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Pharmacology > Lecture 13 (HEENT)- Exam 7 > Flashcards

Lecture 13 (HEENT)- Exam 7 Flashcards

1
Q

Antihistamines
* Histamine is released from what?
* What does histamine binding to H1 receptors result in?

A
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2
Q

Histamine binding to H2 receptors causes what?

A

Histamine binding to H2 receptors on gastric parietal cells increases gastric acid secretion

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3
Q

What do antihistamine do?

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4
Q

First gen antihistamie:
* Where does it bind and what conditions can they help?
* Does it cross the BBB? What are the receptors?
* What are the adverse reactions?

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5
Q

What are the first gen antihistamine drugs?8

A
  • Brompheniramine
  • Chlorpheniramine
  • Cyproheptadine
  • Diphenhydramine
  • Hydroxyzine hcl / pamoate
  • Promethazine
  • Meclizine
  • Dimenhydrinate
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6
Q

2nd gen antihistamie:
* What are they used for and what receptor?
* Does it cross the BBB?
* What are the adverse reactions?

A
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7
Q

What are the 2nd gen antihistamine drugs?

A
  • Cetirizine
  • Levocetirizine
  • Loratadine
  • Desloratadine
  • Fexofenadine

Lora cet AC, she Fex it

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8
Q

Decongestants
* What are the two types?
* What receptors do they bind to and what does that cause?

A

Oral or intranasal sprays
* Respiratory mucosa alpha agonist
* Vasoconstricts superficial blood vessels in nasal mucosa
* Decreases edema, nasal congestion, tissue hyperemia
* Increases nasal patency
* Beta receptor agonist – bronchial relaxation, tachycardia, increased contractility

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9
Q

What are the adverse reactions of decongestants?(8)

A
  • Insomnia
  • Nervousness
  • Tremor
  • Urinary retention
  • Decreased appetite
  • Increased BP, tachycardia, palpitations
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10
Q

Decogestant:
* Who should avoid these drugs? 4

A

Cardiovascular disorders, hypertension, glaucoma, bladder neck obstruction

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11
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13
Q

What happened with pseudoephedrine?

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14
Q

Topical Nasal decongestants
* Adverse reactions?
* What are local effects?
* Fast or slow effects?
* Use for how long?
* What is phinitis medicamentosa?
* What decreases symptoms?
* Recovery when?

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15
Q

Topical nasal decongestants
* What are the medications (3)?

A
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16
Q

Inhaled nasal corticosteroids:
* Decrease what?
* Improves what?
* When does symptoms resolve?
* What are the effects?

A
  • Decrease nasal mucosa inflammation
  • Improves airway patency
  • Days to weeks for symptom resolution
  • No cardiovascular effects
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17
Q

Inhaled nasal corticosteroids:
* What are the adverse effects?(5)

A
  • Nasal mucosa irritation
  • Epistaxis
  • Sore throat - ? candida infections (drink water after using)
  • Pediatric growth suppression (delayed, not stopped)
  • Potential for system steroid adverse effects
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18
Q

What are the different glucocorticoid nasal sparys for treatment of rhiitis?

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19
Q

Otitis Externa (OE)
* What is it?
* What increases the risk?
* What are the MC organisms?

A
  • Otitis externa AKA swimmer’s ear refers to inflammation of the external auditory canal and surrounding tissues (pain with pulling on ear)
  • Continuous wet environment (mc is kid swimming ten sudden pain) or trauma increases risk
  • Pseudomonas aeruginosa and Staphylococcus MC organisms
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20
Q

Otitis Externa (OE)
* Immunocompromised patients at risk of what?

A

Immunocompromised patients at risk of severe OE (Malignant OE)
* Skull osteomyelitis
* Facial nerve palsies

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21
Q

What are the different criteria to diagnosis of otitis externa?

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22
Q

OE – physical exam
* What does it show?
* What should you attempt to view? Why?

A

Physical exam:
* Diffuse erythema and edema
* ± otorrhea
* ± regional lymphadenopathy
* ± cellulitis

Attempt to view tympanic membrane if possible
* Intact or not intact
* Treatment recommendations vary based on TM

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23
Q

Treatment approach of OE:
* What do you do for pain?
* What is not indicated for local disease? What about more serious issues?

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24
Q

Treatment of OE:
* What is that mainstay txt?

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25
For OE therapy what does it lack literature of?
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OE txt: * What agents are safe and not safe when the TM is not intact of cannot be seen?
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What can you apply when the ear cannel is too swollen in OE for txt?
Wicks
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Fill in for OE txt?
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Patient education for eo * What do you tell them? * What is prevention
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Acute Otitis media * What is it? * Precipitated by what? * AOM may also be associated with what?
Acute otitis media (AOM) is an acute infectious process marked by infected middle ear fluid and inflammation of the mucosa lining the middle ear space. * Precipitated by impaired function of the eustachian tube * AOM may also be associated with purulent otorrhea
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What are the sxs of AOM in children
* Acute symptoms onset (< 48 hours) * Tugging, rubbing, holding ear * Irritability, crying * Decreased appetite * Changes in sleep * Fever * Upper respiratory tract symptoms
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Diagnosis of AOM – otoscopic exam * What do you see on exam? * What is not diagnostic?
PE * Bulging TM with impaired mobility * Otorrhea not secondary to OE * Intensely erythematous TM Middle ear fluid not diagnostic * Otitis media with effusion
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What does the TM look like in AOM?
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What are the organisms that cause AOM?
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What is the txt of AOM? (non-pharm)
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Antibiotic therapy * Who should have antibiotic txt and who can be watched?
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Treatment regimens of AOM * What do you give for first line? * What do you give if penicillin allergy?
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* What organisms of AOM can you use amox and amox/clav on? * What are sxs of H.flu infection? * What antibiotics should you use if reoccurance happens within a month and over a month?
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AOM prevention * What is no longer recommended? * When are tubes recommended?
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AOM prevention * What are the vaccies?
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Tympanic Membrane Perforation * How does it heal? * What does it allow? * Promotes what? * What can be added to therapy?
* Majority heal spontaneously * Allows drainage of infected fluid * Relieves middle ear pressure * Promotes quicker healing * Topical antibiotic drops may be added to oral therapy – exact benefit unproven
43
Tympanic Membrane Perforation * Patient should use appropriate water precautions?
* No head submersion (swimming, diving, etc) * Avoid getting water in the affected ear when bathing or showering (ie, use a cotton ball coated with petroleum jelly in the ear to create a barrier)
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Mastoiditis * what is it? * What is the MC organisms? * What is primary treatment?
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Mastoiditis * What are the sx?
46
What is this?
Mastoiditis
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Mastoiditis txt: * What do you consult ENT for? * What do you start?
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Mastoiditis txt: * What is the empiric antibiotic therapy without recurrent history of AOM and with With recurrent history of AOM / invasive disease (abscess, osteomyelitis)?
49
Barotrauma * What are the most common causes? * What are the symptoms?
MCC flying * Other causes: diving, decompression, hyperbaric oxygen chambers, and blast injuries Symptoms: ear pressure, pain, hearing loss, and tinnitus * Less common: TM rupture and bleeding
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Barotrauma * What are the treatments?
* Oral decongestants, antihistamines, nasal decongestant spray prior to flying * Swallowing or the Valsalva maneuver can equalize pressures and prevent tissue injury * Chewing gum or sucking on hard candies can help adults * Nursing or sucking on a bottle may help infants
51
What is grade 1 and 2 barotruma?
52
Dysfunction of eustachian tube (ET) * What is ET? * What are the three primary functions of ET?
ET is a valve-like connection between the middle ear to the nasopharynx Three primary functions: * Equalize pressure across ear drum * Protect middle ear from nasopharynx fluid * Clear out middle ear secretions
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Dysfunction of eustachian tube (ET) * What is the most common dysfunction? * What are sxs?
Most common dysfunction – difficulty equalizing pressure across tympanic membrane * Changes in pressure – flying or diving * Closed tube due to allergies or URI Symptoms: * Pain, ear plugging, decreased hearing or imbalance
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What are the ET dysfunction treatments?
55
Vertigo * Illusion of what? * What are the two types?
* Illusion of self motion or movement of the surrounding environment * Peripheral vs central
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Vertigo: * How does the dix hallpike show for perpheral vertigo and central vertigo?
Dix-Hallpike: peripheral * Delayed nystagmus * (2 to 40 seconds) * < 1 min * Moderate vertigo Dix-Hallpike: Central * Immediate nystagmus * > 1 min * Mild vertigo
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VERTIGO – BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) * MCC of what? * What is the pathophysio? * What are the sxs?
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Vertigo – Benign paroxysmal positional vertigo (BPPV) * How do you dx it? * What is the txt?
Dx: * exacerbation of vertigo with Dix-Hallpike maneuver Treatment: * Epley maneuver / modified Epley (TID until asymptomatic x 24 hours) * Medications – not helpful for short episodes; may help maneuver tolerance->Antihistamines, antiemetics, benzodiazepines
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Vestibular neuritis / labyrinthitis * Second MCC of what? * What is the pathophysio? * What are the sx?
Second MCC of vertigo * Viral etiology – effecting the vestibular portion of the 8th cranial nerve * Rapid onset of severe vertigo associated with nausea, vomiting, gait instability * ± tinnitus / hearing loss (vestibular neuritis + unilateral hearing loss = labyrinthitis)
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Vestibular neuritis / labyrinthitis * How do you dx and txt is?
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Vestibular suppressants * usually need what? * What is the first line? * reserved for what?
* Usually need IV * Antihistamine + antiemetic first-line * Reserve BDZ for refractory cases
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Meniere’s disease * What is the classic triad?
Classic triad: episodic vertigo, tinnitus, and hearing loss
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Meniere’s disease * What is the maintenance treatment?
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Meniere’s disease * What is the txt for acute attacks?
Acute attacks – similar to vertigo treatment
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Epistaxis * No specific definitions of what? * Severe generally?
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Anterior vs posterior blood supply * What are they?
69
FIRST STEPS of nose bleed? * What is needed? * What do you need to compress? * For how long? * How do you place the head? * What medication do you use?
## Footnote * Cheap, non-invasive * Obtain history during compression
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What are the next steps of a nose bleed if the compression does not work? * What do you do if bleeding site is identified and not identified?
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NASAL POLYPS * What is it? * Associated with? * What can happen? * What can increase infections? What does that cause?
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NASAL POLYPS * What are sxs?
* Repeat sinus infections * Decreased smell, snoring, sleep apnea
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Nasal polyps * What is first line txt? What do they cause? * What is second line?
First-line: * Nasal corticosteroids * Decrease nasal mucosal inflammation * Decrease polyp size * Increased nasal airflow * ± leukotriene antagonists Second-line: * Surgical removal * Recurrence common ## Footnote ± leukotriene antagonists:Monteluast, zafirlukast * Neuropsych SE
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What are the different nasal corticosteroids? * What ADRs?
ADRs: nasal irritation, epistaxis, stinging
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Allergic rhinitis * What is it? * What type of reaction? * What does it cause?
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What is the different normal and allergic reaction?
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Allergic rhinitis treatment * What is for all patient
Allergy avoidance – Nasal irrigation
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Allergic rhinitis treatment * What is the txt if the pt has mild symptoms and know allergen?
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Allergic rhinitis treatment * What is the txt if the pt has mod symptoms?
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What are the two inhaled antihistamines meds? What are the adverse reactions?
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Viral Sinusitis * Acute viral rhinosinusitis (AVRS) usually precedes what? When do sx improve? * What are the most common organisms?
* Acute viral rhinosinusitis (AVRS) usually precedes acute bacteria rhinosinusitis (ABRS) * Improvement/resolution within 10 days * MC organisms: rhinovirus, adenovirus, influenza, parainfluenza
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Viral Sinusitis * What are the symptoms? * What does 0.5 to 2% progress to what?
Sinus mucosa edema, ostia obstruction, decreased mucociliary clearance * Increase in stagnant secretions – good environment for bacterial growth * Only 0.5 to 2% progress to ABRS
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What is the txt of viral sinusitis?
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ACUTE BACTERIAL RHINOSINUSITIS * What is it presumed with? * What are other potential symptoms?
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When are the maxillary, ethmoid frontal and sphenoid developed?
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ABRS First-line antibiotic therapy * What are the mc organisms?
: S. pneumonia, H. influenza, M. catarrhalis
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# acute bacterial infection What is the first line therapies for pediatric and adult patients?
Pediatric patients: * High dose amoxicillin or amoxicillin-clavulanate (90 mg/kg/day) * Duration: 10 to 14 days Adult patients: * Amoxicillin 500mg PO TID or 875mg PO BID or * Amoxicillin-clavulanate 875/125mg PO BID * Duration: 5 to 7 days ## Footnote If pinned against, then amox/clav dt older guidelines (have not caught up)
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# FYI ABRS – second-line antibiotic therapy * What are the adults and pedatirc second line?
91
Tooth infections * What are the MCC? * What is the etiology?
* MCC = dental caries or periodontal disease (gingivitis / periodontitis) * Etiology: polymicrobial including viridians group streptococcus, Peptococcus, Peptostreptococcus, Prevotella
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Tooth infections * What are the first line? * What are the penicillin allergic?
First-line: * **Amoxicillin** * Penicillin * Amoxicillin/clavulanate Penicillin allergic: * Azithromycin or clindamycin
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What are the complications of tooth infections?
* Cellulitis * Abscess formation * Sinusitis * Ludwig’s angina – bilateral infection of submandible causing posterior displacement of tongue * Surgical drainage of abscess required if present * Watch airway
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Oropharyngeal Candidiasis * What are the MCC organism * What does it look like and issues that happen? (3)
MCC Candida albicans * White patches overlying inflamed mucosa of buccal and pharyngeal mucosa, palate, and tonsils * Angular cheilitis * Lower tract disease (esophagitis): dysphagia or odynophagia
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Oropharyngeal Candidiasis * What is the txt of mild disease? * What is the txt of moderate to severe disease?
Mild disease: * Clotrimazole troches 10mg 5x/day x 7 to 14 days * Nystatin 5 mL swish and swallow QID x 7 to 14 days (DOC for infants/children) * Not systemic absorb Moderate to severe disease and/or HIV positive: * Fluconazole 100 to 200 mg PO daily x 7 to 14 days
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What is the HSV txts for immunocompromised and immunocomponent? * When should txt be started?
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Laryngitis * What is it? * How long does it last for acute and chronic? * What is the MCC organisms * What are the SX?
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Laryngitis * What is management?
Management of hoarseness depends on the underlying cause * Treatment mostly supportive: * Voice rest, avoid irritants (smoking), steam inhalation
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Pharyngitis-Viral * What are the organisms? * What is the txt?
101
Streptococcal pharyngitis * Which organism is it? * MMC of what? Age? * What are the treatment goals?
Streptococcus pyogenes AKA Group A Streptococcus (GAS) * MCC of bacterial pharyngitis (viral MC overall) * MC in children > 2 years and adolescents Treatment goals: * Reduce duration and severity of symptoms * Prevent acute and delayed complications: Peritonsillar abscess, Rheumatic fever * Prevent the spread of infection to others
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Streptococcal pharyngitis * What is the DOC and what are the alternatives if pen allergic or vomitting ? * When can you retur to school or work
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What are the modified centor criteria?
104
# She skipped this slide so idk What are the post streptococcal complications?
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Peritonsillar cellulitis * What is it?
inflammatory reaction of the tissue between the tonsil/pharyngeal muscles and capsule of the palatine tonsil but not associated with a discrete collection of pus
106
Peritonsillar abscess * What is it? * Who is it common in? * What are the MC organisms? * Wht are the symptoms?
a deep neck infection – abscess (discrete pus collection) between the tonsil/pharyngeal muscles and capsule of the palatine tonsil * MC young adults between 15 and 30 years of age * MC organisms S. pyogenes, Fusobacterium necrophorum, **Streptococcus angiosus**, anerobic bacteria * Symptoms: high fever, odynophagia, unilateral sore throat, otalgia, muffled voice (hot potato voice), trismus (cannot open mouth)
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Peritonsillar abscess/cellulitis * What is the txt?
108
RETROPHARYNGEAL ABSCESS * What does it look like on CT and what do you do?
Drain and anx similar to peritonsillar abcess so (clinda, or metro+ceftriaxone, or amp/sulf, or pip/tazo)
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What are the three major salivary glands?
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Acute suppurative Sialadenitis * What is it? What glands are affected? * Salivary stasis from what? * Retrograde contamination from what? * Who has an increase risk?
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Acute suppurative Sialadenitis * What are the mc organisms? * What are the symptoms
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Acute suppurative sialadenitis * What is the txt? (non pharm)
* Hydration * Warm compresses * Gland massage – express purulent material * Analgesics * Sialagogues (things to stimulate salivary glands) * Discontinue offending agents
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Acute suppurative sialadenitis * What is the txt? ( pharm)
## Footnote Treatment duration: 10 to 14 days (may change to oral therapy when appropriate)
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Viral parotitis * What is the MCC? * MC in who? * What are the sxs?
MCC mumps * MC unvaccinated children (2 to 9 years) * Prodrome: fever, HA, myalgia, fatigue, anorexia * With 48 hours: salivary gland swelling * Initially unilateral - 90% bilateral
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Viral parotitis * When does it resolve? * What are the complications? * What is the txt? * what is the prevent?
117
Leukoplakia * what is it? * Malignany? * Prevalence rate is what? * What are the risk factors?
White patches on the oral mucosa that cannot be wiped off with gauze * Oral potentially malignant disorder (OPMD) – 5% develop into squamous cell carcinoma * Prevalence rate of approximately 4 percent * Risk factors include tobacco use (smoked and especially smokeless) and alcohol drinking
118
Leukoplakia * What are the two forms? * The diagnosis of leukoplakia requires what? * What is the txt?
Two forms: * Homogeneous * Nonhomogeneous (higher risk of oral cancer) * The diagnosis of leukoplakia requires a biopsy for histopathologic examination Treatment * Excision vs conservative approach
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Oral Hairy leukoplakia * What is it? * Affects what? * MC in who? * What virus is assoicated with it? What is it not associated with it? * What is therapy?

Pharmacology (14 decks)

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