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D&M 1- Med and Dosages Exam 1 With Complete Solution
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D&M 1- Med and Dosages Exam 1 With Complete Solution...
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D&M 1- Med and Dosages Exam 1 With Complete Solutioncerumen impaction
-debrox, mineral oil, olive oil
*2-3 drops in the ear every day for 1 week
-loosen cerumen before lavage and curettage
-do NOT use debrox if TM perforation
cholesteatoma
Ofloxacin - coverage is the same as with otitis media
*IF TM IS NOT INTACT
-no aminoglycosides
-otoxic agents
otoxic agent ex
aminoglycoside antibiotics (gentamicin), cisplatin, carboplatin, aspirin, quinine, loop
diuretics
vestibular neuritis
-anticholinergics
-antihistamines
-benzos
-antiemetics
*careful with sedation and drowsiness in eldery
Vestibular neuritis drug examples
Antihistamine (1st gen)
-diphenhydramine 25-50 mg q 4-6 hr (max dose 300mg)
Benzo
,-alprazolam (xanax), clonazepam (klonopin), diazepam (valium), lorazepam (ativan)
Ondansetron, promethazine
tinnitus
-no medication cures tinnitus
-vasodilators, tranquilizers, antidepressants, seizure meds can reduce s/s
-placebos
mild OE with intact TM
-combo topical preparation
*acetic acid-hydrocortison (Acetasol/HC/VoSol/Vosol HC)
5 drops 3-4x daily for 7 days
Acetic acid stops bacteria growth, steroid decrease inflammation
-Domeboro (acetic acid/aluminum acetate)
*discourages Pseudomonas
VoSol and VoSol-HC contraindications
-perforated eardrum
-VolSo-HC is contraindicated with viral otic infections
moderate OE with/without intact TM
Topical acidic ABX/glucocort combo
*FIRST LINE: Ciprofloxacin-hydrocortisone (Cipro-HC) and neomycin-polymyxin
b-hydrocortisone for 7 days
*3-4x daily for 7 days
, *can be extended for additional 7 days if improving but not resolved
*ENT refer if no improve/worsening after 7 days
*neomycin aminoglycoside abx- not for tm perf
If concerned about integrity of TM
do NOT use
*neomycin-polymyxin B-hydrocortisone
*preparations containing aminoglycosides
*acidifying agents
**should be avoided due to potential ototoxicity
S Suspensions are indicated instead of the solution if the integrity of the tympanic
membrane is in question.
Suspension vs solution
mild/moderate OE w nonintact TM and able to tolerate fluroquinolones
-topical fluroquin for 7 days
*cipro-dexameth
*ciprofloxacin - 0.25 ml twice daily
*ofloxacin - 10 drops once dailu
wicking
When the patient's ear canal is sufficiently occluded by edema or discharge, which
prohibits passage of otic drops, gently insert a cotton ear wick (approximately 1 inch for
adults) to enable passage of dropscan spontaneously extrude once edema
resolvessevere OE and intact TMtopical, systemic ABX, wick placement, cx of ear*FIRST
LINE: Cipro-HC and neomycin-polymyxin Bhydrocortisone3-4x daily for 7 dayssevere OE
and cellulitisuse topical and systemiORAL:
*fluoroquinolones (levofloxacin 500mg qd for 7 days)
*antistaphylococcal beta-lactam such as cefuroxime 500 mg BID
*Augmentin 875 mg BID for seven days for methicillin-susceptible to S. aureus
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