1
Q
Rx options for Otitis Externa
A
Anti-infectives w/ or w/out steroids
Acid-alcohol solutions
2
Q
Best Rx for Otitis Externa w/ tubes or perforated TM
A
Ofloxacin
3
Q
Rx for Otitis Externa to avoid with tubes or perforated TM
A
Neomyacin, acid-alcohol solutions
4
Q
Route of administration for anti-infective for Otitis externa
A
Topical
5
Q
Most common Rx for Otitis Externa
A
Ones w/ steroids:
Ciprofloxacin/hydrocortisone
Ciprofloxacin/dexamethasone
Hydrocortisone/neomycin/polymycin (not w/tubes)
6
Q
Rx for Otitis Externa w/ pseudomonas
A
Ciprofloxacin or Ofloxacin
7
Q
What do Otitis Externa Anti-infectives end in?
A
-acin
8
Q
5 acid-alcohol solutions
A
acetic acid/aluminum acetate acetic acid/propylene glycol acetic acid/propylene glycol/hydrocortisone isopropyl alcohol/glycerine isopropyl alcohol/propylene glycol
9
Q
Side effects of anti-infectives
A
ear pain, contact dermatitis, ototoxicity
10
Q
Side effects of acid-alcohol solutions
A
Stinging, burning, local irritation
11
Q
Benefits of acid-alcohol solutions for otitis externa
A
Induces drying, supplements natural environment of ears
12
Q
What should you do if Otitis Externa hasn’t responded after 1 wk of treatment?
A
Culture
13
Q
OTC treatment options for water clogged ears
A
- Isopropyl alcohol (95%) in anhydrous glycerine (5%)
- 50:50 acetic acid + isopropyl alcohol **
14
Q
Antibiotic therapy treatment guidelines for AOM in 6 mo+ old
A
Bilateral or unilateral AOM + severe signs/symptoms
15
Q
Antibiotic therapy treatment guidelines for AOM in 6-24 mos old
A
Bilateral AOM
16
Q
Watch and wait treatment guidelines for AOM in 6 mo-23 mo old
A
Non severe unilateral AOM
17
Q
Watch and wait treatment guidelines for AOM in 24 mo+ old
A
Nonsevere AOM
18
Q
Rx of choice for AOM
A
Amoxicillin
19
Q
Do you give any meds for watch and wait AOM? What?
A
Yes, ibuprofen/acetaminophen
20
Q
If pt with AOM had recent treatment with Amoxicillin, what should you add to current treatment
A
B-lactamase coverage (clavulanate)
21
Q
Amoxicillin resistance with AOM, med?
A
Amoxicillin/clavulanate
22
Q
Best Rx choice to treat AOM in pt with tubes?
A
Ofloxacin
23
Q
Options for cerumen impaction
A
- Carbamide peroxide
- Triethanolamine polypeptide oleate
- Hydrogen peroxide/warm water
- Olive/sweet oil
- Glycerin
24
Q
If you need to also dry the ear canal when removing cerumen impaction, what treatment would you avoid?
A
Hydrogen peroxide/ warm water
25
Which cerumen softener is an emollient?
Glycerine
26
Contraindications for cerumen impaction treatment
- Tubes or perforated TM
| - history of adverse rxn
27
Possible side effects of cerumen treatment
* Mild itching
* Burning
* Ear pain
* Erythema of the ear canal
* Allergic ReacAons (hives, difficulty breathing, swelling of face, lips, tongue, throat) EMERGENCY
28
Do's of cerumen impaction treatment
- Do instill med, and once wax is softened follow with warm water irrigation via syringe
- Do make sure to completely remove drops
- Do understand that periodic prophylactic removal may be appropriate
29
Do not's of cerumen impaction treatment
- Don't use carbamide peroxide longer than 4 days (damage to TM possible)
- Don't use Q-tip to clean out wax
- Don't leave drops in ears longer than 30 minutes
30
Things to remember regarding Otic meds
- Think twice and avoid neomycin use with tubes or perforated TM
- Ofloxacin is good choice for AOM w/ tubes
31
Ophthalmic Anesthetic options
Amino Esters:
- proparacaine
- tetracaine
Amino-amides:
-lidocaine
32
Improper use of ophthalmic anesthetic can lead to:
Deep corneal infiltrates, ulceration, and perforation
33
When would you use an ophthalmic anesthetic?
Local anesthesia for procedures: foreign bodies, sutures, scrapings for Dx
34
MOA for ophthalmic anesthetic
Penetrate to sensory nerve endings in corneal tissue, bind to receptors within sodium channels ->blocks sodium, no depolarization, nerve cannot transmit pain impulses
35
```
ophthalmic anesthetic:
A
D
M
E
```
A: Rapid @ conjunctival capillaries, local action
D: protein binding high
M: unknown in eye/skin, some metabolism
may occur if systemically absorbed
E: Lidocaine? Tetracaine, proparacaine->bile
36
T1/2 for Ophthalmic anesthetics
proparacaine -shorter
lidocaine - medium
tetracaine -longer
37
Possible adverse rxn to ophthalmic anesthetics
Burning or stinging on application
Extended use: Severe keratitis, opacification, scarring of cornea and loss of vision possible (rare)
38
Possible side effects or adverse rxn to ophthalmic anti-infectives
Blurry vision, local irritation, super-infections possible with long term use
39
Bacteriostatic
Prevents growth of bacteria
40
Bactericidal
Kills bacteria
41
Bacteriostatic ophthalmic anti-infectives
- Sulfacetamide
- Bacitracin
- Erythromycin
- Fluoroquinolone: ciprofloxin, moxifloxin, etc
42
Bactericidal ophthalmic anti-infectives
- Tobramycin/gentamicin
| - Polymixin B
43
Possible causes of conjunctivitis
Allergic
| Infective (bacterial, viral, fungal(rare))
44
Contraindications for ophthalmic anti-infectives
Sulfa allergy (Sulfacetamide)
45
Good choice of ophthalmic anti-infective for contact wearers
Fluoroquinolone: ciprofloxin, moxifloxin, etc
| broader spectrum
46
Good choice of ophthalmic anti-infective for infants and children
Erythromycin ointment has good coverage and is easier to administer than drops.
– Well tolerated
47
Which ophthalmic anti-infectives can cause irritation that look like failed treatment?
Sulfacetamide and gentamicin
48
MOA for Ophthalmic Mast Cell Stabilizers
Inhibits degranulation of mast cells after exposure to antigen. Reduces histamine release
49
Ophthalmic Mast Cell Stabilizers options
| -crom-
- Nedocromil 2%
- Cromolyn Sodium 4%
- Iodoxamide 0.1%
50
What would you use an Ophthalmic Mast Cell Stabilizer for?
Allergic conjunctivitis & keratitis
51
Adverse rxns to Ophthalmic Mast Cell Stabilizers?
Transient stinging or burning, blurry vision, photophobia, mydriasis, rhinitis, sinusitis, headache
52
Adverse rxns to Ophthalmic Antihistamines
Transient stinging or burning, blurry vision, photophobia, mydriasis, rhinitis, headache
53
Ophthalmic Antihistimine options (-astine)
- Azelastine
- Epinastine
- Emedastine
- Ketotifen
- Levocabastine
- Olopatadine
54
What Rx blocks the effects of histamine and blunts symptoms of allergic conjunctivitis. H1 blocker, and good at relieving the itching.
Ophthalmic antihistamines
55
Best to use to treat redness associated with allergic conjunctivitis
Ophthalmic vasoconstrictors/decongestant
56
MOA of Ophthalmic vasoconstrictors/decongestant
Constricts the blood vessels in the conjunctiva. Weak sympathomimetic
57
What can happen with overuse of Ophthalmic vasoconstrictors/decongestant?
Rebound congestion/redness
58
Use of Ophthalmic vasoconstrictors/decongestants should be avoided if...
- Hx of heart disease, high BP, enlarged prostate, narrow angle glaucoma.
- Wears contacts
- Takes MAOI's or tricyclics
59
Adverse effects of Ophthalmic vasoconstrictors/decongestants if absorbed systemically?
Tachycardia, aggravation of arrhythmias
60
Local adverse effects of Ophthalmic vasoconstrictors/decongestants?
mydriasis (pupil dilation), burning/stinging, blurry vision
61
OTC options for Ophthalmic vasoconstrictors/decongestants? (-zoline)
- Naphazoline -best option (Clear Eyes)
- Tetrahydrozoline (Visine)
- Oxymetazoline -fewer side fx (Vision LR)
- Phenylephrine (glaucoma risk)
62
OTC combination products to treat Allergic Conjunctivitis
- Naphazoline + pheniramine
| - Naphazoline + antazoline
63
Contraindications for OTC combination products to treat allergic conjunctivitis
Heart disease, high BP, enlarged prostate, narrow angle glaucoma (due to vasoconstrictors)
64
Sx of Dry Eye
Ocular burning, redness, blurred vision, discomfort, desire to rub eye
65
Options for Dry Eye
- Artificial Tears
- Ocular Emollients
- Cyclosporine
66
Artificial tear options
- Cellulose derivatives: longer lasting, but can leave a crust on the eyes
- Polyvinyl alcohol: shorter acting, but no crust
- Povidone and dextran 70: transient stinging and burning
67
Ocular emollient options
Lanolin, mineral oil, white ointment, yellow wax, white wax, petroleum
(ointment or liquid)
68
Rx for keratoconjunctivitis sick (suppressed tear production due to ocular inflammation)
Cyclosporine (Restasis)
69
MOA for Cyclosporine
Inhibits interleukin 2 that is needed for T cell action
70
Adverse effects of cyclosporine
burning, eye discomfort
71
Sx of corneal edema
Foggy vision, haloes around lights, photophobia, irritation, foreign body sensation, extreme eye pain
72
Etiology of corneal edema
Prolonged contact lens wearing, infection, glaucoma, iritis
73
Tx of corneal edema
Sodium chloride (2-5%), ointment if drops ineffective
74
MOA of pupillary dilation agents
Muscarinic agents - block parasympathetic receptors (that would normally cause pupils to constrict if stimulated)
75
Parasympathetic action of the eye:
Constriction (miosis) inner circular muscle constricts
76
Sympathetic action of the eye:
Dilation (mydriasis) outer radial muscle constricts
77
Pupillary Dilation agents:
- Tropicamide- peaks @ 20-30 min, lasts 2-7 hours
- Cyclopentolate- peaks @ 25-75 min, lasts 6-24 hrs
- Homatropine -lasts 24-72 hours
78
Possible adverse rxn of pupillary dilation agents
Tachycardia, flushing, blurry vision, photophobia, dry mouth, slurred speech, drowsiness, hallucinations, congestion, irritated eyes
79
Contraindications for pupillary dilation agent use
Closed angle glaucoma- dilation can occlude outflow of aqueous humor, raise IOP which further occludes outflow
80
Used to detect corneal defects and abrasions
Fluorescein- fluoresces under ultraviolet spectrum. Will stain epithelial damage, but does not stain cornea
81
What is fluorescein?
Yellow, water-soluble dibasic-acid xanthine dye
82
Beclomethasone
Intranasal Corticosteroid
83
Nudesonide
Intranasal Corticosteroid
84
Ciclesonide
Intranasal Corticosteroid
85
Flunisolid
Intranasal Corticosteroid
86
Fluticasone furoate
Intranasal Corticosteroid
87
Fluticasone proprionate
Intranasal Corticosteroid
88
Mometasone
Intranasal Corticosteroid
89
Triamcinolone acetonide
Intranasal Corticosteroid
90
What is the MOA for intranasal corticosteroids?
Decrease influx of inflammatory cells, inhibits release of cytokines which reduces inflammation of nasal mucosa.
91
What is the MOA for oral antihistamines?
H1 receptor antagonist.
92
What is an H1 antagonist?
Blocks the action of the histamine at the H1 receptor, which helps relieve allergic reactions. Antihistamine.
93
What are examples of first generation oral antihistamines?
Chlorpheniramine. Brompheniramine. Diphenhydramine. Clemastine.
94
What are the key points of 1st generation antihistamines?
Nonselective. Sedating. More frequent dosing.
95
What are the key points of 2nd generation antihistamines?
Peripherally selective. Low incidence of sedation. Once/daily. No anticholinergic effect.
96
What is the most effective 2nd generation antihistamine?
Cetirizine.
97
What are 4 2nd generation antihistamines?
Loratidine. Cetirizine. Fexofenadine. Desloratadine.
98
Which type of antihistamine crosses the blood-brain barrier?
1st generation.
99
Which type of antihistamine has less side effects?
2nd generation.
100
What are some contraindications for antihistamines?
Don’t drive or operate heavy machinery. Narrow-angle glaucoma possible. Avoid alcohol.
101
What are 2 Intranasal antihistamines?
Azelastine. Olopatadine
102
What is the MOA of oral decongestants?
Alpha-adreneric agonist>vasoconstriction. Reduces blood supply to nasal mucosa. Decreases mucosal edema. NO EFFECT ON HISTAMINE.
103
What are contraindications for nasal decongestant?
AVOID if uncontrolled heart disease. Can increase IOP and BP.
104
What are some side effects of Intranasal Corticosteroids?
Headache. Elevated BP. IOP. Tremor. Dizziness. Tachycardia. Insomnia.
105
What are two examples of nasal decongestants?
Phenylephrine. Pseudoephedrine.
106
What is the MOA for topical decongestants?
Alpha agonist that act locally as vasoconstrictors. Decrease blood supply to nose by constricting blood vessels.
107
What are examples of topical decongestants
Phenylephrine. Oxymetazoline.
108
What are contraindications for topical decongestants?
Rhinitis medicamentosa!
109
What are the key points for Intranasal Cromolyn?
Prevents and treats SYMPTOMS of Allergic Rhinitis.
110
What does a mast cell stabilizer do?
Prevents mast cells from releasing histamine. (Intranasal cromolyn).
111
How do intranasal anticholinergics work?
They block acetylcholine receptors.
112
What is an example of an intranasal anticholinergic?
Ipratropium
113
What would you consider using to reduce ocular symptoms in Allergic Rhinitis?
Leukotriene Receptor Antagonists.
114
What is an option for patients with asthma who have allergic rhinitis?
Leukotriene receptor antagonists (montelukast). Reduces bronchospasm.
115
How long does it usually take for immunotherapy to work? How long can it last?
5-7 yrs. 12.
116
2nd generation antihistamines
| -adine
- Fexofenadine
- Desloratadine
- Loratadine
- Cetirizine **(most effective)
117
1st generation antihistamines
| -amine
Diphenhydramine
Chlorpheniramine
Brompheniramine
Clemastine
118
What works well to REDUCE RHINORRHEA?
Ipratropium (many other answers).
119
What is a major anticholinergic side effect?
DRYNESS
120
Is the common cold usually viral or bacterial?
Viral
121
Is the onset for a cold gradual or rapid?
Gradual, 1-2 weeks.
122
Meds to treat anaphylaxis
* Epinephrine -life saving
* Antihistamine- symptom relief
* Corticosteroid -suppress biphasic or rebound run
Don't forget to stop the offending drug or whatever caused the rxn to begin with
123
Medical term for pupil constriction
Miotic
124
Main goal of Glaucoma Tx
Reduce IOP either by slowing production or increase drainage of aqueous humor to prevent optic nerve damage and visual field loss
125
Drug classes to treat Glaucoma
- Prostaglandin Analogues
- Beta blockers
- Alpha-adrenergic agonists
- Carbonic anhydrase inhibitors
- Cholinergics
- Mannitol
126
How does systemic absorption occur with topical anti-glaucoma meds?
Primarily through the nasolacrimal duct
127
MOA of Prostaglandin Analogues (1st line Tx)
Synthetic analogues of prostaglandin act on RF (prostaglandin receptor), increase outflow of intraoccular aqueous humor through uveoscleral pathway, which lowers IOP 23-35%
128
Helpful med to prevent biphasic rxn in anaphylaxis
Corticosteroids
- first dose IV
- typically multi-day course. Short term! (3-5 days)
129
MOA of corticosteroids
Decreases influx of inflammatory cells, inhibits release of cytokines -> reduce inflammation
- prednisone
- prednisolone
- Methylprednisolone
- Dexamethasone
- many more
130
```
Corticosteroids:
A
D
M
E
T1/2
```
```
A: GI tract, highly bioavailable
D: 70-90% protein bound
M: Liver
E: Renal
T1/2: 2-4 hours
```
131
Adverse rxns of corticosteroids
Hypertension, body fluid retention, impaired glucose tolerance, increased appetite, weight gain, osteoporosis, disturbance in mood, delirium
132
Adverse rxns of beta blockers
Bradycardia, bronchospasm, depression, fatigue, ocular dryness
133
MOA of Alpha-Adrenergic Agonists (a2)
Decreases aqueous humor production by causing vasoconstriction (maybe increases outflow)
134
Options for Glaucoma Alpha-Adrenergic Agonist Rx (-idine)
- Brimonidine
| - Apraclonidine
135
What are CYP450s?
Drug metabolizing enzymes
136
MOA of Carbonic Anhydrase Inhibitors
Slows action of carbonic anhydrase to decrease aqueous humor volume -> decreases IOP
137
Glaucoma Carbonic Anhydrase Inhibitor Rx options (-zolamide)
- Acetazolamide*
- Dorzolamide
- Brinzolamide
- Methazolamide*
- Dichlorphenamide
* oral tablets used less often
138
Adverse rxns of Carbonic Anhydrase Inhibitors
Ocular irritation, sour taste
139
Contraindications for use of Carbonic Anhydrase Inhibitors
Sulfa Allergy
140
MOA of Cholinergics
Has similar effects as acetylcholine -> parasympathetic response of miosis (essentially it contracts the iris sphincter muscle, which opens the canal of Schlemm, which increase the outflow of aqueous humor through trabecular meshwork, which decreases IOP =>miosis)
Direct- directly stimulates ocular cholinergic receptors
Indirect- bind to and activate cholinesterases (that break down acetylcholine-> keep acetylcholine around)
141
Direct-Acting Cholinergics (Miotics)
- Pilocarpine
| - Carbachol
142
Indirect Acting Cholinnergics (Miotics)
Echothiophate
| very long half life, irreversible
143
Adverse rxns of Cholinergics (Miotics)
Blurred vision, poor night vision, eye pain, headache
144
Combination drops to treat Glaucoma
Timolol + dorzolamide
145
Glaucoma drug interactions
Acetazolamide interacts with
- aspirin
- Cyclosporine
- Lithium
- Phenytoin
146
Glaucoma drug classes that slow production of aqueous humor:
Beta blockers
Alpha 2 agonists
Carbonic anhydrase inhibitors
147
Glaucoma drug classes that increase drainage of aqueous humor
Prostaglandins
| Cholinergics/muscarinics
148
Drug used to treat acute attack of closed angle glaucoma
Mannitol, Glycerin
149
Pharmacologic Tx for Mild Allergic Rhinitis
antihistamines prn
150
MOA of Mannitol, Glycerin
Causes blood to be hypertonic compared to intraocular and spinal fluids, which causes osmotic gradient (pulls water from intraocular and spinal areas out to bloodstream), and excess fluid is secreted in the urine
151
Pharmacologic Tx for Severe Allergic Rhinitis
Refer to specialty/immunotherapy
152
Humoral immunity (antibodies & B cells) + cellular immunity =(no antibodies & T cells)
Acquired immunity
153
Hypersensitivity Rxn Types :(resulting from interaction between antigen and immune system)
Type I: IgE-mediated -antigen complex binds to mast cells causing release of histamine and inflammatory mediators (anaphylaxis/allergy)
(Also Types II- IV)
Pseudoallergic (anaphylactoid)
154
Spectrum of Effects of IgE mediated rxns
- Mild = allergic rhinitis
- Moderate (!!) = urticaria (hives), angioedema (swelling)
- Severe (!!!!!) = anaphylaxis
155
Benefits of intranasal corticosteroids
Reduces ocular symptoms, nasopharyngeal itching, sneezing, rhinorrhea.
More effective than antihistamines in severe cases
156
2nd generation antihistamines (-adine)
- Fexofenadine
- Desloratadine
- Loratadine
- Cetirizine
157
1st generation antihistamines
Diphenhydramine
158
Follow up Rx for moderate hypersensitivity rxn
Oral corticosteroids -short course (e.g. prednisone for 3-5 days)
159
Further Rx care following moderate hypersensitivity rxn
Epinephrine auto injector
160
What type of rxn is anaphylaxis?
IgE mediated (Type I Rxn)
161
What is the time frame for an anaphylactic response? 2nd Rxn? (Biphasic Rxn)
- W/in 1 hour (5-30 min)
| - 8-72 hours later
162
Meds to treat anaphylaxis
Epinephrine -life saving
Antihistamine- symptom relief
Corticosteroid -suppress biphasic or rebound run
Don't forget to stop the offending drug or whatever caused the rxn to begin with
163
MOA of epinephrine
Alpha & beta adrenergic agonist (sympathomimetic)
- causes rapid vasoconstriction and rapid relaxation of bronchial smooth muscle
164
MOA of oral/topical decongestants
- Alpha-adreneric agonists → vasoconstriction
- Constriction of blood vessels to decrease blood supply to nasal mucosa, decrease mucosal edema
- > no effect on histamine
165
Adverse effects of epinephrine
agitation, anxiety, tremulousness, headache, dizziness, pallor, palpitations, arrhythmias
166
2nd line Tx for anaphylaxis
Antihistamines
- helps erythema & pruritus, but doesn't help with airway obstruction or high BP
- given IV, IM or po
- couple with epinephrine
167
MOA of antihistamines
H1 receptor antagonists
1st gen: sedating, nonselective (diphenhydramine)
2nd gen: selective, low sedation, no anticholinergic fx
168
Helpful med to prevent biphasic rxn in anaphylaxis
Corticosteroids
- first dose IV
- typically multi-day course (3-5 days)
169
MOA of corticosteroids
Decreases influx of inflammatory cells, inhibits release of cytokines -> reduce inflammation
- prednisone
- prednisolone
- Methylprednisolone
- Dexamethasone
- many more
170
```
Corticosteroids:
A
D
M
E
T1/2
```
```
A: GI tract, highly bioavailable
D: 70-90% protein bound
M: Liver
E: Renal
T1/2: 2-4 hours
```
171
Alternative to Topical Decongestants
Saline nasal drops, spray, rinse: no interactions, very safe, use if unsure cold vs allergies
172
What are the 4 types of hypersensitivity reactions?
Type I: IgE-mediated- release of histamine and inflammatory mediators (minutes to hours) (anaphylaxis/allergy)
Type II: Cytotoxic reaction (variable timing)- IgM or IgG antibodies attack drug coated cell
Type III: immune complex (1-3 wks)- drug antibody complexes deposit on tissues
Type IV: delayed, cell-mediated (2-7 days) - presentation of drug molecules to sensitized T cells ->cytokine and inflammatory mediator release
173
What is pseudo allergic?
Results from direct mast cell activation, degranulation
- looks like Type I
- Anaphylactoid = mimics anaphylaxis
- e.g. anaphylactoid rxn after radiocontrast media
174
Importance of Distribution (of drug)
How much is free in the blood affects dosing. Drug in tissue must get back to blood in order to be excreted; too much drug in tissue can cause lethal toxicity
Amount of drug in the body divided by the concentration in the blood = distribution
175
What are CYP450s?
Drug metabolizing enzymes
176
Montelukast -> leukotriene receptor antagonist to treat allergic rhinitis
- Reduce ocular symptoms, sneezing, rhinorrhea
| - May be particularly useful for patients with asthma
177
What is half-life?
how long does it take for half of the drug to leave the body. Good for dosing intervals, determining how long it takes to reach a steady state, or when drug is finally cleared from the body. Usually takes 5-6 half-lives to completely leave the body (some adverse effects take longer or are irreversible)
178
How often do you give a drug if you are trying to build up the level in the body?
Give every half of a half life
179
What is Glomerular filtration rate (GFR)?
How well kidneys are filtering. Another way is CrCl, which is how well body is clearing creatinine (good indicator of how well the kidneys are working)
180
What is the Therapeutic Index (TI)?
level between too much that will be toxic and too little when it won't work.
181
What is a loading dose?
Large first dose - some gets bound up in the tissues and the rest can go around and attack what it needs
182
What is the fastest rate of onset of a drug? Slowest?
- (fastest) IV or inhalation -> 30 sec-1min
- (fast) IM ->5 min
- (Mid) Subcutaneous, oral -> 30 min
- (Slower) transdermal, oral-> 2 hours
183
What is the best way to administer a drug that is degraded in the digestive tract?
Subcutaneous or IV
184
What is the preferred route of administration?
Oral
185
Codeine w/guaifenesin
- narcotic, helps pt sleep
- Prodrug
- some people can be poor metabolizers or ultra rapid metabolizers
Avoid in children <12
Avoid alcohol
186
What is the abbreviation:
od
ad
Right eye
| Right ear
187
Hydrocodone
-Narcotic, helps pt sleep
Avoid in children <12
Avoid alcohol
188
What is the abbreviation:
ou
au
Both eyes
| both ears
189
Pharmacologic Tx for Mild Allergic Rhinitis
antihistamines pen
190
Pharmacologic Tx for Moderate Allergic Rhinitis
intranasal steroid +/- antihistamine +/- decongestant for nose +/- ophthalmic antihistamine for eyes
191
Pharmacologic Tx for Severe Allergic Rhinitis
Refer to specialty/immunotherapy
192
Sore Throat/cough remedies
-Saline gargle
-Sprays, lozenges (numb locally)
Benzocaine
Dyclonine
Phenol
Menthol
-Honey (Buckwheat)
-Lots of water
193
MOA of intranasal corticosteroids
Decrease influx of inflammatory cells, inhibit release of cytokines -> reduce nasal mucosal inflammation
194
How long does it take intranasal corticosteroids to work? Peak?
Less than 30 min, peaks hours-days
195
Benefits of intranasal corticosteroids
Reduces ocular symptoms, nasopharyngeal itching, sneezing, rhinorrhea.
More effective than antihistamines in severe cases
196
Intranasal corticosteroid options (-onide)
- Beclomethasone
- Budesonide
- Ciclesonide
- Flunisolid
- Fluticasone furoate (no alcohol)
- Fluticasone propionate (no alcohol)
- Mometasone
- Triamcinolone acetonide (no alcohol)
197
Adverse effects of Intranasal corticosteroids
Bitter aftertaste,
| burning, epistaxis, headache, nasal dryness, possible systemic absorption, stinging, throat irritation
198
```
Antihistamines
A
D
M
E
T1/2
```
A: Rapid
D: 60-70% protein bound
M: minimal; desloratadine is a prodrug (first pass metabolism)
E: fexofenadine, desloratadine, loratadine→feces and urine; others → urine
T1/2: variable
199
Side fx of 1st gen antihistamines
- Cross blood-brain barrier ->sedation, fatigue, impaired mental status.
- Paradoxical stimulation in some children, elderly
200
Side fx of 2nd get antihistamines
Don't cross blood-brain barrier-> less sedative (except for cetirizine 1/10)
201
Precautions/contraindications for antihistamines
- Do not drive, operate heavy machinery
- Avoid alcohol
- Prostatic hyperplasia can occur
- Narrow-angle glaucoma possible
202
Intranasal antihistamine options
Azelastine
Olopatadine
Azelastine/fluticasone combo ($$$)
203
Adverse rxn of intranasal antihistamine
bitter aftertaste, headache, nasal irritation, sedation, epistaxis
204
MOA of oral decongestants
- Alpha-adreneric agonists → vasoconstriction
| - Constriction of blood vessels to decrease blood supply to nasal mucosa, decrease mucosal edema
205
Oral decongestant options
Phenylephrine (low bioavailability)
| Pseudoephedrine
206
Side fx of oral decongestants
- Headache
- Elevated blood pressure
- IOP
- Tremor
- Urinary retention
- Dizziness
- Tachycardia
- Insomnia
207
Precautions/contraindications for oral decongestants
-Avoid in uncontrolled HTN, heart disease, DM, Hyperthyroidism, enlarged prostate, narrow angle glaucoma, high BP
208
Side fx of topical decongestants
- Minimal systemic absorption, few side effects
- Local burning
- Nasal irritation, dryness
- Sneezing
209
Precautions/contraindications of topical decongestants
Rebound congestion (rhinitis medicamentosa) may occur if use > 3-5 days
210
Options for topical decongestants
Phenylephrine
| Oxymetazoline
211
Alternative to Topical Decongestants
Saline nasal drops, spray, rinse: no interactions, very safe, use if unsure cold vs allergies
212
Intranasal mast cell stabalizer
Cromolyn ->Prevent and treat allergic symptoms: nasopharyngeal itching, sneezing, rhinorrhea
- only works if taken regularly, and must take 4-6 times daily, 2-3 wks for max effect
213
Side fx of Intranasal Cromolyn
nasal irritation, nasal burning, stinging, sneezing, cough, unpleasant taste, epistaxis
214
Intranasal anticholinergics option
Ipratropium ->reduces rhinorrhea
215
MOA of Intranasal anticholinergics
Block acetylcholine receptors -> less mucus
216
Montelukast ->leukotriene receptor antagonist
- Reduce ocular symptoms, sneezing, rhinorrhea
| - May be particularly useful for patients with asthma
217
Immunotherapy for allergic rhinitis best for pts who...
- are unresponsive to usual treatment
- who cannot tolerate usual treatment
- who want to avoid long term med use
- with allergic asthma
218
Nonpharmacologic Tx for common cold
humidifiers, increase fluids, rest
219
Pharmacologic Tx of common cold
- Decongestants +/- antihistamines
- analgesics
- local anesthetic (lozenges, spray)
- cough meds??
220
Meds to treat fever, pain, headaches
Acetaminophen
| NSAIDS: ibuprofen, naproxen
221
Who should not take cough meds at all
Children <6 yo
222
Cough/cold meds are mostly ineffective, what might be helpful?
- High-dose inhaled corticosteroids
- Buckwheat honey (not <1yo)
- nasal irrigation with saline
- vapor rub
- Zinc sulfate?
223
Cough med options
Antitussives
Expectorants
Sore throat remedies
224
Antitussive options
Codeine (w/guaifenesin)
Hydrocodone
Dextromethorphan
Benzonatate
225
Codeine w/guaifenesin
- narcotic, helps pt sleep
- Prodrug
- some people can be poor metabolizers or ultra rapid metabolizers
Avoid in children <12
Avoid alcohol
226
```
Codeine w/guaifenesin
A
D
M
E
T1/2
```
```
A: absorbed orally
D: crosses blood brain barrier
M: primarily in liver; prodrug, variable metabolism
E: urine
T1/2: 2.5-4 hours
```
227
Hydrocodone
-Narcotic, helps pt sleep
| -
228
Dextromethorphan
- For non-productive cough
- interacts with MAO inhibitors
- MOA- centrally mediated
- maybe has some benefit
229
```
Dextromethorphan
A
D
M
E
T1/2
```
```
A: Absorbed from GI
D: crosses blood brain barrier
M: prodrug, liver CYP2D6 → active drug
E: urine
T1/2: variable (2-24 hours)
```
230
Benzonatate
MOA: anesthetizes respiratory passage, lung, pleural stretch receptors (reduces cough reflex)
Adverse Reactions: hypersensitivity, GI upset, sedation
Maybe has benefit
M: Liver, unknown CYP450
E: urine
T1/2: ?
231
Expectorant
Guaifenesin
MOA: thinning of mucus to enhance clearance
For productive cough
Side effects: GI discomfort
Counseling point: increase fluid intake
Maybe has benefit
232
Sore Throat/cough remedies
-Saline gargle
-Sprays, lozenges (numb locally)
Benzocaine
Dyclonine
Phenol
Menthol
-Honey (Buckwheat)
-Lots of water
Fun Med Fall-AM
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Decks in class (5)
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