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HEENOT > Pharm - Ear > Flashcards

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
Q

Goals/parameters of chronic suppurative otitis media (CSOM)

A

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
Q

Place in therapy for drug class in CSOM

A
  • topical abx

- systemic abx if risks

27
Q

causative organisms in CSOM

A
  • gram-neg: pseudomonas, proteus, klebsiella
  • gram-pos: staph aureus
  • anaerobe: bacteroides, peptostreptococcus, peptococcus
28
Q

Tx of CSOM

A
  • 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
Q

Place in therapy for drug class in acute mastoiditis in adults

A

IV abx:

  • ceftriaxone (rocephin)
  • cefotaxime (claforan)
  • cefepime
30
Q

Place in therapy for drug class in acute mastoiditis in children

A
  • 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
Q

causative organisms for acute mastoiditis in children

A
  • Staph aureus
  • Pseudomonas and enteric gram-negative rods
  • Steptococcus
  • H. Influenza
32
Q

causative organisms for acute mastoiditis in adults

A
  • Staph aureus (MSSA)
  • Strep pneumonia
  • H. influenza
33
Q

Tx for acute mastoiditis in adults

A

1st line - IV abx:

  • Ceftriaxone (Rocephin) 3rd gen ceph
  • Cefotaxime (Flaforan) 3rd gen ceph
  • Cefepime (Maxipime) 4th gen ceph
34
Q

Tx for acute mastoiditis in children w/ no recurrent OM or recent abx therapy

A

IV vanc

35
Q

Tx for acute mastoiditis in children w/ hx of recurrent OM or recent abx therapy but no allergy

A

IV vanc PLUS one of the following

  • Ceftazidime (Fortaz) 3rd gen ceph
  • Cefepime (Maxipime) 4th gen ceph
  • Piperacillin-tazobactam (Zosyn) Penicillin
36
Q

Tx for acute mastoiditis in children w/ type 1 allergy

A

vanc + Aztreonam

37
Q

Tx for acute mastoiditis in children w/ non-type 1 allergy

A

vanc +

  • caftazidime
  • cefepime
38
Q

What is the second line abx choice in tx for acute mastoiditis in adults?

A
  • Moxifloaxacin (Avelox) Fluoroquinolone
  • Levofloxacin (Levequin) Fluroquinolone
  • Doxycycline, Tetracycline
39
Q

place in therapy for drug class in vestibular neuritis (labrynthitis)

A

Dependent upon symptoms

40
Q

causative organisms of vestibular neuritis

A

thought to be viral, postviral, anti-inflammatory

41
Q

Tx of vestibular neuritis

A
  • 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
Q

goals of tx of meiere’s disease

A
  • 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
Q

Tx of Menier’s disease

A
  • Diuretics (hydrochlorothiazide)
  • Antiemetic (meclizine, dramamine)
  • Anxiolytics to suppress the central vestibular response: alprazolam (Xanax)
  • Antihistamine when allergies are linked as a trigger (Loratadine)
44
Q

MoA of antiemetics

A

reduce vomiting

45
Q

MoA of anxiolytics

A

suppress central vestibular response (anti anxiety)

46
Q

Glucocorticoid MoA

A

decrease inflammation, pain, pruritis. when added to abx, decrease time to symptom resolution (make you feel better faster)

47
Q

Antiseptic MoA

A

lower pH to decrease favorability of environment for bacteria. irritating to middle ear

48
Q

tetracylcines MoA

A

inhibition of ribosome subunit 30s - inhibits protein synthesis which leads to cells wall impairment and death

49
Q

fluoroquinolones MoA

A

inhibit DNA gyrase (topoisomerase II) and topoisomerase IV which leads to DNA strand breakage

50
Q

cephalosporin MoA

A

bind to PBP and prevent cell wall synthesis

51
Q

acetaminophen MoA

A

inhibits prostaglandin synthesis to block pain impulses - no anti-inflammatory properties

52
Q

ibuprofen MoA

A

decrease pain, temp, and inflammation through inhibiting COX

53
Q

adverse effects of corticosteroids

A
  • 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
Q

adverse effects of aminoglycosides

A

ototoxicity

e.g: neomycin, tobramycin

55
Q

adverse effects of tetracyclines

A

GI symptoms, grey teeth, phototoxicity

56
Q

adverse effects of fluoroquinolones

A

safety consideration for pregnant women and children - tendons

57
Q

adverse effects of cephalosporins

A

allergic rxn 1-3% of the time

58
Q

adverse effects of cefdinir specifically

A

the dye in it can cause red stool - advise parents

59
Q

acetaminophen oral dose for kids < 12

A

10-15 mg/kg q 4-6 hrs (MAX 5 doses in 24 hrs)

60
Q

ibuprofen oral dose for kids <12

A

4-10 mg/kg q 6-8 hrs (MAX dose 40 mg/kg/day)

HEENOT (13 decks)

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