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ENT > Medications > Flashcards

Medications Flashcards

1
Q
  • older H1 antagonists, work well for most allergic rhinitis sxs.
  • with prolonged use, patient tolerance to side effects improves
  • usually taken QHS
  • class is more lipid soluable and cross the blood brain barrier
A

1st generation antihistamines

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2
Q

what are the usual side effects of 1st generation anithistamines? what medications are 1st generation?

A

side effects: Drowsiness, cognitive impairment, driving skills affected , anticholinergic effects

meds: chloropheniramine, diphenhydramine (benedryl)

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3
Q
  • one of the safest during pregnancy
  • competes with histamine on H1 receptor sites of blood vessels and respiratory tract
  • for >2y/o dose by age and weight in peds
A

Chlorpheniramine

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4
Q
  • also safe in pregnancy
  • competes with histamine on H1 receptor sites of blood vessels and respiratory tract
  • for >3y/o, dose by age and weight in peds
A

Diphenhydramine

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5
Q
  • newer antihistamines, aka nonsedating antihistamines
  • compete with histamine on H1 receptor sites of blood vessels, GI tract and respiratory tract inhibiting the effect that histamine would have on the cell
  • lower rate of sedation and anticholinergic effects
  • help with allergic rhinitis sxs, but not nasal congestion (combination)
A

2nd generation antihistamines

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6
Q

which medications are 2nd generation antihistamines?

A

fexofenadine (allegra)
loratadine (claritin)
certirizine (Zyrtec)- can be used >6months , dose by weight for peds, >6 y/o dose as adult

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7
Q
  • highly efficacious for allergic rhinitis, more effective than monotherapy with antihistamines
  • controls the 4 major sxs of allergic rhinitis (sneezing, itiching, rhinorrhea, congestion)
  • poor control of ocular symptoms
  • not associated with significant systemic effects in adults (preg. Category B)
  • can cause nasal dryness and epistaxis
  • works better when used daily instead of PRN
  • tolerance with prolonged use
A

corticosteroid nasal spray

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8
Q

prevention and pain control for otitis media

A

Prevention
* vaccines (pneumococcal, influenza, HIB…)
* environmental factors (pets/allergies, tobacco exposure)
* bottle feeding in bed

Pain management
* ibuprofen 10mg/kgs po TID prn pain best per studies
* acetaminophen 10-15mg/kg q 4-6 hrs prn for pain
* auralgan (topical benzacaine)- rapid improvement in pain

acetaminophen helps with pain, but not inflammation

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9
Q

what does not improve or have any benefits for otitis media

A
  • antihistamines & decongestants do not improve healing or minimize the complications
  • corticosteroids (PO) have shown no benefit in treating AOM
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10
Q

who are antibiotics recommended for in AOM treatment?

A
  • all children <6m/o with findings consistent with AOM
  • children <2 y/o with bilateral AOM
  • children with AOM with Otorrhea
  • children 6 m/o to 2 y/o when the diagnosis is certain
  • children > 2y/o with severe infection/illness (Moderate otalgia of tem >39 degrees)
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11
Q

what is the 1st line antibiotics selection for AOM?

A

high-dose amoxicillin 80-90mg/kg PO BID x 10 days
* children 2-6 y/o can be treated for 5-7 days
* amoxicillin is safe, effective, inexpensive and has a narrow spectrum of activity

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12
Q

what is 2nd line for treatment of AOM?

A
  • amoxicillin/Clavulanate (augmentin) 80-90mg/kg/d x10d
  • cefuroxime axetil (Ceftin) 30mg/kg/day BID x 10d
  • ceftriaxone (rocephin) 50mg/kg IM daily x 3 days
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13
Q

Treatment for persistent AOM treatment
* if already on antibiotic therapy and not improved

A

Azithromyin (3 dosing patterns)
* 30mg/kg one-dose, 20mg/kg/D x3D, 5-10mg/kg/d x 5D
* Augmentin (amox+clavulanic acid) high dose @ 90mg/kg/day BID x 10D
* clindamycin (cleocin) 30-40mg/kg/day TID/QID x 10D
* If allergic to PCN (cephalosporins, TMP sulfa, or macrolides

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14
Q

treatment of tympanostomy tube ottorhea in kids?

A
  • tx w/ topical abx ear drops, with or without corticosteroids
  • oxfloxacin 5 drops BID x 5-7 days
  • if granulation tissue, add topical steroid (cipro/dexamethasone)
  • topical failures, switch to PO antibiotics (amox, clavulanate)
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15
Q

what is the dosing for ibuprofen?

A

10mg/kg PO TID PRN

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16
Q

what is dosing of acetaminophen?

A

10-15mg/kg Q 4-6 hours PRN

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17
Q

treatment of bacterial otitis externa

A
  • 2% acetic acid drops to restore normal flora, or:
  • cortisporin Otic
  • polymyxin B
  • ofloxacin 0.3% (for use with TM rupture)
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18
Q

Dosing for high dose amoxicillin?

A

80-90mg/kg PO BID x 10 D

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19
Q

Dosing for amoxillin/cavulanate (augmentin)

A

80-90mg/kg/d x 10d

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19
Q

What treatment should be used for patients with otitis externa in toxic state or unresponsive to treatments

A
  • dicloxacillin
  • if severe pain & granulation - Parenteral
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20
Q

treatment of fungal otitis externa

A
  • cleanse canal, acidifying drops
  • if not resolved- OTC 1% clotrimazole
  • if TM perforated- tolnaftate
  • all tx above 3-4 drops BID x 7 days
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21
Q

Treatment of the common cold?

A

decongestants +/- 1st generation antihistamines
*Relieve nasal symptoms, cough
*antihistamines alone not recommended
*rest and hydration
*intranasal steroids not recommended

22
Q

MOA: sympathomimetic alpha adrenergic agonist; vasoconstricts blood vessles to decrease swelling and discharge
* absorbed in the gut/urine excreted
* much better absorbed than phenylephrine
* routes: Oral

A

Pseudophedrine

23
Q

what are adverse effects of pseudophedrine? what are contraindactions?

A

AE: tachycardia, decreased appetite, elevated BP &HR, insomnia
contraindication: cardiac disease, HTN, glaucoma, during/within 14 days of MAOI use

24
Q

MOA:sympathomimetic alpha adrenergic agonist; vasoconstrict blood vessels to decrease swelling and discharge

  • absorbed in the gut (only 38% bioavailable)
  • routes: oral, intranasal, IV/injectable
A

phenylephrine

25
Q

MOA: sympathomimetic alpha adrenergic vasoconstriction; decreases mucosal edema

  • absorbed through the mucous membranes, onset in 10 minutes
  • route: intranasal
  • same adverse effects as pseduophedrine but also rhinitis medicamentoa
A

oxymetazoline

26
Q

what medications are decongestants?

A

pseudophedrine
phenylephrine
oxymetazoline

27
Q

which medications are expectorants?

A

Guaifenesin

28
Q

which medications are antitussives?

A

dextromethorphan
codeine
hydrocodone

29
Q

MOA: increases the effective hydration of the respiratory tract; reduces viscosity of mucus, facilitating its removal by natural clearance processes
Route: PO (liquid and tablet)
pharmacokinetics: Well absorbed, excreted in urine

A

guaifenesin

30
Q

adverse effects of gauifenesin? Contraindications?

A
  • AE: N/V, dizziness, drowsiness, headache, rash, nephrolithiasis
  • cautions: hypersensitivity to drug/class/component, nephrolithiasis, patients < 6
31
Q
  • MOA: central depression of the cough center (medulla oblongata) uncompetitive NMDA receptor antagonist and sigma-1 receptor agonist
  • absorbed in the gut, processed in the liver
  • route: oral (liquid and pill/capsule)
  • adverse effects: N/V, diarrhea, drowsiness, nervousness, restlessness
A

dextromethorphan

32
Q

contraindications of dextromethorphan?

A

children <4 y/o
do not use if using MAO inhibitor

33
Q

MOA: central depression of the medulla oblongta
* commonly combined with promethazine (an antihistamine) in cough syrup; one of the most commonly prescribed antitussives, but some research shows not effective at reducing cough in acute URI
* absorbed in gut, processed in liver, exreted by kidney
* Route: Oral

A

Codeine

34
Q
  • Not effective as monotherapy in treating the common
  • studies show that combined with a decongestant, more effective than either drug
  • diphenhydramine may offer some relief of rhinorrhea and sneezing but side effects make it impractical
A

antihistamines

35
Q

treatment for pediatric patients with URI or sinusitis?

A
  • good hydration, humidifier
  • rest, elevate head of bed
  • nasal saline with suction
  • warm liquids, honey

OTC medications:
Children 0-12: antipyretics/analgesics
children >12: as above + decongestants

36
Q
  • First line treatment in bacterial sinusitis?
A
  • Amoxicillin
    *augmentin for tx failures
37
Q

which antibiotics can be used to treat bacterial rhinosinusitis?

A
  • amoxicillin/augmentin
  • erythromycin/azithromycin
  • levofloxacin
  • TMP-sulf
  • doxycycline
  • clindamycin
38
Q
  • these drugs have potent glucocorticoid and weak mineralcorticoid activity
  • have multiple mechanisms of action, including anti-inflammatory activity, immunosuppressive properties, and antiproliferative actions
  • anti-inflammatory result from decreased formation release and mediators of inflammation
A

Nasal steroid

39
Q

which medications are steroids?

A

Mometasone
fluticasone
budesonide

40
Q

MOA: Anti-inflammatory glucocorticosteroid for the once daily treatment of non-infectious rhinitis, and treatment and prevention of nasal polypsis
* May decrease the # and activity of inflammatory cells
* reduces intraepithelial eosinophilia & inflammatory cell infiltration
* no mineralcorticoid or androgenic effects
* can be used in as young as 2 years old

A

memetasone

41
Q
  • MOA: Anti-inflammatory glucocorticosteroid for the once daily treatment of non-infectious rhinitis, and treatment and prevention of nasal polypsis
  • may decrease the # and activity of inflammatory cells
  • for use as an adult in 4 >y/o
A

fluticasone

42
Q

MOA: Anti-inflammatory glucocorticosteroid for the once daily treatment of non-infectious rhinitis, and treatment and prevention of nasal polypsis
*may decrease the number of activity of inflammatory cells
*has an H2O component, which decreases drying, irritating effect. Better tolerated

A

budesonide

43
Q

benefits of intranasal antihistamines vs. PO

A
  • Delivers higher concentration directly to tissue
  • less ADR than oral (only has bitter taste, epistaxis, sedation, irritation)
  • onset of action within 15 minutes and lasts up to 4 hours

Still 2nd line therapy due to cost, ADRs, efficacy compared to steroid

44
Q

which medications are intranasal antihistamines?

A

azelastine, oloptadine

45
Q
  • MOA: inhibits degranulation of mast cells
  • OTC and safe but decreased efficacy and compliance (QID)
A

cromolyn

46
Q
  • MOA: antagonizes acetylcholine receptors, inhibiting nasal mucous gland secretions
  • not systemically absorbed
  • great for excessive rhinorhhea
  • ADR: mucosal dryness, epistaxis, HA
  • ipratropium is an example
A

Intranasal anticholinergics

47
Q
  • MOA: Works as a leukotriene receptor antagonist, preventing their release from mast cells and eosinophils
  • An oral antihistamine alternative
  • for seasonal and perennial, also used for long-term asthma control and exercisie induced bronchospasms
  • ADR: URI, fever, HA, pharyngitis, cough, abdominal pain and neuropsychiatric and suicidality ADR
A

Montelukast (singulair)

48
Q

first line alterantive to PCN in URI and sinusitis

A

Doxycyline

49
Q

when should you treat acute otitis media in children?

A

most children will improve with watchful waiting
* if still symptomatic in 48-72 hours–> treat
* minimize risk factors: tobacco exposure, pacifier use, bottle feeding, daycare attendance
* follow-up in 8-12 weeks

50
Q

what are some UNPROVEN therapies in AOM?

A
  • decongestants & antihistamines- increased ADRs, without improved healing
  • if child has AOM as a result of allergic rhinitis nasal steroid is better option
51
Q

how should you treat OM with effusion?

A
  • persistent middle ear effusion after resolution of AOM is not treatment failure (requires Q3-6m monitoring and reassurance)
  • tympanostomy (PE tubes) is preferred therapy for prolong effusion and advere sequelae (hearing, language delay)
  • oral or nasal steroids may help with short term resolution but does not decrease long term recurrences
52
Q

Bacterial etiology of tympanostomy tube ottorhea in kids

A
  • Children < 2yo
    s.pneumonia, M. cattarhalis, H. influenzae
  • Children > 2yo
    Pseduomonas aeruginosa and staph. aureus

ENT (13 decks)

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