Exam I Medications Grouped Flashcards
Treatments used for Otitis Externa (Non-Specific)
Anti-infectives with or without Steroids
Acid-Alcohol Solutions - for external auditory ear canal infections
Anti-Infectives without Steroids
Ciprofloxacin - fluoroquinolone (use for cellulitis, serious cases)
Ofloxacin - fluoroquinolone (use for cellulitis, serious cases)
Neomycin - watch for ototoxicity; not for tubed or perforated ears; itchy rash
Bacitracin
Mupirocin
Polymyxin B/Neomycin/Bacitracin (OTC)
Route: Topical
Purpose: treat Otitis Externa
Adverse Reactions: ear pain, discomfort, irritability, ototoxicity, contact dermatitis (itchy rash)
Contraindications: hypersensitivity to ingredients or vehicle; Neomycin should not be used if patient has tubed or perforated ears
Anti-Infectives with Steroids
Ciprofloxacin/Hydrocortisone - more common
Ciprofloxacin/Dexamethasone - more common
Hydrocortisone/Neomycin/Polymyxin B
Hydrocortisone/Neomycin/Colistin
Chloroxylenol/Pramoxine/Hydrocortisone
Route: Topical
Purpose: treat Otitis Externa; steroids are used for their anti-inflammatory, antipruritis, and anti-allergenic effects
Adverse Reactions: ear pain, discomfort, irritability, ototoxicity, contact dermatitis (itchy rash)
Contraindications: hypersensitivity to ingredients or vehicle; Neomycin should not be used if patient has tubed or perforated ears
More common to prescribe anti-infectives with steroids than without
Acid-Alcohol Solutions
Acetic Acid/Aluminum Acetate Acetic Acid/Propylene Glycol Acetic Acid/Propylene Glycol/Hydrocortisone - steroid Isopropyl Alcohol/Propylene Glycol Isopropyl Alcohol/Glycerin
Route: Topical
Purpose: treat Otitis Externa and other superficial external auditory canal infections; increase acidity which promotes drying and kills bacteria
Adverse Reactions: stinging, burning, local irritation
Contraindications: perforated or tubed ears
anti-infectives and steroids are prescribed more often
Treatment for Water-Clogged Ears
solution of 95% isopropyl alcohol in 5% anhydrous glycerin
50:50 isopropyl alcohol (95%) and acetic acid (5%)
Treatment for Otitis Media
before prescribing, remember that only 50% of cases are bacterial
Pain - ibuprofen or acetaminophen
Amoxicillin - 6+ mo with unilateral or bilateral AOM with severe symptoms; 6-23 mo with bilateral AOM
Watch and Wait/Consider Amoxicillin - 6-23 mo with nonsevere AOM; 24+ mo with nonsevere AOM
Amoxicillin/Clavulanate (B-lactamase coverage) - if patient has had Amoxicillin recently or has had a previous Amoxicillin resistance
Ofloxacin for tubed ears
Cerumenolytics/Cerumen Softening Agents
Carbamide Peroxide 6.5% in anhydrous glycerin - bubbling sounds can occur; no more than 4 days (tympanic membrane damage)
Triethanolamine Polypeptide Oleate
Hydrogen Peroxide (3%) and Water - not good for drying
Glycerin
Olive Oil/Sweet Oil
Route: Topical
Purpose: soften earwax for removal
Adverse Reactions: mild itching, burning, ear pain, erythema of ear canal, allergic reactions (emergency)
Ophthalmic Anesthetics
Proparacaine 0.5% Solution - amino ester
Tetracaine 0.5% Solution - amino ester
Lidocaine - amino amide
Route: Topical
Purpose: numbing agents; bind to receptors within sodium channels in the sensory nerve endings, inhibiting their function; sodium cannot enter cells to cause depolarization; no depolarization along axon = no pain signal
work in 20-30 seconds and up to 15 minutes
A: rapid at conjunctival capillaries; local action
D: high protein binding - remains in blood stream
M: unknown in eye/skin; some metabolism may occur systemically
E: tetracaine and proparacaine through bile/feces
T 1/2: proparacaine < lidocaine < tetracaine
Adverse Reactions: burning and stinging when applied; severe keratitis, opacification, scarring of the cornea, and loss of vision if used for long periods
Ophthalmic Anti-infectives
Sulfacetamide - bacteriostatic (inhibites bacterial dihydrofolate synthesis); watch sulfa-allergy or hypersensitivity
Bacitracin - bacteriostatic (inhibits incorporation of amino acids and nucleotides)
Erthromycin - bacteriostatic (prevents protein synthesis in bacteria); infants and children
Tobramycin, Gentamicin - bacteriocidal (aminoglycosides)
Fluoroquinolones (ciprofloxacin, moxifloxacin, etc.) - inhibit DNA synthesis of bacteria; contact wearers
Polymixin B - high affinity for phospholipids (increase permeability of cell walls, killing bacteria)
Route: Topical
Purpose: treat Conjunctivitis
Adverse Reactions: local irritation (Sulfacetamide and Gentamicin), blurry vision, super infections (resistance), hypersensitivity to Sulfacetamide
Contraindications: Sulfa-allergy
Allergic Conjunctivitis Treatments (Non-specific)
Ophthalmic Mast Cell Stabilizers Ophthalmic Antihistamines (more common) Ophthalmic Vascoconstrictors/Decongestants (side effects)
Ophthalmic Mast Cell Stabilizers
Nedocromil 2% Solution
Cromolyn Sodium 4% Solution
Iodoxamide 0.1% Solution
Route: Topical
Purpose: treat Allergic Conjunctivitis; reduces histamine release (prevent mast cell degranulation)
Adverse Reactions: transient stinging, blurry vision, photophobia, mydriasis, rhinitis, sinusitis, headache
prescribed less often than antihistamines
Ophthalmic Antihistamines
Azelastine Epinastine Emedastine Ketotifen (more common) Levocabastine Olopatadine (more common)
Route: Topical
Purpose: treat Allergic Conjunctivitis; H1 receptor antagonists (block histamine); temporary relief of symptoms
Adverse Reactions: transient stinging and burning, blurry vision, mydriasis, rhinitis, headache
Ophthalmic Vasoconstrictors/Decongestants
Phenylephrine - bad for narrow-angle glaucoma
Naphazoline - decongestant of choice
Tetrahydrozoline - less likely to alter pupil size
Oxymetazoline - relatively free of side effects
Purpose: treat Allergic Conjunctivitis; weak sympathomimetic (raise blood pressure and constrict conjunctival blood vessels); temporary relief of eye redness
Avoid if: heart disease, high blood pressure, enlarged prostate, narrow-angle glaucoma (contraindication)
Systemic Adverse Reactions: tachycardia, aggravation of arrhythmias
Local Adverse Reactions: mydriasis, burning/stinging, blurry vision
Interactions: increase pressure effects if used with MAOIs and tricyclics
Allergic Conjunctivitis OTC Combination Products
Naphazoline + Pheniramine
Naphazoline + Antazoline
Avoid if: heart disease, high blood pressure, enlarged prostate, narrow-angle glaucoma
Dry Eye Treatments/Ophthalmic Lubricants (2 Non-specific +1)
Artificial Tears
Ocular Emollients
Cyclosporine
Artificial Tears
Cellulose Derivatives (Carboxymethylcellulose) - longer duration; causes eye crust Polyvinyl Alcohol (glycerin, propylene glycol, polyethylene glyc0ls, polysorbate 80) - shorter duration; no crust formation Povidone adn Dextran 70 - can cause transient stinging and burning
Route: Topical
Purpose: treat Dry Eye; act as demulcents (protective film) to mimic mucin (glycoprotein mucus) in tears
Ocular Emollients
Lanolin Mineral Oil Petrolatum White Ointment White Wax Yellow Wax
Route: Topical
Purpose: treat dry eyes; protect and prevent drying
Adverse Reactions: blurry vision (but last longer than drops)
more expensive versions tend to last longer
Cyclosporine
Restasis
Purpose: treat Keratoconjunctivitis Sica (dry eyes); immunosuppressant: polycyclic peptide that inhibits interleukin-2 (needed for T-cell activity)
Adverse Reactions: burning sensation, eye discomfort
expensive, not first line - only prescribe under specialist recommendation
Corneal Edema Treatment
Sodium Chloride (2-5%)
Route: Topical
Purpose: solution pulls water from the eye
Pupillary Dilation Agents
Tropicamide - 20-30 minute peak effect, lasts 2-7 hours
Cyclopentolate 0.5, 1, or 2% Solution - 25-75 minutes to peak effect, lasts 6-24 hours
Homatropine 1 or 5% Solution - lasts 24-72 hours
Route: Topical
Purpose: mydriasis, block parasympathetic receptors (normally cause pupil constriction)
Adverse Reactions: tachycardia, flushing of cheeks, blurry vision, photophobia, dry mouth, slurred speech, drowsiness, hallucinations, congestion, irritated eyes
Contraindications: Closed-Angle Glaucoma - dilation can occlude outlfow of aqueous humor
Fluorescin
used to detect corneal defects
yellow, water-soluble dibasic-acid xanthine dye
does not stain cornea, but will appear bright
green/yellow on a corneal abrasion or defect
fluoresces under ultraviolet light (Wood’s Lamp)
not absorbed
can stain contacts
Glaucoma Treatments (Non-specific)
Prostaglandin Analogues Beta Blockers Alpha-adrenergic Agonists Carbonic Anhydrase Inhibitors Cholinergics Mannitol
Prostaglandin Agonists
Latanprost Bimatoprost Tafluprost Travoprost Unoprostone
Route: Topical
Purpose: treat Glaucoma; synthetic protaglandin and act on prostaglandin receptor (RF); increase outflow through uveoscleral pathway
Adverse Reactions: iris pigmentation,eyelid darkening, lengthening of eyelashes, intraoccular inflammation, keratitis, macular edema, hyperemia (most common)
Typically First-Line
Beta Blockers
Timolol Carteolol Levobunolol Metipranolol Betaxolol - cardioselective (less respiratory side effects)
Purpose: treat Glaucoma; block sympathetic nerve endings in ciliary epithelium (form aqueous humor); decrease aqueous humor formation
Adverse Reactions: bradycardia, bronchospasm, depression, fatigue, ocular dryness
Alpha (2) Adrenergic Agonists
Brimonidine
Apraclonidine
Purpose: treat Gluacoma; cause vasoconstriction in the eyes, which leads to a decrease in aqueous humor production; possible increases outflow
Adverse Reactions: ocular allergy, somnolence, bitter taste, systemic hypotension, irregular heart rate
Carbonic Anhydrase Inhibitors
Acetazolamide - oral tablet Methazolamide - oral tablet Dorzolamide Brinzolamide Dichlophenamide
Purpose: treat Gluacoma; decrease production of aqueous humor by slowing action of carbonic anhydrase (forms aqueous humor)
Cholinergics
Pilocarpine - direct
Carbachol - direct
Echothiophate - indirect; long half life; irreversible
Purpose: treat Glaucoma; stimulate parasympathetic response (similar to acetylcholine), causing pupil constriction (miosis); ciliary muscles contract, which open canal of Schlemm
Direct - stimulate ocular cholinergic receptors (mimic acetylcholine)
indirect - bind to and inactivate cholinesterases (break down acetylcholine); prevents acetylcholine degradation
Adverse Reactions: blurred vision, poor night vision, eye pain, headache
Acetazolamide interacts with Aspirin, Cyclosporine, Lithium, and Phenytoin
Combination Glaucoma Treatment
Timolol 0.5% + Dorzolamide 2%
Acute Glaucoma Treatment
Pilocarpine 2% ever 15 minutes
Acetazolamide 500 mg IV or po
Oral Glycerine or Isosorbide 1cc/kg
Immediately Refer to Ophthalmology
Mannitol
Purpose: Short-term, Emergent Treatment of Glaucoma
MOA: causes blood to by hypertonic compared to intraocular and spinal fluids - pull water into bloodstream to be secreted
used to interupt an acute narrow-angle glaucoma attack
Severe Adverse Reactions: headache, back pain, diuresis, circulatory overload, pulmonary edema, cerebral hemorrhage
Allergic Rhinitis Treatment (Non-Specific)
Avoid Allergens Intranasal Corticosteroids Oral/Intranasal Antihistamines (Mild) Oral/Topical Decongestants Intranasal Cromolyn Intranasal Antichilinergics Leukotriene Receptor Antagonists Immunotherapy (severe)
Intranasal Corticosteroids
Beclomethasone
Mometasone - more common
Budesonide
Ciclesonide
Triamcinolone Acetonide - more common; no alcohol (less side effects)
Flunisolid
Fluticasone Furoate - more common; no alcohol (less side effects)
Fluticasone Propionate - more common; no alcohol (less side effects)
Purpose: treat Allergic Rhinitis (more persistent and severe); reduce ocular symptoms, nasopharyngeal itching, sneezing, rhinorrhea; decreases influx of inflammatory cells, reducing cytokines (chemical released by mast cells) and resulting inflammation of nasal mucosa
Adverse Reactions: bitter aftertaste, burning, epistaxis, headache, nasal dryness, possible systemic absorption, stinging, throat irritation
more effective than antihistamines in more persistent and severe cases
Oral Antihistamines
1st Generation: Chloropheniramine Brompheniramine Diphenhydramine Clemastine
2nd Generation: Loratidine Cetirizine - most effective 2nd gen; can cross BBB and cause sedation in 1/10 Fexofenadine Desloratadine - prodrug
Purpose: treat Allergic Rhinitis; reduce nasopharyngeal itching, sneezing, rhinorrhea; H1 receptor antagonists
1st Generation: older, nonselective, sedating, cross BBB, more effective, dosed several times daily
2nd Generation: newer, nonsedating, less effective, 24 hr effect
A: rapid
D: 60-70% protein bound
M: minimal; desloratadine is a prodrug
E: fexofenadine, desloratadine, loratadine through feces and urine; others through urine
T 1/2: variable
do not drive, avoid alcohol, prostatic hyperplasia can occur, narrow-angle glaucoma possible
Intranasal Antihistamines
Azelastine
Olopatadine
Purpose: treat Allergic Rhinitis; treat symptoms of conjunctivitis, rhinitis, congestion by blocking H1 receptors
Adverse Reactions: bitter aftertaste, headache, nasal irritation, sedation, epistaxis
Oral Decongestants
Phenylephrine (OTC Sudafed PE) - not effective orally
Pseudoephedrine - effective Sudafed; must get from pharmacist
Purpose: treat Allergic Rhinitis; reduce rhinorrhea; alpha-adrenergic agonists that cause vasoconstriction, so less mucous is produced
Adverse Reactions: headache, elevated blood pressure and heart rate, tremor, urinary retention, dizziness, tachycardia, insomnia
Contraindications: hypertension, heart disease, diabetes, hyperthyroidism, enlarged prostate, narrow-angle glaucoma, blood pressure
no effect on histamine
Topical Decongestants
Phenylephrine - good topical use; bad oral use
Oxymetazoline
Saline Nasal Drops (safer, less side effects)
Purpose: treat Allergic Rhinitis; reduce rhinorrhea; alpha agonists that cause local vasoconstriction, which decrease mucosal edema
Adverse Reactions: local burning, nasal irritation and dryness, sneezing
do not use for more than 3-5 days; watch for rebound congestion
no effect on histamine
Intranasal Cromolyn
Purpose: treat Allergic Rhinitis; mast cell stabilizer that prevents histamine release; relieves nasopharyngeal itching, sneezing, and rhinorrhea
Adverse Reactions: nasal irritation, nasal burning, stinging, sneezing, cough, unpleasant taste, epistaxis
Dosed 4-6 times daily &
2-3 weeks for max effect; must be taken regularly (downside, not first line)
Intranasal Anticholinergics
Ipratropium
Purpose: treat Allergic Rhinitis; reduce rhinorrhea by blocking acetylcholine receptors (block parasympathetic response, leading to vasoconstriction)
Adverse Reactions: epistaxis, headache, nasal dryness
Leukotriene Receptor Antagonist
Montelukast
Purpose: treat Allergic Rhinitis; reduce ocular symptoms, sneezing, and rhinorrhea; by blocking leukotriene, a chemical released by mast cells
Adverse Reactions: elevated levels of alanine transaminase, aspartate transaminase, bilirubin (mess with lab values)
good option for patients with asthma - also treats asthma
Immunotherapy
subcutaneous injections given for 5-7 years that can last up to 12 years
very effective
reserved for patients who are unresponsive or cannot tolerate other treatment, patients who want to avoid long-term med use, patients with allergic asthma
Cold Treatments (Non-specific)
humidifiers increase fluid intake rest Decongestants Analgesics (pain relievers) Local Anesthetic (Lozenges, sprays) Cough Medications
Fever Treatments
Acetaminophen
Non-steroidal Anti-Inflammatory Drugs - ibuprofen or naproxen
Possibly Effective Cough Treatment
High-Dose Inhaled Corticosteroids (wheezing children) Buckwheat Honey Nasal Irrigation with Saline Vapor Rub Zinc Sulfate
Cough Treatment Options
Antitussives
Expectorant
Sore Throat Remedies
Narcotic Antitssives
Codeine - prodrug,
morphine is its active metabolite (some may not metabolize fast enough, some may metabolize too fast and risk overdose)
Hydrocodone
Purpose: reduce night cough: suppress cough centrally in the medulla of the brain - bind to opioid receptors and produce analgesia, sedation, and cough suppression; best use to help patients sleep
Adverse Reactions: sedation, respiratory, nausea (codeine), depression (hydrocodone), constipation
avoid alcohol, not for children under 12
no more effective than placebo
OTC Antitussive
Dextromethorphan
Purpose: for nonproductive cough; suppresses cough at the medulla by elevating the threshold for cough reflex
Adverse Reactions: drowsiness, GI effects
Drug Interactions: MAO inhibiters
A: absorbed in GI
D: crosses BBB
M: prodrug, liver, CYP2D6
E: urine
T 1/2: 2-24 hours; variable
Non-narcotic, Non-OTC Antitussive
Benzonatate
Purpose: treats cough; anesthetizes respiratory passage and lung stretch receptors; numbs cough reflex
Adverse Reactions: hypersensitivity, GI upset, sedation
M: liver
E: urine
pill rolls easily - difficult for elderly
Expectorant
Guaifenesin
Purpose: treats productive cough; thins mucus to enhance clearance
Adverse Reaction: GI effects
counsel patient to increase fluid intake
Sore Throat Remedies
saline gargle
sprays, lozenges (numb locally: benzocaine, dyclonine, phenol, menthol
buckwheat honey
high fluid intake
Treatment for Urticaria and Angioedema
Hives and Swelling
Second Generation Antihistamines Fexofenadine Desloratadine Loratadine Cetirizine
First Generation (if necessary) Diphenhydramine
Follow-up with short course Oral Corticosteroids
Prescribe Epipen in case the next exposure leads to Anaphylaxis
Anaphylaxis Treatment
Epinephrine First!
Antihistamines - symptom relief; diphenhydramine
Corticosteroids - prevent biphasic or rebound reaction; prednisone (po), prednisolone (po, liquid for kids, injection, etc.), dexamethasone (IV, po, other); only for short-term
Epinephrine
Purpose: treat Anaphylaxis; alpha and beta adrenergic agonist (sympathetic response) causing bronchodilation
Adverse Reactions: agitation, anxiety, tremulousness, headache, dizziness, pallor, palpitations, arrhythmias
A: injection - rapid
D: systemic
M: hepatic, rapidly degraded
E: renal/urine
