Flashcards in ENT Pharm Deck (100)
What nasal spray is an antihistamine?
Azelastine HCl (Asteliln)
What nasal spray is a corticosteroid?
Fluticasone Propionate (Flonase)
What nasal spray is a anticholinergic?
Ipratropium Br (Atrovent)
What nasal spray is a mast cell stabilizer?
Cromolyn Na (Nasalcrom)
How long should patients use Oxymetazoline
3-5 days. Professor White said more like 5.
What is the MoA for oxymetazoline?
Vasosconstriction (direct-acting alpha agonist)
What are some SE/ADRs of oxymetazoline?
Rebound mucosal congestion & vascular irritation, stinging, burning, dryness, sneezing; hypertension in large dose; epistaxis, tachyphylaxis
Contraindications for oxymetazoline?
Continuous use, glaucoma
What should we monitor with oxymetazoline?
Length of use
What class is oxymetazoline?
Topical Nasal Decongestant NS
What class is Azelastine?
When do you use azelastine?
What is the MoA for azelastine?
H1 receptor blocker
Side effects of azelastine?
Headache, bitter taste, rhinitis, cough, somnolence; Hypertension, tachycardia, anxiety, glaucoma
Contraindicated for azelastine?
What kind of nasal spray is Oxymetazoline?
Dx-Dx interactions for azelastine?
Other anti-cholinergic or sedating drugs
What class is Fluticasone a part of?
Corticosteroid nasal spray
When do you use Fluticasone?
Rhinitis (allergic, occupational, atrophic, vasomotor)
What is the MoA of Fluticasone?
Anti-inflammatory with vasconstrictor activity
SE/ADR of fluticasone?
Burning, irritation, dryness, headache, epistaxis; nasal septal perforation, epistaxis
What should we monitor in patients who take fluticasone?
What class is Ipratropium Br a part of?
Anticholinergic (antimuscarinic) nasal spray
When do we use Ipratropium?
MoA for Ipratropium?
Blocks acetylcholine at muscarinic receptors in parasympathetic nervous system
SE/ADR for ipratropium?
Epistaxis, dryness, nausea; avoid with glaucoma
What is contraindicated for Ipratropium?
Hypersensitivity; caution in asthma, prostatic hypertrophy, angle-closure glaucoma
What class is Cromolyn a part of?
Mast cell stabilizer nasal spray
When do you prescribe cromolyn?
MoA for cromolyn?
Stabilizes mast cell membrane so mediators (histamine, leukotrienes, etc) not released
SE/ADR for cromolyn?
Local stinging, burning, unpleasant taste, sneezing, occasional epistaxis
H1 antihistamine receptors are?
smooth muscle, endothelium, brain
H2 antihistamine receptors are?
GI mucosa, cardiac muscle, mast cells, brian
H1 generation is sedating or no?
H2 generation is sedating or no?
What kind of drug is diphenhydramine?
1st generation antihistamine
When do you use diphenhydramine?
MoA for diphenhydramine?
SE/ADR for diphenhydramine?
drowsiness (frequently significant); anti-cholinergic side effects.
Contraindications for diphenhydramine?
Prostatic hypertrophy, dementia; caution in asthma, angle-closure glaucoma
What often happens when children take diphenhydramine?
They get cray cray. That means crazy.
ok, ok..hyperactivity/excitatory impact
Dx-Dx for diphenhydramine?
other sedating drugs, especially other anti-cholinergic
Is diphenhydramine is effective as nasal corticosteroids?
What class does Fexophenadine belong to?
2nd generation oral antihistamine
When do use fexophenadine?
How many things do we use to treat allergic rhinitis?
too many. moving on.
MoA for fexophenadine?
H1 receptor blocker
SE/ADR for fexophenadine?
Headache, somnolence, dizziness; increases any anticholinergic effect of other co-administered drugs
Does fexophenadine cross the blood brain barrier?
What class does Benzocaine Otic belong to?
Topical otic analgesic
When do we use Benzocaine Otic?
Otalgia with intact tympanic membrane
MoA for benzocaine otic?
SE/ADR for benzocaine otic?
How effective is this in children?
About 50 percent of the time. Lasts about 30-60 minutes
What is the pH or eye drops?
What is the pH of ear drops?
What class does Neomycin, Colistin, Hydrocortisone, Thonzonium (Corticosporin-TC Otic Solution/Suspension) belong to?
Antibiotic-hydrocortisone Otic solution/suspension
FYI just calling this drug Corticosporin from now on.
When do we use Corticosporin-TC?
Otitis externa with intact tympanic membrane
SE/ADR of corticosporin?
Mucosal irritation and edema with over use; Neomycin sensitivity can develop during course of use
What do we need to look out for with corticosporin?
Hypersensitivity--especially to neomycin
What class does Nystatin belong to?
Polyene Antifungal Antibiotic, topical use only, candida species only
When do we use Nystatin?
Thrush, oral candidiasis in immune intact host
MoA of nystatin?
Binds to fungal membrane, creates pores in membrane disrupting membrane integrity
SE/ADR of nystatin?
Unpleasant taste, NVD; Too toxic for systemic use (IV or IM)
Is the oral form absorbed systemically?
No. Swish/swirl/swallow 4 times a day
What class does Meclizine belong to?
When do use Meclizine?
Prevent/treat vertigo, motion sickness
MoA of Meclizine?
Anticholinergic impact on chemoreceptor trigger zone; blocks conduction in middle ear vestibular-cerebellar pathway
Contraindications for meclizine?
Hypersensitivity; caution in asthma, prostatic hypertrophy, angle-closure glaucoma, dementia
SE/ADR of meclizine?
Sedation, thickening bronchial secretions
Dx-dx of meclizine?
Avoid ethanol, other anticholinergic medications
What class does acyclovir belong to?
Nucleoside Anti-herpes virus
When do you use acyclovir?
HSV-1, HSV-2, VZV, EBV, CMV (not as much(, HHV-6
MoA for acyclovir?
Block herpes virus nucleic acid synthesis
SE/ADR for acyclovir?
Nausea, diarrhea, headache; nephritis, tremors, delirium, seizures with overdose
What else should we know about acyclovir?
White wrote A LOT so....
PO, IV, topical formulations; requires viral kinase for activation so accumulates only in virus infected cells. Eliminated via glomerular filtration and tubular secretion; variability in viral sensitivity so varying dosing levels by virus; resistance may develop.
If any of you are still reading this, i love you.
What class does Betaxolol belong to?
Ophthalmic beta1 blocker anti-glaucoma drug
When do you use Betaxolol?
Chronic open-angle glaucoma; ocular hypertension
MoA of Betaxolol?
Reduces IOP by decreasing production of aqueous humor
SE/ADRs of Betaxolol?
Ocular discomfort, bradycardia, bronchospasm, depression, heart block, exacerbation heart failure
Contraindications for betaxolol?
Sinus bradycardia, heart block >1st degree
What should you monitor when patients are on betaxolol?
FYI, that's for every glaucoma drug so i'm only asking it once. Monitor IOP. Got it!?!?
What class of drug is Bimatoprost?
Ophthalmic prostaglandin anti-glaucoma drug
How does Bimatoprost work?
Synthetic analog of prostaglandin which deceases IOP by increasing outflow of aqueous humor
I want to make this clear... what does a prostaglandin do?
increases outflow of aqueous humor.
When do we use Bimatoprost?
Chronic open-angle glaucoma or ocular hypertension; hypotrichosis of eyelashes
SE/ADRs of Bimatoprost?
Ocular hyperemia, growth of eyelashes, ocular pruritus, headache, dry eyes, photophobia, brown pigmentation of iris and eyelid skin
Who shouldn't you prescribe this drug to?
What class does Brimonidine belong to?
Ophthalmic Alpha2 Agonist anti-glaucoma drug
When do you prescribe Brimonidine?
Chronic open-angle glaucoma, ocular hypertension
MoA for Brimonidine?
Selective agonism for alpha2-receptors causes reduced production of aqueous humor and increased outflow
AKA, this guy does both
SE/ADRs of Brimonidine?
Somnolence, allergic conjunctivitis, hyperemia, eye pruritus, HTN, xerostomia, CNS depression
Who don't we prescribe Brimonidine too?
What class of drug does Dorzolomide belong to?
Ophthalmic Carbonic Anhydrous Inhibitor anti-glaucoma drug
When do you use Dorzolomide?
Chronic open-angle glaucoma or ocular hypertension
MoA for Dorzolomide?
Reversible inhibition of renal carbonic anhydrase causing increased renal excretion sodium, potassium, bicarbonate and water with decrease production of aqueous humor
SE/ADRs of Dorzolomide?
Eye discomfort, superficial punctate keratitis, ocular allergic reaction, blurred vision, photophobia, possible SJS
What happens when you co-administer verapamil and fexophenadine?
Increases the serum levels of fexophenadine