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Phar455 > Shevchuk- sinusitis > Flashcards

Shevchuk- sinusitis Flashcards

1
Q

what are your sinuses (include sinus ostia)

A
  • 4 symmetrical air filled spaces called paranasal sinuses
  • lined by ciliated, columnar epithelium
  • interconnected through small tubular openings (sinus ostia)
  • all drain into the osteomeatal complex which drains into nasal cavity
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2
Q

what are the 4 sinuses called

A
  • ethmoid (above eye)
  • sphenoid (beside eye)
  • frontal (between eyes)
  • maxillary (under eyes)
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3
Q

what do sinuses to

A
  • make mucus appropriate viscosity, composition and volume
  • normal mucociliary flow
  • oen ostia to allow for adequate drainage and airflow
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4
Q

which sinus is functioning cilia of the utmost importance?

A

-maxillary sinus, because drainage is against gravity

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5
Q

how can you damage your cilia

A
  • smoking and viruses mainly
  • air concentrations that are too high or low
  • certain diseases (cystic fibrosis, etc)
  • fire smoke, etc
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6
Q

what is sinusitis (aka ____), and 4 things it can be from, who gets it

A

inflammation of the mucous membrane lining the paranasal sinuses

  • aka rhinosinusitis (as nasal mucosa is always involved)
  • viral, allergic, bacterial or fungal
  • both adults and kids get
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7
Q

4 types of sinusitis

A
  • acute- new infection less than 4 weeks in duration (divided into severe and non severe)
  • subacute (4-12 weeks)
  • chronic (sx over 12 weeks)
  • recurrent (3 or more episodes in a year, but normal in between episodes. If not, its chronic)
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8
Q

what causes sinusitis

A

blockage or inflammation of osteomeatal complex

  • it interferes with the mucociliary clearance
  • early phase is often a viral infection (about 10 days), then about 0.5-2% progress to bacterial aerobes, then bacterial anaerobes (after 3 months) (not known if they are a cause of chronic form or just inhabiting the area, controversy that it might just be an inflammatory disease and no chronic infection)
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9
Q

sinusitis can commonly be caused by this infection

A
  • URTI- all tubes are connected, and URTI commonly results in sinus infection
  • 0.5% of all URTIs are complicated by sinusitis
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10
Q

once drainage and ventilation of the sinuses is compromised, what happens?

A
  • ph decreases
  • oxygen content decreases
  • cilia is less functional
  • mucosal lining is damaged
  • ULTIMATELY THESE THINGS MAKE YOU MORE SUSCEPTIBLE TO INFECTION!
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11
Q

predisposing factors for sinusitis

A
  • immune deficiencies
  • foreign bodies
  • fractured nose
  • polyps
  • allergies/asthma
  • dental infection
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12
Q

what viruses typically cause sinusitis

A

mostly rhinovirus

-also adenovirus, influenza and parainfluenza

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13
Q

is viral or bacterial sinusitis more common?

A

viral is 20-200 times more common therefore ABs not needed

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14
Q

signs and sx of sinusitis

A
  • mucopurulent nasal discharge
  • nasal congestion
  • tenderness over sinus/facial pain
  • fever
  • headache and cough
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15
Q

common bacterial sinusitis in children- presentation

A
  • persistent sx of URTI w/o improvement after 10-14 days with both
  • purulent nasal discharge and continued unwell state
  • can include fever, cough, irritability, lethary, facial pain
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16
Q

severe bacterial sinusitis in children- presentation

A
  • severely ill child with both
  • purulant nasal discharge and a fever of over 39 (not responding to appropriately dosed antipyretics)
  • ususally associated with cough, headache, facial swelling, sinus tenderness
  • less common
  • “severe sx for at least 3 days in febrile child who has purulant nasal discharge and seems ill”
17
Q

common bacterial sinusitis in adolescents/adults- presentation

A
  • persistant sx of URTI w/o improvement after 10-14 days or worsening after 5 days with both
  • nasal congestion/purulant nasal discharge and facial pain
  • with or without fever, molar toothache, facial swelling, headache, bad breath, fatigue, cough, facial pain worse on bending forward, ear pain/pressure, loss of smell
18
Q

how to dx

A

-based on signs and sx, also patient history and physical exam

19
Q

things that are not helpful to diagnose

A
  • nasal aspirates
  • transilllumination of maxillary and frontal sinuses
  • xray, ct scan to see abnormalities- but bacteria and viruses produce the same ones
20
Q

if sinusitis is bacterial, caused by these bacteria

A
  • S pneumoniae (most common)
  • haemophilus influenzae, maxilla catarrhalis
  • *same list as AOM!
  • in immunocompromised or hospital acquired, expect more gram negative bacteria or fungus
21
Q

when does sinusitis clear up

A

-usually recover spontaneously w/o ABs within 10 days (some still after 2 weeks though)

22
Q

complications

A
  • rare, but include
  • abscess, cellulitis and osteomyelitis
  • spread of infection to the nervous system
23
Q

non pharm tx

A
  • steam inhalation
  • fluids (never a bad thing, and can help with mucus viscosity)
  • apply warm face cloth or heat of some kind
  • avoid irritant like smoke (esp if have allergies)
  • saline drops or irrigation
24
Q

pharm tx

A
  • analgesic
  • oral/topical decongestants (have some benefit)
  • intranasal steroid- not as beneficial in acute
  • avoid 1st gen AHs for drying SE- we want sinuses to drain
  • oral steroids- reduce edema and inflammation, but little evidence of benefit in acute
  • ABs if bacterial
25
Q

when should you consider ABs for tx

A
  • if still bothersome a week to 10 days after it first starts and meets clinical criteria (use for 1 week=90% cure rate)
  • BUT latest guidelines suggest that if criteria for bacterial sinusitis are met, you should treat not watch and wait
26
Q

goals of AB tx

A
  • restore/improve sinus fx
  • prevent intracranial complications
  • eradicate pathogen
27
Q

first line AB tx in adults

A

-amox 500mgTID for 5-10 days

28
Q

second line AB tx in adults

A
  • amox/clav 500mg TID or 875mgBID
  • 2nd gen cephalosporin (cefuroxime, cefprozil)
  • TMP/SMX 1 DS tab BID
  • doxycycline 100mg BID day one then 100 mgOD
  • clarith/azith
  • all for 5-10 days
29
Q

third line tx in adults

A

fluoroquinolones-levofloxacin 500mg OD or Moxifloxacin 400 mg OD for 5-10 days

  • reserved generally for resistance/severe allergy b/c very valuable and don’t want to promote resistance
  • do not use in children –> bone/joint deformities
30
Q

first line AB tx in kids

A

amox 40-80mg/kg/day given BID or TID not over 3g/day

-for 10-14 days

31
Q

second line AB tx in kids

A
  • amox/clav 40-80mg/kg/day divided BID
  • cefprozil 30mg/kg/day divided BID
  • for 10-14 days
32
Q

third line AB tx in kids

A
  • clarith 15mg/g/day divided BID
  • azith 10mg/kg/day on first day, then 5 mg/kg/da for 4 days
  • TMP/SMX: 5-10 mg/kg/day divided BID
33
Q

what is different about chronic sinusitis

A
  • persists for 3 months
  • see more s.aureus and anaerobes
  • treat for 3 weeks to make sure organism is eradicated
  • amox/clav or clind are good choices

Phar455 (6 decks)

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