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ENT Flashcards

1
Q

What are the routes of transmucosal drug delivery

A 
Nasal
Rectal
Vaginal
Ocular
Oral cavity
 (Buccal, Sublingual, Local)
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2
Q

What is transmucosal administration?

A

Systemic absorption across mucosal linings.

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3
Q

What of the benefits of transmucosal drug delivery?

A

Avoids first-pass metabolism
Avoids enzymatic degradation within GI tract
Oral mucosa
Rich blood supply
Short recovery time after stress or damage
Cell turnover within 5 – 6 days
Tolerant to potential allergens

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4
Q

What patients should you avoid transmucosal drug delivery?

A

Pt w/ nausea

Careful stroke/facial paralysis

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5
Q

What benefits of sublingual delivery?

A

High drug concentrations in sublingual region before systemic absorption
Rapid onset of action

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6
Q

What population should you not use sublingual delivery

A

Smokers (vasoconstriction caused by smoking may decrease absorption)

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7
Q

What are the two categories of drugs that treat dizziness

A

Anticholinergics

Antihistamines

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8
Q

What are the symptoms of anticholinergic toxidrome?

A 
Hot as Hades - Fever
Fast as a Hare - Tachycardia
Dry as a Bone – Lack of diaphoresis
Red as a Beet – Flushed skin
Mad as a Hatter – Delirium
Full as a Tick – Urinary retention
Blind as a Bat – Mydriasis
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9
Q

What class of drugs is Scopolamine and what does it treat?

A

Drug class: Anticholinergic
Most effective medication for motion sickness
Transdermal preparation for motion sickness
Indicated for treatment of n/v assoc with motion sickness and post-op recovery
Applied to post auricular skin

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10
Q

How is scopolamine administered?

A

Commerical patch

Compounded gel or cream

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11
Q

Which barriers does scopolamine across?

A

Cross BBB

Cross placenta

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12
Q

What conditions is scopolamine contraindicated for?

A

Angle closure glaucoma

Oral: obstructive uropathy or GI disease

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13
Q

What is the warning for scopolamine?

A

Idiosyncratic psychoiss

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14
Q

What are the cautions for scopolamine?

A

Chronic open-angle glaucoma
Peds, Elderly (dose may be increased for these populations)
Driving motor vehicle or operating heavy machinery

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15
Q

How do you dose scopolamine?

A

Commerical patch

Compounded gel or cream

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16
Q

What dosing instructions should you give the patient for the scopolamine patch?

A

Patch behind the ear 4 hrs prior to the need for effect
One patch lasts 3 days
If patch falls off, add new patch behind other ear
Wash hands with soap and water after applying patch
Do not cut patch
Dose-dumping

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17
Q

What off label condition is scopolamine used for?

A

Vertigo

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18
Q

What are the 3 dosage forms in the oral cavity?

A

Buccal
Sublingual
Local

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19
Q

What receptors are involved in allergic reactions?

A

H1 receptor

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20
Q

Why does an epipen help with Type 1 allergic reactions w/anaphylaxis?

A

Functional antagonist to histamine

21
Q

Name was 1st generation competitive H1 receptor antagonists?

A 
Meclizine (Bonine, Antivert)
Hydroxyzine (Atarax)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Promethazine (Phenergan)
Brompheniramine (Bromax)
Chlorpheniramine (Allergy Relief)
Doxylamine (Alka Seltzer Plus)
(Some may be inverse agonists)
22
Q

How do you dose the epipen?

A

IM injection anterolateral thigh

23
Q

What are the ADRs for epipen (epinephrine)

A

Anxiety, restlessness, tremor, weakness, palpitations, pallor, N/V, HA, respiratory issues

24
Q

Organize the oral mucosal permeability higher to lower.

A

sublingua l> buccal» palatal

25
What are the disadvantages to sublingual administration?
Constant salivary action Difficult for dosage forms to remain in place Good for drugs with short delivery period and infrequent administration Low drug permeability
26
Where are buccal drugs administered?
Drug administration through mucus membranes lining the cheeks and area between gums and upper and lower lips to systemic circulation
27
What are the advantages and disadvantages of buccal administration?
No water required Rapid onset of action due to fast dissolution lower bioavailability
28
What does Scopolamine contain?
Henbane (belladonna)
29
What is the MOA of Scopolamine?
Competitive antagonist at muscarinic receptors Acts on smooth muscles that respond to acetylcholine but lack cholinergic innervation blocks cholinergic transmission from vestibular nuclei to higher CNS centers and from the reticular formation to the vomiting center
30
How does this present clinically?
``` Inhibits saliva/sweat secretion decreases GI secretions and motility decreases nausea/emesis causes drowsiness dilates pupils increases heart rate depresses motor function ```
31
What is the absorption rate and half life of transdermal patches?
Absorption: Onset 4 hrs Peak 24 hrs t1/2 = 9.5 hrs
32
What drugs are associated with direct histamine release?
Red-man's syndrome Opiods Tubocurarine Amphotercin
33
What is the MOA of epinephrine?
Functional antagonist to histamine-induced bronchoconstriction Alpha agonist Decreases vasodilation and vascular permeability that leads to hypotension and loss of fluid volume B2 agonist Relaxes bronchial smooth muscle
34
How do you properly dose the epipen?
IM injection anterolateral thigh Glute may not give appropriate efficacy (If accidentally injected in fingers, hands or feet, patient needs immediate medical attention) (IV injection may cause cerebral hemorrhage)
35
What are the ADRs for the epipen?
Anxiety, restlessness, tremor, weakness, palpitations, pallor, N/V, HA, respiratory issues (Be careful when administering to CV pts. Epipen will cause tachycardia)
36
What is the MOA for 1st gen antihistamines?
Block histamine H1 receptors: Inhibits histamine effects on smooth muscle Decreases inflammation, itching, sneezing, rhinorrhea, capillary permeability Decreases CNS neurotransmitter release Decreased cognitive and psychomotor performance Increased sedation Increased appetite
37
What disadvantages of use a 1st gen antihistamine?
Distribute into all tissues, including CNS Can also stimulate CNS causing central excitation, restlessness, nervousness and insomnia. Non-selective Significant anticholinergic effects Dry mouth, urinary retention, sinus tachycardia Alpha blocker effects Hypotension, dizziness, reflex tachycardia Serotonin blocker effects Increased appetite
38
What are the advantages of the 1st generation antihistamine?
Well-absorbed orally | High bioavailability
39
What are the half lives for antihistamine?
Half-life = approx 4 – 6 hrs | Meclizine 12 – 24 hrs
40
How long do the effects of antihistamines last?
Duration of effect: 4 – 6 hrs | (meclizine, diphenhydramine, chlorpheniramine) hydroxyzine 12 – 24 hrs
41
What are the specific uses of some of the 1st generation antihistamines?
Promethazine used primarily as antiemetic Hydroxyzine primarily for pruritus Meclizine, dimenhydrinate for motion sickness
42
Name the 2nd generation antihistamines.
``` Loratadine (Claritin, Alavert) Desloratadine (Clarinex) Fexofenadine (Allegra) Cetirizine (Zyrtec) Levocetirizine (Xyzal) no advantage ```
43
What are the benefits of using 2nd generation antihistamine over 1st generation.
Better side effect profile than 1st generation Less sedating (Cetirizine, levocetirizine still have some sedation) (Now 1st line for sneezing and itching due to allergic rhinitis)
44
What are the indications for Fexofenadine (Allegra)?
Indications: Treatment of allergic rhinitis in pts > 2 yo Treatment of chronic urticaria in pts > 6 months
45
What are the ADRs for Fexofenadine?
Headache, cough, URI, fever, back pain, dysmenorrhea
46
What drugs interaction does Fexofenafine exhibit?
Ketoconazole, erythromycin, grapefruit juice, Al and Mg antacids (p450 issues)
47
What are the indications for Cetirizine and Levocetirizine?
Allergic rhinitis in patients 6 months or older | Chronic urticaria in patients 6 months or older?
48
What information should you consider before Cetirizine and Levocetirizine?
``` Cmax in one hr Crosses BBB so some sedation Take w/ or w/o food Half-life 8 -9 hrs Prolonged in patients over 75yrs Excreted via urine, some in feces ```
49
What are ADRs for Cetirizine and Levocetirizine?
Somnolence, fatigue, dry mouth, dizziness, headache, abdominal pain, and nausea

Pharmacology (13 decks)

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