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ENT Pharmacology Flashcards

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1
Q

Viral Infection Therapy

A 
Symptomatic
Analgesics
Saline irrigation
Topical steroids
Topical decongestants
Oral Decongestants
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2
Q

Common Bacteria that Cause Sinusitis

A 
Strep pneumo
H. flu
Pseudomonas
Staph aureus
M. cat
Anaerobic bacteria
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3
Q

Antibiotics for Acute Sinusitis

A 
Amoxicillin
Augmentin
Doxycycline
Clarithromycin
Zithromax
Levofloxacin
Bactrim
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4
Q

Warnings for using Amoxicillin

A

Monitor blood, renal and hepatic function for long term use

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5
Q

Adverse Reactions for Amoxicillin

A 
GI upset
Hypersensitivity reactions (urticaria, rash, SJS, yeast infections)
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6
Q

Which antibiotic is first line for acute sinusitis?

A

Amoxicillin

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7
Q

What antibiotic is best for penicillin allergy in acute sinusitis?

A

Augmentin

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8
Q

Contraindications for Augmentin

A

Severe renal impairment

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9
Q

Adverse Reactions for Augmentin

A 
Diarrhea
Nausea
Abdominal pain
Rash
Urticaria
Vomiting
Vaginitis
Anaphylaxis
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10
Q

Augmentin Pregnancy Class

A

Class B

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11
Q

Warnings for Doxycycline

A 
Hepatotoxicity
Hypersensitivity
Photosensitivity
Tissue Hyperpigmentations
Peds: tooth enamel hypoplasia or permanemtn tooth discoloration
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12
Q

Can you use doxycycline during pregnancy and why?

A

No- reduced bone growth

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13
Q

Special Alerts for Azithromycin

A

Elderly
QT prolongation
Electrolyte disturbances

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14
Q

Adverse Reactions for Aithromycin

A 
Diarrhea
Abdominal pain
Anorexia
Cramping
Vomiting
Vaginitis
Acute renal failure
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15
Q

What is the drug of choice for acute sinusitis in penicillin allergic patients?

A

Azithromycin

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16
Q

How to treat uncomplicated acute sinusitis with mild symptoms?

A

Pseudoephedrine (Sudafed)
Oxymetazoline
NS nasal spray

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17
Q

Warnings for Psuedephedrine (Sudafed)

A

HTN
CVD
DM
Thyroid

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18
Q

Adverse Reactions for Psuedephedrine (Sudafed)

A

Nervousness
Dizziness
Insomnia

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19
Q

How long should antibiotics be prescribed for acute sinusitis?

A

5-7 days

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20
Q

Reasons for failure of treatment in acute sinusitis

A

Resistant pathogens
inadequate dosing
Structural abnormalities
Noninfectious etiology

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21
Q

When to refer sinusitis to ENT

A

Multiple episodes of acute bacterial rhinosinusitis (ABRS)
Chronic rhino sinusitis with exacerbations of ABRS
Allergic rhinitis who may be candidates for immunotherapy

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22
Q

Urgent referral to ENT

A

Severe infection

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23
Q

Symptomatic Treatment of OM

A

Ibuprofen/Motrin
Auralgan
Topical aqueous lidocaine

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24
Q

Antibiotics vs. Observation in OM

A
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25
Base Antibiotics Treatment on:
``` Clinical & microbiologic efficacy Acceptability SE & toxicity Convenience of dosing schedule Cost ```
26
Antibiotics for OM
``` Amoxicillin Augmentin Azithromycin Clarithromycin Erythromycin/Sulfisoxazole ```
27
Alternative Antibiotic Options for OM
Cefdinir (Omnicef) | Cefuroxime (Ceftin)
28
Recommended Duration of Treatment
29
Prophylaxis can be given when
3 infections in 3 months 4 episodes in 6 months 6 episodes in 12 months
30
Pain Control in OM
Auralgan | Tylenol/Ibuprofen
31
Indications for Auralgan
Reduce pain and swelling | Remove or soften cerumen
32
OM Drug of Choice
Amoxicillin
33
Adverse Reactions of Amoxicillin
``` GI upset Hypersensitivity reactions Hyperactivity Blood dycrasias Yeast infections ```
34
Medication for severe otalgia or elevated temperature
Augmentin
35
Adverse Reactions for Augmentin
``` GI upset Diarrhea Nausea Abdominal pain Rash urticaria Vomiting Vaginitis Anaphylaxis ```
36
Drugs can use if penicillin allergy without urticaria or anaphylaxis in OM
Cefdinir Cefpodoxime Cefuroxime Ceftriaxone
37
Drugs can use if severe penicillin allergy in OM
Erythromycin + sulfisoxazole Azithromycin Clarithromycin Bactrim
38
Define Malignant Otitis Externa
Invasive infection of the canal and skull base
39
Patients at high risk for malignant otitis externa
Elderly patients with DM | HIV
40
Antibiotics for Malignant Otitis Externa
ANTIPSUEDEMONALS Ciprofloxacin Levofloxacin
41
Initiating Events in Otitis Externa
``` Moisture trapped in ear canal Occurs after swimming or bathing Hot, humid weather Trauma Cleaning the ear with cotton swab, paper clip, bobby pin, etc. ```
42
Causative Agents of Otitis Externa
``` Pseudomonas Staph Enterobacter aerogenes Proteus mirabilis Fungi ```
43
Sings & Symptoms of Otitis Externa
Ear pain with movement of pinna | Erythematous auditory canal
44
First step in treatment of Otitis Externa
Remove cerumen, desquamated skin, and purulent material
45
Why do we clean the ear canal to treat otitis externa?
Facilitates healing | Enhances penetration of drops
46
Description of Otics
Antibiotic or a mixture of antibiotic and cortisone
47
Considerations Before Use of Cortisporin-Otic Suspension
``` Allergies Other ear infection Perforated TM Pregnancy (Cat C) Breastfeeding ```
48
Adverse Reactions of Cortisporin-Otic Suspension
Local reactions Extended use can lead to resistant infections & thinning or atrophy of skin Use with caution in perforated TMs
49
Considerations Before Use of Cipro HC Otic Suspension, Ciloxan
``` Allergies Other ear infection Perforated TM Pregnancy (Cat C) Breastfeeding ```
50
Adverse Reactions for Ciprodex Otic Suspension
Ear discomfort/pain Pruritis Dysgeusia Erythema
51
What population can you not use ciprodex otic suspension?
Children
52
What population is Ofloxin 0.3% solution not recommended?
Children
53
Considerations Before Use of Ofloxin 0.3% Solution
Allergies Other ear infection Pregnancy (Cat C) Breastfeeding
54
Which medication is safe in the case of a perforated TM?
Ofloxin 0.3% solution
55
Adverse Reactions of Ofloxin 0.3% Solution
``` Pruritis Local reactions Taste changes if TM perforated Dizziness Ear pain ```
56
Contraindications to Tobradex
Documented hypersensitivity
57
Which ophthalmic medication is used off label as an otic preparation?
Tobradex (Tobramycin & dexamethasone)
58
Pregnancy Category for Tobradex
Category B
59
Precautions with Torbradex
Perforated TM- ototoxicity
60
How does Acetic acid in aluminum acetate (Domeboro) work?
Acidifies ear canal Exerts astringent Bactericidal Fungicidal
61
What is a good alternative to an antibiotic solution for ear drops?
Acetic acid in aluminum acetate (Domeboro)
62
When is Domeboro not recommended or contraindicated?
``` TM perforation (C) Children ```
63
Adverse Reactions for Domeboro
Burning Stinging Irritation
64
What does 5% Aluminum Acetate (Burow's Solution) treat?
Bacterial external otitis | Fungal external otitis
65
Alcohol Vinegar Otic Mix
Pregnancy Cat. A Prevention of OE Flushing solution for fungal infections Avoid with perforated TM
66
Indications for Auralgan
Analgesic-anesthetic | Cerumen removal adjunct
67
Otic dosage for ear pain caused by infection
Enough medicine to fill ear canal every 1-2 hours until pain is relieved
68
Otic dosage for softening earwax before removal
Enough medicine to fill ear canal 3 times a day for 2 or 3 days
69
SE of Auralgan
Itching Burning Redness
70
Indications for Debrox
Cerumen removal
71
Contraindications for Debrox
Perforated TM Ear drainage or discharge Ear pain or irritation Dizziness
72
Prevention of Otitis Externa
Wearing ear plugs when swimming or showering Drying ear with hair dryer Avoid removing ear wax mechanically
73
Why would one use an ear wick?
Helps topical mediation penetrate a severely swollen ear canal
74
Treatment for Mild Otitis Externa
Acetic acid/Hydrocortisone
75
Treatment for Moderate and Severe Otitis Externa
Cipro HC | Cortisporin
76
What are Vertigo Syndromes?
Subtype of dizziness in which a patient inappropriately experiences the perceptions of motion due to dysfunction of the vestibular system
77
Treatment of Vertigo Syndromes
Symptomatic treatment until cause is determined
78
Treatment of Labrynthitis
Prochlorperazine (Compazine) Meclizine (Antivert) Diazepam
79
Indications for Prochlorperazine (Compazine)
Severe N/V
80
Adverse Reactions for Prochlorperazine (Compazine)
``` Drowsiness Dizziness Blurred vision Anticholinergic effects Lowered seizure threshold ```
81
Indications for Meclizine (Antivert)
N/V | Vertigo of vestibular origin
82
Adverse Reactions of Meclizine (Antivert)
Drowsiness Sedation Dry mouth Blurred vision
83
Indication for Diazepam
Suppress the vestibular system
84
Adverse Reactions for Diazepam
CNS depression Ataxia Memory impairment
85
Medications for Meniere's Disease
``` Diuretics Antiemetics Anxiolytis Antihistamines Scopolamine ```
86
Types of Diuretics for Meniere's Disease
Hydrochlorothiazide (HCTZ) Hydrochlorothiazide and triamterene (Maxzide) Acetazolamide (Diamox)
87
Contraindications for Hydrochlorothiazide (HCTZ)
Sulfonamide allergy
88
Warnings for HCTZ
Renal or hepatic impairment DM Gout
89
Adverse Reactions for HCTZ
Hypokalemia | Hyperglycemia
90
Contraindications for HCTZ and triamterene (Maxzide)
Sulfonamide allergy
91
Antiemetics for Meniere's Disease
Prochlorperazine (Compazine) | Meclizine (Antivert)
92
Indications for Meclizine (Antivert)
N/V
93
Adverse Reactions for Meclizine (Antivert)
Drowsiness Sedation Dry mouth Blurred vision
94
Types of Anxiolytics for Meniere's Disease
Valium/Diazepam | Atarax (Hydroxyzine)
95
Adverse Reactions of Atarax (Hydroxyzine)
Drowsiness | Dry mouth
96
Medications for Allergic Rhinitis
Intranasal glucocorticoids (topical)
97
Mechanism of Action of Topical Intranasal Glucocorticoids
Inhibit allergic inflammation
98
First Generation of Topical Intranasal Glucocorticoids
Beclomethason (Beconase AQ) Flunisolide (Nasalide) Budesonide (Rhinocort Aqua)
99
Second Generation of Topical Intranasal Glucocorticoids
Fluticasone (Fonase) | Mometasone (Nasonex)
100
Adverse Reactions for Topical Intranasal Glucocorticoids
Headache Pharyngitis Epistaxis
101
Warnings of Topical Intranasal Glucocorticoids
Adrenal suppression Delayed wound healing Immunosuppression Risk vs. benefit

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