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Pharmacology Exam 1 > Sinusitis > Flashcards

Flashcards in Sinusitis Deck (11)
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1
Q

Sinusitis - common pathogens

A

Strep pneumo (30-40%) gr+ cocci
H. Influenza (20-30%) gr - bacilli
Moraxella gr- cocci
(Similar to OM and pharyngitis)

strep pyogenes and viruses

2
Q

Sinusitis - clinical presentation/indicators for abx

A

Persistent >10 days without improvement
or
Severe s/s with high fever, purulent discharge, facial pain x 3-4 days
or
“double sickening” - was a viral URI, now new onset fever

3
Q

Sinusitis treatment plan

A
  1. Symptomatic relief: analgesics, nasal irrigation.
  2. Restore/improve sinus function. Consider decongestants.
  3. Abx
  4. Consider intranasal steroids (in allergic rhinitis patients)
4
Q

Why are antihistamines generally not recommended in sinusitis?

A

Dries up secretions/increases viscosity.

5
Q

If a pt with sinusitis improves after 3-5 days of antibiotics, how long do you continue therapy?

A

5-7 days if 1st line therapy or 7-10 days if 2nd line therapy

6
Q

If a pt with sinusitis worsens in 48-72 hours or does not improve after 3-5 days of antibiotics, what is your next action?

A

Broaden coverage or switch to another class

7
Q

After broadening coverage or changing classes for a patient that is not improving (sinusitis), what is your next action?

A

CT scan or MRI

8
Q

Sinusitis - DOC

A

AMX-CLA

If PCN sensitive, Doxycycline or Macrolid (Azithro or Clarithro)

9
Q

Why are macrolides not recommended as empiric therapy for bacterial sinusitis?

A

High rate of resistance for strep pneumo (30%)

10
Q

Should Intranasal steroids be started as an adjunct to abx for sinusitis?

A

Yes, if history of allergic rhinitis.

11
Q

Compare Tx of OM - Pharyngitis - Sinusitis

A

Similar
OM and pharyngitis are AMX
Sinusitis is a little more serious b/c close to brain so step it up - Augmentin