Nasal physiology and conditions Flashcards by Samantha Hughes

What is the main role of the nose?

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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What part of the nose detects smell

Olfactory epithelium

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What is the role of. the nasal turbinates?

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

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Name 8 roles of the Nose

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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What are the 4 main types of rhinitis

Allergic rhinitis - hayfever
Non allergic vasomotor rhinitis
Infectious rhinitis
Rhinorrhoea

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What is the mechanism of decgonestants?

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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What is the difference between direct and indirect acting sympathomimetics?

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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Name decongestants and state their formulations

Ephedrine Intranasal
Pseudoephedrine oral
Phenylephrine Oral
Xylometazoline Intranasal

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What decongestant is a direct alpha 1 agonist?

Phenylephrine

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

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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Name intranasal glucocorticoids

Fluticasone
Beclometasone
Mometasone
Betmethasone

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

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

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What is the mechanism of antihistamines?

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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Name non-sedating. antihistamines

Loratadine
Cetirizine
Acrivastine

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What is an intranasal H1 antagonist (antihistamine)?

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

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

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

What is allergic rhinitis?

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.

How is allergic rhinitis treated?

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

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

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

What is infectious rhinitis?

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

What is rhinorrhoea? how to treat?

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

How often a day can intranasal antihistamines be used?

What is the onset?

2-4 times a day

15mins

How often a day can oral antihistamines be used?

What is the onset?

Once daily

onset within an hour

How often a day can intranasal cotricosteroids be used?

What is the onset?

Once daily

onset in 12hours

What is sinusitis? What are the symptoms?

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

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

<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)

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

Phenoxymethylpenicillin 500mg QDS for 5 days If severe. - use of co-amoxiclav

What is nasal staphylococci?

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

How is nasal staph treated?

Chlorhexidine and neomycin (Naseptin) QDS for 10 days

What is the mechanism of neomycin?

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

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

Mupirocin ointment | Inhibits. bacterial protein synthesis and RNA synthesis

How long can you use mupirocin for?

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

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

Chlorhexidine and neomycin

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

- 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