Week 4- HEENT Flashcards

Question

Glaucoma: Miotics, cholinesterase inhibitors -MOA

Answer 1

1. Mechanism of action (MOA): stimulates cholinergic receptors in the eye causing decreased resistance to aqueous humor outflow leading to a decrease in intraocular pressure

Answer 2

1. Adverse effects: 1. Hyperemia 2. Myopia (pupil constriction) 3. Eye discomfort/burning sensation 4. Blurred vision 5. Eyelid irritation/eye redness 6. Photophobia/headache

Answer 3

1. Contraindications: 1. Active inflammation of the eye 2. Iritis, uveitis, secondary glaucoma

Answer 4

1. Agents: 1. Netarsudil (Rhopressa®) 0.02% solution

Answer 5

1. Mechanism of action (MOA): decreases resistance in the trabecular network to increase aqueous humor outflow

Answer 6

1. Adverse effects: 1. Conjunctival hyperemia 2. Corneal verticillata (corneal deposits froming a golden brown or gray whorl patter in the inferior cornea; most resolved when treatment was discontinued) 3. Eye pain, corneal staining, blurred vision, increased lacrimation, eyelid erythema, reduced visual acuity

Answer 7

1. Typical treatment 1. First-line therapy: topical drugs that lower intraocular pressure (IOP) 1. Prostaglandin analog monotherapy is preferred for initial treatment 2. A topical beta blocker, carbonic anhydrase inhibitor, selective alpha2-agonist, or netarsudil could be added or substituted if IOP fails to reach the target range (8-22 mm Hg). 2. Alternatives: laser trabeculoplasty and surgery

Answer 8

Inflammation of conjunctiva

Answer 9

1. Noninfections: 1. Allergic 2. Mechanical/irritative/toxic 3. Immune-mediated 4. Neoplastic 2. Infections: 1. Viral 2. Bacterial

Answer 10

- Bilateral red eyes and itching - Environmental allergens (pollen, animal dander) - remove and avoid allergen; FIRST LINE: artificial tears, topical antihistamines, systemic antihistamines - Provide symptomatic relief

Answer 11

- "Pink eye", unilateral or bilateral, red eyes, itchy, watery discharge - Adenovirus, most common pathogen - Cold compress, proper hygiene, artificial tears - Usual self-limiting and resolves within 2 weeks

Answer 12

- Unilateral or bilateral purulent discharge - S. pneumonia, H. influenza, S. aureus - ophthalmic antibiotics - Mild form: usual self-limiting in adults - Severe form: may persist without treatment

Answer 13

Topical (ophthalmic) options

Answer 14

1. Available as gel, solution, ointment 2. Usual directions: 1. Apply 1-2 drops into eyes as needed (gel, solution) 2. Apply ~1/4 inch into inside of eyelid 1-2 times daily as needed (ointment) 3. MOA: offer a tear-like lubrication for relief of dry eyes and eye irritation 1. Multiple different types (e.g. dextran, hydroxypropyl methylcellulose, mineral oil, sodium chloride, etc.)

Answer 15

1. Example products (OTC): 1. Naphazoline (e.g. Clear Eyes®) 2. Oxymetazoline (e.g. OcuClear®) 3. Tetrahydrozoline (e.g. Visine®) 2. Usual dosing: 1-2 drops in each eye four times a day 3. MOA: cause vasoconstriction in conjunctival blood vessels leading to decreased conjunctival edema 1. Used to relieve eye redness 4. Adverse effects: temporary blurring of vision, mydriasis (dilation of pupil), transient stinging/burning 5. Warnings/precautions: If symptoms worsen or persist for more than 72 hours, patient should be seen by an ophthalmologist 1. Rebound congestion or redness can develop with frequent or extended use of ophthalmic vasoconstrictors

Answer 16

1. Example products (OTC): 1. Antazoline/naphazoline (e.g. Vasocon-A®) 2. Ketotifen (e.g. Alaway®), Zaditor®) 3. Pheniramine/naphazoline (e.g. Naphazoline Plus®, Opcon-A®) 2. Example prescription products: 1. Olopatadine (Pataday®, Patanol®, Pazeo®) 2. Azelastine (Optivar®) 3. Mechanism of action: block H1 histamine receptors to inhibit release of histamine from mast cells, leading to decreased ocular pruritus 4. Adverse effects: 1. Headache

Answer 17

1. Example products (prescription only): 1. Diclofenac (Voltaren®) 2. Flurbiprofen(Ocufen®) 3. Ketorolac(Acular®) 2. Mechanism of action: block the action of cyclooxygenase (COX) and inhibit the conversion of arachidonic acid to prostaglandins which reduces pain/inflammation 3. Adverse effects: 1. Minor ocular irritation 4. Warnings/precautions: 1. Caution in patients with aspirin/NSAID sensitivity

Answer 18

1. Example products (prescription only): 1. Loteprednol (Lotemax®) 2. Prednisolone (Pred Mild®) 3. Fluorometholone (FML Forte®) 2. Mechanism of action: suppress the late-phase reaction of allergic inflammation 3. Adverse effects: 1. Potential severe: glaucoma; cataracts 2. Systemic side effects may develop with extensive use 4. Warnings/precautions: 1. NOT recommended for typical management of acute conjunctivitis due to adverse effects and risk of sight-threatening complications (e.g. corneal scarring, melting, and perforation)

Answer 19

1. Majority of cases of acute, infections conjunctivitis are viral and self-limited 2. Do NOT require antimicrobial treatment 3. Medications used to mitigate symptoms: 1. Artificial tears 2. Topical antihistamines 3. Topical steroids 4. Oral analgesics 5. Cold compresses

Answer 20

1. Common pathogens: 1. Infants \<1 month (ophthalmia neonatorum): chlamydia most common, gonococcal most serious 2. Children 3 months through 8 years: staphylococcal, streptococcal, or Haemophilus conjunctivitis. 3. Older adults: Staphylococcus aureus and Pseudomonas aeruginosa

Answer 21

Gonococcal conjunctivitis: requires intramuscular ceftriaxone Prevention: erythromycin ointment within 1 hour of birth Chlamydial conjunctivitis: requires treatment with systemic erythromycin

Answer 22

1. Mild bacterial conjunctivitis is usually self-limiting, but topical antibiotic therapy may speed clinical improvement (especially if given before day 6)

Answer 23

1. Typical first line options: 1. Polymyxin B/trimethoprim solution 1 drop every 6 hours x 5-7 days 2. Erythromycin ointment 1 cm ribbon up to 6 times daily

Answer 24

1. 2nd line: 1. Polymyxin B with bacitracin ointment 2. Azithromycin solution 3. Tobramycin or gentamycin solution 4. Ciprofloxacin, moxifloxacin, levofloxacin solution

Answer 25

1. Obtain culture for Gram staining if gonococcal infection is a possibility in sexually active individuals

Answer 26

1. General adverse effects: 1. Local irritation 2. Superinfection with prolonged use

Answer 27

1. Hypersensitivity to any component of the preparation 1. Chance for cross-sensitivity between individual agents of same class 2. May retard corneal healing after ocular trauma or ocular surgery

Answer 28

1. Goals: relief of symptoms, maintain or improve visual acuity, prevent long-term adverse effects from dry eye

Answer 29

Nonpharmacologic: warm compresses, humidifier, remove medications that cause dry

Answer 30

1. **1st line: artificial tears** 2. Cyclosporine (Restasis®) 0.05% solution 1 drop twice daily 1. Adverse effects: burning sensation in eye 3. Lifitegrast (Xiidra®)5% solution 1 drop twice daily 1. Adverse effects: eye irritation/discomfort, bad taste

Answer 31

1. Remove contacts before using eye medicines and do not reinsert for 15 minutes 2. Do not touch the tip of eye dropper or ointment tube on the eye or any other surface. 3. Suspension eye drops need to be shaken before use. 4. Vision may be blurry in the moments following use of eye medicines. 5. If multiple medications are indicated, wait at least 5 minutes between drops. 6. Order of administration if using multiple formulations: 1. 1. eye drop solution 2. 2. eye drop suspension 3. 3. eye ointment

Answer 32

1. Eye drop solution 2. Eye drop Suspension 3. Eye drop ointment

Answer 33

Ointment preferred in children (easier to administer, stays on the lid better)

Answer 34

1. Wash hands thoroughly with soap and water. 2. Check the solution for color, particles and the dropper tip to make sure that it is not chipped or cracked. Avoid touching the dropper tip against the eye or anything else. 3. Tilt head back 4. With both eyes open, gently pull down the lower lid of eye to form a “pocket” 5. Gently squeeze the dropper so that the drop falls into the pocket of the lower eyelid. 6. May brace hand holding the dropper against face if needed 7. Close eye. Do not rub. Try not to blink 8. May place one finger at the corner of the eye near the nose and apply gentle pressure for up to 1 minute to prevent the medication from draining out of the eye. 9. Replace and tighten the cap right away. Do not wipe or rinse the dropper tip.

Answer 35

1. Wash hands thoroughly with soap and water. 2. Hold the tube in hand for 1-2 minutes to warm it 3. With first use of a new tube, squeeze out and discard the first 0.25 in. of medication. 4. Holding the tube between thumb and forefinger, place it as near to eyelid as possible without touching it. 1. Brace the remaining fingers of that hand against your face if necessary 5. With your index finger, pull the lower eyelid down to form a pocket and squeeze a thin ribbon of ointment (~0.25-0.5 in.) into the pocket. 6. Blink eye gently; then close eye for 1 to 2 minutes to rotate and distribute. Do not rub. 7. With a tissue, wipe any excess ointment or gel from the eyelids and lashes. With another clean tissue, wipe the tip of the tube clean. 8. Replace and tighten the cap right away. 9. Wash hands to remove any medication.

Answer 36

1. Inflammation of the middle ear 1. Acute otitis media (AOM) – rapid, symptomatic infection with effusion (fluid) in the middle ear 2. Otitis media with effusion (OME) – NOT an acute illness, but is characterized by middle ear effusion (NO inflammation of middle ear). 1. Develops from a mechanical/obstructive phenomenon

Answer 37

1. Common pathogens: 1. Streptococcus pneumoniae 2. Haemophilus influenzae 3. Moraxella catarrhalis

Answer 38

1. Risk factors 1. Allergies 2. Anatomic defects (e.g. cleft palate) 3. Daycare attendance 4. Siblings 5. Tobacco smoke exposure

Answer 39

1. Symptoms: 1. Ear pain (often unilateral) 2. Hearing loss 3. Fever 4. Tinnitus

Answer 40

1. Treatment Goals: 1. alleviate ear pain and fever, eradicate infection, prevent complications, and avoid unnecessary antibiotic use

Answer 41

1. Majority of uncomplicated infections resolve spontaneously 2. Nonpharmacologic therapy: 1. Watch and wait in patients with non-severe illness for 48-72 hours after diagnosis to see if self-resolves. 2. Heat to affected ear for comfort

Answer 42

1. Antipyretics 1. Acetaminophen – usual dosing 325-650 mg by mouth every 4-6 hours as needed (Maximum 4,000 mg/day) 1. Children: 10-15 mg/kg every 4-6 hours as needed 2. Ibuprofen 200-400 mg by mouth every 4-6 hours as needed 1. Children 5-10 mg/kg every 6-8 hours as needed

Answer 43

1. **1st line:** 1. **Amoxicillin** 2. **Amoxicillin/clavulanate** 2. Mild allergy to penicillins: cephalosporins 1. E.g. cefdinir, cefuroxime; ceftriaxone 3. Severe allergy to beta-lactams: 1. Azithromycin, clarithromycin 4. Duration: 5-7 days for mild infections, 10 days for severe infections

Answer 44

1. Painful, inflammatory condition of external auditory canal 1. AKA swimmer’s ear

Answer 45

1. Most common pathogens: 1. P. aeruginosa 2. S. aureus

Answer 46

1. Treatment: topical agents recommended as initial therapy 1. Treating inflammation and infection: 1. Otic anti-infectives 2. Otic acidifying agent 3. Otic antibiotics/glucocorticoid combination product. 2. Pain control 1. Otic analgesics: topical benzocaine may mask disease progression and cause contact dermatitis which can worsen or prolong otitis. Topical benzocaine products are not FDA approved and have been removed from the market. 2. Oral analgesics

Answer 47

1. Adverse effects: itching/application site pain, headache 2. Precautions: 1. Exposure following otic administration is typically substantially lower than with systemic exposure

Answer 48

(i) Ciprofloxacin 0.2% otic solution – 1 single use container in affected ear(s) every 12 hours for 7 days (ii) Ofloxacin 0.3% otic solution 10 drops once daily for 10 days (5 drops daily for children \<12 years) (iii) Ophthalmic preparations may also be used (e.g. gentamicin 3 mg/mL solution)

Answer 49

1. Acetic acid 2% otic solution - instill 4 to 6 drops into the external auditory canal. Maintain administration position for 5 minutes. Repeat the procedure every 2 to 3 hours.

Answer 50

1. Mechanism of action: reduce inflammation, and antibacterial and antifungal properties (exact MOA unknown)

Answer 51

1. Place in therapy: may consider for mild external otitis

Answer 52

1. Adverse effects: localized burning, stinging 2. Precautions: 1. Avoid use of acidifying agents if tympanic membrane is known or suspected to be non-intact

Answer 53

1. Ciprofloxacin/hydrocortisone (e.g. Cipro HC®) 2. Ciprofloxacin/dexamethasone (e.g. Ciprodex® otic) 3. Neomycin/polymyxinB/hydrocortisone (E.g. Cortisporin® otic)

Answer 54

1. Place in therapy: 1. Topical antibiotic/steroid combinations decrease symptoms (e.g., pain, inflammation, itch) faster than antibiotics alone but do not improve the overall cure rate.

Answer 55

1. Adverse effects: Fairly well tolerated, mostly topical adverse effects 2. Precautions: 1. Ciprofloxacin/hydrocortisone (Cipro HC®), a non-sterile otic suspension, and aminoglycoside (e.g. neomycin) combination products should not be used in patients with a tympanic membrane perforation.

Answer 56

1. Otic analgesics: topical benzocaine may mask disease progression and cause contact dermatitis which can worsen or prolong otitis. Topical benzocaine products are not FDA approved and have been removed from the market. 1. Benzocaine/antipyrine/glycerin otic solution 2. Benzocaine/antipyrine/propylene glycol otic solution 2. Oral analgesics 1. E.g. acetaminophen, ibuprofen

Answer 57

1. Ophthalmic formulations may also be used in ears (e.g. due to cost or availability) 1. Eye drops can be used in ears, but ear drops can NOT be used eyes due to sterility 2. Examples: 1. Ciprofloxacin ophthalmic plus dexamethasone ophthalmic may be a lower cost option for patients when ciprofloxacin/dexamethasone (Ciprodex®) otic is too expensive 2. Ciprofloxacin or ofloxacin ophthalmic agents may be used in the ear if less expensive for the patient 3. Referral to ENT in patients with a tympanic membrane perforation 1. Also if initial presentation is severe, poor response to treatment, recurrent problems, unable to determine if tympanic membrane is perforated or patient is immunocompromised (e.g., diabetes mellitus, on chemotherapy).

Answer 58

1. Wash hands. 2. Hold the bottle of ear drops in hands for a few minutes to warm them up. 3. Shake the bottle gently for about ten seconds. 4. Open the bottle; avoid touching the dropper to any surface 5. Lie on side, or tilt head, so ear is facing up. 6. Place drops into ear. 1. Gently pull the ear up and back before placing the drops 2. In young children, the earlobe should be pulled downward to fill the ear canal 7. Remain lying on side, or tilting head, for three to five minutes 1. May also place a cotton ball in ear canal for 20 minutes to maximize medicine exposure 8. Repeat on other side if needed, then wash hands

Answer 59

1. Inflammation of the nasal cavity and paranasal sinuses

Answer 60

1. Etiology 1. Most common: respiratory viruses 2. Allergies 3. Environmental irritants 4. Secondary bacterial infection in 0.2-2% of adults and 5-13% of children 1. \<7 days likely viral, \>7 days or more severe is likely bacteria

Answer 61

1. Pathophysiology 1. Mucosal inflammation and mucociliary dysfunction from viral infection or allergy leading to blocked sinuses 2. Causative organisms: S. pneumoniae, H. influenzae most common.

Answer 62

1. Goals: relieve symptoms, promote sinus drainage, prevent complications

Answer 63

1. Nonpharmacologic: 1. Humidifiers 2. Saline nasal sprays 3. Nasal irrigations

Answer 64

1. Pharmacologic: 1. Monitor with supportive care for 7-10 days before starting antibiotics 2. If viral, likely to improve/resolve within 10 days 3. Analgesics 4. Decongestants 5. Antibiotics

Answer 65

1. 1st line: 1. Amoxicillin 500 mg PO TID or 875 mg PO BID 2. Amoxicillin-clavulanate 500 mg/125 mg PO TID or 875 mg/125 mg PO BID 2. Risk factors for pneumococcal resistance: 1. Age \>65, hospitalization in last 5 days, antibiotics in past month, immunocompromised, multiple comorbidities, severe infection 2. High-dose amoxicillin-clavulanate 2 g/125 mg ER tab PO BID 3. Penicillin allergy: 1. Doxycycline 100 mg PO BID or 200 mg PO daily 1. NOT in children 2. Third-generation cephalosporin (cefixime, cefpodoxime) ± clindamycin 3. Respiratory fluoroquinolone (levofloxacin or moxifloxacin) 4. Duration: 5-7 days

Answer 66

1. Inflammation of the throat (often from infection) 1. Generally self-limited

Answer 67

1. Etiology 1. Common manifestation of viral upper respiratory tract infections (URIs) 2. Bacterial causes: Streptococcus pyogenes (Group A streptococci) most common 1. Others: corynebacterium diptheriae, Group C and G strep, Chlamydia pneumonia, Mycoplasma pneumonia, and Neisseria gonorrheae 3. Viral causes: rhinovirus, coronavirus, adenovirus, influenza, Epstein-Barr virus 2. Important to distinguish between viral and bacterial to avoid unnecessary antibiotic therapy and untreated streptococcal infection

Answer 68

1. Signs/Symptoms: 1. Sore throat w/ severe pain while swallowing 2. Fever 3. Headache, abdominal pain, nausea, vomiting 4. Tender, anterior cervical lymphadenitis 5. Swollen red uvula 6. Halitosis 7. Soft palate petechiae

Answer 69

1. Rapid antigen detection test (RADT): 70-90% sensitivity, results available within minutes 2. Throat culture – “gold standard” – results within 24-48 hours 3. Only perform tests when signs/symptoms indicate potential infection 1. ~20% of children are colonized

Answer 70

1. Goals: shorten disease course, reduce spread, prevent complications

Answer 71

1. Nonpharmacologic: 1. Salt water gargle

Answer 72

1. Symptom management: 1. Allergy causes: antihistamines (e.g. loratadine) 2. GERD causes: H2 antagonists (e.g. ranitidine) or PPIs (e.g. omeprazole) 3. Pain: acetaminophen or ibuprofen 2. Antibiotics – only when confirmed by lab and clinical symptoms

Answer 73

1. Only treat with antibiotics if signs/symptoms of severe infection, ruled out viral infection, and positive RADT/throat culture 2. 1st line: 1. Penicillin V 500 mg PO 2-3 times daily x 10 days 2. Amoxicillin 500 mg PO BID x 10 days 3. Mild penicillin allergy: cephalosporins 1. Cephalexin 500 mg PO BID x 10 days 2. Cefdinir 300 mg PO BID x 5-10 days 3. Others 4. Severe penicillin allergy 1. Azithromycin 500 mg PO day 1, then 250 mg PO days 2-5 5. Penicillin allergy and macrolide resistance: Clindamycin 300 mg PO TID x 10 days

Answer 74

1. Self-limiting viral URI

Answer 75

1. Etiology 1. Common viruses: rhinoviruses, coronaviruses, parainfluenza viruses, respiratory syncytial virus, and adenoviruses 2. Can become complicated by bacterial superinfections

Answer 76

1. Pathophysiology 1. Symptoms arise from epithelial damage, inflammation, vasodilation, local tissue edema, increased mucus production, and impaired mucociliary clearance

Answer 77

1. Goals: minimize discomfort from symptoms

Answer 78

1. Nonpharmacologic 1. Air humidifiers 2. Intranasal saline drops/sprays 2. Increased fluid intake 3. Saline gargles 4. Rest 5. Nasal strips 6. Common Cold Treatment

Answer 79

1. AVOID antibiotics! 2. Medications for symptom relief as needed: 3. Fever/pain: antipyretics and analgesics 4. Throat pain: local anesthetics (lozenges and sprays) – benzocaine, 5. Congestion: decongestants 1. Limit use to 3 days to avoid rebound congestion 6. Cough: 1. Suppressant: dextromethorphan 2. Expectorant: guaifenesin 7. Avoid antihistamines (impair mucociliary clearance of thick mucus)

Answer 80

1. Examples: 1. Pseudoephedrine 60 mg by mouth every 4-6 hours OR 120 mg extended release every 12 hours OR 240 mg extended release every 24 hours 2. Phenylephrine 1. Oral: 10 mg by mouth every 4 hours as needed for up to 7 days 2. Nasal 1. 0.25%-1% solution – instill 2-3 sprays in each nostril no more than every 4 hours for up to 3 days

Answer 81

1. Mechanism of action: alpha-adrenergic agonist activity which produces systemic arterial vasoconstriction

Answer 82

1. Adverse Effects 1. Nasal: Burning, stinging, sneezing 2. Oral: Anxiety, dizziness, insomnia 2. Warnings/Precautions 1. Frequent or prolonged use of nasal decongestants may cause rebound nasal congestion 2. Use with caution in patients with hypertension or heart disease 1. May cause hypertension

Answer 83

1. Dextromethorphan 20 mg every 4 hours as needed (max of 6 doses in 24 hours) 1. Children 4-6 years: 5 mg every 4 hours as needed 2. Children 6-12 years: 10 mg every 4 hours as needed

Answer 84

1. Mechanism of action: decreases the sensitivity of cough receptors and interrupts cough impulse transmission

Answer 85

1. Adverse Effects: 1. Dizziness 2. Drowsiness 3. Nervousness/restlessness 4. GI distress/nausea 2. Warnings/Precautions 1. Increased risk of serotonin syndrome with other serotonergic drugs 2. Potential for abuse/misuse

Answer 86

Guaifenesin 200-400 mg every 4 hours as needed OR 600 mg extended release every 12 hours as needed

Answer 87

1. Mechanism of action: increases the effective hydration of the respiratory tract, facilitating reduced viscosity of respiratory mucus

Answer 88

1. Place in therapy 1. Limited efficacy of benefit

Answer 89

1. Adverse effects: 1. Dizziness 2. Drowsiness 3. Headache 4. Skin rash

Answer 90

1. Allergic Rhinitis 1. IgE-mediated inflammation of the upper respiratory tract due to allergy 2. Initial contact sensitizes patient, and those with inherited tendency to allergic disorders produce IgE antibodies 3. Subsequent exposures trigger allergic responses: 1. Early-phase: allergen binds to IgE on mast cells w/in minutes of exposure 1. Mast cells release mediators (histamine) which stimulates production of other mediators (e.g. cysteine leukotrienes and prostaglandin D2) 2. Mediators bind to receptors in the nose and cause vasodilation, mucosal edema and hypertrophy  nasal congestion 2. Late-phase 1. Occurs in ~50% of AR sufferers; begins 2 hrs after early phase; peak at 6-12 hrs 2. Second release of mediators + an inflammatory component leading to severe and long-lasting nasal congestion

Answer 91

1. Outdoor plant pollen triggers: 1. Limit outdoor exposure during high pollen conditions 2. Wear a face mask during activities that would have many allergens in the air 3. Keeps windows and doors closed 4. Use air conditioning 2. Indoor allergens (dust mites, mold/fungi, cockroaches, pets) 1. Air conditioning 2. Humidity below 50% 3. Clean frequently 4. Vacuum frequently 5. Minimize carpeting, fabric-covered furniture 6. Launder bed frequently 3. Irritants 1. Avoid smoke, chlorine fumes, and other substances identified as irritant triggers

Answer 92

1. Glucocorticoid nasal spray 2. 2nd generation antihistamines 3. Antihistamine nasal spray (azelastine, olopatadine) 4. Cromolyn nasal spray 5. Montelukast (with concomitant asthma)

Answer 93

1. Examples: 1. Mometasone (e.g. Nasonex®) 50 mcg/act 2. Fluticasone (e.g. Flonase®) 50 mcg/act 3. Triamcinolone (e.g. Nasacort®) 55 mcg/act

Answer 94

1. Typical dosing: 1-2 sprays in each nostril once or twice daily

Answer 95

1. MOA: inhibit allergic inflammation by downregulating inflammatory responses

Answer 96

1. Place in therapy: 1. 1st line 2. Works best if used daily, also can be used as needed

Answer 97

1. Warnings/precautions: 1. May cause hypercortisolism or suppression of the hypothalamic-pituitary-adrenal axis leading to adrenal crisis 2. Delayed wound healing 3. Immunosuppression 2. Adverse effects: 1. Headache 2. Nausea/vomiting 3. Local irritation

Answer 98

1. Examples: 1. Cetirizine (Zyrtec®) 2. Loratadine (Claritin®) 3. Fexofenadine (Allegra®) 4. Desloratadine (Clarinex®) 5. Levocetirizine (Xyzal®)

Answer 99

1. MOA: competitively inhibits histamine from binding to H1-receptors, thereby reducing allergy symptoms such as itching

Answer 100

1. Warnings/precautions: 1. May cause CNS depression/sedation (less sedation and anticholinergic effects with 2nd and 3rd generation antihistamines compared to 1st generation (e.g. diphenhydramine) 2. Adverse effects 1. Headache 2. Drowsiness 3. xerostomia

Answer 101

1. Examples: 1. Azelastine (Astepro®) 2. Olopatadine (Patanase®)

Answer 102

1. MOA: competitively inhibits histamine binding to H1 receptors, reduces hyper-reactivity of airways, and improves mucociliary transport

Answer 103

1. Warnings/precautions: 1. May cause CNS depression 2. Risk of nasal ulcerations (olopatadine) 2. Adverse effects 1. Bitter taste 2. Headache 3. Drowsiness 4. Cough

Week 4- HEENT Flashcards

(131 cards)