EENT Flashcards
(93 cards)
1
Q
What are the 3 mechanisms of action of an antibiotic?
A
- Cell wall synthesis
- nucleic acid synthesis
- protein synthesis
2
Q
What are classic sxs of GABHS, or sore throat?
A
- fever > 38deg
- TTP anterior cervical adenopathy
- NO cough
- pharyngotonsillar exudate
3
Q
Treatment for sore throat.
A
- Penicillin
- Erythromycin
4
Q
Distinguish between bacterial and viral pharyngitis on clinical presentation.
A
Both: red, swollen tonsils and throat redness
Bacterial: swollen uvula, whitish spots, gray furry tongue
5
Q
MOA of Penicillin
A
Inhibits bacterial cell wall synthesis (Beta-Lactam)
6
Q
Adverse events/side effects of Penicillins (beta-lactams)
A
- Hypersensitivity (i.e. hives, swelling to lips, tongue, mouth, or throat)
- Mild N/V/D
7
Q
What do you want to monitor when prescribing Penicillin?
A
- opportunistic infection (i.e. unhealed sores, white plaques, purulent vaginal dc)
- Signs of anaphylaxis during 1st dose
8
Q
What are the different ways you can give Penicillin? When should you adjust the dose?
A
Orally - Penicillin VK x10 days or Amoxicillin
IM - Penicillin G Benzathine (Bicillin Long Acting or Crystal Repository)
- adjust does in renal impairment
9
Q
What are the drug interactions for Penicillin?
A
May enhance anticoagulant effect of Warfarin (Vitamin K antagonist)
Tetracycline derivatives- diminish therapeutic effect (bacteriostatic w/bactericidal)
Probenecid - increase serum concentration
10
Q
MOA of Erythromycin
A
inhibitor of translation and transcription
11
Q
What med can you give a patient for bacterial pharyngitis w/ a PCN allergy? and what are possible side effects?
A
Erythromycin (macrolide):
- GI disturbances
- QTc prolongation
- ototoxicity (hearing loss)
12
Q
What should you monitor in Erythromycin?
A
Report immediately –> unusual malaise, N/V, abd pain, Fv, rash/itching, easy bruising or bleeding
13
Q
Erythromycin: adult dosage and interaction
A
Erythromycin Base
Erythromycin Ethylsuccinate
Azithromycin
Interaction = effects on CYP450
14
Q
What is the cause and treatment for acute laryngitis?
A
Usu. viral –> M. catarrhalis & H. influenzae
Tx: Erythromycin (macrolide), Cefuroxime, Amoxicillin-clavulanate (Augmentin)
15
Q
What is characteristic of HSV 1 or 2 and what 2 drugs can you treat it with?
A
- Prodrome of burning, pain, tingling
- Burning erythematous papules –> vesicles that rupture –> superficial ulcers –> scabs
Acyclovir and Valacyclovir
16
Q
What can you recommend for pain and fluid management for a pt w/ Viral-Herpes Simplex?
A
- rinse and spit every 2 hrs w/ diphenhydramine mixed w/ Magnesium-Aluminum 1:1
- Topical lidocaine
- ice, popsicles
17
Q
Side effects of antiherpetic drug?
A
Malaise and headache
18
Q
What should you monitor when giving anti-herpetic drugs?
A
Labs: UA, BUN, serum Cr, liver enzymes, CBC
19
Q
What are the drug interactions of Acyclovir-Valacyclovir and Famciclovir?
A
Hold antiviral meds for at least 24 hrs prior
and 14 days after live attenuated Zoster vaccine bc it may diminish therapeutic effect
20
Q
What is the treatment for Fungal-Oral Candidiasis?
A
1st line = topicals
* Nystatin Suspension
Clotrimazoles troches
Itraconazole susp.
2nd line = oral
Fluconazole (prototype)
21
Q
MOA of oral Fluconazole
A
binds to sterols in fungal cell membrane –> changes cell wall permeability –> leakage of cellular contents
22
Q
What are adverse/side effects to giving oral Fluconazole?
A
Increased Alk phos, ALT, AST, hepatic failure, hepatitis, jaundice
- monitor labs periodically and adjust for renal impairment
23
Q
What are the drug interactions of oral Fluconazole?
A
Inhibits CYP1A2 (weak), CYP2C19 (strong, CYP2c9 (strong), CYP3A4 (mod)
- incr. serum concentration
- dec. metabolism
- enhance adverse/toxic effect
– Do an interaction check! –
24
Q
What is the treatment for viral conjunctivitis?
A
topical antihistamine/decongestants
lubricating agents
cool compresses
hygiene awareness
25
Most common bacterial causes of conjunctivitis? adults? in contact wearers?
"her majesties secret service"
- H. influ, M. catarrhalis, S. aureus, St. pneumo
Adults = S. aureus
Contact lenses = Pseudomonas aerusginosa
26
What is the Tx for bacterial conjunctivitis?
Ophthalmic- topical abx's
- Macrolides - Erythro/Azithromycin
- Aminoglycosides - Gentamicin, Tobramycin (best for psuedomonas)
- Polymixin-Trimethoprim (polytrim)
27
What is the Tx for blepharitis?
warm compresses, baby shampoo
Abx- Erythromycin ophtho ointment
If susp. viral cause - Acyclovir, Valacyclovir, Famciclovir
28
What is the Tx for Preseptal cellulitis aka periorbital cellulitis?
If MSSA (sensitive)--> Amoxicillin-clavulanate, Cefpodoxime, Cefdinir
If CA-MRSA susp --> Trimethoprim-sulfamethoxazole, Clindamycin, Doxycycline
29
What is the Tx for Orbital Cellulitis?
Inpatient tx w/empiric Vancomycin + Ceftriaxone
30
What is the Tx for Corneal abrasion? What med is contraindicated?
Tx: Ophthalmic antibiotics: Erythromycin ointment, Ciprofloxacin
and
Topical NSAIDs
** aminoglycosides if contact wearer
CI's: Steroids bc they slow healing
31
What is the Tx for corneal ulcer?
STAT ophtho referral
| Ophthalmic Fluoroquinolones
32
What is the Tx for HSV keratitis?
```
STAT ophtho referral
Topical antivirals (ganciclovir gel, trifluridine sol'n)
```
* corticosteroids given ONLY by ophto
33
What is the Tx for eye infection caused by Herpes Zoster?
Ophthalmic antivirals and abx
Corticosteroids ONLY by ophtho
FYI - p/w pain despite local anesthetic and psuedodendrite
34
What is a common side effect of ophthalmic ointments given for bacterial conjunctivitis?
blurry vision for 20 mins after dose is administered
35
In how many days should a patient respond to abx treatment for bacterial conjunctivitis?
1 to 2 days and if not... OPTHO
36
Primary care clinicians should NOT prescribe ____ for acute conjunctivitis?
Glucocorticoids
37
True or false. You should not prescribe an abx for nonbacterial conjunctivitis, even if it is required for a patient to return to school or daycare.
FALSE.
low cost topical abx = erythromycin or sulfa
38
MOA and side effects for Erythromycin Ophth ointment and Azithromycin Ophth sol'n
MOA: inhibit RNA-dependent protein synthesis at the chain elongation step
ADE's: hypersensitivity, minor ocular irritation, redness
39
MOA and side effects of Sulfacetamide 10% eye sol'n
MOA: inhibits bacterial folic acid synthesis, which interferes w/bacterial growth
ADE's: irritation, burning, stinging
40
MOA and side effects of Polymixin-Trimethoprim ophth sol'n
MOA's
1. binds to phospholipids --> alters permeability and permits leakage
2. inhibits folic acid reduction --> inhibits microbial growth
ADE's: burning, itching, edema, rash, redness, stinging, tearing
41
MOA and side effects of Fluoroquinolones for eye infections
i.e. Ofloxacin, Cipro, Moxi, Levo
MOA: DNA gyrase inhibitor
ADE's: FB sensation, itchy, photophobia, hypersensitivity
42
What is unique about dosage for fluoroquinolones for eye infections?
Level of severity (i.e. conjunctivitis vs. corneal ulcer) determines how much to front-load
43
When are aminoglycosides for eye complaints indicated?
i.e. Gentamicin, Tobramycin
| Contact lens wearers w/an abrasion d/t risk of pseudomonas infection
44
When is Ketorolac 0.5% ophth sol'n (NSAID) use indicated?
sol'n for post-op inflammation following cataract surgery and/or laser corneal surgery
allergic eye dz
45
What is the MOA of Ketorolac 0.5% ophth sol'n (NSAID)?
reversibly inhibits cyclooxygenase-1 and 2 --> decreased formation of prostaglandin precursors
46
What are the side effects of Ketorolac 0.5% ophth sol'n (NSAID)?
ocular inflammation, irritation, pain, ocular pressure, increased tearing
47
MOA and side effects of Ganciclovir 0.15% ophth gel (antiviral)
inhibition of viral DNA synthesis - competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase
ADE's: blurred vision and irritation
48
MOA and side effects of Trifluridine 1% ophth sol'n
MOA: interferes w/viral replication by inhibiting thymidylate synthetase
ADE's: mild local irritation of conjunctiva and cornea
49
Who prescribes corticosteroids for eye infections and why? What are the side effects?
Ophthalmologist
- decrease inflammation by suppressing normal immune response
- steroids may mask infection or enhance existing ocular infection
ADE's: cataract formation, glaucoma, globe perforation
50
What are examples of corticosteroids?
Hydrocortisone, dexamethasone, prednisolone
51
What is the Tx for otitis externa?
Decrease excessive moisture w/ acetic acid (VoSol) or 50/50 mixture of isopropyl alcohol/vinegar
Antibacterial/fungal solutions:
- Fuoroquinolones (Ciprofloxacin)
- Aminoglycosides (Neomycin/Polymxin/HC or Genta/Tobramycin +/- corticosteroids)
52
What can you treat with VoSol HC otic? and what are its side effects?
otitis externa
transient burning or stinging after instillation in the acutely inflamed ear
53
List examples of medications that are mixed antibiotic products with corticosteroids used to treat otitis externa. MOA?
Neomycin sulfate
Polymyxin sulfate
Hydrocortisone Otic Sol'n/Susp'n
MOA: interferes w/bacterial protein synthesis by binding to 30S ribosomal subunits
54
What are the side effects of fluoroquinolones used to treat OE?
pain, fungal superinfection, pruritis
55
What med should you not give if you cannot visualize the TM?
Aminoglycosides ophth sol'n because of irreversible ototoxicity if TM is perforated
i.e. Gentamicin or Tobramycin
56
What is the Tx for Acute OM?
1st line = HIGH dose Amoxicillin
Erythromycin plus sulfonamide
Cefaclor
Amoxicillin-clavulanate
57
If a pt being treated for AOM has a Penicillin allergy but did NOT experience an immediate type 1 hypersensitivity reaction what drugs would you consider?
Cephalosporins:
- cefdinir
- cefpodoxime
- cefuroxime
- ceftriaxone
58
MOA and side effects of Cephalosporins
Inhibits bacterial cell wall synthesis
ADE's: rash, diarrhea, increased transaminases, vaginitis
59
If a pt being treated for AOM has a Penicillin allergy and experienced an immediate type 1 hypersensitivity reaction what drugs would you consider?
Macrolide or lincosamide abx's:
- Azithromycin
- Clarithromycin
- Erythromycin-sulfisoxazole
60
T or F: Increasing the dose of macrolide abx overcomes macrolide resistance among pneumococcal isolates as with beta-lactam drugs.
False.
increasing dose for macrolides --> does NOT overcome resistance
Increasing dose for beta-lactam drugs --> does overcome resistance
61
How many days should you prescribe medication for AOM in pediatric patients?
Children <2 y/o: w/AOM + TM perf & pt's with h/o recurrent AOM = 10 days
Children >2 y/o: w/out TM perf or a hx of recurrent AOM = 5-7 days
62
What is the first line Tx for AOM in pediatric patients at initial dx and after failure at 48-72 hours?
Amoxicillin
Amoxicillin-clavulanate (Augmentin)
63
What is the most common cause of sinusitis?
*Most sinusitis is VIRAL
Bacteral: S. pneumoniae, H. influenza, M. catarrhalis
64
When should you prescribe an antibiotic for sinusitis?
Only if sxs worsen after 5-7 days or if sxs persist >10-14 days
65
What is the 1st line/2nd line Tx for Sinusitis and how many days should you give the medication to begin working?
1st line: Amoxicillin, TMP-SMX, Doxycycline,
2nd line: Amox-Clav INI after 3 days on 1st line
66
What medication should you give to a pt who suffered a recent (4-6 weeks) previous infection of sinusitis?
Levfloxacin or Amoxicillin-clavulanate
67
What is the MOA of TMP-SMX (trimethoprim-sulfamethoxazole)?
MOA: sulfamethoxazole and trimethoprim are folate antagonist anti-infectives
68
What are the adverse/side effects of TMP-SMX (trimethoprim-sulfamethoxazole)?
- N/V, anorexia, rash, Stevens-Johnson syndrome
| - Fv, arthralgia, pallor, purpura, or jaundice may indicate serious reactions
69
What should you monitor in a patient on TMP-SMX (trimethoprim-sulfamethoxazole)?
- Use cation if severe allergy or bronchial asthma
- Hemolysis if pt has G6PD deficiency
- Caution w/impaired hepatic function
- Adjust dose in renal impairment
70
What are the drug interactions for TMP-SMX (trimethoprim-sulfamethoxazole)?
- Inhibition of warfarin clearance
- Increased digoxin concentrations
- decreased efficacy of the tricyclic antidepressant
71
What should you tell patients to take with Doxycycline? What are the side effects?
Cola
SE's: Photosensitivity, rash, vomiting, tooth discoloration in children
(do not use in pregnancy and up to age 8)
72
What are the drug interactions of Doxycycline?
Antacids/vitamins - may decrease absorption of Tetracycline
Carbamazepine - may dec. serum concentration of doxy
73
What is the MOA of Fluoroquinolones?
DNA gyrase inhibitor (inhibits DNA syntesis and integrity)
74
What are examples of Fluoroquinolones? What are the adverse/side effects?
N/V/D, constipation, abd pain, dyspepsia, HA, insomnia
75
What is considered first line empirical therapy for acute bacterial rhinosinusitis in pediatric patients?
Amoxicillin-clavulanate
76
What medications could you give for a pediatric patient with a Penicillin allergy suffering from acute bacterial rhinosinusitis?
Clindamycin + cefixime or cefpodoxime
or
Levofloxacin
77
T or F: Most upper respiratory tract infections have a bacterial etiology and tend to resolve spontaneously w/out pharmacologic therapy.
FALSE.
VIRAL cause
78
What are the most common bacterial causes for... Acute otitis media? acute sinusitis? acute pharyngitis?
AOM and acute sinusitis = Strep pneumoniae
acute pharyngitis = group A beta-hemolytic Strep
79
Vaccination against influenza and pneumococcus may decrease the risk of...?
Acute otitis media
80
What are the empiric medications of choice for acute otitis media, acute sinusitis, and acute pharyngitis?
AOM and acute sinusitis = Amoxicillin
acute pharyngitis = Penicillin
81
What medication is recommended for otitis media in a patient who is at high risk for a penicillin-resistant pneumococcal infection?
high-dose amoxicillin (80-90mg/kg/day)
82
What are the goals of Tx for primary open-angle glaucoma?
Goal is to decrease IOP.
1. increase aqueous drainage
2. decrease aqueous production
3. surgery if unresponsive to meds
83
What meds can be given for primary open-angle glaucoma in order to increase aqueous drainage?
1st line = prostaglandin analogues (Lantanoprost, bimatoprost)
2nd line = topical alpha adrenergics (alphagan)
3rd line = topical cholinergics (pilocarpine)
84
What meds can be given for primary open-angle glaucoma in order to decrease aqueous production?
1st line = topical BB's (timolol)
2nd/3rd line = topical/oral carbonic anhydrase inhibitor (cosopt, diamox)
85
What is the MOA of prostaglandin analogues?
prostaglandin F2-alpha analog reduces IOP by increaing outflow of aqueous drainage
86
What are the adverse drug events of prostaglandin analogues?
blurry vision, burning, stinging, conjunctival hyperemia, FB sensation, increased pigmentation of the iris, and abnormal hair growth
87
What is the half-life of prostaglandin analogues?
17 mins
88
MOA of topical alpha adrenergics (Brimonidine)
selective agonist for alpha2 receptors --> reduction of aqueous humor formation and increased uveo-scleral outflow by prevention of vasoconstriction
89
What are the ADE's for topical alpha adrenergics (Brimonidine)?
- Allergic conjunctivitis, conjunctival hyperemmia, eye prurits
- Somnolence
- HTN < hypotension
- hypercholesterolemia
90
MOA of topical cholinergics (Pilocarpine)
directly stimulates cholinergic receptors in the eye causing miosis
91
ADE's of topical cholinergics (Pilocarpine)
"SLUDGE"
salivation, lacrimation, urination, defecation, gastric, emesis
- HTN, tachycardia, diaphoresis
- Ocular: burning, ciliary spasm, conjunctival vascular congestion, corneal granularity, lacrimation, lens opacity, myopia, rential detachment, supraorbital or temporal HA, visual acuity dec.
- bronchial spasms and pulmonary edema
- dec. visual acuity at night
92
What is the MOA of Topical Beta-blocker Timolol? and what are some ADE's?
blocks both beta1 and beta2, reduces IOP by reducing aqueous production
ADE's: decreased HR, contractility, hypotension, bronchospasm
93
What are examples of a topical and oral carbonic anhydrase inhibitor? and what is the MOA?
Cosoft-dorzolamide (w/timolol), Diamox
MOA of dorzolamide: inhibits carbonic anhydrase in the ciliary processes of the eye -
- decreases aqueous production
