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Pharmacology > Final Exam lectures 11, 12 & 13. > Flashcards

Final Exam lectures 11, 12 & 13. Flashcards

1
Q

Damage to the inner ear, targeting cochlear and vestibular structures and sensory function, due to exposure to certain pharmaceuticals, chemicals, and/or ionizing radiation

A

ototoxicity/vestibulotoxicity

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2
Q

ototoxicity/vestibulotoxicity

A

Damage to the inner ear, targeting cochlear and vestibular structures and sensory function, due to exposure to certain pharmaceuticals, chemicals, and/or ionizing radiation

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3
Q

It is the alteration of hearing or balance by drugs and chemicals acting at the level of brainstem or central connections of the cochlear and vestibular nuclei

A

neurotoxicity

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4
Q

Define neurotoxicity

A

It is the alteration of hearing or balance by drugs and chemicals acting at the level of brainstem or central connections of the cochlear and vestibular nuclei

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5
Q

Define hepatotoxicity

A

Causes liver damage, will result in metabolism issues and toxicity because the drug will not be able to excrete the body appropriately and will sit in the liver too long

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6
Q

Causes liver damage, will result in metabolism issues and toxicity because the drug will not be able to excrete the body appropriately and will sit in the liver too long

A

hepatotoxicity

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7
Q

Tubular cell injury because of drug accumulation, which may be reversible
It contributes to ototoxicity because renal toxicity causes the drug to accumulate and stay longer in the body

A

nephrotoxicity

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8
Q

nephrotoxicity

A

Tubular cell injury because of drug accumulation, which may be reversible
Kidney
It contributes to ototoxicity because renal toxicity causes the drug to accumulate and stay longer in the body

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9
Q

risk factors for ototoxicity

A

Dosage
Hepatic function
Renal function
polypharmacology
Age
Pre-existing SNHL

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10
Q

Discuss the rationale for the high frequency sensorineural hearing loss related to ototoxicity

A

The outer hair cells are the first to be destroyed from the base to the apex resulting in a high frequency SNHL

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11
Q

During Ototoxicity what physiology occurs?

A

The outer hair cells are the first to be destroyed from the base to the apex resulting in a high frequency SNHL

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12
Q

Discuss ototrauma and its effects

A

Very loud noise; sudden onset with short duration

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13
Q

Very loud noise; sudden onset with short duration

A

Ototrauma

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14
Q

List primarily ototoxic drugs

A

Amikacin and neomycin are more ototoxic

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15
Q

List Primarily vestibulotoxic drugs

A

Streptomycin and gentamicin are more vestibulotoxic

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16
Q

Amikacin and neomycin are more _____

A

Ototoxic

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17
Q

Streptomycin and gentamicin are more _______

A

vestibulotoxic

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18
Q

One antibiotic can cancel out desired effects of the other

A

Antibiotic antagonism

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19
Q

Antibiotic antagonism

A

One antibiotic can cancel out desired effects of the other

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20
Q

Antibiotic antagonism example

A

if tetracycline and penicillin are given together, penicillin will not be effective

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21
Q

Antibiotic synergism

A

Using more than one antibiotic increases the spectrum of kill and produces a desired effect of greater magnitude

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22
Q

Using more than one antibiotic increases the spectrum of kill and produces a desired effect of greater magnitude

A

Antibiotic synergism

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23
Q

Antibiotic Synergism examples

A

streptomycin given with penicillin, will kill the enterococci bacteria completely

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24
Q

Limitation of Antibiotic Synergism

A

Use of multiple antibiotics raises the risk of polypharmacy and adverse reactions including ototoxicity

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25
Q

The target organism for antibiotic therapy

A
  • The target organism for antibiotics are ** bacteria**
    - Antibiotics are
    ineffective against virus
  • Affect both gram-positive and gram-negative bacteria
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26
Q

Bacteria that stain dark blue or violet by Gram staining because of high amounts of peptidoglycan in cell wall

A

Gram-positive bacteria
(positive, Lilys fav color)

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27
Q

Gram-positive bacteria

A

Bacteria that stain dark blue or violet by Gram staining because of high amounts of peptidoglycan in cell wall

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28
Q

Bacteria cannot retain the crystal violet stain because they typically lack the outer membrane found in gram-positive bacteria
Instead they take up the counterstain (e.g., safranin or fuchsine) and appear red or pink

A

Gram-negative bacteria
Red, Negative- Inside out

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29
Q

Gram-negative bacteria

A

Bacteria cannot retain the crystal violet stain because they typically lack the outer membrane found in gram-positive bacteria
Instead they take up the counterstain (e.g., safranin or fuchsine) and appear red or pink

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30
Q

pathophysiology of ototoxicity

A
  • Loss of hair cells is most severe at the cochlear basal turn moving towards the apex
  • structures damaged include; Stria vascularis, spiral ligament, Reissner’s membrane
  • Nerve fiber damage is secondary to hair cell loss
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31
Q
  • Loss of hair cells is most severe at the cochlear basal turn moving towards the apex
  • structures damaged include; Stria vascularis, spiral ligament, Reissner’s membrane
  • Nerve fiber damage is secondary to hair cell loss
A

pathophysiology of ototoxicity

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32
Q

Identify common classes of antibiotics

A

Aminoglycosides
Penicillin
Macolides

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33
Q

Aminoglycosides indications

A

Used to treat infections caused by aerobic gram-negative bacteria that can cause serious and life-threatening infections, for e.g.,
- Endocarditis
- Septicemia
- Kidney infections

All the above conditions in turn can increase the risk of ototoxicity

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34
Q

Penicillin Indications

A
  • Amoxicillin is one of the most commonly prescribed drugs in the U.S. for otitis media
  • Augmentin is used for otitis media if patients develop resistance or no benefits from amoxicillin

Generally penicillin is not considered to be ototoxic or vestibulotoxic

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35
Q
  • Amoxicillin is one of the most commonly prescribed drugs in the U.S. for otitis media
  • Augmentin is used for otitis media if patients develop resistance or no benefits from amoxicillin
A

Penicillin Indications

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36
Q

Second generation Penicillin

A

Ampicillin, Amoxicillin, Amoxicillin with Clavulanic Acid (Augmentin)

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37
Q

Used to treat infections caused by aerobic gram-negative bacteria that can cause serious and life-threatening infections, for e.g.,
- Endocarditis
- Septicemia
- Kidney infections

All the above conditions in turn can increase the risk of ototoxicity

A

Aminoglycosides indications

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38
Q

_________ is one of the most commonly prescribed drugs in the U.S. for otitis media

A

Amoxicillin is one of the most commonly prescribed drugs in the U.S. for otitis media

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39
Q

_______ is used for otitis media if patients develop resistance or no benefits from ________

A

Augmentin is used for otitis media if patients develop resistance or no benefits from amoxicillin

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40
Q

Amoxicillin is one of the most commonly prescribed drugs in the U.S. for _________

A

otitis media

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41
Q

Augmentin is used for otitis media if patients ______ ______ or _____ _____ from amoxicillin

A

Augmentin is used for otitis media if patients develop resistance or **no benefits ** from amoxicillin

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42
Q

True or False
penicillin is ototoxic & vestibulotoxic

A

FALSE

penicillin is not considered to be ototoxic or vestibulotoxic

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43
Q

Other structures damaged during ototoxicity

A

Stria vascularis, spiral ligament, Reissner’s membrane

Nerve fiber damage is secondary to hair cell loss

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44
Q

During Ototoxicity
____________ are affected first
___________ and rest of the _________ can be damaged in more severe cases

A

Outer hair cells are affected first
Inner hair cells and rest of the organ of corti can be damaged in more severe cases

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45
Q

True or False
Aminoglycosides only cause permanent functional effects

A

FALSE
Aminoglycosides can result in ** both ** acute physiological and permanent functional effects

  • Hearing loss can sometimes be reversible following discontinuation of drug
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46
Q

what is the Primary target of aminoglycoside antibiotics

A

Cochlear hair cells are the primary targets of aminoglycoside antibiotics

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47
Q

During Aminoglycosides in the vestibular system what occurs?

A
  • Type 1 hair cells are lost first
  • Primary site of lesion depends on the drug,
  • All aminoglycosides can damage one or both end organs
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48
Q

True or False Ototoxicity and vestibulotoxicity with aminoglycosides is always Dose dependent?

A

FALSE

Ototoxicity and vestibulotoxicity with aminoglycosides is dose-dependent unless it’s genetic ototoxicity

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49
Q

Ototoxic monitoring after drug discontinued

A

ototoxic hearing loss can be progressive, occurring > 6 to 12 months after drug regimen is discontinued

Ototoxic monitoring is necessary for several weeks and months after the drug is discontinued

** - After discontinuation, 3, 6, 9, 12 months of monitoring *** (3 mos 1st year)
** - Annually for platinum based drugs **

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50
Q

What drug is used to treat

Endocarditis
Septicemia
Kidney infections

A

Aminoglycosides

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51
Q

What drug primarily used to treat otitis media?

A

Penicillin
Amoxicillin & Augmentin

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52
Q

What drug is used to treat

Otitis media
Respiratory tract infections including
- Strep throat,
tonsillitis, pharyngitis
Sexually transmitted diseases
Useful when patients are allergic to penicillin

A

Macrolides Indications

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53
Q

Macrolides Indications

A

Otitis media
Respiratory tract infections including
- Strep throat,
tonsillitis, pharyngitis
Sexually transmitted diseases
Useful when patients are allergic to penicillin

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54
Q

Which antibiotics are commonly used to treat otitis media?

A

Penicillin
- Amoxicillin & Augmentin
Macrolides
- Erythromycin, clindamycin, azithromycin

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55
Q

Which antibiotics are MOST often associated with ototoxicity?

A

Aminoglycosides
Macrolides (generally reversible)
Glycopeptide antibiotics (e.g., vancomycin)

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56
Q

_____ , ______dividing cells respond best to chemotherapy

A

Small, rapidly dividing cells respond best to chemotherapy

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57
Q

______ _______ do not respond well to chemotherapy

A

Solid tumors do not respond well to chemotherapy

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58
Q

Why do Solid tumor not respond well to chemo?

A

Because of the slower growth/division of these cells
These tumors often require radiation and/or surgery as well

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59
Q

Why are normal cells affected by chemotherapy

A

Normal cells also rapidly divide and are subjected to the effects of chemotherapy

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60
Q

Tumor cells mutate, which allows them to_______

A

Tumor cells mutate, which allows them to metastasize

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61
Q

What is it when a tumor Metastasize

A
  • Original tumors may respond well to chemotherapy, but metastatic lesions may be less responsive, poor prognosis
  • Because as they mutate, their response to chemotherapy may change (e.g., altered cell receptors)
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62
Q

Describe the challenges associated with antineoplastic combination chemotherapy

A

Antineoplastic = chemotherapeutic medications
- particularly platinum-based drugs
This fact results in dose-limiting toxicities
- The challenge is to give an adequate dose to kill the cancer cells without killing too many healthy cells
Many toxicities

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63
Q

what is Antineoplastic

A

Antineoplastic = chemotherapeutic medications

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64
Q

List Platinum-derived compound

A

Cisplatin
Carboplatin
Multifactorial mechanism of Cisplatin Ototoxicity (60%)

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65
Q

Indications for what drug
Germ cell tumors
- Ovarian & testicular tumors (including metastatic lesions)
Bladder cancer
Gynecological
Lung tumors
Tumors of head/neck region and brain tumors
Many childhood tumors including neuroblastoma

A

Cisplatin

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66
Q

Cisplatin indications

A

Germ cell tumors
- Ovarian & testicular tumors (including metastatic lesions)
Bladder cancer
Gynecological
Lung tumors
Tumors of head/neck region and brain tumors
Many childhood tumors including neuroblastoma

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67
Q

Indications for what drug
is the same as cisplatin, Less nephrotoxicity, equal ototoxic and more vestibulotoxic

A

Carboplatin

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68
Q

Carboplatin indications

A

SAME AS cisplatin
Germ cell tumors
- Ovarian & testicular tumors (including metastatic lesions)
Bladder cancer
Gynecological
Lung tumors
Tumors of head/neck region and brain tumors
Many childhood tumors including neuroblastoma

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69
Q

What drug treats tumors and less Nehrotoxic, Same ototoxic but more vestibulotoxic in comparison to cisplatin

A

Carboplatin

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70
Q

Carboplatin Limiations

A
  • ototoxic I s equal to cisplatin
  • more vestibulotoxic
  • Significant bone marrow toxicity, which is dose limiting
    - BM Toxicity can be overcome by treatment with stem cell rescue
  • Mechanism of toxicity is probably reactive oxygen and nitrogen species
    Toxicity risk increases with previous cisplatin or aminoglycoside administration
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71
Q

Multifactorial mechanism of Cisplatin-induced ototoxicity

A

Damage caused by free radical generation and inhibition of anti-oxidation processes

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72
Q

Cisplatin-induced Permanent hearing loss is probably caused by

A

Loss of OHCs in the basal turn initially resulting in earlier high frequency SNHL

Damage later spreads to rest of the cochlea

Degeneration of the stria vascularis also occurs

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73
Q

Folate analog inhibitors indications

A

Methotrexate is in this class of drugs and used to treat
- Severe cancers of the blood, bone, lung, breast, head and neck, rheumatoid arthritis, psoriasis, and Cogan’s syndrome
- It is often given in conjunction with Vinblastine & Cisplatin

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74
Q

Folate metabolism is

A

Folate (natural form of vitamin B9) metabolism is fundamental to both cancerous and normal cells

75
Q

True or False
Folate analog inhibitors are not ototoxic

A

FALSE
Highly ototoxic, especially in children especially if given with other cancer drugs, also nephrotoxic, and neurotoxic

Teratogenic and abortifacient (used in ectopic pregnancy)
Recommendation to wait 3 to 6 months after taking methotrexate to get pregnant

76
Q

Folate analog inhibitors Limitations

A

Highly ototoxic, especially in children especially if given with other cancer drugs, also nephrotoxic, and neurotoxic

Teratogenic and abortifacient (used in ectopic pregnancy)

77
Q

Recommended wait time for pregnancy after taking methotrexate

A

Teratogenic and abortifacient (used in ectopic pregnancy)

Recommendation to wait 3 to 6 months after taking methotrexate to get pregnant

78
Q

Folate depletion and its resultant reduction of DNA synthesis is what?

A

Folate depletion and its resultant reduction of DNA synthesis is toxic to both malignant and normal cells

79
Q

Inhibition of folic acid metabolism has been used as …

A

Inhibition of folic acid metabolism has been used as a mechanism for successful elimination of rapidly dividing cells, i.e., tumor cells

80
Q

What is Methotrexate and what is it used for

A

Methotrexate is in the Folate analog inhibitors drug class

  • Severe cancers of the blood, bone, lung, breast, head and neck, rheumatoid arthritis, psoriasis, and Cogan’s syndrome
81
Q

Methotrexate Is often given in conjunction with what?

A

It is often given in conjunction with Vinblastine & Cisplatin

82
Q
  • Used in combination chemotherapy, often with Cisplatin
  • Works by blocking mitosis, cell-cycle specific action
  • Ototoxicity at higher doses
  • Can be neurotoxic causing numbness, pain, & dizziness
A

Vinca Alkaloids

83
Q

Vinca Alkaloids

A

Indications
Leukemia, lymphoma, breast & testicular cancer, in neuroblastoma combination therapy, and Kaposi’s sarcoma

84
Q

What drug is used for Leukemia, lymphoma, breast & testicular cancer, in neuroblastoma combination therapy, and Kaposi’s sarcoma

A

Vinca Alkaloids

85
Q

what cancer drug Is Generally administered IV
Metabolized in the liver and primary excretion is through the fecal route

A

Vinca Alkaloids

86
Q

Vinca Alkaloids discriptors

A
  • Used in combination chemotherapy, often with Cisplatin
  • Works by blocking mitosis, cell-cycle specific action
  • Generally administered IV
  • Ototoxicity at higher doses
  • Can be neurotoxic causing numbness, pain, & dizziness
87
Q

Vinca Alkaloids indications

A

Leukemia,
lymphoma,
breast & testicular cancer, in neuroblastoma combination therapy, and Kaposi’s sarcoma

88
Q

What is the most ototoxic antineoplastic drugs and why

A

Cisplatin (40-60%)
why
- Damage caused by free radical generation and inhibition of anti-oxidation processes

Permanent hearing loss is probably caused by
- Loss of OHCs in the basal turn initially resulting in earlier high frequency SNHL
- Damage later spreads to rest of the cochlea
- Degeneration of the stria vascularis also occurs

Hair cells and spiral ganglion neurons are the most susceptible to apoptosis (Cell death)

89
Q

What medication class
- Relief of mild to moderate pain
- Reduction in inflammation
- Reduction in fever
- Prevention of stroke

A

Salicylates (aspirin)

90
Q

Salicylates (aspirin)
indications

A
  • Relief of mild to moderate pain
  • Reduction in inflammation
  • Reduction in fever
  • Prevention of stroke
91
Q

Drugs such as ibuprofen, naproxen, and ketoprofen
Therapeutic actions are similar to aspirin
Anti-inflammatory, analgesic, and antipyretic effects (reduce fever)

A

Other non-steroidal anti-inflammatory analgesics (NSAIDS)

92
Q

Other non-steroidal anti-inflammatory analgesics (NSAIDS)

A

Drugs such as ibuprofen, naproxen, and ketoprofen
Therapeutic actions are similar to aspirin
Anti-inflammatory, analgesic, and antipyretic effects (reduce fever)

93
Q

An antipyretic, primarily used for the treatment of malaria
Off-label use for benign nocturnal night cramps although not approved by FDA for that use (charley horse)

A

Quinine

94
Q

Quinine

A

An antipyretic, primarily used for the treatment of malaria
Off-label use for benign nocturnal night cramps although not approved by FDA for that use (charley horse)

95
Q

Acetaminophen indications

A

Useful for treating mild pain and fever but it is not an anti-inflammatory agent

96
Q

Salicylates (aspirin)
toxicity

A

Ototoxicity
Tinnitus
Typically Reversible SNHL - (rarely permanent)

97
Q

Other non-steroidal anti-inflammatory analgesics (NSAIDS)
Toxicity

A

All are nephrotoxic and also can affect the GI causing ulcers
Reversible tinnitus and hearing loss
They rarely cause significant or permanent SNHL

98
Q

Quinine toxicity

A

Temporary ototoxicity and vestibulotoxicity
- Reversible bilateral high frequency SNHL with a characteristic 4000 Hz notch
- High pitched tonal tinnitus
- Dizziness/vertigo

Hallmark of acute toxicity especially in malarial patients is referred to as cinchonism and includes
- Tinnitus, hearing loss, dizziness, headache, nausea, and vision changes

99
Q

Acetaminophen toxicity

A

No reported temporary or permanent ototoxic or vestibulotoxic effects

  • hepatotoxic if taken in greater than recommended dosage
  • Overuse or abuse of multi-ingredient substance like Vicodin, however, can cause rapidly progressive profound permanent SNHL
100
Q

what is Vicodin

A

Vicodin is a combination of acetaminophen and hydrocodone

101
Q

Diuretics indications

A

Primary therapeutic indications include
Hypertension, to reduce edema in patients with congestive heart failure, liver (cirrhosis), or kidney disease

102
Q

Diuretics Toxicity

A

Not Ototoxic; Only loop diuretics are believed to be ototoxic

103
Q

function of diuretics

A

All diuretics act the same way by preventing the reabsorption of sodium (salt) in the body
Which excretes water decreasing blood volume & pressure

104
Q
  • All are nephrotoxic
  • can affect the GI causing ulcers
  • Reversible tinnitus and hearing loss
  • They rarely cause significant or permanent SNHL
A

Non-steroidal anti-inflammatory analgesics (NSAIDS)

105
Q

Non-steroidal anti-inflammatory analgesics (NSAIDS)
ototoxic manifestations

A
  • All are nephrotoxic
  • can affect the GI causing ulcers
  • Reversible tinnitus and hearing loss
  • They rarely cause significant or permanent SNHL
106
Q
  • Show reversible biochemical and/or metabolic changes in cochlea with no permanent morphologic abnormality
  • Tinnitus
    High-pitched in the frequency of 6000 to 9000 Hz
  • Becomes louder with continued treatment and abates when treatment ends
  • Reversible SNHL
A

Salicylates

107
Q

Salicylates ototoxic manifestations

A
  • eversible biochemical and/or metabolic changes in cochlea with no permanent morphologic abnormality
  • Tinnitus
    High-pitched
  • Becomes louder with continued treatment and abates when treatment ends
  • Reversible SNHL
108
Q

Temporary ototoxicity and vestibulotoxicity
- Reversible bilateral high frequency SNHL with a characteristic 4000 Hz notch
- High pitched tonal tinnitus
- Dizziness/vertigo

A

Quinine

109
Q

Hallmark of acute toxicity especially in malarial patients is referred to as cinchonism and includes

A

Tinnitus, hearing loss, dizziness, headache, nausea, and vision changes

Quinine use

110
Q

Quinine ototoxic manifestations

A

Temporary ototoxicity and vestibulotoxicity
- Reversible bilateral high frequency SNHL with a characteristic 4000 Hz notch
- High pitched tonal tinnitus
- Dizziness/vertigo

111
Q

No reported temporary or permanent ototoxic or vestibulotoxic effects
- hepatotoxic if taken in greater than recommended dosage
- Overuse or abuse can cause rapidly progressive profound permanent SNHL

A

Acetaminophen

112
Q

Acetaminophen
ototoxic manifestations

A

No reported temporary or permanent ototoxic or vestibulotoxic effects
- hepatotoxic if taken in greater than recommended dosage
- Overuse or abuse can cause rapidly progressive profound permanent SNHL

113
Q

Loop Diuretics
ototoxic manifestations

A
  • Dose-related, reversible depression of endocochlear potential and intra-labryrinth electrolyte changes
  • Reduction in magnitude of the cochlear microphonics (CM)
  • Recovery of cochlear potentials occurs gradually
  • Reversible hearing loss if used alone
  • Significant ototoxicity typically seen when given in high IV doses especially in conjunction with aminoglycosides
  • The result can be rapid onset, flat, typically irreversible SNHL, with roaring tinnitus
    Loop diuretics can also cause dizziness/vertigo
114
Q
  • Dose-related, reversible depression of endocochlear potential and intra-labryrinth electrolyte changes
  • Reduction in magnitude of the cochlear microphonics (CM)
  • Recovery of cochlear potentials occurs gradually
  • Reversible hearing loss if used alone
  • Significant ototoxicity typically seen when given in high IV doses especially in conjunction with aminoglycosides
  • The result can be rapid onset, flat, typically irreversible SNHL, with roaring tinnitus
  • Loop diuretics can also cause dizziness/vertigo
A

Loop Diuretics Ototoxic manifestations

115
Q

What drug does this happen with?
Significant ototoxicity typically seen when given in high IV doses especially in conjunction with aminoglycosides

A

Loop Diuretics
The result can be rapid onset, flat, typically irreversible SNHL, with roaring tinnitus

116
Q

How can blood thinners, bleeding disorders, and diabetes impact the management of an audiologic patient?

A

Small nicks can lead to severe bleeding
Especially important when making impressions, particularly deep canal impressions, and for cerumen management

117
Q

Purpose for ototoxic monitoring per AAA (2009)

A
  • Early detection so changes in the drug regimen may be considered
  • audiologic intervention can occur
118
Q

audiologic intervention for ototoxic monitoring?

A

Use of hearing aid and assistive devices
Programming hearing aids to adapt to changes in hearing sensitivity – progressive hearing loss
Educational support for children with hearing loss

119
Q

True or false
Hearing loss may be unavoidable even with proactive ototoxicity monitoring

A

TRUE
hearing loss may be unavoidable even with proactive ototoxicity monitoring because the priority is effective management of the life threatening disease

120
Q

ASHA criteria for clinically significant change in hearing sensitivity due to ototoxic medication

A

greater than a 20 dB pure-tone threshold shift at one frequency

greater than a 10 dB shift at two consecutive test frequencies

Threshold response shifting to “no response” at three consecutive test frequencies

Significant changes in hearing need to be confirmed within 24 hours

All threshold changes must be confirmed by retest

121
Q

______ dB pure-tone threshold shift at one frequency is asha criteria for change in HS

A

greater than a 20 dB pure-tone threshold shift at one frequency

122
Q

_______ dB shift at two consecutive test frequencies
is asha criteria for change in HS

A

greater than a 10 dB shift at two consecutive test frequencies

123
Q

Threshold response shifting to “no response” at _____ consecutive test frequencies
is asha criteria for change in HS

A

Threshold response shifting to “no response” at three consecutive test frequencies

124
Q

Significant changes in hearing need to be confirmed within _____

A

Significant changes in hearing need to be confirmed within 24 hours

125
Q

All threshold changes must be ___________

is asha criteria for change in HS

A

All threshold changes must be confirmed by retest

126
Q

Potential damage caused to the auditory system with radiation therapy

A
  • potentially damage any of the auditory structures within the radiation field, extending from the external ear to the higher auditory pathways
  • degrade the external ear and middle ear system
  • 1/3 SNHL hearing loss
  • cochlear microvascular fibrosis, in turn causing degeneration of OHCs, IHcs, and VIII N fibers
127
Q

What type of hearing loss from radiation therapy?

A

present as conductive, mixed, sensorineural, or retrocochlear

128
Q

How does radiation therapy degrade the external ear and middle ear system

A

Radiation therapy can degrade the external ear and middle ear system by **thickening of the tympanic membrane, stenosis of the ear canal, inflammation of the ET resulting in a temporary or permanent conductive hearing loss **

129
Q

degrade the external ear and middle ear system by radiation therapy can result in what type of hearing loss?

A

temporary or permanent conductive hearing loss

130
Q

cochlear microvascular fibrosis result of radiation therapy causes what?

A

causing degeneration of OHCs, IHcs, and VIII N fibers

131
Q

Radiation HL is worse when in combination with ________

A

platinum-based chemotherapies

132
Q

SNHL from radiation affects high frequencies more than low and results in

A

It is typically irreversible and progressive

It is typically considered a late adverse effect with onset occurring several years after treatment

Long-term (up to 10 years) audiologic follow-up post treatment is recommended

133
Q

SNHL from radiation affects _____ frequencies more than ____ frequencies

A

SNHL from radiation affects the high frequencies more than the low frequencies

134
Q

List Behavioral and physiologic tests used for ototoxic monitoring

A

Case history
Otoscopy
conventional audio
extended HF (EHF)
Tymp
Speech
OAE
ABR

135
Q

what is EHF

A

High frequency audiometry
- can detect ototoxicity earlier than conventional

136
Q

Tinnitus monitoring and why

A
  • 40% of patients receiving chemotherapy develop tinnitus
  • TOMI
137
Q

what is the TOMI

A

Tinnitus monitoring interview
developed to detect tinnitus onset or chnages
ideally administered by and ENT or AUD

138
Q

Pharmaceutical Cognitive Side Effects

A
  • impaired concentration/ attention, disorientation, & confusion
  • Loss of mental acuity, slowed thinking, & mental clouding
  • Drowsiness & stupor
  • Forgetfulness & dementia
139
Q

Symptoms of what
- impaired concentration/attention, disorientation, & confusion
- Loss of mental acuity, slowed thinking, & mental clouding
- Drowsiness & stupor
- Forgetfulness & dementia

A

Pharmaceutical cognitive side effect can include

140
Q

Pharmaceutical Cognitive side effects can result in

A

Poorer word recognition scores
Poorer pure tone threshold results
Difficulty following instructions
Poor compliance with use of hearing aids

141
Q

for Vestibulotoxicity
_______ can happen if it is unilateral. ______ damage if bilateral

A

Compensation can happen if it is unilateral. Permanent damage if bilateral

142
Q

Vestibulotoxicity monitoring requires

A

Monitoring requires assessment of the balance system including the vestibular reflexes such as vestibulo-ocular reflex (VOR) by caloric and rotary chair testing

143
Q

Vestibulotoxicity treatment includes

A

Treatment can include
Medication
Vestibular rehabilitation therapy

144
Q

Management of ototoxicity

A
  • Counseling prior ototoxic drugs to make patients aware of potential ototoxicity
  • Counseling patient and family after ototoxicity and recommending technology/aural rehabilitation
  • Appropriate intervention
  • Frequent follow up and counseling due to potential progressive loss and cognitive pharmaceutical adverse effects
145
Q
A
146
Q
A
147
Q

Where is the primary damage occur for ototoxicity?

A

hair cells - Primary

148
Q

Primary Target of NSAIDS

A

Kidneys, Nephrotoxics

149
Q

what drug when in conjunction with gentamicin is ototoxic but when take alone is not?

A

Furosemide - Loop diuretic

150
Q

What are the three primary toxcity reaction of aminogylcosides?

A

Nephrotoxity - Kidney
Neuromusulcar Blockade
Ototoxicity/Vestibulotoxity

151
Q

Neuromuscular Blockade

A

Rare
non-depolarizing type of neuromuscular blockade that can lead to respiratory paralysis

152
Q

Aminoglycoside Vestibular system toxcity

A

Type 1 hair cells are lost first casuing disturbances in vest function

153
Q

Cochlear Hair cells are the primary target of what drug?

A

Aminoglycosides

154
Q

Ototoxity Aminoglycosides

A
  • Cochlear Hair cells are the primary target
  • The Outer hair cells first from the base to the apex = HF SNHL
155
Q

why does high frequency SNHL occur in Ototoxity w/ Aminoglycosides

A
  • The Outer hair cells are destroyed first from the base to the apex resulting in HF SNHL
156
Q

Amikacin, Gentamicin, Kanamycin, neomycin, streptomycin and tobramycin belong to what drug class

A

Antibiotics
Aminoglycosdies

157
Q

Gentamicin shows high concentraion where?

A

Stria Vascularis

158
Q

When should the OM baseline eval occur for chemotherapeutic drugs

A

The baseline evaluation should occur before or no later than 24 hours after administration of chemotherapeutic drugs

159
Q

The baseline evaluation should occur before or no later than 24 hours after administration of _________

A

chemotherapeutic drugs

160
Q

When should the OM baseline eval occur for Aminoglycoside antibiotics?

A

Before or no later than 72 hours following administration of aminoglycoside antibiotics

161
Q

The baseline evaluation should occur Before or no later than 72 hours following administration of ___________

A

aminoglycoside antibiotics

162
Q

A recheck of thresholds within ____ hours of the Baseline Test can be helpful for determining _______

A

A recheck of thresholds within 24 hours of the Baseline Test can be helpful for determining patient reliability

163
Q

Monitoring Evaluation occur for Chemo

A

Monitoring Evaluations are performed:
* Periodically throughout treatment, usually prior to each dose for chemotherapy patients

164
Q

Monitoring Evaluation occur for antibiotics

A

Monitoring Evaluations are performed:
* 1 to 2 times per week for patients receiving ototoxic antibiotics

165
Q

What is a monitoring eval and it is dependent on what?

A
  • Monitoring eval are a pared down version of baseline eval
  • ME depends on patients drug regimen & physician recomendation
166
Q

Monitoring and appropriate referrals for further auditory and vestibular testing also are warranted any time when patients’ report what?

A

Increased hearing difficulties
Tinnitus
Aural fullness
Dizziness

167
Q

why do Ototoxic medication post-treatment

A

Because ototoxic hearing loss can be progressive, occurring > 6 to 12 months after drug regimen is discontinued

168
Q

Time line for continuted Oto Monitoring after drug discontinuation

A
  • For up to a year at 3,6,9 & 12 months
  • Then anually thereafter for platinum based drugs
169
Q

Summary of Ototoxic monitoring time line

A
  • Baseline eval
  • recheck of baseline
  • Monitoring Eval
  • Post treatment Monitoring

Specific times vary based on type

170
Q

What is considered the most effective indicator of ototoxic HL

A

Detecting changes in puretone thresholds using serial audiograms is considered the most effective indicator of ototoxic HL
- Paricular when useing ultra HF thresholds are included

171
Q

Why is OM important after drug discontinuation?

A
  • Drug ototoxicity may occur days or weeks after use of ototoxic drugs - delayed onset
  • Hearing loss may be progressive even after discontinuation of the drug
172
Q

Progression after discontinuation is especially common with what drugs

A

Progression is especially common with aminoglycoside antibiotics and platinum-based chemotherapeutic agent

173
Q

True or False
Monitoring Vestibular toxicity is good if you can but not that important since the vestibular system can compensate with minimal long term effects?

A

FALSE
damage caused by vestibular toxicity can result in compensation by the central vestibular system with minimal long-term effects, BUT in some cases the vestibular damage is permanent, especially if there is bilateral peripheral vestibular damage

174
Q

How to conduct Vestibular Toxicity

A

Monitoring requires assessment of the balance system including the vestibular reflexes such as vestibulo-ocular reflex (VOR) by caloric and rotary chair testing

175
Q

Treatments for Vestibular Toxicity

A

Treatment can include
Medication
Vestibular rehabilitative therapy

176
Q

what is radiation therapy used for?

A

Cranial Radiation therapy is routinely used to treat a variety of brain tumors as well as head/ neck cancers in both children and adults

177
Q

True or False
Radiation Therapy and hearing loss exhibit a dose reponse relationship

A

TRUE
as radiation dose incraeses so does the risk and degree of severeity of the hearing loss.

178
Q

Timeline for post-treatment monitoring for radiation therapy

A

Long-term (up to 10 years) audiologic follow-up post treatment is recommended

179
Q

Timeline for post-treatment monitoring for drugs

A

You typically monitor for over a year in 3 month periods and if there is no change you can stop monitoring
* 3 months, 6 months, 9 months, and 12 months
* Then annually thereafter, especially for platinum-based drugs

180
Q

Potential damage caused to the auditory system with radiation therapy

A
  • Any auditory structures within raditation field extending from external ear to higher auditory pathways
  • degrade external ear and ME
  • 1/3 SNHL
  • Cochlear Microvascular Fibrosis
181
Q

Cochlear Microvascular Fibrosis is a result of what?

A

Cochlear Microvascular Fibrosis is a result of radiation therapy.
* causing degenration of OHC,IHCs and VIII N fibers

182
Q

SNHL from radiation exposure affects high frequencies more severely than low frequencies and it is….

A
  • It is typically irreversible and progressive
  • It is typically considered a late adverse effect with onset occurring several years after treatment
  • Long-term (up to 10 years) audiologic follow-up post treatment is recommended
183
Q

Radiation Therapy monitoring timeline

A

Radiation Therapy
Baseline Hearing Assessment: Before starting radiation therapy to establish a baseline for comparison.

Regular Monitoring: Typically, hearing should be monitored every 3 to 6 months during and after the completion of radiation therapy, depending on the risk factors and the specific treatment regimen.

Long-Term Follow-Up: Continued monitoring may be necessary for several years post-treatment, as radiation-induced hearing loss can sometimes develop or progress long after the treatment has ended.

Pharmacology (9 decks)

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