Mouth/ Throat Flashcards
bacterial pharyngitis bacteria that causes
Group A Beta hemolytic streptococcal infection
bacterial pharyngitis patient presents with
Fever over 38 degrees C
Tender anterior cervical adenopathy
lack of a cough
Pharyngotonsillar exudate
bacterial pharyngitis symptoms and likelihood
1 symptom unlikely it is bacterial pharyngitis
and 3 symptoms it is about 90% likely that it is bacterial pharyngitis
bacterial pharyngitis treatment
Penicillins/Cephalosporins 1st gen
Erythromycins/Macrolides
Is gray furry tongue likely seen in bacterial or viral pharyngitis?
bacterial
Are red swollen tonsils seen in bacterial or viral pharyngitis?
both
Penicillin adverse evetns / side effects
hypersensitivity
mild diarrhea, vomitingn nausea, oral candidiasis
describe the hypersensitivity experienced by some patients taking penicillins
rash, hives, itching, swelling of lips, tongue, mouth, or throat
describe the hypersensitivity experienced by some patients taking penicillins
rash, hives, itching, swelling of lips, tongue, mouth, or throat
what should you monitor in patients taking penicillin for bacterial pharyngitis
monitor for signs of anaphylaxis during first dose
also monitor for opportunistic infections
opportunistic infections associated with penicillin and bacterial pharyngitis
fever, chills, unhealed sores, white plaques in mouth or vagina, purulent vaginal discharge, fatigue
Penicillin drug interactions Probenecid
Probenecid may increase the serum concentration of Penicillins
Penicillin drug interactions Tetracycline Derivatives
Tetracycline Derivatives: May diminish the therapeutic effect of Penicillins
Bacteriostatic with bactericidal
Penicillin drug interactions Warfarin
Penicillin may enhance the anticoagulant effect of Vitamin K Antagonist-warfarin
Erythromycin, Macrolides mechanism
Inhibitor of translation and transcription
what drug is given to patients with bacterial pharyngitis that have a penicillin allergy
Erythromycin, Macrolides
Erythromycin, Macrolides adverse events and side effects
hypersensitivity abdominal pain, anorexia, diarrhea (GI disturbances) Qt prolongation pruritus, rash ototoxicity, hearing loss cholestatic jaundice
What should you monitor in patients taking Erythromycin, Macrolides?
ask patients to report immediately any unusual malaise, nausea, vomiting, abdominal colic, or fever; skin rash or itching; easy bruising or bleeding
Erythromycin, Macrolides drug interactions
Effects on CYP450
Macrolides unlabeled use
serve as a gastrointestinal pro kinetic, which serve to increase the movement of ingested material through the GI tract
Acute Laryngitis cause
usually a viral cause
possible bacterial causes are M catarrhalis and H influenzae
Treatment for acute Layngitis
erythromycin (macrolide)
cefuroxime
amoxicillin-clavulanate (Augmentin)
RIH or RAS
few to several vesicles that are shallow with punctate ulcers, attached to the gingiva and hard palate, lasting 1 to 3 weeks, due to a virus
Recurrent Intraoral Herpes (RIH)
RIH or RAS
one to a few ulcers with erythematous halo on the burial mucosa, floor of the mouth, oropharynx, vitiable, tongue lasting one to two weeks
Recurrent Aphthous Stomatitis (RAS) (canker sores)
off label treatment for Viral-Herpes Simplex
Acyclovir, Valacyclovir, Famciclovir
Acyclovir
Viral-Herpes Simplex treatment needs to be used within 3 days of onset for 10 days
Valacyclovir
Viral-Herpes Simplex treatment prodrug of acyclovir
Famciclovir
used for Viral-Herpes Simplex treatment with no randomized control trials
Pain and fluid management for Viral-Herpes Simplex treatment
ice, popsicles, or rinse and expectorate every two hours with diphenhydramine mixed with magnesia-aluminum 1:1
Topical lidocaine
Fluids as tolerated
Adverse events/Side Effects of antiherpetic
malaise, headache
Drug Interactions of antiherpetic
Acyclovir-Valacyclovir, Famciclovir may diminish the therapeutic effect of Zoster Vaccine
discontinue antiviral agents with anti-zoster activity for at least 24 hours prior to and 14 days after receiving a live attenuated zoster vaccine
Fungal-Oral Candidiasis First line treatment
topical due to less adverse events and drug interactions ystatin Suspension 1:100,000 first choice
Fungal-Oral Candidiasis oral prototype
Fluconazole
Binds to sterols in fungal cell membrane, changing the cell wall permeability allowing for leakage of cellular contents
Fungal-Oral Candidiasis adverse effects
Increased Alkaline phosphatase, ALT, AST, hepatic failure (rare), hepatitis, jaundice
Angioedema (rare)
What should you monitor in patents with Fungal-Oral Candidiasis treatment
Periodic liver function tests (AST, ALT, alkaline phosphatase)
Renal function tests: baseline SrCr
Potassium levels
QT prolongation
Fungal-Oral Candidiasis treatment interactions
Inhibits CYP1A2 (weak), CYP2C19 (strong), CYP2C9 (strong), CYP3A4 (moderate) Increase the serum concentration of Atorvastatin, simvastatin Citalopram Phenytoin Proton Pump Inhibitors Sulfonylureas Vitamin K Antagonists
May decrease the metabolism of
Benzodiazepines
Carbamazepine
Losartan
May enhance the adverse/toxic effect of
Calcium Channel Blockers
Fungal-Oral Candidiasis Treatment in pregnancy
Pregnancy category C (single dose for vaginal candidiasis)/D (all other indications)
Ketaconazole
used for Fungal-Oral Candidiasis needs to be taken with breakfast Treatment requires acidic gastric environment
