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ID PHARM 152 > Sinusitis > Flashcards

Sinusitis Flashcards

1
Q

Anatomical facts about sinuses

A

4 symmetrical air filled spaces
Lined by ciliated, columnar epithelium
Interconnected through small tubular openings
All drain into the osteomeatal complex which drains into the nasal cavity

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2
Q

What is the function of the sinuses?

A

Mucus that is of appropriate viscosity, composition and volume
Normal mucocilliary flow
Open Ostia to allow for adequate drainage and air flow

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3
Q

What is sinusitis?

A

Inflammation of the muscles membrane lining the paranasal sinuses

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4
Q

Causes of sinusitis

A

Allergic
Viral
Bacterial
Fungal

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5
Q

Types of Sinusitis

A

Acute
Subacute
Chronic
Recurrent

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6
Q

What is acute sinusitis

A

New infection less than 4 weeks in duration

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7
Q

What is subacute sinusitis

A

Lasting 4 to 12 weeks

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8
Q

What is chronic sinusitis

A

Symptoms lasting over 12 weeks

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9
Q

What is recurrent sinusitis

A

3 or more episodes in a year

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10
Q

What is responsible for the development of sinusitis?

A

Blockage or inflammation of the osteomeatal complex

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11
Q

How gets sinusitis

A

Both adults and kids

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12
Q

What happens once drainage and ventilation of sinuses is compromised?

A

The pH decreases
Oxygen content decreases
Cilia is less functional
Mucosal lining is damage

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13
Q

Predisposing/risk factors for sinusitis

A

Immune deficiencies
Foreign bodies
Fractured nose
Polyps
Allergies/asthma
Dental infection

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14
Q

What is the epidemiology

A

0.5% of all URTICARIA are complicated by sinusitis
Is one of the 10 most common diagnosis in primary care
1 in 10 people visit their doctor with sinusitis every year

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15
Q

Causes of sinusitis

A

A viral infection usually lasting up to 10 days
Mostly rhinovirus, adenovirus, influenza, and parainfluenza viruses

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16
Q

What are signs and symptoms of sinusitis?

A

Mucopurulent nasal discharge
Nasal congestion/obstruction
Tenderness over sinus/facial pain
Sometimes fever,headache and cough

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17
Q

How long does acute viral sinusitis symptoms tend to improve?

A

Within 1 week

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18
Q

When is sinusitis rare?

A

In children less then 9 years old
They have undeveloped sinuses

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19
Q

What does bacterial sinusitis in children look like? Symptoms?

A

Persistent symptoms of URTI without improvement after 10-14 days
Purulent nasal discharge and continued unwell state
With fever, cough, irritability, lethargy

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20
Q

Severe presentation bacterial sinusitis in children

A

Purulent nasal discharge
Fever > 39
With
Cough
Headache
Facial swelling

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21
Q

Bacterial Sinusitis in Adults (common) presentation

A

Persistent symptoms of URTI without improvement after 10 to 14 days or worsening after 5 days

22
Q

Symptoms for common presentation bacterial sinusitis

A

Nasal congestion
Purulent nasal discharge
Facial pain

Fever
Molar toothache
Facial swelling

23
Q

Signs and symptoms of sinutis

A

With the common cold
Sore throat & sneezing (resolve 3-6 days)
Fever, malaise, myalgia (resolve 6-8 days)
Cough, nasal discharge and nasal obstruction

24
Q

Diagnosis

A

Based mostly on signs and symptoms
Along with pt history and physical exam

25
Q

Test that could be used for diagnosis for sinusitis

A

Nasal aspirates
Transillumination of maxillary and frontal sinuses
X-ray, CT scan

26
Q

Microbiology of Sinusitis

A

S. pneumoniae
H. Influenzae
M. Catarrhalis
May also be s. aureus, s. pyogenes

27
Q

Causes of Sinusitis

A

Maybe Anaerobes

28
Q

Clinical Course of Action for SInusitis

A

Usually recovers spontaneously without antibiotics
Most pt will be better within 10 days

29
Q

Non pharm Treatment for sinusitis

A

Steam inhalation
Fluids
Apply warm face cloth or heat of some kind
Avoid irritants such as smoke
Saline drops or irrigation

30
Q

Pharm Treatment for Sinusitis

A

Analgesic
Oral/topical decongestants
Intranasal steroid
Oral steroids

31
Q

How would oral steroids help with sinusitis?

A

Reduce edema and inflammation but little evidence of benefit in acute

32
Q

Antibiotic Treatment strategies

A

Should use the wait and see approach
If still problem 7-10 days after meet with MD then might be warranted

33
Q

Goals of Antibiotic treatments

A

Restore/improve sinus function
Prevent intracranial complications
Eradicate pathogen

34
Q

What is the first line for sinusitis?

A

Amoxicillin

35
Q

What is the dose of amoxicillin (adults) for sinutisis?

A

500-1000 mg TID for 5-10 d

36
Q

What are the second line for sinusitis?

A

Amox/clav
2nd gen cephalosporin
Doxycycline
Clarithromycin or azithromycin

37
Q

What is the dose for adults for amox/clav for sinusitis?

A

500 mg TID or 875 mg BID

38
Q

What is the dose for doxycycline, adults, sinusitis?

A

100 mg BID day1
100 mg OD
Or
200 mg day 1
100 mg BID

39
Q

What is the third line treatment for sinusitis?

A

Levofloxacin
Moxifloxacin

40
Q

What is the dose for levofloxacin for sinusitis?

A

500 mg once daily for 5-10 days

41
Q

What is the dose of moxifloxacin for sinusitis?

A

400 mg once daily for 5-10 days

42
Q

What is the dose for amoxicillin (peds) for sinusitis?

A

40 to 90 mg/kg/day BID or TID
For 10 days

43
Q

What is the second line for peds for sinusitis?

A

Amox/clav
Cefuroxime
Cefprozil

44
Q

What is the peds dose for sinusitis for amox/clav?

A

40-90 mg/kg/day
BID
10 days

45
Q

What is the dose for cefuroxime (peds) for sinusitis?

A

30-40 mg/kg/day
BID
For 10 days

46
Q

What is the peds dose for cefprozil for sinusitis?

A

30 mg/kg/day
BID
For 10 days

47
Q

What is the third line for peds sinusitis?

A

Clarithromycin
Azithromycin
TMP/SMX

48
Q

What is the peds dose of clarithromycin for sinusitis?

A

15 mg/kg/day BID for 10 days

49
Q

What is the peds dose for azithromycin for sinusitis?

A

10 mg/kg/day on 1 day
5 mg/kg/day for 4 days

50
Q

What is the peds dose for TMP/SMX for sinusitis?

A

5-10 mg/kg/d TMP
Divided BID

51
Q

What is the microbiology for chronic sinusitis?

A

S. aureus and anaerobes

52
Q

What is used on chronic sinusitis? How long?

A

Amoxicillin/clavulanate or clindamycin

Treat for 3 weeks

ID PHARM 152 (11 decks)

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