pyridoxine (vitamin B6) Calcium and vitamin D Magnesium Diuretics pamabrom (derivative of theophylline) caffeine

manage pain, remove the exudate, give ear drops intact TM: acetic acid drop (OTC) neomycin/polymyxin B + HCT (hydrochlorothiazide) non-intact TM: ofloxacin 0.3% ciprofloxacin 0.2% + HCT

auro-dri drops swim ear drops: 95% isopropyl alcohol + 5% anhydrous glycerin (reduces over drying) indications: ears that are water-clogged Compounded formulations: 1:1 ratio of 5% acetic acid and 95% isopropyl alcohol has bactericidal and antifungal properties (for pseudomonas, candida, aspergillus) lowers the pH of the ear canal which prevents bacterial growth SE: well-tolerated, may sting or burn broken skin

OTC decongestant, alpha 1 agonist aka Sudafed PE DO NOT GIVE TO SOMEONE WIHT UNCONTROLLED HTN used for nasal congestion SE: dizziness, anxiety, insomnia note: Avoid with MAOIs (inhibit the breakdown of catecholamines [norepi, epi, dop]) and HTN NASAL SPRAY: SE: stinging MAX dose: 60 mg/day → 10 mg po Q4hr PRN

OTC decongestant Sudafed Note: ER may cause insomnia so you should use the IR forms SE: palpitations, insomnia, dizziness, nervousness Can be used to make methamphetamine cant buy more than 3.6 grams/day cant buy more than 9 grams/ month

ENT, URI, and GU Flashcards by Gillian Collom

Benefits vs Risks of OTC

Benefits:
- direct, rapid access to effective medicines
- wide available
- decreased healthcare use and lower healthcare cost
- allowing pts to be in charge of their own health
Risks:
- incorrect self-dx → delaying dx and tx → serious illness
- increased risk of DDI
- increase risk of ADE when not sued appropriately
- potential for misuse and abuse

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risk factors and tx goals for vulvovaginal candidiasis

increased vaginal pH; DM, Abx, immunocompromised
tx goals: relief of sxs, eradiation of infection, reestablishment of normal vaginal flora

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OTC products for vulvovaginal candidiasis

butoconazole nitrate
clotrimazole
Miconazole
Tioconazole
Lactobacillus to restablish normal vaginal flora
NaHCO3 sitz bath
tea tree oil
gentian violet
Boric acid for non-C albicans infections → C-albicans is resistant

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OTC products for Dysmenorrhea

acetaminophen
ASA
ibuprofen
naproxen

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OTC products for PMS

pyridoxine (vitamin B6)
Calcium and vitamin D
Magnesium
Diuretics
- pamabrom (derivative of theophylline)
- caffeine

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Tx of AOM dependent on age and severity of sxs

watchful waiting for age > 6 and adults
pain–analgesics
1st line: high dose amoxiciliin if no abx within last 30 days
PCN allergy : erythromycin base/ sulfisoxazole (Pediazole)
- Cefdinir
2nd line: augmentin or clindamycin +/- ceftriaxone

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tx of AOE

manage pain, remove the exudate, give ear drops
- intact TM: acetic acid drop (OTC)
  - neomycin/polymyxin B + HCT (hydrochlorothiazide)
- non-intact TM: ofloxacin 0.3%
  - ciprofloxacin 0.2% + HCT

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Tx for cerumen impaction

removal of cerumen not by cotton swabs
CARBAMIDE PEROXIDE 6.5%
- non-irritating
- SE: pain, rash, irritation, tenderness, redness, discharge, dizziness
Other agents:
- mineral oil
- olive oil
- DSS
- Glycerin
- NaHCO3
- Diluted H2O2

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Ear-Drying Products

auro-dri drops
swim ear drops:
- 95% isopropyl alcohol + 5% anhydrous glycerin (reduces over drying)
indications: ears that are water-clogged
Compounded formulations:
- 1:1 ratio of 5% acetic acid and 95% isopropyl alcohol
  - has bactericidal and antifungal properties (for pseudomonas, candida, aspergillus)
  - lowers the pH of the ear canal which prevents bacterial growth
  - SE: well-tolerated, may sting or burn broken skin

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Cellular Responses in Allergic Rhinitis

activation and differentiation of T-cells, eosinphils (allergies), mast cells (histamin release) and epithelial cells
chemotaxis, recruitment and trans-endothelial migration of the cells
cytokines and chemokines are released
cells survive longer

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Drugs used for allergic rhinitis

decongestant
1. oral
2. topical-saline irrigation or nasal spray
Antihistamine:
1. 1st gen: chlorpheniramine, clemastine
2. 2nd gen: fexofenadine, loratadine, desloratadine
intranasal corticosteroids
leukotriene receptor antagonists
Allergen immunotherapy
combination
1. steroid/antihistamine

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Phenylephrine

OTC decongestant, alpha 1 agonist

aka Sudafed PE
DO NOT GIVE TO SOMEONE WIHT UNCONTROLLED HTN
used for nasal congestion
SE: dizziness, anxiety, insomnia
note: Avoid with MAOIs (inhibit the breakdown of catecholamines [norepi, epi, dop]) and HTN
NASAL SPRAY:
- SE: stinging
MAX dose: 60 mg/day → 10 mg po Q4hr PRN

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Pseudoephedrine

OTC decongestant
Sudafed
Note: ER may cause insomnia so you should use the IR forms
SE:
- palpitations, insomnia, dizziness, nervousness
Can be used to make methamphetamine
- cant buy more than 3.6 grams/day
- cant buy more than 9 grams/ month

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fexofenadine + dose (Allegra)

non-sedating antihistamine

indications: allergic rhinitis and urticaria
fruit juice may limit the bioavailability → drink separately by 2-4 hours
- grapefruit, orange and apple juice are organic anion trasporting peptide (OATP) 1A2 inhibitors
  - OATP1A2 is in charge of absorbing fexofenadine from the GI tract
  - inhibition by the juices reduces the concentration of fexofenadine in the serum by 70%
dose: 60 mg BID or 180 Qday

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loratidine + dosing (Claritin)

aka Claritin, Alavert
non-drowsy antihistamine
Note: decrease dose in liver failur or renal insufficiency
well tolerated
Dose: 10 mg PO Qday

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Non-sedating Antihistamines

fexofenadine and loratidine

Sedating Histamines

cetirizine (Zyrtec)(2nd generation →mildly sedating)
chlorpheniramine
Clemastine
diphenhydramine (disrupts REM sleep in elderly)
meclizine

Diphenhydramine

sedating anithistamine

Benadryl
indications:
- allergic rhinitis,
- hypersensitivity rxn
- motion sickness
- drug-induced parkinsonism
- anti-tussive
- EPS
- insomnia
NOTES:
- Anticholinergic SEs: worsen dementia or delirium in elderly
- AVOID TAKING WITH Donepezil, Rivastigmine or Galantamine (lipid soluble anticholinesterases used to treat alzheimers)

Meclizine

sedating anti-histamine
indication: motion sickness and vertigo
SE: tachycardia, confusion, dry mouth → anticholinergic SEs

Cromolyn

used for allergic rhinitis
nasal spray indicated for children
MOA: mast-cell stabilizer → less degranulation

Fluticasone

aka Flonase

nasal steroid
allergic rhinitis
SE: nasal irritation
DDI: may interact with 3A4 inhibitors

Nasal Steroids

fluticasone
triamcinolone (Nasacort)(similar SEs to flonase → nasal irritation)
Budesonide (Rhinocort allergy spray)

Oxymetazoline

alpha 1 and alpha 2 agonist
nasal spray for nasal congestion
do not use more than 5 days in a row***
NOTE: overuse can lead to rebound congestion
- can substitute with nasal steroids or PO decongestant may be helpful
- can taper by alternating nostril sides then discontinuing the oxymetazoline

Chlophedianol

OTC antitussive (OTC for cough)
antihistamine derivative with antitussive effects
also provides a local anesthetic quality
centrally acting cough supressant
mildly anticholinergic effects
SE:
- excitation
- hyperirritability
- nightmares
- dry mouth
- vertigo

Topical Antitussives

* Camphor * Menthol

Antibiotics for common oral and dental conditions

* **Augmentin** (PCN alone no longer recommended due to increased drug resistance) * **Clindamycin** if pt has a PCN allergy

Antifungal Treatment of Common Oral and Dental Conditions

* Clotrimazole * Miconazole * Nystatin * Fluconazole

Steroid treatment for Common Oral and Dental Conditions

* **Triamcinolone oral paste**: * stomatitis and ulcerative lesions * **Fluocinonide gel**: * stomatitis and oral inflammatory ulcerative lesions * SE: intracranial HTN, localized burning and irritation

Pregnant and Lactating Patients and URI drugs

* avoid: "extra strength" "maximum strength" or "long acting" * avoid combining products * avoid systemic decongestants * **pseudophedrine PO is linked to abdominal wall malformation in newborns** * Can use pseudophedrine while breastfeeding * but may reduce milk production * \*\*preferred decongestant for lactating mothers\*\* * Benzocaine, camphor (topical), menthol (topical), * all low risk and okay for pregnant women or breastfeeding mothers

Dosing for Acetaminophen

* max 4g/day (4000mg/day) * 650-1000mg q4-6hr PRN * same as ASA

Dosing for ASA

* max 4gm/day (4000mg/day) * 650-1000mg Q4-6hrs PRN * same as acetaminophen

Dosing for Ibuprofen

* max: 3200mg/day * 200-400 Q4-6hrs PRN

Dosing for Naproxen

* Max: 1500mg/day * 220-440mg Q8-12hours PRN * NSAID →not indicated for elderly