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EENT Pharm Flashcards

1
Q

MOA of intranasal corticosteroids:
What they treat:

A

-deliver the drug directly to the nasal mucosa which reduces inflammatory mediators that cause edema, rhinorrhea, sneezing, itching, congestion
- rhinitis and rhinosinusitis

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2
Q
  • Are fluticasone, mometasome first or second generation intranasal corticosteroids?
  • what is the benefit of this?
A
  • Second generation (aka flonase)
  • less systemic absorption because they don’t cross the epithelium barrier
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3
Q

-What generation are these intranasal corticosteroids beclomethasone, triamcinolone, budesonide?

A
  • first
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4
Q
  • Local adverse effects of IN corticosteroids?
  • Systemic effects of IN corticosteroids?
A
  • local irritation, epistaxis, nasal ulceration
  • adrenal suppression, increased intraocular pressure, increased risk of nasal and pharyngeal candida infection
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5
Q

-Adverse effects of opthalmic corticosteroids?

A
  • Increased risk of cataracts and glaucoma, increased risk of infection, delayed healing
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6
Q
  • where are cholinergic receptors found?
  • types?
A
  • CNS and PNS
  • nicotinic and muscarinic receptors
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7
Q

Most cholinergic drugs act on what receptor?

A

Muscarinic

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8
Q

In the periphery, where are muscarinic receptors found?

A
  • on parasympathetic end-organs
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9
Q
  • Muscarinic agonists will mimic what?
A
  • parasympathetic nervous system stimulation
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10
Q
  • What are the important effects of peripheral muscarinic activity on the eye?
  • and on the nasal mucosa?
A
  • eye: pupil constriction, lens accomodation, increased lacrimation
  • nasal mucosa and salivary glands: increased secretions
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11
Q
  • Pilocarpine is a:
  • Used topical in an emergency to treat:
    -Oral is used for:
A
  • muscarinic agonist
  • Acute angle-closure glaucoma (sometimes maintanence)
  • treat dry mouth and dry eyes in Sjogren’s
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12
Q

Side effects of muscarinic agonist (pilocarpine):

A

blurry vision
night blindness
dose-dependent cholinergic effects

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13
Q

Anticholinergic Drug effects:

A
  • Eye: pupil dilation, LOC, decreased lacrimation
  • Decreased nasal mucosa and salivary gland secretion
  • bronchodilation
    -confusion, delirium, sedation, decreased perspiration, flushed face
  • tachycardia
    -inhibition of GI motility
    -decreased urination
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14
Q

Scopolamine and Atropine are what type of drugs?
What are they used for?

A

-Tropane alkaloids
- Pupil dilation during opthalmic procedures
Cycloplegic for uveitis, iritis, UV keratitis

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15
Q

-What does scopolamine act on?
-Used for?
-oral or topical?

A
  • Acts centrally on vestibular function
  • Vertigo, motion sickness, Meniere’s disease
    -topical bc poor oral absorption
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16
Q

-What type of drug is Ipratropium? Made from?
- Used for?
- Not helpful for?
- Side effects?

A
  • anticholinergic drug; semisynthetic medication from atropine
  • used as a topical intranasal spray for rhinitis
  • not helpful for sneezing, itching, congestion
  • systemic anticholinergic effects as side effects can occur
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17
Q

How do adrenergic dugs work?

A

Bind to adrenergic receptors or by changing the concentration of NE

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18
Q

Adrenergic agonists mimic:

A

effects of sympathetic stimulation

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19
Q

Alpha 1 receptor effects:

A
  • Pupil dilation
  • Conjunctival vasoconstriction
    -decreased secretions from nasal mucosa and salivary glands
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20
Q

Alpha 2 receptor effects

A

-Decreased production of aqueous humor
- Decreased saliva production

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21
Q

Beta 1 and Beta 2 receptor effects:

A

Increased production of aqueous humor

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22
Q

Alpha 1 agonists (adrenergic drugs) are used for:

A

Nasal congestion and red eyes

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23
Q

Alpha 1 agonists should NOT be used in:

A
  • HTN and CVD
    Angle-closure glaucoma
    Urinary retention
    Bowel obstruction
    Concurrent used with MAOIs (phenlzine)
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24
Q

What type of drug is psuedoephedrine?

A

Non selective adrenergic agonist but the therapeutic use is due to it’s action on alpha-1 receptors

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25
Psuedoephrine is used for:
orally as a decongestant in treatment of rhinitis
26
Phenylephrine is a:
Alpha 1 agonist (selective) sudafed
27
Phenylephrine is used for:
sx relief in rhinitis and allergic conjuctivitis (sudafed)
28
Oxymetazoline is a: AKA: Used for:
topical alpha 1 agonist afrin, visine oral ingestion medical emergency
29
How do alpha 2 agonists decrease IOP? What are they used for? Names:
By decreasing the production of aqueous humor Used topically gluacoma management -Apraclonidine, brimonidine
30
What part of the eye do beta blockers work on? How?
Work on the ciliary body of the eye which contains beta-1 and beta-2 receptors
31
What does the activation of beta1- or beta-2 receptors on the ciliary body of the eye do?
Increased aqueous humor production which can lead to increased IOP
32
Topical beta blockers are used for:
Glaucoma
33
Adverse effects of beta blockers (in EENT)
eye discomfort/ irritation, keratitis, blurred vision, photophobia
34
natural ligand for adrenergic receptors is:
norepinephrine
35
when should beta blockers be used with caution?
Asthma, COPD, insulin-dependent diabetics
36
Alpha 1 effects:
-constriction of smooth muscle -vasoconstriction -increase tone of bladder sphincter -increase BP, peripheral resistance
37
alpha 2 effects:
-usually found in presynaptic neurons -inhibits release of: NE, Ach, insulin
38
beta 1 effects:
-tachycardia by increasing cAMP concentrations in the cell -increase lipolysis and release of renin
39
beta 2 effects:
-increased cAMP, causing vasodilation -increase muscle and liver glycogenesis -increase glucagon secretion -relax uterine smooth muscle
40
Histamine causes:
- vasodilation - increased vascular permeability (edema and redness) - stimulates of afferent neurons, leading to increased pruritis and pain signaling - contraction of bronchial smooth muscle, leading to bronchoconstriction
41
Action of Antihistamines:
- block histaminic receptors (they do NOT block the release of histamine)
42
Action of mast cell stabilizers:
prevent release of histamine from the mast cells
43
Olopatadine actions:
antihistamine and mast cell stabilizer
44
Action of H1 antagonist (antihistamine) - other actions?
- Reduce itching, sneezing, rhinorrhea, congestion of allergic rhinitis and eyes - anticholinergic activity
45
What population should H1 antagonists NOT be used?
-Elderly due to cholinergic burden -Kids younger than 2 due to paradoxical agitation
46
Diphenhydramine and hydroxyzine are what type of drug? Generation? - Generic name?
H1 antagonist First generation Benadryl
47
Does diphenhydramine and hydroxyzine cross the blood brain barrier? What does this cause?
Yes Causes sedation and central anticholinergic effects
48
Names of second generation of H1 antagonist? Brand name
Loratadine (claritin), cetirizine (zyrtec) , fexofenadine (allegra)
49
Loratadine (claritin), cetirizine (zyrtec) , fexofenadine (allegra) - do they cross the BBB?
- no (less likely) bc they are ionized at physiological pH - less side effects!
50
Why are H1 antagonist useful in treating vertigo and meniere's disease?
H1 antagonists that are centrally acting inhibit the signals from the vestibular nucleus from going to the vomiting center (in the medulla)
51
What H1 antagonist are centrally acting and are used in vertigo and Meniere's disease?
diphenhydramine, meclizine, promethazine
52
Action of mast cell stabilizers?
inhibit degranulation of mast cells which prevents the release of histamine and other inflammatory mediators - don't stop the action of histamine once they have already been released - best used prophylactically
53
Cromolyn sodium is a: - Used for:
mast cell stabilizer - Intranasally for allergic rhinitis and as eye drops
54
Ketofin (zaditor) is a: Used for:
- Mast cell stabilizer and an H1 antagonist - ONLY SEVERE - Allergic conjunctivitis - topical
55
Claritin (loratidine) has the longest half life - true or false?
true - long term coverage!
56
Name the 4 drugs that mediate eicosanoids:
NSAIDs, acetaminophen, latanoprest, montelukast
57
COX pathway converts what to what:
arachidonic acid to prostaglandins and thromboxanes
58
LOX pathway converts what to what
arachidonic acid into leukotrienes
59
How do NSAIDs work
inhibit COX enzymes which prevents the formation of pro-inflammatory prostaglandins such as PGE2
60
Acetaminophen is a:
central COX inhibitor
61
COX 1
- GI protection, mucosal secretions -Activating platelets
62
COX 2
inflammatory enzyme
63
Latanoprost is a: Action: Used for: Side effects:
Prostaglandin F2 analogues -Increases outflow of aqueous humor - Used for glaucoma - Increased lash growth, change in eye color
64
Montelukast is a:
- Leukotrienes antagonist - Used for allergic rhinitis, chronic rhinosinusitis - More effective when combined with antihistamine (IN glucocorticoids more effective)
65
Docusate Sodium is a: Adverse effects:
Cerumenolytics AE: allergic reaction, local irritation
66
Silver nitrate is:
styptic used to stop bleeding in epistaxis - chemically cauterize the vessel (topical anesthetic should be applied first)
67
How do antifungals work?
Azoles: inhibit ergosterol synthesis Nystatin: disrupt cell wall
68
Adverse effects of oral and topical antifungals?
Oral: GI disturbance, hepatotoxicity, drug interactions Topical: local hypersensitivity reactions
69
What topical antifungal is used for otitis externa? Oral?
nystatin topically - fluconazole - oral if topical doesnt work
70
Gentian violet is: Should not be used:
Antibacterial and antifungal activity used for otitis externa - should NOT be used with TM perforation due to potential ototoxicity
71
What antibiotics are cell wall inhibitors?
penicillins, cephalosporins, vancomycin, polymyxin B, bacitracin
72
What antibiotics are protein synthesis inhibitors?
Tetracyclines, aminoglycosides, macrolides, lincosamides
73
What antibiotics are RNA/DNA synthesis inhibitors
Mupirocin, rifaximin, rifampin, fluoroquinolones
74
What antibiotics are bacterial metabolism inhibitors
- Folate synthesis and reduction inhibitor --> sulfamethoxazole-trimethoprim - Mycolic acid synthesis inhibitor -> isoniazid (mycobacteria only)
75
What antibiotics are beta lactams
penicillins and cephalosporins
76
what antibiotics are tetracyclines
doxycycline, minocycline
77
What antibiotics are macrolides
azithromycin, clarithromycin, erythromycin
78
what antibiotics are fluoroquinolones
ciprofloxacin, levofloxacin, ofloxacin
79
what class of antibiotics are clindamycin
lincosamides
80
what class of antibiotics are gentamicin and neomycin?
aminoglycosides
81
4 scenarios when antibiotics should be prescribed:
-Infections threatening deeper structures - For cases not responding to palliative treatment - For specific populations (immunocompromised) - In special circumstances (patients with strep)
82
B-lactams (penicillins, cephalosporins) MOA:
Inhibit biosynthesis of peptidoglycan in bacterial cell wall (polymer cross-linking)
83
Are B-lactams more effective in gram positive or negative bacteria? Why?
More effective for gram positive due to the thicker peptidoglycan layer
84
Penicillin G is most commmonly used for:
syphilis
85
What is the first line therapy for group A strep pharyngitis:
Penicillin VK (oral)
86
Amoxicillin, ampicillin is first line therapy for:
AOM Bacterial rhinosinusitis First line alternative for GAS
87
Amoxicllin is often formulated with:
clavulanic acid which is a b-lactamase inhibitor
88
What antibiotic do you prescribe if your patient has a mild reaction to penicillin?
Cephalosporins - use with caution
89
Antibiotic used for uncomplicated urogenital, pharyngeal, or rectal gonococcal infection:
Ceftriaxone (500 mg IM)
90
MOA for tetracyclines (doxycycline, minocycline)
Bind to 30S subunit of the bacterial ribosome and prevent protein synthesis - take away from food high in calcium
91
Adverse effects of tetracyclines:
Deposition in bones and teeth, phototoxicity, vestibular dysfunction, contraindicated in pregnancy
92
What is recommended as an alternative for penicillin-allergic patients in the tx of bacterial sinusitis or AOM?
Doxy!
93
MOA of macrolides (azithromycin, clarithromycin, erythromycin)
Binds to the 50S subunit of the bacterial ribosome preventing protein synthesis
94
Erythromycin and clarithromycin inhhibit what?
CYP 450 enzymes Can cause drug interactions!
95
When is topical erythromycin (macrolides) used?
bacterial conjunctivitis - newborns prophylaxis against chlamydial and gonorrheal conjunctivitis
96
MOA of lincosamides (clindamycin, lincomycin)
reversibly binds to 50S subunit of the bacterial ribosome
97
What is the box warning for clindamycin?
increase the risk of C diff 4 fold
98
Oral aminoglycosides (gentamicin) are significantly associated with what?
ototoxicity, nephrotoxicity, neuromuscular paralysis
99
What is gentamicin used for?
-topical for otitis externa (TM intact) and bacterial keratitis - saved for serious multi-drug resistant conditions orally - end stage intractable meniere disease to destroy the inner ear through trans-tympanic injection
100
MOA of fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin)
Inhibits bacterial DNA gyrase (and some degree of topoisomerase IV) preventing nucleic acid replication - broad spectrum - topical and oral
101
Adverse effects of fluoroquinolones
GI upset, tendinitis, tendon rupture
102
When is topical fluoroquinolones recommended?
otitis externa in the case of TM rupture
103
What is mupirocin used for
antibiotic used against MRSA - topical
104
MOA of Acyclovir and valacyclovir (more bioavailable prodrug)
guanine analogues that inhibit viral DNA polymerase (acts like guanine) - only works on actively replicating virus, no activity on latent virus

Pharmacology (3 decks)

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