URI, pharyngitis, sinusitis, otitis media, and otitis externa

Question 1

how do we treat URIs initially?

Answer 1

viral URIs are self-limiting and require no tx other than symptomatic relief

Question 2

mainstay of pharmacological management for a cold

Answer 2

a decongestant, either systemic or topical

Question 3

topical decongestants

Answer 3

• Afrin
• Neo-synephrine

Question 4

how long can topical decongestants be used?

Answer 4

3 days
after that, may cause rebound congestion

Question 5

oral decongestants

Answer 5

• Pseudoephedrine HCI (Sudafed)
• Phenylephrine (Sudafed PE)
• Cannot be used to make meth

Question 6

cardiac patients using oral decongestants

Answer 6

need to be monitored carefully d/t increased risk of HTN from the added vasoconstriction

Question 7

nonpharmacological therapy for URIs

Answer 7

• Increasing fluid intake
• Using nonmedicated cough drops
• Using nasal saline spray or drops to decrease the viscosity of nasal secretions
• Rest

Question 8

nonpharmacological therapy for URIs in infants

Answer 8

Suction the infant’s nose with a nasal bulb syringe to clear secretions before the infant eats or drinks
- Infants can’t breathe and drink at the same time if their nose is clogged

Question 9

how to suspect sinusitis is bacterial in nature?

Answer 9

any URI lasting longer than 10 days without any clinical improvement

or with severe s/s
- High fever (greater than or equal to 39C)
- Facial pain
- Purulent nasal discharge that last 3-4 consecutive days

Question 10

three s//s have high specificity and sensitivity for diagnosing acute sinusitis

Answer 10

 Purulent rhinorrhea
 Facial pain or pressure
 Nasal obstruction

Question 11

goals of treatments for sinusitis

Answer 11

absence of infection demonstrated by the patient’s freedom from all s/s

Question 12

first choice of abx for sinusitis

Answer 12

amoxicillin (with or without clavulanate)

Question 13

guidelines for starting abx therapy for sinusitis

Answer 13

observe pt for 3 days before beginning abx therapy
abxs are started if there is no improvement of s/s or if the patient worsens during the observation period

Question 14

abx choice for sinusitis if the pt has PCN allergy (for adults)

Answer 14

Doxycycline or a respiratory fluroquinolone (levofloxacin or moxifloxacin)

Question 15

abx choice for sinusitis if the pt has PCN allergy (for children)

Answer 15

Third generation cephalosporin (cefdinir, cefuroxime, cefpodoxime)

Question 16

outcome evaluation of abx therapy in sinusitis

Answer 16

s/s should resolve after 7 days of tx

Question 17

most common cause of pharyngitis

Answer 17

group A streptococcal (GAS)

Question 18

pharynx assessment in pharyngitis

Answer 18

• Erythematous, with or without exudate
• Petechiae may be present on the soft palate
• Uvula may be red and swollen
• May have strawberry tongue

Question 19

how to confirm GAS infection

Answer 19

confirmed by rapid antigen testing or culture

Question 20

goals of tx for pharyngitis

Answer 20

• Eradicate the bacteria from the pharynx and prevent the development of acute rheumatic fever (ARF)
• ARF may be prevented if antimicrobial therapy is started within 9 days of onset of symptoms

Question 21

first line tx for pharyngitis

Answer 21

beta-lactams (Penicillin V or amoxicillin)

Question 22

first line drugs for pharyngitis if pt has a nonanaphylactic PCN allergy

Answer 22

first generation cephalosporin

Question 23

first line tx for pharyngitis if pt has an anaphylactic PCN allergy

Answer 23

clindamycin or azithromycin

Question 24

outcome evaluation for pharyngitis tx

Answer 24

s/s should start to improve in the first 24 hours of tx

full therapy is required to prevent ARF

Question 25

guidelines to diagnosing AOM in children

Answer 25

- moderate to severe bulging of the TM or new onset of otorrhea not due to acute otitis externa - mild bulging of the TM and recent (less than 48 hrs) onset of ear pain or intense erythema of the TM - no diagnosis of AOM in children who do not have middle ear effusion (MEE)

Question 26

first line choice of abx for AOM

Answer 26

amoxicillin

Question 27

drug of choice for AOM in pt with PCN allergy

Answer 27

cefdinir cefuroxime cefpodoxime ceftriaxone

Question 28

outcome evaluation for tx of AOM

Answer 28

Should be evaluated 8-12 weeks from the beginning of tx to determine whether the infection is completely resolved

Question 29

otitis externa

Answer 29

an acute infection that causes an inflammatory response in the external auditory canal

Question 30

nickname for OE

Answer 30

swimmer's ear

Question 31

medications of choice for OE

Answer 31

Topical therapy delivers a high concentration of the antimicrobial to the infected tissue, significantly more than can be delivered via systemic antimicrobial treatment Medication of choice is antibiotic/steroid ear drops - Ciprofloxacin and hydrocortisone (cipro HC otic) - Ciprofloxacin and dexamethasone (ciprodex)

Question 32

outcome evaluation for OE

Answer 32

patients should begin to experience relief from pain in 3-4 days