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Flashcards in ENT Pharm Deck (25)
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1

Sinus infection is likely to be caused by bacteria rather than virus if any of what the three conditions are present?

1. sx last for 10days w/o evidence of clinical improvement

2. severe sx, fever 102 or greater, nasal discharge and facial pain for at least 3-4days, maxillary tooth pain, unilateral maxillary sinus tenderness.

3. sx or signs worsen as characterized by new fever or HA developing or nasal discharge increasing, typically after a viral upper resp infection taht lasted 5-6 days and initially seemed to improve.

2

What are the three hallmark sx of sinusitis?

Do you need to be stronger/more aggressive when treating children w/ abx?

HA, fever, sinus pain

YES!!! b/c they have less of an immune system.

3

Symptomatic tx of viral sinusitis?

-analgesics (ibuprofen)
-saline irrigation
-topical steroids
-topical decongestants
-oral decongestants.

4

Tx of bacterial sinusitis?

What are the common bacteria causing sinusitis?

-abx!!!!, tx initiated empirically & cultures only for complicated cases.

*if absolute dx of strep pneumo sinusitis give Pen VK, otherwise first line is AMOXACILLIN 500mg PO TID x 7days.
*if bacteria is beta lactam resistant you give them AUGMENTING.
*DOXYCYCLINE; dont use this though its recommended next.
*AZITHROMYCIN: indicated for pregnant pt who are pcn allergic.
*LEVOFLOXACIN
*BACTRIM

Bugs:
-strep pneumo
-h flu
-pseudomonas
-staph aureus
-m. cat
-anaerobic

5

Adverse Rxn of:

-Amoxicillin
-Augmentin
-doxycycline
-azithromycin

Amoxicillin-GI upset, rash, SJS

Augmentin: diarrhea, rash, and n/v
*CI in severe renal impairment

Doxycycline: hepatotoxicity, rash, cant use in kids or pregnancy!!

Azithromycin:
-GI upset, acute renal failure. QT prolongation

6

Tx of acute sinusitis if uncomplicated with mild sx?

-pseudoephedrine (Sudafed)
-afrin (oxymetazoline)
-normal saline nasal spray

7

Acute sinusitis duration of tx?

-abx should be prescribed for 5-7days

8

Chronic Sinusitis
-tx
-reasons for tx failure
-what is empiric 2nd line after tx failure?

Tx: abx usually not effective, consult ENT MDD

Tx failure: resistant pathogen, inadequate dosing, structural abnormalitis, noninfectious etiology

2nd line:
-amoxicilling-clavulanate, levofloxacin, or moxifloxacin

9

When to refer chronic sinusitis to ENT?

-multiple episodes of acute bacterial rhinosinusitis.

-pts with allergic rhinitis who may be candidates for immunotherapy

-urgent referral: severe infection( high persistent fever, orbital edema, HA, visual disturbance, altered mental status)

10

what is the key to dx of otitis media?

pneumoscopy, the TM will not move.

11

AOM
-most frequent dx in what age?
-sx treatment
-tx
-recommnded duration of tx

-kids ages 1-3

-sx tx:
--ibuprofen/motrin
--auralgan (benzocaine & glycerin), never use in children under 2. reduces pain and swelling
-topical aqueous lidocaine

Tx:
-amoxicillin is 1st line
-augmentin
-kids allergic to PCN get azithromycin
-clarithromycin
-erythromycin
*alternatives:
-cefdinir (omnicef)
-cefuoxime (ceftin)


Duration of tx:
-10day course in those younger than 2 years
-5-7day course for children 6yrs and older
-single dose azithromax has FDA approval.

12

AAP/AAFP guidline committee recommends abx when?

-any child younger than 6mo

-ages 6mo - 2 years when dx is certain or the dz is uncertain but illness is severe.
*observation is an option for children in whom the dz is not certain and illness is not severe.

-abx recommended fro children older than 2 yeaers if the dx is certain and illness is severe.
*observation is an option when the dx is certain but illness is not severe and in pts with uncertain dx.

13

Prophylactic tx for otitis media in children who have had 3 infections in 3 months or 4 episodes in 6mo or 6 episodes in 12mo?

amoxicillin 20mg/kg/d for 3-6mo

14

Malignant otitis externa
-aka
-what is this?
-MC bug?
-PE findings
-tx

aka: necrotizing external otitis

what: invasive infection of the canal and skull base

Most common bug: pseudomonas!

PE: mastoid and tragus tenderness.

Tx: antipseudomonal antimicrobials!
-ciprofloxacin
-levofloxacin

15

otic drops are acidic or basic?

-slightly acidic because the external auditory canal is acidic.

16

Otitis Externa
-infection where?
-aka
-cause of infection
-signs and sx

infection of the skin or the ear canal.

aka: swimmers ear

Cause:
-moisture trapped in the ear canal
-hot humid weather
-trauma (cotton swab)
-pseudomonas
-staph
-proteus mirabilis
-fungi

Signs and Sx:
-ear pain with movement of the pinna
-erythematous auditory canal.

17

Otitis Externa
-tx

-remove cerumen, desquamated skin, and purulent material from ear canal (facilitates healing & enhances penetration of ear drops)

-Cortisporin Otic Suspension
--polymyxin
--neomycin
--hydrocortisone

-Cipro HC otic suspension, Ciloxan (ciprofloxacin/hydrocortisone)

-FQ w/ acitivity against pseudomonasm strep, MRSA, staph

-Ciprodex Otic suspension (Cirpo/dexamethasone)

-ofloxin* SAFE in cases of perforated tympanic membrane! this is DOC when perforated TM cannot be ruled out!

-tobradex (tobramycin & dexamethasone); used off label as an otic preparation

-Burows solution (5% aluminum acetate); effective against both bacterial and fungal external otitis

-alcohol vinegar otic mix
--rubbing alcohol, white vinegar, distill water

18

Auralgan
-indications
-SE

analgesic anesthetic: relieve pain, swelling, and congestion of some ear infections.

-cerumen removal adjunct (softens earwax so it can be washed away more easily)


SE:
-itching
-burning
-redness

19

Debrox
-uses

use: cerumen removal

20

Pt education while using OTICS

wash hands first

avoid contamination and do not touch the dropper or let it touch the ear

if drops are in suspension shake well for 10seconds before using

if edema is evident and prevents application use cotton gauze saturated with abx drops and place in ear. after 24-48hrs the cotton can be removed and the medication applied directly into the canal.

-keep water away from the ear until infection clears and for 4-6wks afterwards

21

Ear Wick
-use

use of ear wick helps topical medication penetrate a severely swollen ear canal (like a sponge)

the ear wick is placed in the ear canal an moistened with topical abx eardrops andd removed after 2-3days

22

summary for OE TX
-mild
-moderate/severe

1. CLEAN

2. mild: non abx topical prep containing acidifying agent and glucocorticoid (acetic acid/hydrocortisone)

3. Moderate/severe: need a prep that contains an abx, an antiseptic, and glucocorticoid (Cipro HC, Cortisporin)


4. wick, protect from water, and NSAIDS

23

Labrynthisis
-tx

Tx: compazine (prochlorperazine) 5-10mg po TID-QID PRN nausea

meclizine (antivert)

Adverse rxns ^^^ drowsiness, sedation, dry mouth, blurred vision


diazepam; supress the vestibular system
Adverse Rxn: cns depression, memory impairment, ataxia

24

Menieres
-tx

diuretics (HCTZ)
antiemetics (compazine, meclizine)
anxiolytics (valium/diazepam)
antihistamines
scopolamine

25

Allergic Rhinitis
-tx
-adverse rxn of meds

intranasal glucocorticoids; beclomethasone, flunisolide, budesonide (rhinocort)

Adverse rxn:
-HA, pharyngitis, epistaxis
*warning: adrenal suppression, delayed wound healing, immunosuppression)