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NRS 270: Pharmacology > ENT, URI, and GU > Flashcards

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
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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
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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
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4
Q

OTC products for Dysmenorrhea

A
  • acetaminophen
  • ASA
  • ibuprofen
  • naproxen
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5
Q

OTC products for PMS

A
  • pyridoxine (vitamin B6)
  • Calcium and vitamin D
  • Magnesium
  • Diuretics
    • pamabrom (derivative of theophylline)
    • caffeine
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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
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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
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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
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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
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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
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11
Q

Drugs used for allergic rhinitis

A
  1. decongestant
    1. oral
    2. topical-saline irrigation or nasal spray
  2. Antihistamine:
    1. 1st gen: chlorpheniramine, clemastine
    2. 2nd gen: fexofenadine, loratadine, desloratadine
  3. intranasal corticosteroids
  4. leukotriene receptor antagonists
  5. Allergen immunotherapy
  6. combination
    1. steroid/antihistamine
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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
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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
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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%
  • dose: 60 mg BID or 180 Qday
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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
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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

NRS 270: Pharmacology (14 decks)

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