EENT Pharmacology

Question 1

What is the tx to GABHS pharyngitis?

Answer 1

• 1st line: Penicillin, 1st generation cephalosporin

- macrolides/erythromycin

Question 2

Name the four symptoms present in GABHS?

Answer 2

• absent cough
• tender anterior cervical lymphadenopathy
• tonsillar exudate
• fever greater than 38C

Question 3

Name penicillin susceptible narrow spectrum drugs

Answer 3

• Penicillin VK

- Penicillin G

Question 4

T/F Narrow spectrum penicillins cover gram pos bacteria while broad spectrum cover both gram pos and gram neg?

Answer 4

True

Question 5

What is drug that is narrow spectrum and penicillinase resistant?

Answer 5

Nafcillin

Question 6

What class drug is amoxicillin?

Answer 6

-broad spectrum penicillin

Question 7

What are examples of penicillinase inhibitors (2)?

Answer 7

• sulbactam

- clavulanic acid

Question 8

What are adverse effects of penicillins(4)?

Answer 8

• hypersensitivity rxn’s/maculopapular rash
• c diff colitis
• hemolytic anemia
• overgrowth of opportunistic infections

Question 9

What are drug interactions with penicillins (3)?

Answer 9

• reduces Vitamin K/warfarin anticoagulation function
• probenecid-penicillin stops clearance from kidneys
• tetracycline is bacteriostatic and penicillin is bactericidal so don’t combine

Question 10

Name 1st generation and 2nd generation cephalosporin?

Answer 10

• cephalexin

- cefuroxime

Question 11

name 3rd and 4th gen cephalosporin?

Answer 11

• ceftriaxone
• cefixime
• cefipime 4th

Question 12

name 5th gen cephalosporin?

Answer 12

ceftaroline?

Question 13

1st gen cephalosporin clinical use?

Answer 13

-skin, soft tissue, UTI

Question 14

2nd gen cephalosporin clinical use?

Answer 14

-more active against Strep pneumo, H. flu, and B fragilis

Question 15

3rd gen cephalosporin clinical use?

Answer 15

• pneumoniae, meningitis, and gonorrhea

- broad spectrum, beta lactamase stable

Question 16

4th gen cephalosporin clinical use?

Answer 16

pseudomonas coverage

Question 17

5th generation?

Answer 17

skin soft tissue

-CAP

Question 18

Why don’t you give ceftriaxone to infants?

Answer 18

-this increases serum bilirubin that can deposit in tissues

Question 19

If patient has IgE hypersensitivity rxn to penicillin, which cephalosporin should you avoid?

Answer 19

–all of them, they only one that has partial cross reactivity is 1st generation ceph

Question 20

What is MOA of penicillins?

Answer 20

cell wall synthesis inhibitors

-they act as substrate for penicillin binding protein and inhibit NAG+NAM linking

Question 21

What is MOA of macrolides?

Answer 21

Protein synthesis inhibitors (stop translation and transcription)
-affect 50S subunit/ribosome

Question 22

When would you give macrolides to patient with GABHS?

Answer 22

if patient has true allergic rxn to penicillin

Question 23

What are side effects of macrolides?

Answer 23

• QT prolongation
• abdominal pain
• diarrhea/GI disturbances
• Ototoxicity

Question 24

Name two macrolide drugs?

Answer 24

erythromycin

azithromycin

Question 25

What is an "off label use" of macrolides?

Answer 25

-GI prokinetic

Question 26

Drug interactions of macrolides?

Answer 26

-affects CYP450

Question 27

What viruses cause acute laryngitis?

Answer 27

- M. catarrhalis | - H. flu

Question 28

Name two antivirals?

Answer 28

- acyclovir | - valacyclovir

Question 29

What is MOA of antivirals?

Answer 29

-stop DNA synthesis and viral replication by competing for viral DNA polymerase

Question 30

T/F Valacyclovir is a prodrug and is more expensive than acyclovir

Answer 30

true

Question 31

How do you manage fluid and pain in patients with herpes or aphthous ulcers?

Answer 31

- topical lidocaine - rinse and expectorate with 12.5/5 diphenhydramine and mixed with magnesium and aluminum 1:1. - ice popsicles

Question 32

What are side effects of antiherpetic drugs?

Answer 32

- headaches | - malaise

Question 33

What is a drug interaction of antivirals?

Answer 33

-valacyclovir and acyclovir can diminish therapeutic effect of zoster vaccine. Don't give it 24 hrs before receiving vaccine and wait 2 weeks after vaccine has been given to administer the antivirals.

Question 34

What is clinical presentation of oral candidiasis?

Answer 34

- painful creamy white curd like patches that brush off | "Thrush will brush"

Question 35

What is MOA of antifungal?

Answer 35

Nystatin-binds sterols in fungal cell membrane and increase permeability of cells; cells leak contents and die Azoles: inhibit cell membrane synthesis by stopiping Cytochrome P450 and thus stop ergosterol synthesis

Question 36

What is 1st line tx for oral candidiasis?

Answer 36

Nystatin oral soln: 1:100,000 - 5 ml swish, hold and swallow QID x 7-10 days - Clotrimazole troches

Question 37

What is 2nd line tx for oral candidiasis?

Answer 37

Fluconazole PO | itraconazole suspension

Question 38

What are some adverse side effects of antifungals?

Answer 38

- increased ALP, ALT, AST, jaundice, hepatitis, hepatic failure - angioedema (rare)

Question 39

What should you monitor in patients taking antifungals?

Answer 39

- LFT - Qt prolongation - baseline serum creatinine

Question 40

What are drug interactions with antifungals?

Answer 40

- enhances toxic effects of calcium channel blockers - increases serum concentrations of Vitamin K antagonists, proton pump inhibitors, atorvastatin and simvastatin - decrease metabolism of benzos and losartan

Question 41

What is pregnancy category for antifungals?

Answer 41

Category C | -give single dose for vaginal candidiasis