Eyes, Ears, Nose & skin conditions Flashcards
intranasal steroids
first line for chronic, moderate-to-severe symptoms of allergic rhinitis
oral antihistamines
used in milder, intermittent symptoms of allergic rhinitis
Common intranasal steroids
budesonide (rhinocort allergy) - OTC (preferred in pregnancy)
Fluticasone (flonase) - RX and OTC
Triamcinolone (Nasacort) - OTC
antihistamines
-blocking histamine at the H1 receptor
-effective at reducing symptoms of itching, sneezing, rhinorrhea
-have little effect on nasal congestion
1st generation antihistamines
benadryl, hydroxyzine, mecliizine cause more sedation
diphenhydramine (benadryl)
-treatment of acute allergic rxns
-prevention of allergic rxns
-allergic rhinitis
-cough
-sleep
-dystonic reactions (anticholinergic properties)
-motion sickness
*avoid in elderly (BEERS List-anticholinergic effects)
what disease states can benadryl worsen
BPH, constipation, dementia, glaucoma
benadryl dose
25 mg PO Q4-6H or 50 mg PO Q6-8H
benadryl in those < 6
do not use unless directed by healthcare provider
fenofaxidine
do not take with fruit juice due to decrease absorption
antihistamines to use in pregnancy
loratadine and cetirizine
most sedating second generation antihistamines
cetirizine and levocetirizine
least sedating second generation antihistamines
fexofenadine and loratidine
problems with afrin
rebound congestion if used longer than 3 days (rhinitis medicamentosa)
intranasal cromolyn
OTC mast cell stabilizer used for tx or ppx of allergic rhinitis
montelukast
leukotriene modifying agent indicated for treatment of both allergic rhinitis and asthma
common cold
zinc or vitamin C (shown to decrease days of cold symptoms)
dextromethorphan
-acts as a serotonin reuptake inhibitor at usual doses
-high doses act as an NMDA-receptor blocker and cause euphoria and hallucinations
safety of dextromethorphan +/- guaifenesin
-do not use within 14 days of MAOi
-risk of serotonin syndrome
codeine safety (C2 as a single agent and CIV as combined)
-respiratory depression/death
-ultra-rapid metabolizers due to CYP450 2D6 polymorphisms
-do not use in children under 12 or in children < 18 who underwent a tonsillectomy and/or adenoidectomy
combined products: D
decongestant (phenylephrine or pseudoephedrine)
combined products: PE
phenylephrine
combined products: DM
dextromethorphan
combined products: AC
contains codeine
guaifenesin
ycolytic
analgesic
contains cough and cold products
chlorpheniramine/hydrocodone
Tussicaps/Tussionex
CII
cough/cold products: children < 18 years
avoid codeine and hydrocodone - containing cough and cold products (FDA)
cough/cold products: children < 4 years
avoid otc cough and cold products
cough/cold products: children < 2 years
-avoid otc cough and cold products
-avoid promethazine
-avoid topical menthol and camphor
AD
right ear
AS
left ear
AU
each ear
OD
right eye
OU
each eye
OS
left eye
eye/ear solutions: 1 drop
0.05 mL
drugs that increase IOP
-anticholinergics
-decongestants
-chronic steroids
-topiramate
normal IOP
12-22
open-angle glaucoma
no symptoms and treated with eye drops or surgery
close-angle glaucoma
blockage and sudden increase of IOP - medical emergency and treated surgically