Therapeutic Agents for Eyes, Ears, Nose & Throat – Quick Review

Eye: Anatomy & Physiology

  • Protective/adnexa: eyebrows, eyelashes, orbit, conjunctiva, lacrimal gland
  • Fibrous/vascular layers: cornea, sclera, choroid coat, ciliary body, iris
  • Internal media: aqueous humor, vitreous humor/body, posterior cavity
  • Retina: rods\text{rods} (dim/ B&W), cones\text{cones} (color) → optic nerve → occipital lobe

Allergic Conjunctivitis

  • S/Sx: itchy, red, watery eyes (seasonal common)
  • Tx sequence: avoid irritant → mast-cell stabilizers (e.g., cromolyn) → antihistamines → decongestants; corticosteroids for severe inflammation

Ophthalmic Inflammation (Infection/Injury)

  • Corticosteroids (soln, susp, oint) ↓ inflammation; SE: transient burn, blur, pain, HA
  • NSAIDs inhibit COXCOX

Ophthalmic Infections

  • Conjunctivitis “pink eye”: viral, bacterial, fungal, allergy; highly contagious
    • Bacterial drugs: fluoroquinolones (ciprofloxacin), aminoglycosides (gentamicin), macrolides, sulfonamides, bacitracin
    • Viral: herpes simplex/keratitis → antivirals; SE: photophobia, sting
    • Fungal: natamycin

Glaucoma

  • Etiology: ↑ intra-ocular pressure (IOP)(IOP) via ↑ aqueous humor or blocked drainage
  • Untreated → blindness; types: primary, acute congestive, chronic simple
  • Drug classes: β-blockers, carbonic anhydrase inhibitors, cholinergic agonists (miotics), sympathomimetics, prostaglandin analogs

Misc. Ophthalmic Agents

  • Artificial tears: NaClNaCl, buffers, viscosity agents; relieve dry-eye/irritation

Drug-Induced Ophthalmic Disorders

  • Possible outcomes: dry eye, cataracts, retinopathy, optic neuropathy → require prevention/monitoring

Ear: Anatomy & Physiology

  • External: auricle, auditory canal, tympanic membrane, cerumen
  • Middle: ossicles, eustachian tube
  • Inner: labyrinth, cochlea, vestibule, semicircular canals + nerves

Common Ear Issues

  • Infection, cerumen, eardrum damage, congenital loss
Otitis Media
  • Middle-ear/eustachian infection
  • Drugs: cephalosporins, macrolides, penicillins
Cerumen Buildup
  • Tx: irrigation (saline + syringe); emulsifier carbamide peroxide (Debrox)
Drug-Induced Ototoxicity
  • Reversible/irreversible loss; culprits: aminoglycosides (gentamicin, tobramycin, amikacin), macrolides (clarithromycin, erythromycin), salicylates/NSAIDs, loop diuretics (furosemide, ethacrynic acid), platinum agents (cisplatin), quinine, quinidine, vancomycin
  • Sign: tinnitus

Nose & Sinuses: Anatomy

  • Nose/cavities, septum + cilia; pharynx; larynx
Allergic Rhinitis
  • S/Sx: itchy/runny nose, sneeze, congestion, postnasal drip
  • OTC: antihistamines, decongestants; Rx intranasal corticosteroids: triamcinolone (Nasacort), fluticasone (Flonase)
Bacterial Sinusitis
  • S/Sx: congestion, purulent discharge, cough, sinus pressure, HA, fever
  • Tx: antibiotics (amoxicillin, doxycycline, clarithromycin, azithromycin, TMP-SMX) ± analgesic, decongestant, antihistamine, mucolytic, intranasal steroid

Throat Disorders

Strep Throat / Tonsillitis
  • Streptococcal tonsillopharyngitis: abrupt sore throat, fever, tonsillar exudate
  • Tx: penicillin, ampicillin, amoxicillin, cephalosporins, macrolide azithromycin (Z-Pak)\text{azithromycin (Z-Pak)}, clindamycin + symptomatic relief (analgesics, lozenges, sprays)
Gastroesophageal Reflux Disease (GERD)
  • Cause: relaxation of upper gastric sphincter; RF: obesity, smoking, pregnancy
  • Meds: antacids, H2H_2 antagonists, proton-pump inhibitors (PPIs)