HEENT Flashcards
1
Q
Functions of the immune system
A
- Protect against foreign pathogens
- Diff b/w self & non-self
- Regulate response to antigens
2
Q
_____ immune response + ____ immune response = immune system
A
innate + adaptive -> immune system
3
Q
innate immunity is (specific or nonspecific?)
A
nonspecific
it recognizes a limited # of molecular patterns common to a variety of pathogens
Components: physical/chemical barriers, phagocytes and NKC, proteins
4
Q
Inflammation is produced in response to release of _____
A
cytokines and chemokines
5
Q
Five signs of inflammation
A
Redness, swelling, pain, warmth, loss of function
6
Q
Adaptive immunity is (specific or nonspecific?)
A
Specific to distinct pathogens
adapts to changes to maintain effectiveness of immune response to protect the body
components: lymphocytes + Antibodies
7
Q
Adaptive immunity = ____ + _____
A
humoral + Cellular
8
Q
Humoral immunity = ____ Cells -> ______
A
Humoral = B Cells -> Antibodies
managed by lymphocytic T cells
regulate intensity, type, duration of immune response
9
Q
Cellular Immunity = ____ Cells
A
T Cells
kill it or help kill it
10
Q
Protein molecules which bind to specific antigens and destroy them
A
immunoglobulins (Ig)
Antibodies
11
Q
5 types of immunoglobulins
A
12
Q
Innapropriate immune response or appropriate immune response that is too strong
A
Hypersensitivity
Allergy
13
Q
Poison ivy: innapropriate or appropriate but too strong immune response?
A
innapropriate
14
Q
Asthma: innapropriate or appropriate but too strong immune response?
A
Appropriate but too strong
15
Q
There are ___ different types of hypersensitivites (allergies)
A
4
16
Q
Type 1 hypersensitivity is _____ mediated
A
IgE
Skin
17
Q
Type I Hypersensitivities affect which parts of the body
A
- Skin (eczema)
- Eyes (conjunctivitis)
- Nasopharynx (rhinorrhea)
- Bronchopulmonary (asthma)
- GI (gastroenterittis)
18
Q
General trmnts for Type I hypersensitivity
A
Antihistamines, epi, corticosteroids
19
Q
Anaphylactic rxns belong to Type ___ hypersensitivity
A
1
20
Q
Type ___ = “immediate hypersensitivity”
A
Type 1
21
Q
Type II hypersensitivity is _____ mediated
A
IgM, IgG
autoimmune
both from blood
22
Q
Type ___ hypersensitivity
Antibody-antigen complexes don’t clear well and build up -> inflammation
A
Type III
23
Q
Type III hypersensitivity is ____ mediated
A
IgG, some IgM
both from blood
24
Q
Type ___ hypersensitivity rxn = Delayed-type
Antigen exposure -> response 2-3 days later
A
IV
25
Type IV hypersensitivity is ___ mediated
T Cells and macrophages
| NOT antibodies
26
Epi MOA
Histamine competitive inhibitor
counteracts massive histamine release by competitively inhibiting receptor binding
27
two types of histamine receptors
| where are there (mainly?)
H1: airway
H2: gastric
28
1st Gen H1RB
Diphenhydramine (benadryl)
Brompheniramine (dimetapp)
Doxylamine (unisom)
29
2nd gen H1RB
Loratadine (claritin)
Desloratadine (Clarinex)
Fexofenadine (allegra)
Citirizine (xyrtec)
Levocertirizine (Xyzal)
30
Common H2RBs
Famotidine (pepcid)
Ranitidine (Zantac)
31
Why should you use caution when rx antihistamines (H1RB) to elderly
| especially 1st gen
fall risk due to dizziness and sedation
32
Cautions for antihistamines
elderly (fall risk)
renal dysfunction (renally cleared)
33
H1RB side effects
dry mouth + fall risk
34
H2RB side effects
constipation and diarrhea
35
Adverse drug rxns are usually type ___ or ___ reactions
I or IV
## Footnote
Type I: beta-lactams, quinolones, platinum (FAST)
Type IV: local anesthetics, topical ABX (SLOW)
36
Can you come straight out the womb with an insect allergy?
no, prior exposure required
37
Food allergy intolerannce vs hypersensitivity
Intolerance - physiological response (lactose intolerance)
hypersensitivity - immune allx rxn (hives)
38
Food allergies are type ___ rxns
1
39
fancy name for hives
utricaria
40
angioedema
| nonpitting
41
meds that cause Angioedema
- ACE inhibitors (BP meds; can happen anytime like years later)
- Fibrinolytics (alteplase)
42
trmnt for utricaria and angioedema
Antihistamines & oral steroids
## Footnote
both **H1RB (2nd gen** >1st gen) & H2RB
43
Allergic Rhinitis is a type ___ rxn
I
44
Allergic Rhinitis 1st line trmnt
| examples and MOA
Intranasal Corticosteriods
- Fluticasone (Flonase, Veramyst)
- Mometasone (Nasonex)
- Budesonide (Rhinocort)
- Triamcinolone (Nasacort)
- Beclomethasone (Qnasl, Beconase AQ)
| MOA: local anti-inflammatory
45
pt has runny nose and congestion. Will H1RB antihistamines help?
It will dry secretions (anticholinergic) but has no effect on nasal congestion
46
Decongestants MOA
alpha-agonist (sympathomimetic) causes vasoconstriction of arterioles in nasal mucosa and limits mucus from the start
47
Nasal decongestants should only be used for up to ___ to avoid ___
up to 3 days to avoid rebound nasal congestion
48
Oral nasal decongestant example
Sudafed
49
# Allergic Rhinitis Trmnt
Intranasal Mast-Cell Stabilizer example and MOA
Cromolyn (Nasal Crom)
- inhibits mast cell degranulation, **limits release of histamine, tryptase, and prostaglandin D2**
50
# Allergic Rhinitis Trmnt
Intranasal Anti-Muscarinic
Ipratropium
- MOA: inhibits serous & serous gland secretions
- not regularly used
## Footnote
for severe cases
51
# Allergic Rhinitis Trmnt
Anti-Tussives (OTC)
Dextromethorphan (Delsym)
- MOA: interuppts cough impulse in the medulla
- not for kids <4 yr old
## Footnote
better for URI (expectorants for LRI)
for post nasal drip
52
# Allergic Rhinitis Trmnt
Anti-Tussives (Rx)
Benzonatatate (Tessalon)
- MOA: topical anesthetic on respiratory stretch receptors
- Not for kids < 10 yo
53
# Allergic Rhinitis Trmnt
Anti-Tussives Rx Only
| list
- Benzonatate (tessalon)
- Codeine (Cheratussin AC, Virtussin AC)
- Hydrocodone (tussionex)
54
# MOA
Anti-Tussives - Codeine
| Cheratussin AC, Virtussin AC
- MOA: bind to opiod receptors in CNS and depresses cough center in medulla
- not for kids < 12 yo
- controlled substance
## Footnote
wont be on test
55
Rx Anti-tussive for allergic rhinitis that is not a controlled substance
Benzonatate (Tessalon)
56
# What
bil eyes are itching, tearing, watery discharge
| type ____ rxn
Allergic Conjunctivitis
| type I rxn
57
what type of antihistamines for allergic conjunctivitis
| topical trmnt
H1RB
Pheniramine/naphazoline (Naphon-A, Visine - A)
- MOA: **blocks anthistamine receptors** in conjunctiva and eyelids
- Decongestant: **vasoconstriction and decreased conjunctival edema**
58
# Allergic conjunctivitis
avoid H1RB in pts with ___
narrow angle glaucoma (vasoconstrictor component)
59
Antihistamines with Mast Cell-stabilizers end in _____
“-dine or - tine”
* Olopata**dine** (Patanol, Pataday, Pazeo)
* Alcafta**dine** (Lastacaft)
* Azelas**tine** (Optivar)
* Epinas**tine** (Elestat)
* Ketotifen (Ketotifen, Zaditor)
60
OTC Mast-Cell Stabilizer
Ketotifen
61
Mast Cell Stabilizers (w/o antihistamines) have ___ in their name
"crom"
* **Crom**olyn sodium (Opticrom)
* Nedo**crom**il (Alocril)
* Iodoxamide tromethamine (Alomide)
* Mechanism of Action: previously discussed
* Full efficacy in 5-14 days
* Four times daily dosing
62
Topical Glucocorticoids have ___ in their name
"pred" or "-olone"
* Lote**pred**nol (Lotemax)
* Rimex**olone** (Vexol)
* Prednis**olone** (Pred Mild)
* Fluorometh**olone** (FML)
63
Topical Glucocorticoids MOA & caution
MOA: suppress late-phase reaction of allergic inflammation
Caution: cataract, **elevated intaocular pressure -> glaucoma**
## Footnote
last resort option
64
# Pink eye
____ Conjunctivitis = watery discharge
Viral
65
____ Conjunctivitis = purulent discharge
Bacterial
66
Bacterial Conjunctivitis Trmnt options
* Erythromycin ophthalmic ointment
* Trimethoprim-polymyxin B (Polytrim) ophthalmic drops
* Bacitracin-polymyxin B ophthalmic ointment
* Ofloxacin (Ocuflox) ophthalmic drops
* Ciprofloxacin (Ciloxan) ophthalmic drops
* Azithromycin (Azasite) ophthalmic drops
67
Contact lens wearers with pink eye should be Rx
Fluoroquinolone drops (ciprofloxacin and ofloxacin)
68
Causes of dry eye
decreased tear production or increased evaporative loss
69
Dry eye Rxs
Cyclosporine emulsion (restasis)
- calcineurin inhibitor; immunosuppressant agent
Lifitegrast (Xiidra)
- integrin antagonist
70
2nd most common cause of blindness in US
glaucoma
71
Primary, closed, narrow angle glaucoma
Outflow issue
Anterior chamber angle is reduced and limits aqueous humor outflow
- medical emergency
72
Open-angle, secondary glaucoma
Increased production of aqueous humor or degenerative change in the outflow system
73
Glaucoma Trmnts
-#1 topical prostaglandiin agonists
- #2 or 1 Beta-adrenergic antagonists (beta blockers)
- Alpha-2 Adrenergic Agonists
- Miotics
- Carbonic Anhydrase Inhibitors
- Netarsudil (Rhopressa)
74
Topical Prostaglandin Agonists
Latanaprost (Xalatan), bimatoprost (Lumigan), travoprost (Travatan), unoprostone (Rescula)
- once daily dosing
- side effects: **discoloration of iris (permanent), eyelash changes**
## Footnote
glaucoma
75
Beta-adrenergic agonists (topical beta blockers)
Betaxolol (betoptic), Carteolol (ocupress)
- decrease intraocular pressure 22%
- MOA: decreases aqueous humor production by interfering with cAMP
- Contraindications: cardiac/pulm disease
## Footnote
glaucoma
76
Alpha-2 adrenergic agonists
Apraclonidine (iopidine), dipivefrin (propine), **brimonidine (alphagan)**
- MOA: **decrease prod of aqueous humor** and **increase its outlfow**. mimics epi and dilates iris muscle to decrease congestion of blood vessels in conjunctiva
## Footnote
glaucoma
77
# examples, MOA, caution
Miotics
Carbachol (**isopto** carbachol), pilocarpine (**isopto** carpine)
MOA: increase outlfow of aqueous humor -> decreases IOP
Caution: Hx of retinal detachment or corneal abrasion
## Footnote
contracts muscles
78
Carbonic Anhydrase Inhibitors
Topical: brinzolamide (Azopt), dorzolamide (Trusopt)
Oral: acetazolamide (Diamox)
- MOA: feedback mech leads to decreased production of aqueous humor and decrease in IOP
- Caution: Sulfa Allx
## Footnote
glaucoma
79
Netardsudil (Rhopressa)
MOA: rho kinase inhibitor; increase outflow of aqueous humor
- add-on to prostaglandin antagonist therapy
## Footnote
glaucoma
80
Brimonidine + timolol = ____
Brimonidine + brinzolamide = ______
Dorzolamide + timolol = _____
81
Meds that increase intraocular pressure and shouldnt be given to pts with glaucoma
- antihistamines
- anticholinergics (oxybutynin, tolterodine, benztropine)
- chronic corticosteroids (especially eye drops, prednisolone)
82
1st line trmnt for otitis externa
Cleaning the ear canal
83
Topical therapy options for otitis externa (mild, mod, severe)
Mild: acidifying agent + glucocorticoid
Mod: ABX + glucocorticoid
Severe: ABX + glucocorticoid +/- wick +/- systemic ABX
84
Ear fullness + hearing loss
Cerumen impaction
85
Cerumen impaction trmnt
Ceruminolytics to soften and remove
- Carbamide peroxide (debrox) 4 days max
- Triethanolamine 10% (cerumenex)
86
1st line trmnt for otitis media (and dosing) for an **adult** with no recent beta-lactam therapy, hx of recurrent AOM, or conjunctivitis
Amoxicillin-clavulanate (Augmentin)
(90mg/kg/day of amoxicillin and 6.4mg/kg/day clavulanate divided twice daily
87
1st line trmnt for otitis media (and dosing) for a **child** with no recent beta-lactam therapy, hx of recurrent AOM, or conjunctivitis
Amoxicillin (Amoxil)
90mg/kg/day divided twice daily
88
1st line trmnt for otitis media (and dosing) for a pt with recurrent AOM unresponsive to amoxicillin
Amoxicillin-clavulanate (Augmentin)
(90mg/kg/day of amoxicillin and 6.4mg/kg/day clavulanate divided twice daily
89
Other otitis media trmnt options
90
Glaucoma trmnt opt if only one eye has increased pressure
Beta-adrenergic agonists (beta-blockers)
## Footnote
Betaxolol (Betoptic), carteolol (Ocupress), levobunolol (Betagan), timolol (Timoptic)
91
1st line trmnt for otitis media (and dosing) for an **adult** with no recent beta-lactam therapy, hx of recurrent AOM, or conjunctivitis
