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Fun Med Fall-AM > EENT Pharm > Flashcards

EENT Pharm Flashcards

1
Q

Rx options for Otitis Externa

A

Anti-infectives w/ or w/out steroids

Acid-alcohol solutions

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2
Q

Best Rx for Otitis Externa w/ tubes or perforated TM

A

Ofloxacin

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3
Q

Rx for Otitis Externa to avoid with tubes or perforated TM

A

Neomyacin, acid-alcohol solutions

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4
Q

Route of administration for anti-infective for Otitis externa

A

Topical

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5
Q

Most common Rx for Otitis Externa

A

Ones w/ steroids:
Ciprofloxacin/hydrocortisone
Ciprofloxacin/dexamethasone
Hydrocortisone/neomycin/polymycin (not w/tubes)

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6
Q

Rx for Otitis Externa w/ pseudomonas

A

Ciprofloxacin or Ofloxacin

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7
Q

What do Otitis Externa Anti-infectives end in?

A

-acin

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8
Q

5 acid-alcohol solutions

A 
acetic acid/aluminum acetate
acetic acid/propylene glycol
acetic acid/propylene glycol/hydrocortisone
isopropyl alcohol/glycerine
isopropyl alcohol/propylene glycol
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9
Q

Side effects of anti-infectives

A

ear pain, contact dermatitis, ototoxicity

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10
Q

Side effects of acid-alcohol solutions

A

Stinging, burning, local irritation

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11
Q

Benefits of acid-alcohol solutions for otitis externa

A

Induces drying, supplements natural environment of ears

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12
Q

What should you do if Otitis Externa hasn’t responded after 1 wk of treatment?

A

Culture

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13
Q

OTC treatment options for water clogged ears

A
  • Isopropyl alcohol (95%) in anhydrous glycerine (5%)

- 50:50 acetic acid + isopropyl alcohol **

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14
Q

Antibiotic therapy treatment guidelines for AOM in 6 mo+ old

A

Bilateral or unilateral AOM + severe signs/symptoms

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15
Q

Antibiotic therapy treatment guidelines for AOM in 6-24 mos old

A

Bilateral AOM

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16
Q

Watch and wait treatment guidelines for AOM in 6 mo-23 mo old

A

Non severe unilateral AOM

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17
Q

Watch and wait treatment guidelines for AOM in 24 mo+ old

A

Nonsevere AOM

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18
Q

Rx of choice for AOM

A

Amoxicillin

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19
Q

Do you give any meds for watch and wait AOM? What?

A

Yes, ibuprofen/acetaminophen

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20
Q

If pt with AOM had recent treatment with Amoxicillin, what should you add to current treatment

A

B-lactamase coverage (clavulanate)

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21
Q

Amoxicillin resistance with AOM, med?

A

Amoxicillin/clavulanate

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22
Q

Best Rx choice to treat AOM in pt with tubes?

A

Ofloxacin

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23
Q

Options for cerumen impaction

A
  • Carbamide peroxide
  • Triethanolamine polypeptide oleate
  • Hydrogen peroxide/warm water
  • Olive/sweet oil
  • Glycerin
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24
Q

If you need to also dry the ear canal when removing cerumen impaction, what treatment would you avoid?

A

Hydrogen peroxide/ warm water

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25
Q

Which cerumen softener is an emollient?

A

Glycerine

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26
Q

Contraindications for cerumen impaction treatment

A
  • Tubes or perforated TM

- history of adverse rxn

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27
Q

Possible side effects of cerumen treatment

A
  • Mild itching
  • Burning
  • Ear pain
  • Erythema of the ear canal
  • Allergic ReacAons (hives, difficulty breathing, swelling of face, lips, tongue, throat) EMERGENCY
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28
Q

Do’s of cerumen impaction treatment

A
  • Do instill med, and once wax is softened follow with warm water irrigation via syringe
  • Do make sure to completely remove drops
  • Do understand that periodic prophylactic removal may be appropriate
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29
Q

Do not’s of cerumen impaction treatment

A
  • Don’t use carbamide peroxide longer than 4 days (damage to TM possible)
  • Don’t use Q-tip to clean out wax
  • Don’t leave drops in ears longer than 30 minutes
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30
Q

Things to remember regarding Otic meds

A
  • Think twice and avoid neomycin use with tubes or perforated TM
  • Ofloxacin is good choice for AOM w/ tubes
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31
Q

Ophthalmic Anesthetic options

A

Amino Esters:

  • proparacaine
  • tetracaine

Amino-amides:
-lidocaine

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32
Q

Improper use of ophthalmic anesthetic can lead to:

A

Deep corneal infiltrates, ulceration, and perforation

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33
Q

When would you use an ophthalmic anesthetic?

A

Local anesthesia for procedures: foreign bodies, sutures, scrapings for Dx

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34
Q

MOA for ophthalmic anesthetic

A

Penetrate to sensory nerve endings in corneal tissue, bind to receptors within sodium channels ->blocks sodium, no depolarization, nerve cannot transmit pain impulses

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35
Q 
ophthalmic anesthetic:
A
D
M 
E
A

A: Rapid @ conjunctival capillaries, local action
D: protein binding high
M: unknown in eye/skin, some metabolism
may occur if systemically absorbed
E: Lidocaine? Tetracaine, proparacaine->bile

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36
Q

T1/2 for Ophthalmic anesthetics

A

proparacaine -shorter
lidocaine - medium
tetracaine -longer

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37
Q

Possible adverse rxn to ophthalmic anesthetics

A

Burning or stinging on application

Extended use: Severe keratitis, opacification, scarring of cornea and loss of vision possible (rare)

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38
Q

Possible side effects or adverse rxn to ophthalmic anti-infectives

A

Blurry vision, local irritation, super-infections possible with long term use

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39
Q

Bacteriostatic

A

Prevents growth of bacteria

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40
Q

Bactericidal

A

Kills bacteria

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41
Q

Bacteriostatic ophthalmic anti-infectives

A
  • Sulfacetamide
  • Bacitracin
  • Erythromycin
  • Fluoroquinolone: ciprofloxin, moxifloxin, etc
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42
Q

Bactericidal ophthalmic anti-infectives

A
  • Tobramycin/gentamicin

- Polymixin B

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43
Q

Possible causes of conjunctivitis

A

Allergic

Infective (bacterial, viral, fungal(rare))

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44
Q

Contraindications for ophthalmic anti-infectives

A

Sulfa allergy (Sulfacetamide)

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45
Q

Good choice of ophthalmic anti-infective for contact wearers

A

Fluoroquinolone: ciprofloxin, moxifloxin, etc

broader spectrum

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46
Q

Good choice of ophthalmic anti-infective for infants and children

A

Erythromycin ointment has good coverage and is easier to administer than drops.
– Well tolerated

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47
Q

Which ophthalmic anti-infectives can cause irritation that look like failed treatment?

A

Sulfacetamide and gentamicin

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48
Q

MOA for Ophthalmic Mast Cell Stabilizers

A

Inhibits degranulation of mast cells after exposure to antigen. Reduces histamine release

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49
Q

Ophthalmic Mast Cell Stabilizers options

-crom-

A
  • Nedocromil 2%
  • Cromolyn Sodium 4%
  • Iodoxamide 0.1%
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50
Q

What would you use an Ophthalmic Mast Cell Stabilizer for?

A

Allergic conjunctivitis & keratitis

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51
Q

Adverse rxns to Ophthalmic Mast Cell Stabilizers?

A

Transient stinging or burning, blurry vision, photophobia, mydriasis, rhinitis, sinusitis, headache

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52
Q

Adverse rxns to Ophthalmic Antihistamines

A

Transient stinging or burning, blurry vision, photophobia, mydriasis, rhinitis, headache

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53
Q

Ophthalmic Antihistimine options (-astine)

A
  • Azelastine
  • Epinastine
  • Emedastine
  • Ketotifen
  • Levocabastine
  • Olopatadine
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54
Q

What Rx blocks the effects of histamine and blunts symptoms of allergic conjunctivitis. H1 blocker, and good at relieving the itching.

A

Ophthalmic antihistamines

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55
Q

Best to use to treat redness associated with allergic conjunctivitis

A

Ophthalmic vasoconstrictors/decongestant

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56
Q

MOA of Ophthalmic vasoconstrictors/decongestant

A

Constricts the blood vessels in the conjunctiva. Weak sympathomimetic

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57
Q

What can happen with overuse of Ophthalmic vasoconstrictors/decongestant?

A

Rebound congestion/redness

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58
Q

Use of Ophthalmic vasoconstrictors/decongestants should be avoided if…

A
  • Hx of heart disease, high BP, enlarged prostate, narrow angle glaucoma.
  • Wears contacts
  • Takes MAOI’s or tricyclics
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59
Q

Adverse effects of Ophthalmic vasoconstrictors/decongestants if absorbed systemically?

A

Tachycardia, aggravation of arrhythmias

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60
Q

Local adverse effects of Ophthalmic vasoconstrictors/decongestants?

A

mydriasis (pupil dilation), burning/stinging, blurry vision

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61
Q

OTC options for Ophthalmic vasoconstrictors/decongestants? (-zoline)

A
  • Naphazoline -best option (Clear Eyes)
  • Tetrahydrozoline (Visine)
  • Oxymetazoline -fewer side fx (Vision LR)
  • Phenylephrine (glaucoma risk)
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62
Q

OTC combination products to treat Allergic Conjunctivitis

A
  • Naphazoline + pheniramine

- Naphazoline + antazoline

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63
Q

Contraindications for OTC combination products to treat allergic conjunctivitis

A

Heart disease, high BP, enlarged prostate, narrow angle glaucoma (due to vasoconstrictors)

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64
Q

Sx of Dry Eye

A

Ocular burning, redness, blurred vision, discomfort, desire to rub eye

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65
Q

Options for Dry Eye

A
  • Artificial Tears
  • Ocular Emollients
  • Cyclosporine
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66
Q

Artificial tear options

A
  • Cellulose derivatives: longer lasting, but can leave a crust on the eyes
  • Polyvinyl alcohol: shorter acting, but no crust
  • Povidone and dextran 70: transient stinging and burning
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67
Q

Ocular emollient options

A

Lanolin, mineral oil, white ointment, yellow wax, white wax, petroleum
(ointment or liquid)

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68
Q

Rx for keratoconjunctivitis sick (suppressed tear production due to ocular inflammation)

A

Cyclosporine (Restasis)

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69
Q

MOA for Cyclosporine

A

Inhibits interleukin 2 that is needed for T cell action

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70
Q

Adverse effects of cyclosporine

A

burning, eye discomfort

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71
Q

Sx of corneal edema

A

Foggy vision, haloes around lights, photophobia, irritation, foreign body sensation, extreme eye pain

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72
Q

Etiology of corneal edema

A

Prolonged contact lens wearing, infection, glaucoma, iritis

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73
Q

Tx of corneal edema

A

Sodium chloride (2-5%), ointment if drops ineffective

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74
Q

MOA of pupillary dilation agents

A

Muscarinic agents - block parasympathetic receptors (that would normally cause pupils to constrict if stimulated)

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75
Q

Parasympathetic action of the eye:

A

Constriction (miosis) inner circular muscle constricts

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76
Q

Sympathetic action of the eye:

A

Dilation (mydriasis) outer radial muscle constricts

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77
Q

Pupillary Dilation agents:

A
  • Tropicamide- peaks @ 20-30 min, lasts 2-7 hours
  • Cyclopentolate- peaks @ 25-75 min, lasts 6-24 hrs
  • Homatropine -lasts 24-72 hours
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78
Q

Possible adverse rxn of pupillary dilation agents

A

Tachycardia, flushing, blurry vision, photophobia, dry mouth, slurred speech, drowsiness, hallucinations, congestion, irritated eyes

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79
Q

Contraindications for pupillary dilation agent use

A

Closed angle glaucoma- dilation can occlude outflow of aqueous humor, raise IOP which further occludes outflow

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80
Q

Used to detect corneal defects and abrasions

A

Fluorescein- fluoresces under ultraviolet spectrum. Will stain epithelial damage, but does not stain cornea

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81
Q

What is fluorescein?

A

Yellow, water-soluble dibasic-acid xanthine dye

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82
Q

Beclomethasone

A

Intranasal Corticosteroid

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83
Q

Nudesonide

A

Intranasal Corticosteroid

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84
Q

Ciclesonide

A

Intranasal Corticosteroid

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85
Q

Flunisolid

A

Intranasal Corticosteroid

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86
Q

Fluticasone furoate

A

Intranasal Corticosteroid

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87
Q

Fluticasone proprionate

A

Intranasal Corticosteroid

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88
Q

Mometasone

A

Intranasal Corticosteroid

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89
Q

Triamcinolone acetonide

A

Intranasal Corticosteroid

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90
Q

What is the MOA for intranasal corticosteroids?

A

Decrease influx of inflammatory cells, inhibits release of cytokines which reduces inflammation of nasal mucosa.

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91
Q

What is the MOA for oral antihistamines?

A

H1 receptor antagonist.

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92
Q

What is an H1 antagonist?

A

Blocks the action of the histamine at the H1 receptor, which helps relieve allergic reactions. Antihistamine.

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93
Q

What are examples of first generation oral antihistamines?

A

Chlorpheniramine. Brompheniramine. Diphenhydramine. Clemastine.

94
Q

What are the key points of 1st generation antihistamines?

A

Nonselective. Sedating. More frequent dosing.

95
Q

What are the key points of 2nd generation antihistamines?

A

Peripherally selective. Low incidence of sedation. Once/daily. No anticholinergic effect.

96
Q

What is the most effective 2nd generation antihistamine?

A

Cetirizine.

97
Q

What are 4 2nd generation antihistamines?

A

Loratidine. Cetirizine. Fexofenadine. Desloratadine.

98
Q

Which type of antihistamine crosses the blood-brain barrier?

A

1st generation.

99
Q

Which type of antihistamine has less side effects?

A

2nd generation.

100
Q

What are some contraindications for antihistamines?

A

Don’t drive or operate heavy machinery. Narrow-angle glaucoma possible. Avoid alcohol.

101
Q

What are 2 Intranasal antihistamines?

A

Azelastine. Olopatadine

102
Q

What is the MOA of oral decongestants?

A

Alpha-adreneric agonist>vasoconstriction. Reduces blood supply to nasal mucosa. Decreases mucosal edema. NO EFFECT ON HISTAMINE.

103
Q

What are contraindications for nasal decongestant?

A

AVOID if uncontrolled heart disease. Can increase IOP and BP.

104
Q

What are some side effects of Intranasal Corticosteroids?

A

Headache. Elevated BP. IOP. Tremor. Dizziness. Tachycardia. Insomnia.

105
Q

What are two examples of nasal decongestants?

A

Phenylephrine. Pseudoephedrine.

106
Q

What is the MOA for topical decongestants?

A

Alpha agonist that act locally as vasoconstrictors. Decrease blood supply to nose by constricting blood vessels.

107
Q

What are examples of topical decongestants

A

Phenylephrine. Oxymetazoline.

108
Q

What are contraindications for topical decongestants?

A

Rhinitis medicamentosa!

109
Q

What are the key points for Intranasal Cromolyn?

A

Prevents and treats SYMPTOMS of Allergic Rhinitis.

110
Q

What does a mast cell stabilizer do?

A

Prevents mast cells from releasing histamine. (Intranasal cromolyn).

111
Q

How do intranasal anticholinergics work?

A

They block acetylcholine receptors.

112
Q

What is an example of an intranasal anticholinergic?

A

Ipratropium

113
Q

What would you consider using to reduce ocular symptoms in Allergic Rhinitis?

A

Leukotriene Receptor Antagonists.

114
Q

What is an option for patients with asthma who have allergic rhinitis?

A

Leukotriene receptor antagonists (montelukast). Reduces bronchospasm.

115
Q

How long does it usually take for immunotherapy to work? How long can it last?

A

5-7 yrs. 12.

116
Q

2nd generation antihistamines

-adine

A
  • Fexofenadine
  • Desloratadine
  • Loratadine
  • Cetirizine **(most effective)
117
Q

1st generation antihistamines

-amine

A

Diphenhydramine
Chlorpheniramine
Brompheniramine
Clemastine

118
Q

What works well to REDUCE RHINORRHEA?

A

Ipratropium (many other answers).

119
Q

What is a major anticholinergic side effect?

A

DRYNESS

120
Q

Is the common cold usually viral or bacterial?

A

Viral

121
Q

Is the onset for a cold gradual or rapid?

A

Gradual, 1-2 weeks.

122
Q

Meds to treat anaphylaxis

A
  • Epinephrine -life saving
  • Antihistamine- symptom relief
  • Corticosteroid -suppress biphasic or rebound run

Don’t forget to stop the offending drug or whatever caused the rxn to begin with

123
Q

Medical term for pupil constriction

A

Miotic

124
Q

Main goal of Glaucoma Tx

A

Reduce IOP either by slowing production or increase drainage of aqueous humor to prevent optic nerve damage and visual field loss

125
Q

Drug classes to treat Glaucoma

A
  • Prostaglandin Analogues
  • Beta blockers
  • Alpha-adrenergic agonists
  • Carbonic anhydrase inhibitors
  • Cholinergics
  • Mannitol
126
Q

How does systemic absorption occur with topical anti-glaucoma meds?

A

Primarily through the nasolacrimal duct

127
Q

MOA of Prostaglandin Analogues (1st line Tx)

A

Synthetic analogues of prostaglandin act on RF (prostaglandin receptor), increase outflow of intraoccular aqueous humor through uveoscleral pathway, which lowers IOP 23-35%

128
Q

Helpful med to prevent biphasic rxn in anaphylaxis

A

Corticosteroids

  • first dose IV
  • typically multi-day course. Short term! (3-5 days)
129
Q

MOA of corticosteroids

A

Decreases influx of inflammatory cells, inhibits release of cytokines -> reduce inflammation

  • prednisone
  • prednisolone
  • Methylprednisolone
  • Dexamethasone
  • many more
130
Q 
Corticosteroids:
A
D
M
E
T1/2
A 
A: GI tract, highly bioavailable
D: 70-90% protein bound
M: Liver
E: Renal
T1/2: 2-4 hours
131
Q

Adverse rxns of corticosteroids

A

Hypertension, body fluid retention, impaired glucose tolerance, increased appetite, weight gain, osteoporosis, disturbance in mood, delirium

132
Q

Adverse rxns of beta blockers

A

Bradycardia, bronchospasm, depression, fatigue, ocular dryness

133
Q

MOA of Alpha-Adrenergic Agonists (a2)

A

Decreases aqueous humor production by causing vasoconstriction (maybe increases outflow)

134
Q

Options for Glaucoma Alpha-Adrenergic Agonist Rx (-idine)

A
  • Brimonidine

- Apraclonidine

135
Q

What are CYP450s?

A

Drug metabolizing enzymes

136
Q

MOA of Carbonic Anhydrase Inhibitors

A

Slows action of carbonic anhydrase to decrease aqueous humor volume -> decreases IOP

137
Q

Glaucoma Carbonic Anhydrase Inhibitor Rx options (-zolamide)

A
  • Acetazolamide*
  • Dorzolamide
  • Brinzolamide
  • Methazolamide*
  • Dichlorphenamide
  • oral tablets used less often
138
Q

Adverse rxns of Carbonic Anhydrase Inhibitors

A

Ocular irritation, sour taste

139
Q

Contraindications for use of Carbonic Anhydrase Inhibitors

A

Sulfa Allergy

140
Q

MOA of Cholinergics

A

Has similar effects as acetylcholine -> parasympathetic response of miosis (essentially it contracts the iris sphincter muscle, which opens the canal of Schlemm, which increase the outflow of aqueous humor through trabecular meshwork, which decreases IOP =>miosis)

Direct- directly stimulates ocular cholinergic receptors

Indirect- bind to and activate cholinesterases (that break down acetylcholine-> keep acetylcholine around)

141
Q

Direct-Acting Cholinergics (Miotics)

A
  • Pilocarpine

- Carbachol

142
Q

Indirect Acting Cholinnergics (Miotics)

A

Echothiophate

very long half life, irreversible

143
Q

Adverse rxns of Cholinergics (Miotics)

A

Blurred vision, poor night vision, eye pain, headache

144
Q

Combination drops to treat Glaucoma

A

Timolol + dorzolamide

145
Q

Glaucoma drug interactions

A

Acetazolamide interacts with

  • aspirin
  • Cyclosporine
  • Lithium
  • Phenytoin
146
Q

Glaucoma drug classes that slow production of aqueous humor:

A

Beta blockers
Alpha 2 agonists
Carbonic anhydrase inhibitors

147
Q

Glaucoma drug classes that increase drainage of aqueous humor

A

Prostaglandins

Cholinergics/muscarinics

148
Q

Drug used to treat acute attack of closed angle glaucoma

A

Mannitol, Glycerin

149
Q

Pharmacologic Tx for Mild Allergic Rhinitis

A

antihistamines prn

150
Q

MOA of Mannitol, Glycerin

A

Causes blood to be hypertonic compared to intraocular and spinal fluids, which causes osmotic gradient (pulls water from intraocular and spinal areas out to bloodstream), and excess fluid is secreted in the urine

151
Q

Pharmacologic Tx for Severe Allergic Rhinitis

A

Refer to specialty/immunotherapy

152
Q

Humoral immunity (antibodies & B cells) + cellular immunity =(no antibodies & T cells)

A

Acquired immunity

153
Q

Hypersensitivity Rxn Types :(resulting from interaction between antigen and immune system)

A

Type I: IgE-mediated -antigen complex binds to mast cells causing release of histamine and inflammatory mediators (anaphylaxis/allergy)
(Also Types II- IV)

Pseudoallergic (anaphylactoid)

154
Q

Spectrum of Effects of IgE mediated rxns

A
  • Mild = allergic rhinitis
  • Moderate (!!) = urticaria (hives), angioedema (swelling)
  • Severe (!!!!!) = anaphylaxis
155
Q

Benefits of intranasal corticosteroids

A

Reduces ocular symptoms, nasopharyngeal itching, sneezing, rhinorrhea.
More effective than antihistamines in severe cases

156
Q

2nd generation antihistamines (-adine)

A
  • Fexofenadine
  • Desloratadine
  • Loratadine
  • Cetirizine
157
Q

1st generation antihistamines

A

Diphenhydramine

158
Q

Follow up Rx for moderate hypersensitivity rxn

A

Oral corticosteroids -short course (e.g. prednisone for 3-5 days)

159
Q

Further Rx care following moderate hypersensitivity rxn

A

Epinephrine auto injector

160
Q

What type of rxn is anaphylaxis?

A

IgE mediated (Type I Rxn)

161
Q

What is the time frame for an anaphylactic response? 2nd Rxn? (Biphasic Rxn)

A
  • W/in 1 hour (5-30 min)

- 8-72 hours later

162
Q

Meds to treat anaphylaxis

A

Epinephrine -life saving
Antihistamine- symptom relief
Corticosteroid -suppress biphasic or rebound run

Don’t forget to stop the offending drug or whatever caused the rxn to begin with

163
Q

MOA of epinephrine

A

Alpha & beta adrenergic agonist (sympathomimetic)

  • causes rapid vasoconstriction and rapid relaxation of bronchial smooth muscle
164
Q

MOA of oral/topical decongestants

A
  • Alpha-adreneric agonists → vasoconstriction
  • Constriction of blood vessels to decrease blood supply to nasal mucosa, decrease mucosal edema
  • > no effect on histamine
165
Q

Adverse effects of epinephrine

A

agitation, anxiety, tremulousness, headache, dizziness, pallor, palpitations, arrhythmias

166
Q

2nd line Tx for anaphylaxis

A

Antihistamines

  • helps erythema & pruritus, but doesn’t help with airway obstruction or high BP
  • given IV, IM or po
  • couple with epinephrine
167
Q

MOA of antihistamines

A

H1 receptor antagonists
1st gen: sedating, nonselective (diphenhydramine)
2nd gen: selective, low sedation, no anticholinergic fx

168
Q

Helpful med to prevent biphasic rxn in anaphylaxis

A

Corticosteroids

  • first dose IV
  • typically multi-day course (3-5 days)
169
Q

MOA of corticosteroids

A

Decreases influx of inflammatory cells, inhibits release of cytokines -> reduce inflammation

  • prednisone
  • prednisolone
  • Methylprednisolone
  • Dexamethasone
  • many more
170
Q 
Corticosteroids:
A
D
M
E
T1/2
A 
A: GI tract, highly bioavailable
D: 70-90% protein bound
M: Liver
E: Renal
T1/2: 2-4 hours
171
Q

Alternative to Topical Decongestants

A

Saline nasal drops, spray, rinse: no interactions, very safe, use if unsure cold vs allergies

172
Q

What are the 4 types of hypersensitivity reactions?

A

Type I: IgE-mediated- release of histamine and inflammatory mediators (minutes to hours) (anaphylaxis/allergy)

Type II: Cytotoxic reaction (variable timing)- IgM or IgG antibodies attack drug coated cell

Type III: immune complex (1-3 wks)- drug antibody complexes deposit on tissues

Type IV: delayed, cell-mediated (2-7 days) - presentation of drug molecules to sensitized T cells ->cytokine and inflammatory mediator release

173
Q

What is pseudo allergic?

A

Results from direct mast cell activation, degranulation

  • looks like Type I
  • Anaphylactoid = mimics anaphylaxis
  • e.g. anaphylactoid rxn after radiocontrast media
174
Q

Importance of Distribution (of drug)

A

How much is free in the blood affects dosing. Drug in tissue must get back to blood in order to be excreted; too much drug in tissue can cause lethal toxicity

Amount of drug in the body divided by the concentration in the blood = distribution

175
Q

What are CYP450s?

A

Drug metabolizing enzymes

176
Q

Montelukast -> leukotriene receptor antagonist to treat allergic rhinitis

A
  • Reduce ocular symptoms, sneezing, rhinorrhea

- May be particularly useful for patients with asthma

177
Q

What is half-life?

A

how long does it take for half of the drug to leave the body. Good for dosing intervals, determining how long it takes to reach a steady state, or when drug is finally cleared from the body. Usually takes 5-6 half-lives to completely leave the body (some adverse effects take longer or are irreversible)

178
Q

How often do you give a drug if you are trying to build up the level in the body?

A

Give every half of a half life

179
Q

What is Glomerular filtration rate (GFR)?

A

How well kidneys are filtering. Another way is CrCl, which is how well body is clearing creatinine (good indicator of how well the kidneys are working)

180
Q

What is the Therapeutic Index (TI)?

A

level between too much that will be toxic and too little when it won’t work.

181
Q

What is a loading dose?

A

Large first dose - some gets bound up in the tissues and the rest can go around and attack what it needs

182
Q

What is the fastest rate of onset of a drug? Slowest?

A
  • (fastest) IV or inhalation -> 30 sec-1min
  • (fast) IM ->5 min
  • (Mid) Subcutaneous, oral -> 30 min
  • (Slower) transdermal, oral-> 2 hours
183
Q

What is the best way to administer a drug that is degraded in the digestive tract?

A

Subcutaneous or IV

184
Q

What is the preferred route of administration?

A

Oral

185
Q

Codeine w/guaifenesin

A
  • narcotic, helps pt sleep
  • Prodrug
  • some people can be poor metabolizers or ultra rapid metabolizers

Avoid in children <12
Avoid alcohol

186
Q

What is the abbreviation:
od
ad

A

Right eye

Right ear

187
Q

Hydrocodone

A

-Narcotic, helps pt sleep

Avoid in children <12
Avoid alcohol

188
Q

What is the abbreviation:
ou
au

A

Both eyes

both ears

189
Q

Pharmacologic Tx for Mild Allergic Rhinitis

A

antihistamines pen

190
Q

Pharmacologic Tx for Moderate Allergic Rhinitis

A

intranasal steroid +/- antihistamine +/- decongestant for nose +/- ophthalmic antihistamine for eyes

191
Q

Pharmacologic Tx for Severe Allergic Rhinitis

A

Refer to specialty/immunotherapy

192
Q

Sore Throat/cough remedies

A

-Saline gargle
-Sprays, lozenges (numb locally)
Benzocaine
Dyclonine
Phenol
Menthol
-Honey (Buckwheat)
-Lots of water

193
Q

MOA of intranasal corticosteroids

A

Decrease influx of inflammatory cells, inhibit release of cytokines -> reduce nasal mucosal inflammation

194
Q

How long does it take intranasal corticosteroids to work? Peak?

A

Less than 30 min, peaks hours-days

195
Q

Benefits of intranasal corticosteroids

A

Reduces ocular symptoms, nasopharyngeal itching, sneezing, rhinorrhea.
More effective than antihistamines in severe cases

196
Q

Intranasal corticosteroid options (-onide)

A
  • Beclomethasone
  • Budesonide
  • Ciclesonide
  • Flunisolid
  • Fluticasone furoate (no alcohol)
  • Fluticasone propionate (no alcohol)
  • Mometasone
  • Triamcinolone acetonide (no alcohol)
197
Q

Adverse effects of Intranasal corticosteroids

A

Bitter aftertaste,

burning, epistaxis, headache, nasal dryness, possible systemic absorption, stinging, throat irritation

198
Q 
Antihistamines
A
D
M
E
T1/2
A

A: Rapid
D: 60-70% protein bound
M: minimal; desloratadine is a prodrug (first pass metabolism)
E: fexofenadine, desloratadine, loratadine→feces and urine; others → urine
T1/2: variable

199
Q

Side fx of 1st gen antihistamines

A
  • Cross blood-brain barrier ->sedation, fatigue, impaired mental status.
  • Paradoxical stimulation in some children, elderly
200
Q

Side fx of 2nd get antihistamines

A

Don’t cross blood-brain barrier-> less sedative (except for cetirizine 1/10)

201
Q

Precautions/contraindications for antihistamines

A
  • Do not drive, operate heavy machinery
  • Avoid alcohol
  • Prostatic hyperplasia can occur
  • Narrow-angle glaucoma possible
202
Q

Intranasal antihistamine options

A

Azelastine
Olopatadine
Azelastine/fluticasone combo ($$$)

203
Q

Adverse rxn of intranasal antihistamine

A

bitter aftertaste, headache, nasal irritation, sedation, epistaxis

204
Q

MOA of oral decongestants

A
  • Alpha-adreneric agonists → vasoconstriction

- Constriction of blood vessels to decrease blood supply to nasal mucosa, decrease mucosal edema

205
Q

Oral decongestant options

A

Phenylephrine (low bioavailability)

Pseudoephedrine

206
Q

Side fx of oral decongestants

A
  • Headache
  • Elevated blood pressure
  • IOP
  • Tremor
  • Urinary retention
  • Dizziness
  • Tachycardia
  • Insomnia
207
Q

Precautions/contraindications for oral decongestants

A

-Avoid in uncontrolled HTN, heart disease, DM, Hyperthyroidism, enlarged prostate, narrow angle glaucoma, high BP

208
Q

Side fx of topical decongestants

A
  • Minimal systemic absorption, few side effects
  • Local burning
  • Nasal irritation, dryness
  • Sneezing
209
Q

Precautions/contraindications of topical decongestants

A

Rebound congestion (rhinitis medicamentosa) may occur if use > 3-5 days

210
Q

Options for topical decongestants

A

Phenylephrine

Oxymetazoline

211
Q

Alternative to Topical Decongestants

A

Saline nasal drops, spray, rinse: no interactions, very safe, use if unsure cold vs allergies

212
Q

Intranasal mast cell stabalizer

A

Cromolyn ->Prevent and treat allergic symptoms: nasopharyngeal itching, sneezing, rhinorrhea
- only works if taken regularly, and must take 4-6 times daily, 2-3 wks for max effect

213
Q

Side fx of Intranasal Cromolyn

A

nasal irritation, nasal burning, stinging, sneezing, cough, unpleasant taste, epistaxis

214
Q

Intranasal anticholinergics option

A

Ipratropium ->reduces rhinorrhea

215
Q

MOA of Intranasal anticholinergics

A

Block acetylcholine receptors -> less mucus

216
Q

Montelukast ->leukotriene receptor antagonist

A
  • Reduce ocular symptoms, sneezing, rhinorrhea

- May be particularly useful for patients with asthma

217
Q

Immunotherapy for allergic rhinitis best for pts who…

A
  • are unresponsive to usual treatment
  • who cannot tolerate usual treatment
  • who want to avoid long term med use
  • with allergic asthma
218
Q

Nonpharmacologic Tx for common cold

A

humidifiers, increase fluids, rest

219
Q

Pharmacologic Tx of common cold

A
  • Decongestants +/- antihistamines
  • analgesics
  • local anesthetic (lozenges, spray)
  • cough meds??
220
Q

Meds to treat fever, pain, headaches

A

Acetaminophen

NSAIDS: ibuprofen, naproxen

221
Q

Who should not take cough meds at all

A

Children <6 yo

222
Q

Cough/cold meds are mostly ineffective, what might be helpful?

A
  • High-dose inhaled corticosteroids
  • Buckwheat honey (not <1yo)
  • nasal irrigation with saline
  • vapor rub
  • Zinc sulfate?
223
Q

Cough med options

A

Antitussives
Expectorants
Sore throat remedies

224
Q

Antitussive options

A

Codeine (w/guaifenesin)
Hydrocodone
Dextromethorphan
Benzonatate

225
Q

Codeine w/guaifenesin

A
  • narcotic, helps pt sleep
  • Prodrug
  • some people can be poor metabolizers or ultra rapid metabolizers

Avoid in children <12
Avoid alcohol

226
Q 
Codeine w/guaifenesin
A
D
M
E
T1/2
A 
A: absorbed orally
D: crosses blood brain barrier
M: primarily in liver; prodrug, variable metabolism
E: urine 
T1/2: 2.5-4 hours
227
Q

Hydrocodone

A

-Narcotic, helps pt sleep

-

228
Q

Dextromethorphan

A
  • For non-productive cough
  • interacts with MAO inhibitors
  • MOA- centrally mediated
  • maybe has some benefit
229
Q 
Dextromethorphan
A
D
M
E
T1/2
A 
A: Absorbed from GI
D: crosses blood brain barrier
M: prodrug, liver CYP2D6 → active drug
E: urine
T1/2: variable (2-24 hours)
230
Q

Benzonatate

A

MOA: anesthetizes respiratory passage, lung, pleural stretch receptors (reduces cough reflex)

Adverse Reactions: hypersensitivity, GI upset, sedation

Maybe has benefit

M: Liver, unknown CYP450
E: urine
T1/2: ?

231
Q

Expectorant

A

Guaifenesin

MOA: thinning of mucus to enhance clearance
For productive cough
Side effects: GI discomfort
Counseling point: increase fluid intake

Maybe has benefit

232
Q

Sore Throat/cough remedies

A

-Saline gargle
-Sprays, lozenges (numb locally)
Benzocaine
Dyclonine
Phenol
Menthol
-Honey (Buckwheat)
-Lots of water

Fun Med Fall-AM (5 decks)

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