Week 3 - HEENT & Skin Flashcards
What causes excessive cerumen in the ear?
Excessive wax being pushed further into the ear canal while cleaning
What is the treatment for excessive cerumen in the ear?
- Irrigation with warm water or saline
- Debrox (OTC med of carbamide peroxide) can be used to soften was for easy removal
How do we treat otomycosis?
Thorough cleansing and application of 2% vinegar solution 4xday for 7 days. Antifungal drug solution can be used if this is not effective.
What are the signs and symptoms of acute otitis media?
- Infection, inflammation, and fluid in the middle ear
- Ear pain
- n/v
- fever
- anorexia
- irritability
- sleeplessness diarrhea
What are the diagnostic requirements for acute otitis media?
- Acute onset s/s
- Middle ear effusion (fluid in the ear) or purulent otorrhea if the tympanic membrane has ruptured
- Middle ear inflammation (bulging tympanic membrane with limited mobility or purulent otorrhea)
How do we treat pediatric patients with acute otitis media? (drug and dose)
Amoxicillin 40-45mg/kg/day - usually split into two doses.
What is the guideline treatment for otitis media in children under 6 months?
Antibiotics regardless of diagnostic certainty or symptom severity
What is the guideline treatment for otitis media in children from 6 months to 2 years?
Antibiotics are indicated when diagnosis is certain
What is the guideline treatment for otitis media in children 2 years and older?
Antibiotics are only indicated if diagnosis is certain AND if symptoms are severe – all other cases observation is recommended.
What is the monoclonal antibody drug treatment for allergic rhinitis?
Omalizumaub
(only approved for allergy mediated asthma)
How do we treat glaucoma in someone with asthma or COPD?
Betaxolol
- use because it is a selective beta blocker and won’t cause bronchoconstriction
What are the side effects of Lantoprost?
- Brown pigmentation of the iris (stops progression with dc of drug but does not reverse)
- Blurred vision
- Stinging/burning
- Conjunctival hypermia
- Conjunctival edema
- Punctate keratopathy
- Macular edema
What is the therapeutic action of glucocorticoids in allergic reactions?
Control symptoms of allergic reactions by reducing inflammation from histamine response
What it the mechanisms of action for antihistamines?
Bind to H1 histamine receptors thereby blocking the actions of histamine at these sites. Do not block release of histamine from mast cells or basophils. (can also bind to muscarinic receptors which cause some of the side effects)
What is the mechanism of action of cromolyn?
Suppresses inflammation (it is a mast cell stabilizer)
- Prevents release of inflammatory mediators from mast cells and can decrease all symptoms (benefits are modest). Can be used for allergic rhinitis and asthma (as prophylaxis).
What it the mechanisms of action of sympathomimetics?
These are decongestants
Cause vasoconstriction to reduce nasal congestion (does not treat sneezing, itching or rhinorrhea)
What are some examples of sympathomimetics?
Pseudoephedrine
Phenylephrine
What is the therapeutic action of guaifenisen?
Renders cough more productive by stimulating flow of respiratory tract secretions
What are the indications for topical benzoyl peroxide?
First line drug for mild to moderate acne. Suppresses the growth of P. acnes.
What are the side effects of Benzoyl peroxide?
- Flaking/peeling skin
- Local irritation
- Burning
- Swelling
- Scaling
- Blistering
- Hypersensitivity reactions in patient with asthma
What patient teaching is needed for Benzoyl peroxide?
- Increased risk for sunburn – avoid exposure
- Avoid irritant soaps and scrubs
- Wash and dry skin before applying medication
- Keep away from mucous membranes
- Report severe irritation including
* Blistering
* Intense burning
* Swelling
What is the risk of prescribing budesonide in children?
Increases the risk for slowing linear growth
Organic sunscreen needs what ingredient to be effective?
Avobenzone
First line topical treatments for mild acne
Benzoyl peroxide or topical retinoid or combination
First line oral treatments for
moderate acne
Oral antibiotics
- Doxycycline, minocycline
Comedolytics
- Retinoids, azelaic acid
Hormonal Drugs
spironolactone
First line treatment for severe acne
Oral antibiotic (isotretinoin) plus topical combination therapy (doxycycline and topical retinoid)
Only used for patients who do not respond to other therapies like antibiotics
Which topical antibiotics are used to treat mild acne?
- Benozyl peroxide
- Clindamycin/erythromycin
- Dapsone
Which topical retinoids are used to treat mild acne?
- Adapalene
- Tazarotene
- Tretinoin
Which keratolytic agents are used to treat mild acne?
- Azelaic acid
- Salicylic acid
What oral medication is used to treat severe acne?
Isotretinoin
What patient education is needed when prescribing salicylic acid?
Can be toxic when applied in large amounts to large areas inform patient of signs of toxicity including:
- Tinnitus
- Hyperpnea
- Psychologic disturbances
What patient education is needed when prescribing Isotretinoin?
- May affect vision
- May sunburn easily
- Regular blood/pregnancy tests
- Two kinds of birth control needed
- Do not donate blood
- Avoid alcohol
- Avoid supplements with vitamin A
Report severe symptoms including:
o Headaches/vision change
o Vomiting
o Weakness
o Seizures
o Depression/suicidal ideation
o Problems with erectile dysfunction
When to prescribe an intranasal glucocorticoid?
effective drugs for prevention and treatment of seasonal and perennial rhinitis
Tetracycline
- indication
- dose
- directions for use
Indication
- Moderate to severe acne
Dose
- 500mg BID
Directions for use
- Take on an empty stomach
Amoxicillin
- indication
- dose
- directions for use
Indication
- Acute otitis media
Dose
- 40-45mg/kg twice a day (BID) by mouth
Directions for use
- Take medication until course is finished
- 5-10 days depending on severity and patient age
Timolol ophthalmic
- indication
- dose
- directions for use
Indication
- Open angle glaucoma (initial and maintenance therapy)
Dose
- 0.25-0.5% solution/gel
- 1 drop daily
Directions for use
- Take at scheduled time (failure may result in vision loss)
- do not touch dropper to eye
- Close eye for three minutes after administration
Benzoyl Peroxide Cream
- indication
- dose
- directions for use
Indication
- Topical antibiotics for mild/moderate acne
Dose
- 10% cream
Directions for use
- Apply thin film once daily to start, can increase to 2-3xday as needed.
Otomycosis
Fungal infection of the ear canal
