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PM3A > Nasal physiology and conditions > Flashcards

Nasal physiology and conditions Flashcards

1
Q

What is the main role of the nose?

A

Air conditioning

Adjusts temperature and humidity of the air before entering the lungs to ensure it is the correct amount of moisture.

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2
Q

What part of the nose detects smell

A

Olfactory epithelium

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3
Q

What is the role of. the nasal turbinates?

A

Adjusts the air before entering the lungs - warms and moisturises, includes. the concha

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4
Q

Name 8 roles of the Nose

A

1- breathing
2- air conditioning, nasal mucosa adjusts temp/humidity
3- Purification & filtration where hairs (nares) filter and trap large particles and mucus traps smaller particles to go into the nasopharynx and swallow. Secretions also have enzymes to kill microorganisms, antibodies IgA
4- sinus ventilation - makes mucus to moisturise and protect
5- Nasal resistance - maintains positive pressure
6- Olfaction/smell - olfactory epithelium
7- Vocal resonance - chamber. - N, M, NG
8- nasal vessels/flow and secretions controlled by PNS

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5
Q

What are the 4 main types of rhinitis

A

Allergic rhinitis - hayfever
Non allergic vasomotor rhinitis
Infectious rhinitis
Rhinorrhoea

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6
Q

What is the mechanism of decgonestants?

A

Sympathomimetic amines cause vasoconstriction to limit the effects of histamine. Work on alpha. and beta. adrenoceptors via noradrenaline. Vasoconstriction reduces nasal blood flow/oedema

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7
Q

What is the difference between direct and indirect acting sympathomimetics?

A

Direct acting = act directly on noradrenergic receptors

Indirect = taken up via NET transporter to stimulate NA release on the alpha receptors

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8
Q

Name decongestants and state their formulations

A

Ephedrine Intranasal
Pseudoephedrine oral
Phenylephrine Oral
Xylometazoline Intranasal

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9
Q

What decongestant is a direct alpha 1 agonist?

A

Phenylephrine

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10
Q

What are the effects of glucocorticoids, and what are they used for?

A

Glucocorticoid receptor agonists which have Anti-inflammatory effects to reduce inflammation and itch.
Commonly used in allergic rhinitis and allergic conjunctivitis.

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11
Q

Name intranasal glucocorticoids

A

Fluticasone
Beclometasone
Mometasone
Betmethasone

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12
Q

What is the mechanism of sodium cromoglicate (cromolin) and what is it used for?

A

suppresses pro-inflammatory mediator release (histamine) - stabilises mast cells. Used for allergic rhinitis

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13
Q

What is the mechanism of antihistamines?

A

H1 antagonist - Act on H1 histamine receptors to suppress histamine release and reduce histamine related effects e.g. vasodilation, itch, sneezing.

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14
Q

Name non-sedating. antihistamines

A

Loratadine
Cetirizine
Acrivastine

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15
Q

What is an intranasal H1 antagonist (antihistamine)?

A

Azelastine - good as it works quicker than oral and has localised effects.

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16
Q

What can anticholinergics be used for and outline their mechanism, providing an example

A

Used for rhinorrhoea
Works on the parasympathetic nervous system to block secretions (muscarinic Ach m3 antagonist)
e.g. Intranasal ipratropium

17
Q

What is allergic rhinitis?

A 
Inflammation of the mucosa due to. allergens - class 1 hypersensitivity reaction which is. IgE antibody on mast cells stimulating histamine release.
Causes swelling, wheeze, itching, runny nose.
18
Q

How is allergic rhinitis treated?

A

1- remove allergen
2- antihistamines to suppress histamine effects - sneezing, itch, runny nose, watery eyes. (can also use sedating at. night if. itch keeps awake)
3. Could use. short term nasal decongestants - e.g. ephedrine, xylometazoline
- can. also use short term corticosteroids to help with inflammation and itch - beclometasone, fluticasone (perrsistent symptoms)
Short term if nasal blockage or polyps

19
Q

What is non-allergic vasomotor rhinitis and what can treat it?

A

Inflammation of the mucosa and congestion but not due to allergens.
Can use decongestants e.g. intranasal ephedrine or oral pdeudoephedrine.
For the rhinorrhoea can use topical ipratropium bromide
- No antihistamines

20
Q

What is infectious rhinitis?

A

Due to cold/virus - increased. nasal blood flow and blood vessel permeability - symptomatic control until passes

21
Q

What is rhinorrhoea? how to treat?

A

Excess watery nasal mucous secretions from the mucosa - usually self limiting
Can use topical ipratropium bromide spray

22
Q

How often a day can intranasal antihistamines be used?

What is the onset?

A

2-4 times a day

15mins

23
Q

How often a day can oral antihistamines be used?

What is the onset?

A

Once daily

onset within an hour

24
Q

How often a day can intranasal cotricosteroids be used?

What is the onset?

A

Once daily

onset in 12hours

25
Q

What is sinusitis? What are the symptoms?

A

Infection e.g. due to acute rhinovirus. which causes inflammation and nasal mucosa build up.
- sinus headache, jaw/facial pain, blocked nose, fever, bad breath, toothache

26
Q

What are the treatments for sinusitis if :
<10 days
>10 days with no improvement
>10 days

A

<10 days is self care, pain relief. No antibiotics
>10 days with. no improvement can give intranasal corticosteroids for 14 days
>10 days can give a back up prescription due to risk of secondary bacterial infection. Phenoxymethylpenicillin 500mg QDS for 5 days (if severe = co-amoxiclav)

27
Q

If a patient with sinusitis requires a back up prescription, what would be provided?
If the infection was severe - what drug would be used?

A

Phenoxymethylpenicillin 500mg QDS for 5 days

If severe. - use of co-amoxiclav

28
Q

What is nasal staphylococci?

A

Staph infection by staph. aureus, Usually goes away on its own but sometimes need to be treated

29
Q

How is nasal staph treated?

A

Chlorhexidine and neomycin (Naseptin) QDS for 10 days

30
Q

What is the mechanism of neomycin?

A

Aminoglycoside - inhibits bacterial protein synthesis by irreversibly binding to the. 30S subunit of the bacterial ribosome.

31
Q

If nasal staph is MRSA. - what should be used and what is its MoA?

A

Mupirocin ointment

Inhibits. bacterial protein synthesis and RNA synthesis

32
Q

How long can you use mupirocin for?

A

Cannot use for more than 7 days and cannot have repeated use

33
Q

If the MRSA is mupirocin resistant and does not respond after 2 courses - what should be used?

A

Chlorhexidine and neomycin

34
Q

What counselling advice would you give to someone who has allergic rhinitis?

A
  • sunglasses to cover eyes
  • disposable contact lenses so pollen doesn’t build up
  • avoid the trigger/avoid allergens, avoid at high counts
  • Wash hair so its not in hair
  • Don’t dry clothes outside
  • loose clothing
  • can have eye drops to wash out the eye

PM3A (17 decks)

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