Otorhinolaryngology--ENT

Question 1

antihistamines, decongestants, expectorants, corticosteroids, antibiotics and other anit-infectives

Answer 1

ENT drugs (Ear, nose and throat)

Question 2

‘Neo-synephrine’ nasal spray (phenylephrine)–doesn’t last as long as–>’ Afrin’ nasal spray (oxymetazoline)

Answer 2

topical decongestants

Question 3

reduce blood flow to edematous mucous membranes in the nose, sinuses and banks by vasoconstriction to decrease swelling and also open eustachian tubes to even the pressure on both sides of the tympanic membrane (ear drum)

Answer 3

alpha-adrenergic receptor agonists

Question 4

Sudafed (Pfizer’s original formulation with pseudoephedrine–amphetamine class)–which now contains phenylephedrine
Contact (and most others now contain phenylephedrine)

Answer 4

Oral OTC decongestants

*phenylephrine now considered less effective but pseudoephredrines are pretty much banned

Question 5

CNS stimulation, insomnia, anxiety, restless and irritability

Answer 5

side effects of decongestants–oral mostly, which often used to contain ephedrine and pseudoephedrine
*phenylephrine (topical) tends to have less of these

Question 6

These drugs block the H1 Rc on cells found in
the nose and throat. When the H1 rc are blocked,
histamine, which is released from mast cells, cannot bindand cause allergic effects.

Answer 6

Antihistamines
*used in the treatment of hay fever, but have no proven benefits in the treatment of the common cold (even though they are found in numerous OTC cold remedies)

Question 7

They belong to the “-leukast” family of drugs, e.g.
montelukast, and there has only been a few of these drugs developed, to date;
They block these inflammatory mediators (eicosanoids) produced in the arachidonic acid pathway

Answer 7

Leukotriene blockers

*Leukotriene Rc blocker drugs have been approved only for the treatment of asthma, and severe hay fever not responding to antihistamine therapy

Question 8

Singulair (montelukast) by Merck
Accolate (zafirlukast) by Zeneca Pharmaceuticals
» Ultair (pranlukast) by SmithKline Beecham has been approved in Europe and Japan, and is in late stage trials for use in this country

Answer 8

Leukotriene blocker drugs

Question 9

Used for allergies and asthma;
These drugs coat mast cells and prevent the release of their histamine granules (which precipitate the allergic reaction/cause the
symptoms of an allergic reaction)
Theyrevent degranulation and release of histamine
and other inflammatory mediators, they are effective for prophylaxis only - once the allergic reaction has occurred, only α-agonist (oxymetazoline or phenylephrine), will be immediately helpful.
Antihistamines should also be taken before the allergic reaction occurs!

Answer 9

Mast Cell Stabilizers

*cromolyn (NasalCrom) was the first of this type of drug (the prototype) and is still in widespread use

Question 10

-Used for a range of mild to severe conditions (i.e. skin reactions or Rheumatoid arthritis)
-first introduced in the 1950’s as the “miracle drug”
used to lower inflammation
-effective for upper airway (rhinitis, sinusitis, allergies, mouth lesions/swelling, chronic ear inflammation
*potentially for canker sores–not proven
*have a number of side-effects

Answer 10

CORTICOSTEROIDS

i. e. Flonase (fluticasone) and Nasacort (triamcinolone)
* Even though generally only used locally, they still have some absorbtion systemically

Question 11

Oral antibiotics (i.e. to treat Strep):
pen VK, amoxicillin, Biaxin (clarithromycin), ciprofloxacin (Cipro)

Answer 11

ENT drugs for bacterial infections

Question 12

Bactroban (mupirocin), & Neosporin (“Triple Antibiotic”: originally contained Neomycin, polymyxin B, and bacitracin)
*limited to topical use because of toxicity

Answer 12

Topical creams and ointments for impetigo infections around nose and mouth

Question 13

Floxin Otic (ofloxacin)–solution of flouroquinolone

• for external ear infections
• sometimes in combo with an antifungal agent

Answer 13

Antibiotic solutions & suspensions

Question 14

• viruses infect nose and throat
• spread through close contact with saliva & mucous (sneezing, couging, etc.)
• increased by poor handwashing habits and people being in close contact

Answer 14

the common cold

*secondary bacterial infections often complicate
the primary viral infection; this is usually manifested by worsening symptoms after a short period of
recovery (about a week)

Question 15

therapy directed at symptoms of illness NOT the underlying cause of disease

Answer 15

Symptomatic Therapy

Question 16

viral infections of the upper respiratory tract for

which we do have specific therapy

Answer 16

influenza, RSV, and herpetic cold sores
*Herpetic cold sores can be treated with acyclovir-type drugs, and influenza can be treated with oral therapy (Relenza, Tamiflu), or TVI. Most cases of RSV infections in infants don’t require drug therapy.

Question 17

miconazole, clotrimazole and nystatin are used as a “swish and swallow”

Answer 17

ENT Antifungal Therapy:

for oral thrush infections; they can also be part of treating some sinus infections

Question 18

Suppress coughing by working on the cough center in the brain stem or by anesthetizing the stretch receptors in the respiratory tract

Answer 18

Antitussives

*Most coughs caused by URIs, particularly the most
common types of URIs (viral) are simply a nuisance, and can be suppressed without regard to the course of the illness

Question 19

Narcotic cough suppressants that tend to be the best antitussive drugs we have
*codeine was the drug most often given to
suppress a cough – it is still widely used for that purpose, however, dextromethorphan (DM, or DXM) is more widely used nowadays because it isn’t an opioid and its OTC
*because of it ubiquity in OTC medications,
DXM, like acetaminophen, can be inadvertently multipledosed: a problem especially for young children; teens are abusing it and mixing with other drugs

Answer 19

Codeine/morphine (are the classic examples,
but any opioid will do)
Hydrocodone (Hycodan) is also often used

Question 20

Sometimes you shouldn’t suppress a cough because…

Answer 20

In pneumonias, recovery depends on killing the infection, and on coughing-up and clearing the pooled mucous

Question 21

reduce the thickness of sputum so that patients can more easily cough it up
*guaifenesin is the only one we will study
• the active ingredient is derived from the guaiac tree, the resin of which has been used for centuries in cough and cold remedies
• it is a very popular component of many OTC cough and cold preparations (i.e. Robitussin)

Answer 21

Expectorants

Question 22

A disorder with equilibrium, caused a problem in the inner ear. Often it is just a temporary viral infection that causes it—sometimes it can be a sign of more serious inner ear disease

Answer 22

Vertigo

Question 23

Used as drugs for treating motion sickness and the vertigo and nausea the accompanies it -Dramamine (an antihistamine) and scopolamine(Transderm Scop – a belladonna anticholinergic drug) are OTC medications used to prevent motion sickness

Answer 23

Antihistamines and other anticholinergic drugs

Question 24

sympathomimetic drugs that have alpha-agonist activity (vasonconstrictors to reduce upper airway congestion)

• combined with antihistamines in many cold remedies
• best applied locally to affected area

Answer 24

Decongestants