ENT Preparations Lecture PDF

Question 1

Bulging tympanic membrane is typically due to…

Answer 1

…bacterial acute otitis media

Question 2

Middle ear infection mech of action

Answer 2

• 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

Question 3

Middle ear effusion

Answer 3

Absent or limited mobility of tympanic membrane during pneumatic otoscopy and most reliable sign of middle ear effusion

Question 4

Antibiotics should not be used in what type of otitis media?

Answer 4

Otitis media effusion (alone)

Question 5

Vaccines that help limit/prevent acute otitis media in children (2)

Answer 5

• influenza vaccine

- pneumococcal vaccine

Question 6

Analgesics for pain associated with acute otitis media (3)

Answer 6

• acetaminophen
• ibuprofen
• codeine in extreme cases

Question 7

Treatment of choice for acute otitis media as well as 3 alternatives

Answer 7

• 80-90mg/kg/day amoxicillin
• augmentin
• cefdinir
• IM ceftriaxone

Question 8

Amoxicillin ADRs (3)

Answer 8

• GI symptoms
• maculopapular nonpruritic rash (amoxicillin rash, not allergy and not a problem)
• allergic rxn (urticaria, anaphylactic)

Question 9

Otitis externa is very treatable with ___ drugs unlike otitis media

Answer 9

Topical

Question 10

Most common causative agent of acute otitis externa

Answer 10

P aeruginosa

Question 11

2% acetic acid solution

Answer 11

Very cheap, safe, and effective bactericidal OTC agent for otitis externa often completely treating it on its own

Question 12

Fluorquinolones for otitis externa (Cipro + hydrocortisone), (cipro + dexamethasone), (ofloxacin)

Answer 12

Preferred prescribed today as no ototoxicity or local rxns, used topically

Question 13

Necrotizing otitis externa and symptoms (2)

Answer 13

• 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

Question 14

Excessive cerumen impactation pathophys, signs/symptoms, treatment

Answer 14

• 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

Question 15

Cough mech of action

Answer 15

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

Question 16

A productive cough vs nonproductive

Answer 16

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

Question 17

2 broad categories of antitussives

Answer 17

• CNS acting agents

- peripheral acting agents

Question 18

Opioid antitussives

Answer 18

(codeine and hydrocodone) Suppress cough decreasing intensity and frequency acting on CNS respiratory centers in medulla raising cough threshold

Question 19

Dextromethorphan

Answer 19

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

Question 20

Antihistamine antitussive activity

Answer 20

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

Question 21

Benzonatate (Tessalon perles)

Answer 21

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

Question 22

Guiafenesin (mucinex) function

Answer 22

expectorant with proven uses to remove respiratory tract secretions, safe at recommended doses

Question 23

Aromatic oil function

Answer 23

Limmited evidence suggests these can ease cough and nasal congestion and improve sleep thru stimulating sensory nerve endings in nose creating local anesthetic

Question 24

Analgesic choices to relieve symptoms of the common cold in children and adults (4)

Answer 24

• acetaminophen and ibuprofen (kids)

- ASA and ketoprofen (adults)

Question 25

Reye’s syndrome

Answer 25

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

Question 26

Decongestants used to relieve the symptoms of common cold (2)

Answer 26

-phenylephrine (OTC and not very effective) and pseudoephedrine

Question 27

Antihistamines function in the common cold

Answer 27

None, has nothing to do with symptoms but can suppress mucus production and induce drowsiness (1st gen antihistamines such as diphenhydramine)

Question 28

Common local anesthetics used in lozenges, troches, mouth washes and sprays

Answer 28

• benzocaine
• phenol
• menthol
• pectin (demulcent coats throat)