Pharm E1: ENT

Tx AOM Main

Tx AOM Main

high dose Amoxicillin

Tx AOM severe/resistant

Augmentin

Tx AOM PCN allergy

Azithromycin or Cefdinir

Tx of Acute bacterial rhinosinusitis Main

Augmentin

Tx of Acute bacterial rhinosinusitis PCN allergy

Clindamycin + cefixime or levofloxacin

Tx for acute pharyngitis

Amoxicillin PO or Benzathin G penicillin IM

Tx for acute pharyngitis PCN allergy

cephalexin, clindamycin, azithromycin

Tx for AOE main

Ciprofloxacin, Ciprodex, Cortisporin (neomycin, polymixin B, hydrocortisone), Ofloxacin

Ketoconazole

• MOA: alters fungal cell wall permeability by inhibiting CYP450

• Uses: systemic fungal infections

• SE: QT prolong, HLD, orthostatic hypotension, hepatitis, CYP3A4 inhibitor

Nystatin

• MOA: binds to sterols in fungal cell membrane increases cell wall permeability

• Uses: oral candidiasis

• SE: diarrhea, nausea, stomach pain, vomiting

Which antivirals are guanine analogs?

Acyclovir, Penciclovir, Ganciclovir Na, Valacyclovir, Famciclovir, Valganciclovir HCl

Acyclovir

• prevents elongation of viral DNA

• Uses: Herpes simplex, Varicella-zoster

• Adverse: nausea, vomiting, rash, CNS, tremor

• Bioavailabilty: 22%

Valacyclovir

• prevents elongation of viral DNA

• Uses: Herpes simplex, Varicella-zoster

• Adverse: nausea, vomiting, rash, CNS, tremor

• Bioavailability: 70%

Penciclovir

• prevents elongation of viral DNA

• Uses: Herpes simplex, Varicella-zoster

• Adverse: nausea, vomiting, rash, CNS, tremor

• Bioavailability: 5%

Famciclovir

• prevents elongation of viral DNA

• Uses: Herpes simplex, Varicella-zoster

• Adverse: nausea, vomiting, rash, CNS, tremor

• Bioavailability: 77%

Ganciclovir

• prevents elongation of viral DNA

• Uses: CMV in transplant and immunocompromised pts

• Adverse: neutropenia, thrombocytopenia, CNS, confusion, ataxia, seizures, coma

• Bioavailability: 6-9%

Valganciclovir

• prevents elongation of viral DNA

• Uses: CMV in transplant and immunocompromised pts

• Adverse: neutropenia, thrombocytopenia, CNS, confusion, ataxia, seizures, coma

• Bioavailability: 61%

Oseltamivir (Tamiflu)

• MOA: inhibits new virus from being cleaved by budding progeny

• Uses: influenza A & B

• Resistance is growing

Salicylates

• Acetylsalicyclic acid (ASA, Aspirin)

• antiplatelet, antinflammatory, antipyretic-analgesic, salicylism

• Contradictions: bleeding disorders, pregnancy, children w/ fever w/ viral disease

Reye’s Syndrome (fatty liver encephalopathy)

• vomiting, CNS damage, hepatic injury, hypoglycemia

• fatty liver and renal tubules, CNS edema, mitochondrial dysfunction in brain, liver, muscle

• 5 stages

• Symptom’s: URI, influenza, chickenpox

1st stage of Reye’s

rash on hands & feet, vomiting, high fever, lethargy

2nd stage of Reye’s

encephalitis, hyperventilation, fatty liver

3rd stage of Reye’s

coma, cerebral edema

4th stage of Reye’s

coma (deeper), fixed dilated pupils, hepatic dysfunction

5th stage of Reye’s

seizures, multiple organ failure, death

Ibuprofen (Motrin, Advil)

• NSAID: anti-inflammatory, analgesic, and antipyretic

• MOA: reversibly inhibits cyclooxygenase 1 &2, dec prostaglandin synthesis

• Uses: relief mild to moderate pain

• Interactions: dec effect of ACE inhibitors, dec secretion of Lithium and methotrexate → toxic levels, prolong PT time w/ anticoag

• SE: GI ulcers/bleeding, edema, fluid retention, acute renal failure, dec CrCl

Acetaminophen (Tylenol)

• analgesic & antipyretic

• MOA: not fully elucidated

• Uses: pain, fever > 100 F

• well tolerated, no notable side effects

H1 Receptors

• inc post-capillary permeability

• vasodilation

• inc mucus secretion

• inc smooth muscle tone

• stimulate nerve endings

• bronchoconstriction

H2 receptors

• inc cAMP

• inc gastric acid secretion

• vasodilation

• inc contractility

• inc mucus secretion

• dec smooth muscle tone

H1-Receptor Antagonists

• block smooth muscle contraction

• block rapid vasodilation

• dec secretion

• dec edema, vascular permeability

• dec hives, wheals

• dec itching

Azelastine HCl (Astelin)

• antihistamine (nasal spray)

• MOA: Histamine H1 receptor antagonist

• Uses: allergic rhinitis & vasomotor rhinitis

• SE: bitter taste, epistaxis

Nasal Corticosteroids

• Beclomethasone, Budesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone

• Uses: allergic rhinitis & vasomotor rhinitis

• SE: epistaxis, septum perforation, unpleasant taste

Dexamethasone

• synthetic adrenocortical steroid

• Uses: allergic rhinitis, drug hypersensitivity rxns

• SE: CHF, HTN, fluid retention, glucose intolerance, tendon rupture, papilledema, glaucoma, dec resistance to infections

• Interactions: w/ diuretic or digoxin → hypokalemia, dec antidiabetic Rx

Prednisone/Prednisolone

• glucocorticoids

• Uses: allergic rhinitis, allergic conjunctivitis, drug hypersensitivity rxn

• SE: NA retention, fluid retention, CHF, HTN, low potassium, tendon rupture, inc LFTs, compromise immune system

Oxymetazoline (Afrin)

• decongestant

• MOA: alpha agonist, constricts vessels in nasal mucosa

• Uses: nasal congestion

• SE: can cause rebound rhinitis -rhinitis medicamentosa, HTN

• Interactions: MAOIs & antidepressants

Pseduoephedrine (Sudafed)

• oral decongestant

• MOA: alpha agonist, constricts blood vessels in nasal mucosa

• Uses: relieve nasal congestion, relives sinus congestion, eustachian tube dysfunction due to viral illness

• SE: tachycardia, HTN, HA

• Interactions: dec effect of antiHTN

Benzonatate (Tessalon)

• antitussive

• MOA: anesthetizing the stretch receptors in the lungs

• Uses: symptomatic relief of non-productive cough

• SE: local anesthesia from chewing the capsule

Dextromethorphan (Robitussin, Delsym)

• antitussive

• MOA: related to codeine, suppresses medullary cough center through sigma receptor activation

• SE: confusion, excitement, agitation

• Interactions: risk for serotonin syndrome with other pro-serotonergic drugs

Guaifenesin

• mucolytic, expectorant

• Uses: loosens mucus, dec viscosity

• SE: N/V

Dornase alfa

• Pulmozyme

• nebulized once daily

• Uses: CF, mild to moderate

• MOA: cleaves DNA of degenerating neutrophils → reduces viscosity of sputum

Saline

• Hypertonic saline, inh BID

• improves: rheologic properties, transport of mucus, hydration of the airway surface, mucociliary clearance, lung function

N-acetylcysteine (Mucomyst)

• used for acetaminophen toxicity

• mycolytic properties when inhaled

  • reduces viscosity by splitting disulfide bonds linking mucoproteins, has some anti-inflammatory uses

• Adverse: rotten egg smell, bronchospasm