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Pharmacology > Lecture 13 (HEENT)- Exam 7 > Flashcards

Lecture 13 (HEENT)- Exam 7 Flashcards

1
Q

Antihistamines
* Histamine is released from what?
* What does histamine binding to H1 receptors result in?

A
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2
Q

Histamine binding to H2 receptors causes what?

A

Histamine binding to H2 receptors on gastric parietal cells increases gastric acid secretion

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3
Q

What do antihistamine do?

A
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4
Q

First gen antihistamie:
* Where does it bind and what conditions can they help?
* Does it cross the BBB? What are the receptors?
* What are the adverse reactions?

A
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5
Q

What are the first gen antihistamine drugs?8

A
  • Brompheniramine
  • Chlorpheniramine
  • Cyproheptadine
  • Diphenhydramine
  • Hydroxyzine hcl / pamoate
  • Promethazine
  • Meclizine
  • Dimenhydrinate
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6
Q

2nd gen antihistamie:
* What are they used for and what receptor?
* Does it cross the BBB?
* What are the adverse reactions?

A
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7
Q

What are the 2nd gen antihistamine drugs?

A
  • Cetirizine
  • Levocetirizine
  • Loratadine
  • Desloratadine
  • Fexofenadine

Lora cet AC, she Fex it

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8
Q

Decongestants
* What are the two types?
* What receptors do they bind to and what does that cause?

A

Oral or intranasal sprays
* Respiratory mucosa alpha agonist
* Vasoconstricts superficial blood vessels in nasal mucosa
* Decreases edema, nasal congestion, tissue hyperemia
* Increases nasal patency
* Beta receptor agonist – bronchial relaxation, tachycardia, increased contractility

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9
Q

What are the adverse reactions of decongestants?(8)

A
  • Insomnia
  • Nervousness
  • Tremor
  • Urinary retention
  • Decreased appetite
  • Increased BP, tachycardia, palpitations
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10
Q

Decogestant:
* Who should avoid these drugs? 4

A

Cardiovascular disorders, hypertension, glaucoma, bladder neck obstruction

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11
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A
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12
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13
Q

What happened with pseudoephedrine?

A
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14
Q

Topical Nasal decongestants
* Adverse reactions?
* What are local effects?
* Fast or slow effects?
* Use for how long?
* What is phinitis medicamentosa?
* What decreases symptoms?
* Recovery when?

A
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15
Q

Topical nasal decongestants
* What are the medications (3)?

A
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16
Q

Inhaled nasal corticosteroids:
* Decrease what?
* Improves what?
* When does symptoms resolve?
* What are the effects?

A
  • Decrease nasal mucosa inflammation
  • Improves airway patency
  • Days to weeks for symptom resolution
  • No cardiovascular effects
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17
Q

Inhaled nasal corticosteroids:
* What are the adverse effects?(5)

A
  • Nasal mucosa irritation
  • Epistaxis
  • Sore throat - ? candida infections (drink water after using)
  • Pediatric growth suppression (delayed, not stopped)
  • Potential for system steroid adverse effects
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18
Q

What are the different glucocorticoid nasal sparys for treatment of rhiitis?

A
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19
Q

Otitis Externa (OE)
* What is it?
* What increases the risk?
* What are the MC organisms?

A
  • Otitis externa AKA swimmer’s ear refers to inflammation of the external auditory canal and surrounding tissues (pain with pulling on ear)
  • Continuous wet environment (mc is kid swimming ten sudden pain) or trauma increases risk
  • Pseudomonas aeruginosa and Staphylococcus MC organisms
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20
Q

Otitis Externa (OE)
* Immunocompromised patients at risk of what?

A

Immunocompromised patients at risk of severe OE (Malignant OE)
* Skull osteomyelitis
* Facial nerve palsies

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21
Q

What are the different criteria to diagnosis of otitis externa?

A
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22
Q

OE – physical exam
* What does it show?
* What should you attempt to view? Why?

A

Physical exam:
* Diffuse erythema and edema
* ± otorrhea
* ± regional lymphadenopathy
* ± cellulitis

Attempt to view tympanic membrane if possible
* Intact or not intact
* Treatment recommendations vary based on TM

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23
Q

Treatment approach of OE:
* What do you do for pain?
* What is not indicated for local disease? What about more serious issues?

A
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24
Q

Treatment of OE:
* What is that mainstay txt?

A
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25
Q

For OE therapy what does it lack literature of?

A
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26
Q

OE txt:
* What agents are safe and not safe when the TM is not intact of cannot be seen?

A
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27
Q

What can you apply when the ear cannel is too swollen in OE for txt?

A

Wicks

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28
Q

Fill in for OE txt?

A
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29
Q

Patient education for eo
* What do you tell them?
* What is prevention

A
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30
Q

Acute Otitis media
* What is it?
* Precipitated by what?
* AOM may also be associated with what?

A

Acute otitis media (AOM) is an acute infectious process marked by infected middle ear fluid and inflammation of the mucosa lining the middle ear space.
* Precipitated by impaired function of the eustachian tube
* AOM may also be associated with purulent otorrhea

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31
Q
A
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32
Q

What are the sxs of AOM in children

A
  • Acute symptoms onset (< 48 hours)
  • Tugging, rubbing, holding ear
  • Irritability, crying
  • Decreased appetite
  • Changes in sleep
  • Fever
  • Upper respiratory tract symptoms
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33
Q

Diagnosis of AOM – otoscopic exam
* What do you see on exam?
* What is not diagnostic?

A

PE
* Bulging TM with impaired mobility
* Otorrhea not secondary to OE
* Intensely erythematous TM

Middle ear fluid not diagnostic
* Otitis media with effusion

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34
Q

What does the TM look like in AOM?

A
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35
Q

What are the organisms that cause AOM?

A
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36
Q

What is the txt of AOM? (non-pharm)

A
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37
Q

Antibiotic therapy
* Who should have antibiotic txt and who can be watched?

A
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38
Q

Treatment regimens of AOM
* What do you give for first line?
* What do you give if penicillin allergy?

A
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39
Q
  • What organisms of AOM can you use amox and amox/clav on?
  • What are sxs of H.flu infection?
  • What antibiotics should you use if reoccurance happens within a month and over a month?
A
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40
Q

AOM prevention
* What is no longer recommended?
* When are tubes recommended?

A
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41
Q

AOM prevention
* What are the vaccies?

A
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42
Q

Tympanic Membrane Perforation
* How does it heal?
* What does it allow?
* Promotes what?
* What can be added to therapy?

A
  • Majority heal spontaneously
  • Allows drainage of infected fluid
  • Relieves middle ear pressure
  • Promotes quicker healing
  • Topical antibiotic drops may be added to oral therapy – exact benefit unproven
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43
Q

Tympanic Membrane Perforation
* Patient should use appropriate water precautions?

A
  • No head submersion (swimming, diving, etc)
  • Avoid getting water in the affected ear when bathing or showering (ie, use a cotton ball coated with petroleum jelly in the ear to create a barrier)
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44
Q

Mastoiditis
* what is it?
* What is the MC organisms?
* What is primary treatment?

A
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45
Q

Mastoiditis
* What are the sx?

A
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46
Q

What is this?

A

Mastoiditis

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47
Q

Mastoiditis txt:
* What do you consult ENT for?
* What do you start?

A
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48
Q

Mastoiditis txt:
* What is the empiric antibiotic therapy without recurrent history of AOM and with With recurrent history of AOM / invasive
disease (abscess, osteomyelitis)?

A
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49
Q

Barotrauma
* What are the most common causes?
* What are the symptoms?

A

MCC flying
* Other causes: diving, decompression, hyperbaric oxygen chambers, and blast injuries

Symptoms: ear pressure, pain, hearing loss, and tinnitus
* Less common: TM rupture and bleeding

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50
Q

Barotrauma
* What are the treatments?

A
  • Oral decongestants, antihistamines, nasal decongestant spray prior to flying
  • Swallowing or the Valsalva maneuver can equalize pressures and prevent tissue injury
  • Chewing gum or sucking on hard candies can help adults
  • Nursing or sucking on a bottle may help infants
51
Q

What is grade 1 and 2 barotruma?

A
52
Q

Dysfunction of eustachian tube (ET)
* What is ET?
* What are the three primary functions of ET?

A

ET is a valve-like connection between the middle ear to the nasopharynx

Three primary functions:
* Equalize pressure across ear drum
* Protect middle ear from nasopharynx fluid
* Clear out middle ear secretions

53
Q

Dysfunction of eustachian tube (ET)
* What is the most common dysfunction?
* What are sxs?

A

Most common dysfunction – difficulty equalizing pressure across tympanic membrane
* Changes in pressure – flying or diving
* Closed tube due to allergies or URI

Symptoms:
* Pain, ear plugging, decreased hearing or imbalance

54
Q

What are the ET dysfunction treatments?

A
55
Q

Vertigo
* Illusion of what?
* What are the two types?

A
  • Illusion of self motion or movement of the surrounding environment
  • Peripheral vs central
56
Q
A
57
Q

Vertigo:
* How does the dix hallpike show for perpheral vertigo and central vertigo?

A

Dix-Hallpike: peripheral
* Delayed nystagmus
* (2 to 40 seconds)
* < 1 min
* Moderate vertigo

Dix-Hallpike: Central
* Immediate nystagmus
* > 1 min
* Mild vertigo

58
Q

VERTIGO – BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)
* MCC of what?
* What is the pathophysio?
* What are the sxs?

A
59
Q

Vertigo – Benign paroxysmal positional vertigo (BPPV)
* How do you dx it?
* What is the txt?

A

Dx:
* exacerbation of vertigo with Dix-Hallpike maneuver

Treatment:
* Epley maneuver / modified Epley (TID until asymptomatic x 24 hours)
* Medications – not helpful for short episodes; may help maneuver tolerance->Antihistamines, antiemetics, benzodiazepines

60
Q

Vestibular neuritis / labyrinthitis
* Second MCC of what?
* What is the pathophysio?
* What are the sx?

A

Second MCC of vertigo
* Viral etiology – effecting the vestibular portion of the 8th cranial nerve
* Rapid onset of severe vertigo associated with nausea, vomiting, gait instability
* ± tinnitus / hearing loss (vestibular neuritis + unilateral hearing loss = labyrinthitis)

61
Q

Vestibular neuritis / labyrinthitis
* How do you dx and txt is?

A
62
Q

Vestibular suppressants
* usually need what?
* What is the first line?
* reserved for what?

A
  • Usually need IV
  • Antihistamine + antiemetic first-line
  • Reserve BDZ for refractory cases
63
Q

Meniere’s disease
* What is the classic triad?

A

Classic triad: episodic vertigo, tinnitus, and hearing loss

64
Q
A
64
Q

Meniere’s disease
* What is the maintenance treatment?

A
65
Q

Meniere’s disease
* What is the txt for acute attacks?

A

Acute attacks – similar to vertigo treatment

66
Q

Epistaxis
* No specific definitions of what?
* Severe generally?

A
67
Q
A
68
Q

Anterior vs posterior blood supply
* What are they?

A
69
Q

FIRST STEPS of nose bleed?
* What is needed?
* What do you need to compress?
* For how long?
* How do you place the head?
* What medication do you use?

A

  • Cheap, non-invasive
  • Obtain history during compression
70
Q
A
71
Q

What are the next steps of a nose bleed if the compression does not work?
* What do you do if bleeding site is identified and not identified?

A
72
Q
A
73
Q

NASAL POLYPS
* What is it?
* Associated with?
* What can happen?
* What can increase infections? What does that cause?

A
74
Q

NASAL POLYPS
* What are sxs?

A
  • Repeat sinus infections
  • Decreased smell, snoring, sleep apnea
75
Q

Nasal polyps
* What is first line txt? What do they cause?
* What is second line?

A

First-line:
* Nasal corticosteroids
* Decrease nasal mucosal inflammation
* Decrease polyp size
* Increased nasal airflow
* ± leukotriene antagonists

Second-line:
* Surgical removal
* Recurrence common

± leukotriene antagonists:Monteluast, zafirlukast
* Neuropsych SE

76
Q

What are the different nasal corticosteroids?
* What ADRs?

A

ADRs: nasal irritation, epistaxis, stinging

77
Q
A
77
Q

Allergic rhinitis
* What is it?
* What type of reaction?
* What does it cause?

A
78
Q

What is the different normal and allergic reaction?

A
79
Q

Allergic rhinitis treatment
* What is for all patient

A

Allergy avoidance – Nasal irrigation

80
Q

Allergic rhinitis treatment
* What is the txt if the pt has mild symptoms and know allergen?

A
81
Q

Allergic rhinitis treatment
* What is the txt if the pt has mod symptoms?

A
82
Q

What are the two inhaled antihistamines meds? What are the adverse reactions?

A
83
Q

Viral Sinusitis
* Acute viral rhinosinusitis (AVRS) usually precedes what? When do sx improve?
* What are the most common organisms?

A
  • Acute viral rhinosinusitis (AVRS) usually precedes acute bacteria rhinosinusitis (ABRS)
  • Improvement/resolution within 10 days
  • MC organisms: rhinovirus, adenovirus, influenza, parainfluenza
84
Q

Viral Sinusitis
* What are the symptoms?
* What does 0.5 to 2% progress to what?

A

Sinus mucosa edema, ostia obstruction, decreased mucociliary clearance
* Increase in stagnant secretions – good environment for bacterial growth
* Only 0.5 to 2% progress to ABRS

85
Q

What is the txt of viral sinusitis?

A
86
Q

ACUTE BACTERIAL RHINOSINUSITIS
* What is it presumed with?
* What are other potential symptoms?

A
87
Q

When are the maxillary, ethmoid frontal and sphenoid developed?

A
88
Q

ABRS First-line antibiotic therapy
* What are the mc organisms?

A

: S. pneumonia, H. influenza, M. catarrhalis

89
Q

acute bacterial infection

What is the first line therapies for pediatric and adult patients?

A

Pediatric patients:
* High dose amoxicillin or amoxicillin-clavulanate (90 mg/kg/day)
* Duration: 10 to 14 days

Adult patients:
* Amoxicillin 500mg PO TID or 875mg PO BID or
* Amoxicillin-clavulanate 875/125mg PO BID
* Duration: 5 to 7 days

If pinned against, then amox/clav dt older guidelines (have not caught up)

90
Q

FYI

ABRS – second-line antibiotic therapy
* What are the adults and pedatirc second line?

A
91
Q

Tooth infections
* What are the MCC?
* What is the etiology?

A
  • MCC = dental caries or periodontal disease (gingivitis / periodontitis)
  • Etiology: polymicrobial including viridians group streptococcus, Peptococcus, Peptostreptococcus, Prevotella
92
Q

Tooth infections
* What are the first line?
* What are the penicillin allergic?

A

First-line:
* Amoxicillin
* Penicillin
* Amoxicillin/clavulanate

Penicillin allergic:
* Azithromycin or clindamycin

93
Q

What are the complications of tooth infections?

A
  • Cellulitis
  • Abscess formation
  • Sinusitis
  • Ludwig’s angina – bilateral infection of submandible causing posterior displacement of tongue
    * Surgical drainage of abscess required if present
    * Watch airway
94
Q

Oropharyngeal Candidiasis
* What are the MCC organism
* What does it look like and issues that happen? (3)

A

MCC Candida albicans
* White patches overlying inflamed mucosa of buccal and pharyngeal mucosa, palate, and tonsils
* Angular cheilitis
* Lower tract disease (esophagitis): dysphagia or odynophagia

95
Q

Oropharyngeal Candidiasis
* What is the txt of mild disease?
* What is the txt of moderate to severe disease?

A

Mild disease:
* Clotrimazole troches 10mg 5x/day x 7 to 14 days
* Nystatin 5 mL swish and swallow QID x 7 to 14 days (DOC for infants/children)
* Not systemic absorb

Moderate to severe disease and/or HIV positive:
* Fluconazole 100 to 200 mg PO daily x 7 to 14 days

96
Q

What is the HSV txts for immunocompromised and immunocomponent?
* When should txt be started?

A
97
Q
A
98
Q

Laryngitis
* What is it?
* How long does it last for acute and chronic?
* What is the MCC organisms
* What are the SX?

A
99
Q

Laryngitis
* What is management?

A

Management of hoarseness depends on the underlying cause
* Treatment mostly supportive:
* Voice rest, avoid irritants (smoking), steam inhalation

100
Q

Pharyngitis-Viral
* What are the organisms?
* What is the txt?

A
101
Q

Streptococcal pharyngitis
* Which organism is it?
* MMC of what? Age?
* What are the treatment goals?

A

Streptococcus pyogenes AKA Group A Streptococcus (GAS)
* MCC of bacterial pharyngitis (viral MC overall)
* MC in children > 2 years and adolescents

Treatment goals:
* Reduce duration and severity of symptoms
* Prevent acute and delayed complications: Peritonsillar abscess, Rheumatic fever
* Prevent the spread of infection to others

102
Q

Streptococcal pharyngitis
* What is the DOC and what are the alternatives if pen allergic or vomitting ?
* When can you retur to school or work

A
103
Q

What are the modified centor criteria?

A
104
Q

She skipped this slide so idk

What are the post streptococcal complications?

A
105
Q

Peritonsillar cellulitis
* What is it?

A

inflammatory reaction of the tissue between the tonsil/pharyngeal muscles and capsule of the palatine tonsil but not associated with a discrete collection of pus

106
Q

Peritonsillar abscess
* What is it?
* Who is it common in?
* What are the MC organisms?
* Wht are the symptoms?

A

a deep neck infection – abscess (discrete pus collection) between the tonsil/pharyngeal muscles and capsule of the palatine tonsil
* MC young adults between 15 and 30 years of age
* MC organisms S. pyogenes, Fusobacterium necrophorum, Streptococcus angiosus, anerobic bacteria
* Symptoms: high fever, odynophagia, unilateral sore throat, otalgia, muffled voice (hot potato voice), trismus (cannot open mouth)

107
Q

Peritonsillar abscess/cellulitis
* What is the txt?

A
108
Q

RETROPHARYNGEAL ABSCESS
* What does it look like on CT and what do you do?

A

Drain and anx similar to peritonsillar abcess so (clinda, or metro+ceftriaxone, or amp/sulf, or pip/tazo)

109
Q

What are the three major salivary glands?

A
110
Q
A
111
Q

Acute suppurative Sialadenitis
* What is it? What glands are affected?
* Salivary stasis from what?
* Retrograde contamination from what?
* Who has an increase risk?

A
112
Q

Acute suppurative Sialadenitis
* What are the mc organisms?
* What are the symptoms

A
113
Q

Acute suppurative sialadenitis
* What is the txt? (non pharm)

A
  • Hydration
  • Warm compresses
  • Gland massage – express purulent material
  • Analgesics
  • Sialagogues (things to stimulate salivary glands)
  • Discontinue offending agents
114
Q

Acute suppurative sialadenitis
* What is the txt? ( pharm)

A

Treatment duration: 10 to 14 days (may change to oral therapy when appropriate)

115
Q

Viral parotitis
* What is the MCC?
* MC in who?
* What are the sxs?

A

MCC mumps
* MC unvaccinated children (2 to 9 years)
* Prodrome: fever, HA, myalgia, fatigue, anorexia
* With 48 hours: salivary gland swelling
* Initially unilateral - 90% bilateral

116
Q

Viral parotitis
* When does it resolve?
* What are the complications?
* What is the txt?
* what is the prevent?

A
117
Q

Leukoplakia
* what is it?
* Malignany?
* Prevalence rate is what?
* What are the risk factors?

A

White patches on the oral mucosa that cannot be wiped off with gauze
* Oral potentially malignant disorder (OPMD) – 5% develop into squamous cell carcinoma
* Prevalence rate of approximately 4 percent
* Risk factors include tobacco use (smoked and especially smokeless) and alcohol drinking

118
Q

Leukoplakia
* What are the two forms?
* The diagnosis of leukoplakia requires what?
* What is the txt?

A

Two forms:
* Homogeneous
* Nonhomogeneous (higher risk of oral cancer)
* The diagnosis of leukoplakia requires a biopsy for histopathologic examination

Treatment
* Excision vs conservative approach

119
Q
A
120
Q
A
121
Q

Oral Hairy leukoplakia
* What is it?
* Affects what?
* MC in who?
* What virus is assoicated with it? What is it not associated with it?
* What is therapy?

A

Pharmacology (14 decks)

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