterial sinusitis
(give meds for allergic rhinitis)
When do you give abx for a patient that has bacterial sinusitis?
only if sx worsen after 5-7 days or sx persist > 10-14 days
Mechanism: folate-antagonist anti-infectives.
Mechanism for TMP- SMX (bactrim)
Used to treat Bacterial sinusitis
What are 2 treatment options for Bacterial sinusitis?
- Amoxicillin, Amoxicillin-clavulanate (do not give if PCN allergic)
- TMP-SMX
Which medication used to treat bacterial sinusitis has the following ADEs?
- Nausea, vomiting, anorexia
- Rash, urticaria
- Stevens-Johnson syndrome
- Rash, sore throat, fever, arthralgia, pallor, purpura, or jaundice may be early indications of serious reactions.
TMP-SMX (trimethoprim-sulfamethoxazole)
Which medication that is used to tx bacterial sinusitis has the following Efficacy and monitoring recommendations
- Use with caution in patients with severe allergy or bronchial asthma
- Hemolysis may occur in individuals with G6PD deficiency; this effect may be dose-related.
- Use with caution in patients with impaired hepatic function
- Adjust dose in renal impairment
TMP-SMZ
Which medication that is used to tx bacterial sinusitis has the following drug interactions?
–Possible inhibition of warfarin clearance and prolonged PT/INR
–Inhibit metabolism and increase half-life of phenytoin
–Possible potentiation of hypoglycemic effects
–Possible increased digoxin concentrations, especially in geriatric patients
–Possible decreased efficacy of the tricyclic antidepressant
TMP-SMX
What is the MOA of Doxycycline, a medication that can be used to treat bacterial sinusitis
–Inhibits protein synthesis
Which medication has the following adverse Events/Side Effects:
–Photosensitivity, rash, skin hyperpigmentation, Stevens-Johnson syndrome, urticaria
–Anorexia, diarrhea, vomiting
–Tooth discoloration (children)
–Hepatotoxicity (rare)
–BUN increased (dose related)
Doxycycline
which med has the following Adverse event/side effect?
–Tooth discoloration (children)
- Cross the placenta and accumulate in developing teeth and long tubular bones
- Do not use during pregnancy and to age 8 unless benefit exceeds risk
Doxycycline
Which med?
•Efficacy/Monitoring
–Medication may be taken with food if gastric irritation occurs.
–May be sensitive to sunlight.
Doxycycline (can be used to tx sinusitis)
Which med?
•Drug Interactions:
- Antacids/vitamins may decrease the absorption of Tetracycline (any di- or trivalent medications)
- Carbamazepine: May decrease the serum concentration of Doxycycline.
Doxycycline
Which Fluoroquinolones can be used to treat sinusitis?
Moxifloxacin, Levofloxacin
What is the MOA of Moxifloxacin and Levofloxacin?
•Inhibitors of DNA synthesis and integrity
Which meds?
–ADEs
- Nausea, diarrhea, constipation, abdominal pain, dyspepsia, vomiting
- Headache, insomnia, dizziness
Fluoroquinolones (Moxifloxacin, Levofloxacin)
KEY CONCEPT- The most common bacterial causes are _________ (acute otitis media and acute sinusitis) and ______ (acute pharyngitis).
Streptococcus pneumoniae- AOM and acute sinusitis
group A β-hemolytic Streptococcus- acute pharyngitis
____________may decrease the risk of acute otitis media.
Vaccination against influenza and pneumococcus
•When antibiotics are prescribed, the empiric medications of choice are _______ for AOM and acute sinusitis
Amoxicillin
•When antibiotics are prescribed, the empiric medication of choice is ______ for acute pharyngitis.
penicillin
•For otitis media, what medication is recommended if the patient is at high risk for a penicillin-resistant pneumococcal infection.
high-dose amoxicillin (80–90 mg/kg/day)
