ENT cont'd

Question 1

Two classes of Sympathomimetic Decongestants

Answer 1

Pseudoephedrine
Phenylephrine
both Alpha Agonists

Question 2

Three Ocular Decongestants (classes?)

Answer 2

Oxymetazoline (Afrin) - Direct acting, non selective, alpha agonist
Naphazoline
Xylometazoline
O and N are both Alpha Agonists

Question 3

Areas that are inhibited by Sympathomimetics

Answer 3

Gut, bronchial tree, skeletal muscles

Question 4

Mechanisms of sympathomimetics which results in decongestion

Answer 4

Vasoconstriction:

• reduced capillary hydrostatic pressure / blood flow / volume
• decreases edema, reduces “leakage”

Question 5

Cardiac effects of sympathomimetics

Answer 5

Increased heart rate (positive chronotropic) and contractility (positive inotropic)

Question 6

Metabolic effects of sympathomimetics

Answer 6

“stress - like” effects

1. increased glycogenloysis
2. free fatty acid liberation from tissues

Question 7

CNS effects of sympathomimetics

Answer 7

1. Respiratory stimulation
2. Wakefulness
3. Anxiety
4. Appetite reduction

Question 8

Phenlyephrine found in which products?

Answer 8

1. Sudafed PE
2. Tylenol Cold “day time”
3. Hemorrhoidal suppositories

Question 9

3 ADR’s of Phenylephrine

Answer 9

1. Increase BP and compensatory decrease HR (dose-dependent)
2. Arrhythmia, tachycardia
3. Shaking

Question 10

Phenylephrine drugs are contraindicated for which patients?

Answer 10

1. HTN
2. heart disease
3. hyperthyroid
4. BPH (benign prostate hyperplasia)

Question 11

Pseudoephedrine

Answer 11

** Mixed-acting agonist **
same effects as Phenylephrine
Onset of action 15-30 mins, peak effect <60 mins
“behind” the counter, can be reduced to methamphetamine

Question 12

3 Intranasal Steroids

Answer 12

1ST LINE, MOST EFFECTIVE TREATMENT
FOR ALLERGIC RHINITIS
1. Fluticasone (Flonase) for 12 yrs and up only
2. Mometasone (Nasonex)
3. Triamcinolone (Nasocort) for 12 years and up only

Question 13

Intranasal Steroids for Peds 2+

Answer 13

1. Fluticasone furoate (veramyst)

2. Mometasone

Question 14

3 ADRs of Intranasal Steroids

Answer 14

1. Epistaxis
2. Candida infection
3. Nasal septal perforation

Question 15

Mast Cell Stabilizer

Answer 15

Cromolyn Sodium (Nasalcrom)
- Allergic rhinitis (ocular, nasal, bronchial preps)

Question 16

Cromolyn Sodium MOA

Answer 16

Prevents mast cell degranulation and histamine release

Question 17

3 Leukotrine Inhibitors

Answer 17

1. Montelukast (Singulair)
2. Zafirlukast
3. Zileuton

Question 18

Indications for Leukotrine Inhibitors

Answer 18

Best used w antihistamines

Good for chronic asthma

Question 19

3 ADR’s for Leukotrine Inhibitors

Answer 19

1. Headache
2. Dizziness
3. Anxiety

Question 20

Recommended treatment for cough from URI

Answer 20

1st gen antihistamine + decongestant

Question 21

Recommended treatment for cough from chronic bronchitis / COPD

Answer 21

1. Ipatropium bromide

2. Dextromethorphan or Codeine