ENT Preparations Lecture PDF Flashcards
Bulging tympanic membrane is typically due to…
…bacterial acute otitis media
Middle ear infection mech of action
- Viral infection of nasopharynx
- mucosal inflammation blocks eustachian tube leading to neg pressure and accumulation of sterile fluid in middle ear (otitis media with effusion)
- eustachian tube relaxes causing pressure equalization sucking in virus and bacteria into middle ear
Middle ear effusion
Absent or limited mobility of tympanic membrane during pneumatic otoscopy and most reliable sign of middle ear effusion
Antibiotics should not be used in what type of otitis media?
Otitis media effusion (alone)
Vaccines that help limit/prevent acute otitis media in children (2)
- influenza vaccine
- pneumococcal vaccine
Analgesics for pain associated with acute otitis media (3)
- acetaminophen
- ibuprofen
- codeine in extreme cases
Treatment of choice for acute otitis media as well as 3 alternatives
- 80-90mg/kg/day amoxicillin
- augmentin
- cefdinir
- IM ceftriaxone
Amoxicillin ADRs (3)
- GI symptoms
- maculopapular nonpruritic rash (amoxicillin rash, not allergy and not a problem)
- allergic rxn (urticaria, anaphylactic)
Otitis externa is very treatable with ___ drugs unlike otitis media
Topical
Most common causative agent of acute otitis externa
P aeruginosa
2% acetic acid solution
Very cheap, safe, and effective bactericidal OTC agent for otitis externa often completely treating it on its own
Fluorquinolones for otitis externa (Cipro + hydrocortisone), (cipro + dexamethasone), (ofloxacin)
Preferred prescribed today as no ototoxicity or local rxns, used topically
Necrotizing otitis externa and symptoms (2)
- Rare but potentially fatal complication of acute otitis externa when bacteria in the external auditory canal spread to the mastoid or temporal bone, if infection spreads to skull base can affect cranial nerves most often seen in diabetics and immunocompromised
- symptoms include progressive severe otic pain, purulent discharge from ear
Excessive cerumen impactation pathophys, signs/symptoms, treatment
- Overactive glands or patients who wear heearing aids or ear plugs as well as the elderly can see cerumen forced into inner external auditory canal
- Sense of fullness or pressure in ear and gradual hearing loss
- manual removal or carbamide peroxide, glycerin, docusate sodium
Cough mech of action
Important defense reflex of respiratory tract starting with deep inspiration followed by closure of glottis and forceful contraction of chest and abdominal wall against closed glottis, that then opens and with high velocity propels mucus, debris, and foreign material from lower respiratory system
A productive cough vs nonproductive
Productive should not be suppressed - it is removing pathogenic purulent material, a dry cough on the other hand serves no physiologic purpose and often deprives individual of comfort or sleep
2 broad categories of antitussives
- CNS acting agents
- peripheral acting agents
Opioid antitussives
(codeine and hydrocodone) Suppress cough decreasing intensity and frequency acting on CNS respiratory centers in medulla raising cough threshold
Dextromethorphan
OTC derivative of morphine with no analgesic or addictive properties at recommended doses, used in most OTC cough preps, has not been shown to be safe or effective in young children and at high doses can be abused
Antihistamine antitussive activity
Do not suppress cough directly, might reduce post nasal drip and unintentionally help, used widely to treat cold symptoms and are included in many cold and cough products
Benzonatate (Tessalon perles)
Derivative believed to decrease sensitivity of respiratory tract receptors used to decrease cough, not indicated in children as it can cause nausea, dizziness, sedation, or hallucinations, risks associated with it including seizures, arrhythmias, and even death, risks outweigh benefits
Guiafenesin (mucinex) function
expectorant with proven uses to remove respiratory tract secretions, safe at recommended doses
Aromatic oil function
Limmited evidence suggests these can ease cough and nasal congestion and improve sleep thru stimulating sensory nerve endings in nose creating local anesthetic
Analgesic choices to relieve symptoms of the common cold in children and adults (4)
- acetaminophen and ibuprofen (kids)
- ASA and ketoprofen (adults)
Reye’s syndrome
Rare disorder following viral illness most commonly, occurs in children and can result in brain and liver damage as a result of giving ASA to children
Decongestants used to relieve the symptoms of common cold (2)
-phenylephrine (OTC and not very effective) and pseudoephedrine
Antihistamines function in the common cold
None, has nothing to do with symptoms but can suppress mucus production and induce drowsiness (1st gen antihistamines such as diphenhydramine)
Common local anesthetics used in lozenges, troches, mouth washes and sprays
- benzocaine
- phenol
- menthol
- pectin (demulcent coats throat)
