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Pharm - Ear Flashcards

1
Q

Otitis externa goals and parameters

A 
goals
-eradicate infection
-control pain
monitoring parameters
-adherence
-response to therapy for infection and pain control
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2
Q

Place in therapy for any drug class in otitis externa

A

Depending on severity:

  • antiseptics
  • glucocorticoids
  • topical abx
  • wicks
  • add oral fluoroquinolones
  • fungal: antifungals
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3
Q

Most common causative organisms in otitis externa

A
  • Pseudomonas aeruginosa and staphylococcus aureus most prevalent
  • Enterobacter and Proteus mirabilis can be causative
  • Fungal 10% of the time – most common aspergillus; candida can contribute
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4
Q

MILD otitis externa tx

A

acetic acid/hydrocortisone (Acetasol HC, VoSol HC otic) - 7 days

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5
Q

MODERATE otitis externa tx

A

1st line: fluoroquinolones

  • Cipro HC otic
  • Ciprodex
  • cortisporin otic (neomycin, polymyxin and hydrocortisone solution) - note aminoglycoside
  • 7 days
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6
Q

Tx of SEVERE otitis externa if disease is NOT extended beyond ear canal

A
  • same topical as moderate - 7-14 days

- place wick

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7
Q

Tx of SEVERE otitis externa if disease IS extended beyond ear canal

A
  • same topical as moderate
  • prescribe oral fluoroquinolones for 7-10 days
  • place wick
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8
Q

Tx of fungal otitis externa (otomycosis)

A

-antifungals: clotrimazole

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9
Q

acute otitis media goals/monitoring parameters

A 
goals
-eradicate infection
-control pain
monitoring parameters
-adherence
-response to therapy for infection and pain control
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10
Q

place in therapy for any drug class in acute otitis media

A
  • OTC pain managment

- abx

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11
Q

causative organisms in acute otitis media

A
  • streptococcus pneumonia
  • haemophilus influenza
  • moraxella catarrhalis (affinity for URI)
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12
Q

What are the risk factors for streptococcus pneumonia resistance?

A
  • daycare attendance
  • abx w/i last 30 days
  • age < 2 yrs
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13
Q

What is an indicator of a Haemophilus influenza infection?

A

a concurrent purulent conjunctivitis

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14
Q

Tx of AOM if pt has inability to tolerate oral agents/vomiting

A

Rocephin (3rd gen cephalosporin) IM

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15
Q

Tx of AOM if type 1 rxn allergy to penicillin

A
  • azythromycin
  • clarithromycin
  • clindamycin (cleosin)
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16
Q

Azithromycin dosage

A

10 mg/kg per day orally (max 500 mg/day) as a single dose on day 1 and 5mg/kg (max 250 mg/day) for days 2-5

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17
Q

Tx of AOM if non type 1 rxn to penicillin

A
  • 2nd gen cephalosporin: cefuroxime

- 3rd gen cephalosporin: cefdinir, defpodoxime

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18
Q

Cefdinir (omnicef) dosage

A

14 mg/kg per day orally in 1-2 doses (max 600 mg/day) for 10 days

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19
Q

ID the 3 factors that must be considered when choosing tx for AOM when no penicillin allergy is present

A
  • amoxicillin or beta-lactamase abx used in the past 30 days
  • concurrent purulent conjunctivitis
  • Hx of recurrent AOM unresponsive to amoxicillin
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20
Q

Tx for AOM if no allergy to penicillin and none of the 3 risk factors

A

amoxicillin

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21
Q

amoxicillin dosage

A

90 mg/kg/day - two divided doses q 12 hrs

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22
Q

Tx for AOM if no allergy to penicillin but risk factors present

A

augmentin

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23
Q

type 1 penicillin allergy

A

Urticaria, anaphylaxis, angioedema, bronchospasm, urticaria, or serious Type 4 delayed reaction

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24
Q

non-type 1 penicillin allergy

A
  • mild delayed hypersensitivity rxns
  • rxn appeared after more than 1 dose, usually after days of tx
  • none of the scary sx in type 1
  • no reports of serious/life threatening delayed drug rxns (stevens-johnsons syndrome, etc)
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25
Goals/parameters of chronic suppurative otitis media (CSOM)
goal -eradicate infection -prevent complications -long term: healing/repair of TM and improvement of hearing Monitoring parameters: -otorrhea still present in 3 wks, determine cause (resistant org,. keratoma, poor adherence)
26
Place in therapy for drug class in CSOM
- topical abx | - systemic abx if risks
27
causative organisms in CSOM
- gram-neg: pseudomonas, proteus, klebsiella - gram-pos: staph aureus - anaerobe: bacteroides, peptostreptococcus, peptococcus
28
Tx of CSOM
- topical quinolone abx: cipro or ofloxacin otic - systemic abx IF: * complications of CSOM * fail to respond to topical therapy after 2-3 wks * previously treated w/ several courses of empiric topical therapy * at risk for resistant oganisms
29
Place in therapy for drug class in acute mastoiditis in adults
IV abx: - ceftriaxone (rocephin) - cefotaxime (claforan) - cefepime
30
Place in therapy for drug class in acute mastoiditis in children
- vancomycin: used in every med combo! - 3rd and 4th gen cephalosporins: add to vanc w/ hx of OM or recent abx use OR in non-type 1 allergies - penicillin: add to vanc w/ type 1 allergy - monobactam: add to vanc w/ type 1 allergy
31
causative organisms for acute mastoiditis in children
- Staph aureus - Pseudomonas and enteric gram-negative rods - Steptococcus - H. Influenza
32
causative organisms for acute mastoiditis in adults
- Staph aureus (MSSA) - Strep pneumonia - H. influenza
33
Tx for acute mastoiditis in adults
1st line - IV abx: - Ceftriaxone (Rocephin) 3rd gen ceph - Cefotaxime (Flaforan) 3rd gen ceph - Cefepime (Maxipime) 4th gen ceph
34
Tx for acute mastoiditis in children w/ no recurrent OM or recent abx therapy
IV vanc
35
Tx for acute mastoiditis in children w/ hx of recurrent OM or recent abx therapy but no allergy
IV vanc PLUS one of the following - Ceftazidime (Fortaz) 3rd gen ceph - Cefepime (Maxipime) 4th gen ceph - Piperacillin-tazobactam (Zosyn) Penicillin
36
Tx for acute mastoiditis in children w/ type 1 allergy
vanc + Aztreonam
37
Tx for acute mastoiditis in children w/ non-type 1 allergy
vanc + - caftazidime - cefepime
38
What is the second line abx choice in tx for acute mastoiditis in adults?
- Moxifloaxacin (Avelox) Fluoroquinolone - Levofloxacin (Levequin) Fluroquinolone - Doxycycline, Tetracycline
39
place in therapy for drug class in vestibular neuritis (labrynthitis)
Dependent upon symptoms
40
causative organisms of vestibular neuritis
thought to be viral, postviral, anti-inflammatory
41
Tx of vestibular neuritis
- Corticosteroid taper: * treats inflammation * improves recovery of vestibular fxn * 10 day course w/ tapering schedule - Tx of vertigo sx: * antihistamine: meclizine * anticholinergic: scopolamine * benzos: xanax * antiemetic: zofran
42
goals of tx of meiere's disease
- Reduce the frequency and severity of vertigo attacks - Reduce or eliminate hearing loss and tinnitus associated with attacks - Alleviate chronic symptoms (tinnitus and balance issues) - Minimize disability - Prevent disease progression, particularly hearing loss and imbalance
43
Tx of Menier's disease
- Diuretics (hydrochlorothiazide) - Antiemetic (meclizine, dramamine) - Anxiolytics to suppress the central vestibular response: alprazolam (Xanax) - Antihistamine when allergies are linked as a trigger (Loratadine)
44
MoA of antiemetics
reduce vomiting
45
MoA of anxiolytics
suppress central vestibular response (anti anxiety)
46
Glucocorticoid MoA
decrease inflammation, pain, pruritis. when added to abx, decrease time to symptom resolution (make you feel better faster)
47
Antiseptic MoA
lower pH to decrease favorability of environment for bacteria. irritating to middle ear
48
tetracylcines MoA
inhibition of ribosome subunit 30s - inhibits protein synthesis which leads to cells wall impairment and death
49
fluoroquinolones MoA
inhibit DNA gyrase (topoisomerase II) and topoisomerase IV which leads to DNA strand breakage
50
cephalosporin MoA
bind to PBP and prevent cell wall synthesis
51
acetaminophen MoA
inhibits prostaglandin synthesis to block pain impulses - no anti-inflammatory properties
52
ibuprofen MoA
decrease pain, temp, and inflammation through inhibiting COX
53
adverse effects of corticosteroids
- weight gain - abrupt stop: "crisis" - can be fatal - if don't dose in the AM, can impact the hypothalamic-pituitary adrenal axis more strongly
54
adverse effects of aminoglycosides
ototoxicity | e.g: neomycin, tobramycin
55
adverse effects of tetracyclines
GI symptoms, grey teeth, phototoxicity
56
adverse effects of fluoroquinolones
safety consideration for pregnant women and children - tendons
57
adverse effects of cephalosporins
allergic rxn 1-3% of the time
58
adverse effects of cefdinir specifically
the dye in it can cause red stool - advise parents
59
acetaminophen oral dose for kids < 12
10-15 mg/kg q 4-6 hrs (MAX 5 doses in 24 hrs)
60
ibuprofen oral dose for kids <12
4-10 mg/kg q 6-8 hrs (MAX dose 40 mg/kg/day)

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