Pharm ENT module

Question 1

Oxymatazoline HCLDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 1

Nasal decongestant sprayMOA: vasoconstriction, alpha agonistSHORT TERM NASAL DECONGESTION (max 3 days)XGLUCOMA, CONTINUED USE, ORAL DECONGESTANTS PSEUDOPHEDInteresting:1. can be used 3-5 days if a bridge to corticosteroid use2. rebound nasal congestion so switch to corticosteroid fluticasone proprionate3. causes RHINITIS MEDICAMETOSA

Question 2

Azelastine HCLDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 2

Nasal Antihistamine SprayH1 receptor blockerALLERGIC RINHITISXglaucoma, Interesting:1. bitter taste2. SYSTEMIC ABSORPTION3. WILL RELIEVE ALL SYMPTOMS EXCEPT NASAL CONGESTION

Question 3

fluticasone propionateDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 3

corticosteroid nasal sprayMOA: anti-inflammatory with vasoconstrictionall forms of rhinitisCaution: cause nose bleeds, nasal septum perforationX:epitaxis, glaucoma, catarractsInteresting:1. 1-2% systemic bioavaliability2. delayed impact 7-14 days3. avaliable as flovent for inhaler in asthma

Question 4

Ipratropium BromideDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 4

Nasal antimucarinic sprayMOA: blocks acetylcholine at muscarinic receptors in PNSvasomotor rhinitisXother anticholinergic, glucoma, epitaxsisInteresting:1. inhalation form Atrovent MDI2. not for allergies but good for rhinnoreah.03% solution children and .06% for adults

Question 5

which drug do you not what to combine with OTC sleep aids or diphenylhydramine?

Answer 5

ipratropium bromide, causes increased drowsiness and confusion in adult patients

Question 6

vasomotor rhinitis means

Answer 6

nonallergic rhinitis

Question 7

what percent of strep throat is resistance?

Answer 7

20%

Question 8

what is the first and second and third DOC for strep? the second would be used if…? the third would be used if?

Answer 8

DOC:1. penicillin2. clindmycin (if pen allergy, but $$$ and causes c. diff)3. macrolide (azithromycin, erythromycin, and clarithromycin) if resistance in community

Question 9

what should you never do in children, especially obese children, when dosing drugs?

Answer 9

Never give more than the maximum adult dose for a child, adult dose is the MAXIMUM DOSE

Question 10

Cromolyn sodium Drug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 10

mast cell stablizer nasal spraystabalizes mast cell membranes so histamine leukotrienes aren’t releasedallergic rhinitisONLY NASAL SPRAY THAT CAN BE USED IN GLUACOMA!! good for kids and preggoInteresting:1. bad taste2. 3-14 days3. inhalation and opthalmic form

Question 11

what is the only nasal spray that is safe to use in gluacoma???

Answer 11

cromolyn sodiummast cell stabalizer

Question 12

Diphenhydramine

Answer 12

1st generation oral antihistamineMOA: H1 blockerallergic rhinitisANTICHOLENERGIC EFFECT, drowsinessXasthma, angle closer glaucoma dementiaINTERESTING:1. DO NOT USE WITH OTHER ANTICHOLERNERGIC DRUGS LIKE IPRATROPIUM BROMIDE NASAL SPRAY=DROWSINESS CONFUSION2. Elderly it causes confusion and children causes excitatory effect3.always do a urine test in elderly when showing confusion because it can be indicative or a UTI

Question 13

antihistamines (diphenhydramine, fexophenadine, azelastine) all have the same MOA. They work on the_____

Answer 13

H1 receptor

Question 14

fexophenadine HCLDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 14

2nd generation antihistamineAllergic rhinitisMOA: blocks H1 receptorX: Increases cholerginic effect of other drugs, asthma, angle closure gluacoma dementiainteresting:1. Verapamil increases the [conc] of this drug2. dimishes the impact of actetlycholinesterases in dementia3. does not cross BBB, caution in lactation

Question 15

benzocaine oticDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 15

topical otic analgesic, intact TMmay cause vertigoeffective in about 50% of children for 30-60 min

Question 16

Neomycin +colistin, hydrocortisone, ThonzoniumDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 16

topical antibiotic/antinflammatory (steroid)ottisis externa with intact TMcaution in hypersensitivitiyInteresting:1. can be very sensitive and CREATE otitis media externa symptoms in patient with a RASH

Question 17

many people are very sensitive to NEOMYCIN. If sensitive what happens? This happens in what percent of people?

Answer 17

causes otitis externa like symptoms and a rash, people take more of it and then it gets worse15% of people have sensitivity

Question 18

what should you use for ear drops if there is a perforated TM? why?

Answer 18

opthalmicotic drops are acidic like the ear canal but if there is a perforation then it can get into the middle ear which is NOT ACIDIC, therefore you need to use a neutral PH drug, which include opthalmolgoy drops.Use these in the ear instead!

Question 19

NystatinDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 19

oral antifungal medcreates pores in the membrane the fungus causing deathcandidiasis1. oral form not absorbed systemically2. SWISH SWIRL SWALLOW

Question 20

what is it important to do during oral candidiasis? What is the presentation of thrush in children and elderly?

Answer 20

need to swish, swirls, and swallow to get rid of any infection that may have gotten into the esophagusIn children: white patchesIn elderly: bright bright red, need to look under the dentures and encourage good oral hygiene

Question 21

meclizineDrug class?MOA?What do you use it for?Don’t use in?Intresting?

Answer 21

anti-vertigo drugMOA: anticholinergic impact on chemoreptor, blocks conduction in middle ear vestibular-cerebral pathwayX: ALCOHOL and other cholingeric drugsDO NOT DRIVE OR DRINK ALCOHOL WITH THIS DRUG

Question 22

why is it important to presribe meclazine regullary instead of PRN?

Answer 22

want to prescribe regular does and then taper it because PRN you have to wait for the symptoms to come before taking it. Presribe and then taper it off because benign Paryoxymal Postional Vertigo BPPV usualy resolves within 30 days!

Question 23

acyclovir

Answer 23

anti-viral agentMOA: blocks viral nucleic acid synthesisHerpes simplex, varicella zoster, EBV, CMVXCrCl, need to monitor kidney function!!neuro and renal toxicity increased with probenicid cimetadine

Question 24

why does acyclovir only accumulate in viral cells? how long can a person use this drug for? what is the ratio of accumulation vs regular cell?

Answer 24

-requires viral kinases for activation so it only occures in viruses40-100X acculmination in infected cell compared to regular cellthey can use this drug from 1-10 years

Question 25

how is acyclovir excreted? what do you need to monitior?

Answer 25

kidneys, CrCl

Question 26

in acyclovir what do you have to consider when dosing the drug?

Answer 26

dosing is virus specific, viruses vary in sensitivity so you have to dose to the specific virus you are trying to treat

Question 27

what is the oral bioavaliability of acyclovir? what is the relationship between increasing dose and bioavaliability?

Answer 27

oral bioavailiability: 10-30%as you increase dosing, bioavaliability decreases