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PHAR 152* > Sinusitis > Flashcards

Sinusitis Flashcards

1
Q

Explain the paranasal sinuses

A

4 symmetrical air-filled spaces
Lined by ciliated, columnar epithelium
Interconnected thru small tubular openings (sinus ostia)
All drain into the osteomeatal complex which drains into the nasal cavity

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2
Q

What are the 4 sinuses called?

A

Ethmoidal, maxillary, Sphenoidal, Frontal

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3
Q

What does proper function of the sinuses involve?

A

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

Maxillary sinus features drainage against gravity

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4
Q

What is sinusitis?

A

Inflammation of the mucous membrane lining the paranasal sinuses
Best called rhinosinusitis

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5
Q

Who does sinusitis affect? What are the root causes of sinusitis?

A

Adults and kids

Can be allergic, viral, or fungal

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6
Q

What are the different types of sinusitis?

A

Acute - new infxn less than 4 weeks in duration (may be divided in to severe and non-severe

Subacute - lasting 4-12 weeks

Chronic - Sx lasting 12+ weeks

Recurrent - 3 or more episodes per year

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7
Q

What is responsible for the development of sinusitis?

A

Blockage of inflammation of the osteomeatal complex

Obstruction interferes with mucociliary clearance
Tubes are connected -> URTI commonly results in sinus inflammation

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8
Q

What occurs when drainage and ventilation of the sinuses is compromised?

A

pH decreases
Oxygen content decreases
Cilia less functional
Mucosal lining damaged

Ultimately, leading to greater susceptibility to infxn

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9
Q

What are the predisposing/risk factors of sinusitis?

A

Immune deficiencies
Foreign bodies - things being stuck
Fractured nose
Polyps
Allergies/asthma
Dental infxn

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10
Q

Explain the early phase of sinusitis

A

Viral infxn usually lasting up to 10 days
May originated from cold
Mostly rhinovirus, adenovirus, influenza and parainfluenza viruses

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11
Q

Explain the types of organisms that present with sinusitis over time

A

Viral - 8-10days
Aerobes - 10 days to over 3 months
Anaerobes - Before 3 months and continues

*See slide 15 chart

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12
Q

True or False: Viral rhinovirus is much more common than bacterial sinusitis

A

True

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13
Q

What are the signs and symptoms of sinusitis?

A

Mucopurulent nasal discharge (colour of discharge means nothing)
Nasal congestion/obstruction
Tenderness over sinus/facial pain
- Sometimes fever, headache, cough

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14
Q

How long does it take for acute viral sinusitis sx to improve?

A

1 week

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15
Q

True or False: Sinusitis is rare in children under 9 years old

A

True, due to undeveloped sinuses

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16
Q

The 2013 pediatric guidelines for bacterial sinusitis presentation

A

Common: Persistent sx of nasal discharge, daytime cough, or both for at least 10 days without improvement or new onset of sx after initial improvement

Severe: Severe sx for at least 3 days in febrile child (39C) who has purulent nasal discharge and seem ill

17
Q

Explain the sx related to the common cold and the duration of time that it takes to resolve sx

A

Sore throat and sneezing: resolve day 3 to 6
Fever, malaise, myalgia: resolve day 6 to 8
Cough, nasal discharge and nasal obstruction may last weeks (25% have at 14 days)

18
Q

What is the diagnosis of bacterial sinusitis based on?

A

Signs and sx along with patient history and physical exam
if sx beyond 10 days, then could be bacterial

19
Q

Do nasal aspirates and transillumination helpful in diagnosis of sinusitis? How about X-rays and Ct scans?

A

not very helpful

used to see abnormalities or complications (viruses prod same abnormalities as bacteria)

20
Q

Sinusitis is mainly viral. What are the bacterial species responsible for bacterial sinusitis?

A

Most common to least common

S.Pneumoniae, H. influenzae, M. catarrhalis, S.aureus, S.pyogenes (last two - GAS)

21
Q

What species of organisms are you expected to see in immunocompromised or hospital acquired sinusitis?

A

Gram -ve or fungal sp

22
Q

Do we know if anaerobes are a cause of chronic sinusitis or just inhabiting the area?

A

No

23
Q

When will most patients get better from sinusitis?

A

within 10 days

24
Q

What are the complications of sinusitis?

A

Abscess, cellulitis and osteomyelitis
Spread of infxn to the nervous system

25
Q

What are the non-pharmacological symptomatic relief options?

A

Steam inhalation
Fluids -> want to keep mucus moving
Apply warm face cloth or heat of some kind
Avoid irritants such as smoke (allergies)
Saline drops or irrigation

26
Q

What are the pharmacological treatment options?

A

Analgesic
Oral or topical decongestants - no evidence of benefit
Intranasal steroid (better in chronic cases only)
Avoid 1st gen Anti-He (dry out the mucosa, we want to get rid of the mucus)
Oral steroids (reduce edema and inflammation, little evidence for role in acute)

27
Q

When are people who are not given ABs improve?

A

80% improve in two weeks
AB only provide a small benefit compared to placebo

28
Q

What should pharmacists do for deciding antibiotic treatment?

A

Wait a week to 10 days after it first starts, then decided if ABs are needed

29
Q

What are the goals of AB treatment?

A

Restore/improve sinus fxn
Prevent intracranial complications
Eradicate pathogen

30
Q

What is the first line option for acute bacterial sinusitis? Provide the dosing

A

Amoxicillin 500mg-1000mg TID x 5-10d (5 days is sufficient)

31
Q

What are the second line AB options for acute bacterial sinusitis?

A

Amox/clav 500 mg TID or 875 BID
2nd gen cephalosporins
Doxycycline 100mg BID day 1, then 100mg OD OR 200mg day 1, then 100mg BID
Clarithromycin or azithromycin

32
Q

What are the third line option for acute bacterial sinusitis?

A

Quinolones

Levofloxacin 500mg OD
Moxifloxacin 400mg OD

5-10 days (again, 5 days is sufficient)

33
Q

What is the first line AB tx for kids?

A

Amoxicillin 40-90mg/kg/day BID or TID (max 3g/day)

duration 10 days!

34
Q

What is the second line AB tx for kids?

A

Amox/clav 40-90mg/kg/day divided BID
Cefuroxime 30-40mg/kg/day divided BID
Cefprozil 30mg//kg/day divided BID

duration 10 days!

35
Q

What is the third line AB tx for kids?

A

Clarithromycin 15mg/kg/day divided BID
Azithromycin 10mg/kg/day first day, then 5mg/kg OD x4 days
(TMP/SMX 5-10 mg/kg/day TMP divided BID)

36
Q

Explain AB tx for chronic cases. What is the chronic definition? What organisms might you see? What are good AB choices for chronic? How long do you treat for?

A

If the disease persists for 3 months

See more S. aureus and anaerobes

Amoxicillin/clavulanate or clindamycin

Treat for 3 weeks

PHAR 152* (16 decks)

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