Acute and Chronic Sinusitis Treatment Skibidi

what is the MOA of decongestants?

vasoconstriction of vascular smooth muscle, shrink swollen nasal membranes, open eustachian tubes, increase drainage of sinus tissue

what are the indications of decongestants?

-PO: relief of nasal congestion
-topical: relief of nasal mucosal congestion

what are the contraindications of decongestants?

-MOAIs
-hypertension
-hyperthyroidism
-bipolar disorder
-benign prostatic hypertrophy
-glaucoma

what is the pregnancy category of decongestants?

category B/C

what are SE of decongestants?

-cardiovascular: palpitations, arrhythmia, tachycardia, HTN
- CNS: anxiety, restlessness, headache, tremor, insomnia
-other: constipation, sweating, dysuria

what are SE of topical decongestants?

-rebound congestion
-septal perforation

what are examples of a decongestants?

-Psuedoephedrine
-Phenylephrine

what is the MOA of mucolytics and expectorants?

-aid in draining secretions through the sinus ostea into the nasal cavity
-help thin post nasal drip
-generally well tolerated

what is an example of of a mucolytic and expectorant?

Guaifenesin

what does Guaifensin do?

-reduces viscosity of secretions
-increases efficiency of ciliary action
-helps to loosen phlegm and secretions

what are the SE of mucolytics and expectorants?

GI upset, nausea and headache

what is a saline irrigation?

-washes mucus and irritants from your nose
-helps to moisturize the sinus passages
-helps to improve cell function to promote mucus clearance

how do you use saline irrigation?

-use 1/2 tsp salt (non-ionized) in 8 oz of warm water with a pinch of baking soda
-lean over sink and use a ear bulb syringe or neti pot to expel solution into each nostril to flush passages
-do not put used syringe back before washing thoroughly
-best to perform saline rinse before the use of nasal medication for deeper penetration

what is the MOA of nasal corticosteroids?

anti-inflammatory action on the nasal mucosa, helps shrink nasal polyps

what is the most common SE of nasal corticosteroids?

epistaxis (nose bleed)

what is the dosage of nasal corticosteroids?

1-2 sprays each nostril q12h

what are the nasal corticosteroids?

-Nasocort AQ (triamcinolone)
-Rhinocort AQ (budesonide)
-fluticasone (Flonase)

what is the pregnancy category for Rhinocort AQ (budesonide)

category B

what is the MOA of antihistamines?

inhibits the action of histamine by blocking its attachment to H₁ receptors

what are the 1st generation antihistamine?

Diphenhydramine (Benadryl)

Hydroxyzine (Atarax, Vistaril)

what are the 2nd generation antihistamines?

Desloratadine (Clarinex), cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin), Levocetirizine (Xyzal)

what pregnancy categories are antihistamines?

category B/C

what are antihistamines indicated for?

-allergies
-antitussive
-anticholinergic

what are the contraindications of antihistamines?

-Benadryl is not recommended for pts. 60+ or under 6yo, liver impairment

what are the SE of antihistamines?

-dry mouth
-dry throat
-increased HR
-pupil dilation
-urinary retention
-constipation

Drowsiness (First Gen)

what do antibiotics do?

-inhibit cell wall synthesis
-change membrane permeability
-inhibit protein synthesis
-inhibit nucleotide acid synthesis

what is the primary goal of abx?

eradication of pathogen from site of infection

what is the secondary goal of abx?

rapidly reduce tissue edema, re-establish drainage and ventilation of sinus cavity and rapidly resolve signs and symptoms

what are the 4 main classes of antibiotics?

1. penicillin
2. cephalosporins
3. macrolides
4. fluoroquinolones

what are characteristics of penicillins?

-beta-lactam abx
-Gram + coverage
-inhibit bacterial cell wall synthesis

what are characteristics of amoxicillin?

-penicillin class
-inexpensive
-good for first line treatment
-becoming less effective due to resistance

what are SE of amoxicillin?

GI symptoms or allergic rash

what is the pregnancy category for amoxicillin?

category B

what are characteristics of augmentin?

-penicillin class
-amoxicillin with added clavulanate which protects amoxicillin from degradation from B-lactamase enzymes = extends spectrum of activity
-more effective against resistant strains

what are the SE of augmentin?

GI symptoms or allergic rash

what pregnancy category is augmentin?

category B

what are characteristics of cephalosporins?

-4 generations
-inhibit bacterial cell wall synthesis
-generally well tolerated

what is the pregnancy category for cephalosporins?

category B

what are SE of cephalosporins?

GI upset and allergic reactions

Antivitamin K

Disulfiram Reaction

what is the 1st generation of cephalosporins?

Cephalexin (Keflex): has poor H. Influenza coverage

what are 2nd generation of cephalosporins?

-Cefprozil (Cefzil)
-Cefuroxime (Ceftin)

what are the 3rd generation of cephalosporins?

-Cefixime (Suprax)
-Cefpodoxime (Vantin)
-wider bacterial coverage

what is the 4th generation cephalosporin?

cefepime (IV Maxipime)

what are characteristics of 4th generation cephalosporins?

-usually given IV in hospital
-broad spectrum
-crosses blood brain barrier
-effective for meningitis and psedomonas aerugingsa coverage

what is the MOA of macrolides?

-inhibitor of bacterial protein bio-synthesis by binding to the 50S ribosomal units of susceptible bacteria

what are characteristics of macrolides?

-affect gram+ cocci
-bacteriostatic but bactericidal at high doses

what are SE of macrolides?

-GI intolerance
-N/V/D
-impair hepatic metabolism
-metallic taste

what are contraindications of macrolides?

-may elevate PT/INR when taken with Coumadin
-QT-interval prolongation

what are the macrolides?

-erythromycin
-azithromycin (Zithromax)
-clarithromycin (Biaxin)

what is the SE of erythromycin?

not well tolerated by GI system

what is the pregnancy category of erythromycin?

category B

what is the pregnancy category of azithromycin?

category B

what is the best choice in the macrolide class?

clarithromycin (Biaxin)

what are the SE of clarithromycin?

metallic taste

what is the pregnancy category of clarithromycin?

category C

what is the MOA of flouroquinolones?

inhibit bacterial DNA synthesis

what are the SE of fluoroquinolones?

-GI or allergic syndromes
-tendon rupture of shoulder or Achilles
-rhabdomyolysis
-prolonged QT syndrome

what are the fluoroquinolones?

-ciprofloxin (Cipro)
-levofloxacin (Levaquin)
-Moxifloxacin (Avelox)

what are characteristics of ciprofloxin (Cipro)?

great drug for GU disorders but not sure great for sinusitis

what pregnancy category is ciprofloxin?

category C

what is a contraindication of levofloxacin (Levaquin)?

avoid antacids, vitamin or mineral supplements within two hours before or after you take levaquin

what pregnancy category is levofloxacin?

category C

what are characteristics of moxifloxacin (Avelox)?

-good for sinusitis
-can be given oral or IV

what is the pregnancy category of moxifloxacin?

category C

what is the MOA of TMP/SMX (Bactrim)?

-inhibits steps in the folate synthesis pathway
-is becoming resistant to group A strep and strep pneumonia

what are the contraindications of TMP/SMX?

-may cause liver or renal damage
-don't use if have anemia caused by folic acid deficiency

what are SE of TMP/SMX?

-N/V/D
-pale skin
-easy bruising
-unusual bleeding
-difficulty with urination

what is the pregnancy category for TMP/SMX?

category C/D

what is the MOA of doxycycline?

inhibits bacterial protein synthesis

what are the SE of doxyclycline?

-itching/skin rash
-photosensitivity
-headache
-diarrhea

what pregnancy category is doxyclycline?

category D

why is doxycycline pregnancy category D?

can cause harm to unborn baby or cause permanent tooth discoloration later in life

what is chronic sinusitis?

-an inflammatory condition involving the paranasal sinuses and linings of nasal passages which persists for 12 weeks or longer
-often patients will have 2-4 episodes of sinusitis per year for two or more years
-many patients report that symtoms never completely resolve

what bacteria causes chronic sinusitis?

-pseudomonas and MRSA
-may have a fungal component

what are some complications seen with chronic sinusitis?

-CNS infections
-meningitis
-orbital cellulitis

what is the treatment for chronic sinusitis?

-decongestants
-saline washes
-oral and topical corticosteroids
-antibiotic treatment for 2-4 weeks
-referral to ENT

what is the goal of therapy for chronic sinusitis?

most cases cannot be cured so the gaol is to reduce symptoms and improve the patients quality of life

what is the prevention for chronic sinusitis?

-treat seasonal and perennial allergies
-obtain recommended immunizations
-practice proper dental management
-have nasal polyps and septal deviations surgically corrected