ENT, URI, and GU Flashcards
1
Q
Benefits vs Risks of OTC
A
- 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
2
Q
risk factors and tx goals for vulvovaginal candidiasis
A
- increased vaginal pH; DM, Abx, immunocompromised
- tx goals: relief of sxs, eradiation of infection, reestablishment of normal vaginal flora
3
Q
OTC products for vulvovaginal candidiasis
A
- 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
4
Q
OTC products for Dysmenorrhea
A
- acetaminophen
- ASA
- ibuprofen
- naproxen
5
Q
OTC products for PMS
A
- pyridoxine (vitamin B6)
- Calcium and vitamin D
- Magnesium
- Diuretics
- pamabrom (derivative of theophylline)
- caffeine
6
Q
Tx of AOM dependent on age and severity of sxs
A
- 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
7
Q
tx of AOE
A
- 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
- intact TM: acetic acid drop (OTC)
8
Q
Tx for cerumen impaction
A
- 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
9
Q
Ear-Drying Products
A
- 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
- 1:1 ratio of 5% acetic acid and 95% isopropyl alcohol
10
Q
Cellular Responses in Allergic Rhinitis
A
- 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
11
Q
Drugs used for allergic rhinitis
A
- decongestant
- oral
- topical-saline irrigation or nasal spray
- Antihistamine:
- 1st gen: chlorpheniramine, clemastine
- 2nd gen: fexofenadine, loratadine, desloratadine
- intranasal corticosteroids
- leukotriene receptor antagonists
- Allergen immunotherapy
- combination
- steroid/antihistamine
12
Q
Phenylephrine
A
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
13
Q
Pseudoephedrine
A
- 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
14
Q
fexofenadine + dose (Allegra)
A
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%
- grapefruit, orange and apple juice are organic anion trasporting peptide (OATP) 1A2 inhibitors
- dose: 60 mg BID or 180 Qday
15
Q
loratidine + dosing (Claritin)
A
- aka Claritin, Alavert
- non-drowsy antihistamine
- Note: decrease dose in liver failur or renal insufficiency
- well tolerated
- Dose: 10 mg PO Qday
16
Q
Non-sedating Antihistamines
A
- fexofenadine and loratidine
17
Q
Sedating Histamines
A
- cetirizine (Zyrtec)(2nd generation →mildly sedating)
- chlorpheniramine
- Clemastine
- diphenhydramine (disrupts REM sleep in elderly)
- meclizine
18
Q
Diphenhydramine
A
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)
19
Q
Meclizine
A
- sedating anti-histamine
- indication: motion sickness and vertigo
- SE: tachycardia, confusion, dry mouth → anticholinergic SEs
20
Q
Cromolyn
A
- used for allergic rhinitis
- nasal spray indicated for children
- MOA: mast-cell stabilizer → less degranulation
21
Q
Fluticasone
A
aka Flonase
- nasal steroid
- allergic rhinitis
- SE: nasal irritation
- DDI: may interact with 3A4 inhibitors
22
Q
Nasal Steroids
A
- fluticasone
- triamcinolone (Nasacort)(similar SEs to flonase → nasal irritation)
- Budesonide (Rhinocort allergy spray)
23
Q
Oxymetazoline
A
- 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
24
Q
Chlophedianol
A
- 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
25
Q
Topical Antitussives
A
- Camphor
- Menthol
26
Q
Antibiotics for common oral and dental conditions
A
- Augmentin (PCN alone no longer recommended due to increased drug resistance)
- Clindamycin if pt has a PCN allergy
27
Q
Antifungal Treatment of Common Oral and Dental Conditions
A
- Clotrimazole
- Miconazole
- Nystatin
- Fluconazole
28
Q
Steroid treatment for Common Oral and Dental Conditions
A
-
Triamcinolone oral paste:
- stomatitis and ulcerative lesions
-
Fluocinonide gel:
- stomatitis and oral inflammatory ulcerative lesions
- SE: intracranial HTN, localized burning and irritation
29
Q
Pregnant and Lactating Patients and URI drugs
A
- 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
30
Q
Dosing for Acetaminophen
A
- max 4g/day (4000mg/day)
- 650-1000mg q4-6hr PRN
- same as ASA
31
Q
Dosing for ASA
A
- max 4gm/day (4000mg/day)
- 650-1000mg Q4-6hrs PRN
- same as acetaminophen
32
Q
Dosing for Ibuprofen
A
- max: 3200mg/day
- 200-400 Q4-6hrs PRN
33
Q
Dosing for Naproxen
A
- Max: 1500mg/day
- 220-440mg Q8-12hours PRN
- NSAID →not indicated for elderly
