ENT-1 Flashcards
What is the indication and SE for Carbamide peroxide 6.5% (Debrox ® or Murine Ear ®)?
Indication: Excessive/Impacted cerumen (≥12y.o)
Non-irritating
May be used BID x 4 days
SE: Pain, rash, irritation, tenderness, redness, discharge, dizziness
What are non-FDA approved tx for cerumen impaction?
Mineral oil Olive oil DSS Glycerin NaHCO3 Diluted H2O2
What are the indications and SE of Auro-Dri or Swim Ear drops?
Indications: water-clogged ears
95% Isopropyl alcohol + 5% anhydrous glycerin (reduce overdrying)
What are the indications, SE, and contraindications for phenylephrine (Sudafed PE)?
Nasal congestion
10mg po Q4hr prn, max 6doses/day
SE: Dizziness, anxiety, insomnia
Note: Avoid with MAOIs
What are the indications, SE, and contraindications for pseudoephedrine (Sudafed)?
30-60mg Q4-6hrs prn (IR)
120mg ER BID or 240mg ER Qday (max: 240mg/d)
Note: ER may cause insomnia use IR forms
SE: palpitations, insomnia, dizziness, nervousness
What are the non-sedating OTC antihistamines?
Allegra (fexofenadine)
Claritin (Loratadine)
What are the indications and contraindications for Allegra (fexofenadine)?
adj dose in renal impairment 60mg Qday
Ind: Allergic rhinitis; urticaria (hives)
Fruit juice may decrease bioavailability separate out 2-4hrs apart
Grapefruit, Orange and Apple juice
organic anion transporting peptide (OATP) 1A2 inhibitors
OATP1A2 transporters –responsible for absorption of fexofenadine from GI tract
Inhibition of OATP1A2 reduces serum concentrations by up to 70% reducing its effectiveness
What are the indications and contraindications for Claritin (Loratadine)?
Ind: allergic rhinitis
Contra: Decrease dose in liver failure or renal insufficiency
What are the sedating OTC antihistamines?
Benadryl (Diphenhydramine)
Zyrtec (Cetirizine)
Chlorpheniramine (Chlor-trimenton®)
Clemastine (Tavist-1®)
What are the indications, SE, and contraindications for benadryl?
Ind:
Allergic rhinitis; Hypersensitivity rxn; Motion sickness;
Drug-induced parkinsonism; Antitussive; EPS; Insomnia
Notes: Anticholinergic Ses; worsen dementia or delirium in elderly
Avoid: Donepezil; Rivastigmine; or Galantamine
What are the indications and SE of meclazine?
Motion sickness: 25-50mg po 1hr prior to travel
Vertigo: 25mg po 1-4x/day prn
SE: Tachycardia, confusion, dry mouth… (anticholinergic effects)…
What is the indication for a nasal steroid? What is its mechanism?
A nasal corticosteroid spray reduces swelling and mucus in the nasal passageway. The sprays work well for treating: Allergic rhinitis symptoms, such as congestion, runny nose, sneezing, itching, or swelling of the nasal passageway
What are the OTC nasal steroids?
Flonase (Fluticasone ) Triamcinolone (Nasacort AQ®) Budesonide NS (Rhinocort Allergy spray) Cromolyn NS (NasalCrom®) Oxymetazoline (Afrin®)
What are the SE of IN pseudoephedrine?
Stinging
What are some OTC lozenges for the throat pain?
Cepacol sore throat sugar free® Benzocaine 15mg Chloroseptic Sore Throat® Benzocaine 6mg / menthol 10mg Halls Fruit Breezers® Pectin 7mg Sucrets Classic® Dyclonine HCL 2mg – oral anaesthetic Vicks VapoDrops® Menthol 1.7mg (cherry) Menthol 3.3mg (menthol)
What are some OTC throat sprays for sore throat?
Cepacol Ultra Sore Throat Spray
Benzocaine 5%; glycerin 33%
Chloraseptic Sore Throat
Phenol 1.4%
What is an important SE of benzocaine? In what population?
Methemoglobinemia
Peds 2 ys
What is the mechanism of codeine?
Acts centrally at medulla to increase cough threshold
What is the indication, SE of dextromethorpan?
Equipotent with codeine
Methylated analog of levorphanol – similar action as codeine
SE: drowsiness, N/V, constipation, nervousness, irritability
What is the mechanism, indication, and SE of Chlophedianol ( Chlo Tuss Ex = chlophedianol /guaifenesin)
Marketed in 1960 – reintroduced 2009
Antihistamine derivative with antitussive
Moderated local anesthetic
Mild anticholinergic
SE: excitation, hyperirritability, nightmares, dry mouth, vertigo…
What are topical antitussives?
Camphor
Menthol
What is the pathogen, risk factors, and treatment goals of a yeast infection?
Pathogen: 80-92% candida albicans Non-C. Albicans (i.e. Candida glabrata; C. Tropicalis; & Saccharomyces cerevisiae) has increased ~10% of all candida vaginal infections Risk factors: ↑ vaginal pH; DM; Abx; immunocompromised pts Tx Goals: Relief of sxs Eradication of infection Reestablishment of normal vaginal flora
What is the indication for a vaginal antifungal?
Approved for uncomplicated VVC
Relief of itching and irritation
What are the active ingredients in vaginal anti fungal meds?
-zole Butoconazole Clotrimazole Miconazole Tioconazole
What are the SE of treating a yeast infection with tea tree oil?
Allergic dermatitis
What are the indications, route, and SE of gentian violet for yeast infection?
Indication- resistant VVC
Tampon soaked with gentian violet – insert vaginally for several hrs or overnight or BID x 5 days
Drawbacks: Staining of fabric and skin
What is the indication and SE of compounded Boric acid for VVC?
use for non-C. albicans infections – resistant
600mg in size zero gelatin cap vaginally Qday – BID x 14days
5% in lanolin apply topically for vulvar irritation
Toxic or teratogenic – has been reported for PO ingestion
What are some OTC Tx’s for PMS?
Pyridoxine (Vit B6)
80mg Qday improve mood sxs
Limit dose at 100mg Qday d/t increase risk of neuropathy with higher dose
Calcium + vit D
48% reduced sxs by 3rd month – n = 466
29% had >75% improvement in emotional sxs
Magnesium
Deficiency found in women with PMS
360mg Qday during luteal phase reduced sxs
Diuretics
Pamabrom (a derivative of theophylline) 25-50mg – Midol® or Pamprin®
Caffeine (Diurex®) 60-65mg
What decongestants are safe for breast-feeding mothers?
Topical- camphor/menthol = low risk
Pseudepherine- still need to monitor can decrease milk output
What nasal decongestants are to be avoided in pregnancy? What is safe?
“Extra strength”, “Maximum strength”, or “Long acting” and combination products
Systemic decongestants
Ex: pseudoephedrine PO links to abd wall defects in newborns
Nasal decongestants – no clear association
Oxymetazoline NS – poorly absorbed prefer during pregnancy
