ENT-4

Question 1

What is the mechanism of a cough? When to suppress? When not to?

Answer 1

Reflex involving CNS, PNS, and respiration muscles
Beneficial to remove foreign materials
Productive cough should not be suppressed
If disrupt sleep or discomfort – need to suppress
Antitussive – non-productive cough associated with cold or upper respiratory infection (URI)

Question 2

What are the opiod antitussives?

Answer 2

Codeine

Hydrocodone

Question 3

What is the mechanism of codeine?

Answer 3

Act in the CNS to increase cough threshold

Hydrocodone – more potent than codeine but higher risk of abuse

Question 4

What is tussington?

Answer 4

Tussigon (hydrocodone/homeatropine– discourage OD) Have anticholinergic sx before OD

Question 5

What is guaifenesin?

Answer 5

Antitussive

Question 6

What are the SE of opioid antitussives?

Answer 6

sedation, respiratory suppression, CNS depression, bradycardia, seizure, N/V, constipation

Question 7

What is the mechanism of Dextromethorphan?

Answer 7

Suppress cough center in the medulla

Question 8

What is the DDI of dextromethorphan?

Answer 8

MAOI- leads to serotonin syndrome

Question 9

What is the MOA and SE of Benzonatate (Tessalon)?

Answer 9

MOA: decrease cough reflex pathway
SE: sedation, dizziness, constipation, OD– seizures, confusion, arrhythmia
Not approved for children less than 10y.o (TCN derivative)

Question 10

What bacteria cause OM?

Answer 10

Strep pneumo -50%
H. flu - 15-30%
Moraxella
(less common: staph aureus, strep pyrognones, pseudomonas)

Question 11

How to treat PCN-resistant strep pneumo?

Answer 11

Levofloxacin

Question 12

What is the indication for benzocaine/antipyrine (A/B otic)?

Answer 12

Analgesia with OM

Question 13

In OM, what ABx to give? No PCN allergy

Answer 13

Amor
Augmentin (more serious)
2nd gen cephalosporin (more serious)