Transcript Bez nadpisu - Univerzita Karlova v Praze

Jiří Slíva, M.D.
Drugs acting on the ear:
Otitis externa
- inflammatory reaction of the meatal skin => cleansing,
dry mopping, suction
=>introducing of a ribbon gauze dressing soaked with corticosteroids
or with an adstringent aluminium acetate solution
=>presence of an infection - topical application of antiinfective
drugs - neomycin, quinolons - administration usually not longer
than 1 week because of a risk of fungal infection
- chloramphenicol
- aminoglycosides - contraindicated by eardrum perforation
- acetic acid 2% - antifungal and antibacterial effect in the
external ear canal
- systemic application- analgesics,
antibiotics - flucloxacillin- drug of choice, ciprofloxacin (Ps. aerug.)
=>eczema - topical corticosteroid creams, prolong. using prohibited
=>herpes zoster oticus - aciclovir
Drugs acting on the ear:
Otitis media
- the commonest cause of severe pain in small children
- mostly viral ethiology - coryza => analgesics - paracetamol
- bacterial ethiology => systemic antibacterial therapy + analgesics,
local therapy seems to be ineffective
=> in recurrent otitis - antibacterial prophylaxis trimethoprim or erythromycin - during the winter months
- “glue ear” x chronic otitis media (Pseudomonas aerug., Proteus spp.)=> cleansing with aural suction, local debridement of the meatal and
middle ear contents + topical treatment with ribbon gauze dressing
with antibiotics - ciprofloxacin, ofloxacin ear drops in patients with
perforated drum.Aminoglycosides and polymyxines (ototoxicity)
are not here strictly prohibited (the pus seems to be much worse than
these compounds)
Drugs acting on the ear:
Removal of ear wax
WAX - normal bodily secretion provides a protective film
-reasons of the removal -deafness
- interferention with a proper view
of the ear drum
- ways of the removal - syringing with water temperatured to body
temperature
- sodium bicarbonate ear drops
- olive oil
- almond oil
- docusate sodium
Drugs acting on the vestibular system:
Ménière's disease
Symptoms: - vertigo
- pressure - a feeling of „fullness“ in the ear
- hearing loss
- tinnitus
THERAPY
1 Self help techniques
 reduce the amount of salt in their diet
 avoid stress
 use a walking stick, shopping trolley or umbrella for balance
 avoid alcohol and caffeine
 avoid over exertion
 walk along the centre of the pavement or railway
platform, rather than close to the edge
Drugs acting on the vestibular system:
Ménière's disease
THERAPY
2 Pharmacological
anticholinergics - atropine, scopolamine
antihistamines - diphenhydramine, meclisine
Ca blockers – flunarizine, cinarizine
benzodiazepins - diazepam - very severe vertigo
vasodilatators
carbamazepine, Ginkgo, vitamine A, E, B
3 Surgical
Drugs acting on the nose:
Drugs used in nasal allergy
- mild cases - nasal corticosteroids, oral antihistamines, systemic
nasal decongestants, cromoglycate, topical antihistamines
(azelastine, levocabastine) - in seasonal rhinitis treatment should
begin 2-3 weeks before season commences and may have to be
continued for several months
- severe cases - systemic corticosteroids for short period
Sinusitis
Conservative treatment
•
Quietness
•
Antibiotics – drug of choice is amoxiciline and Biseptol [sulphamethoxazole and
trimetoprim], next broad-spectrum antibiotics - pnc (i.e. amox. + clavulanic acid),
cephalosporines /cefuroxim, cefixim/, clarithromycin, doxycycline. Average duration of
treatment: 10 days. Antimycotics - Aspergilus.
•
Support treatment: mucosal decongestion in area of ostiomeatal unit => alpha-1 mimetics
– naphazoline, oxymethazoline, xylomethazoline etc. in form of drops or indirect
sympathomimetics – ephedrine, pseudoephedrine. Topical use no longer than 7 days.
Fomentation with solux usually in stadium of healing.
Drugs acting on the nose:
Topical nasal decongestants
- the nose and nasal sinuses produce a litre of mucus in 24 hours;
much of this way silently into the stomach via nasopharynx
-sodium chloride 0.9% - relief the symptoms by liquefy of mucous
secretions
-corticosteroids - produce shrinkage of nasal polyps
-sympathomimetics - ephedrine (seems to be most safe), oxymetazoline,
xylometazoline, naphazoline (risk of rebound phenomenona) - all these drugs may
cause a hypertensive crisis if
used with a monoamine-oxidase inhibitor
-ipratropium bromide - non-allergic rhinorrhoea
- the use of compounds containing volatile substances (menthol,
eucalyptus) may encourage their use
Drugs acting on the nose:
Nasal infections
- probably 40% of the population have present coagulase-positive
staphylococci in the noses
- chlorhexidine, neomycin - cream, very often re-colonisation occurs
- mupirocin - resistant bacterial strains
Epistaxis
-bismuth iodoform paraffin paste - for packing cavities after surgery
Epistaxis
First medical aid
- sitting position
- head bent forward
- cold lining on nape and front
- blowint the nose
- nose compression
- anemising solutions on cotton, sponge…
- blood control examination – oral antihypertensives captoprile - tbl. 12.5 mg with rapid onset of action: up to
15-30 minutes
- sedatives or anxiolytics p.o. or i.m.
- antishock therapy /fluids, analgesics,…/ in order to support
basic vital functions