19 Ears, Nose, and Throat Drugs
Multimedia Directory Slide 6 Ear Animation Slide 32 Allergic Rhinitis Video Slide 41 Otitis Media Video Slide 70 Otic Drops Video Slide 71 Otic Medications Video
Learning Objectives Describe the therapeutic effect of decongestant drugs Describe the role that histamine plays in allergies Compare and contrast the therapeutic effect of antihistamine drugs and mast cell stabilizer drugs Describe the therapeutic effect of corticosteroid drugs
Learning Objectives Compare and contrast the therapeutic effects of antitussive drugs and expectorant drugs Compare and contrast the therapeutic effects of antibiotic drugs and antiyeast drugs
Learning Objectives Given the generic and trade name of an ENT drug, identify what drug category it belongs to or what disease it is used to treat Given an ENT drug category, identify several generic and trade name drugs in that category
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Decongestant Drugs Act as vasoconstrictors by stimulating alpha receptors in the smooth muscle around the blood vessels Reduce blood flow to edematous mucous membranes in the nose, sinuses and pharynx
Decongestant Drugs Decrease the swelling of mucous membranes Alleviate nasal stuffiness and sinus congestion Allow secretions to drain Help open up eustachian tubes to the ears Commonly prescribed for colds and allergies Can be administered topically as nose drops or nasal sprays or orally
Decongestant Drugs naphazoline (Privine) oxymetazoline (Afrin 12-hour, Duration) phenylephrine (Afrin, Sudafed PE) pseudophedrine (Dimetapp, Drixoral, Sudafed, Triaminic) tetrahydrozoline (Tyzine) xylometazoline (Otrivin)
Figure 19-1 Oxymetazoline. This over-the-counter generic decongestant drug oxymetazoline is also available under the trade names Afrin 12-Hour and Duration. The banner at the bottom left on this box points this out to consumers, advising them to “Compare to the active ingredient of Afrin . . .” Both generic and trade name drugs have the same active ingredient (oxymetazoline), but the generic drug costs less.
Historical Notes The drug phenylpropanolamine was included in many popular combination decongestant drugs in the past. Those combination decongestant drugs were withdrawn from the market by the FDA in 2000 when phenylpropanolamine was linked to deaths due to stroke. This change required the reformulization of many combination decongestant drugs.
Historical Notes Phenylpropanolamine was also found in many over-the-counter weight loss aids, which were also withdrawn.
Anithistamine Drugs Exert their therapeutic effect by blocking histamine (H1) receptors in the nose and throat
Anithistamine Drugs Histamine released from mast cells in the tissues when an antibody-antigen complex is created during an allergic reaction causes vasodilation in which the blood vessels and mucous membranes become swollen and red irritates the tissue directly, causing pain and itching
Anithistamine Drugs Block the action of histamine at H1 receptors to dry up secretions Shrink edematous mucous membranes Decrease itching and redness Side effects older antihistamines causes drowsiness newer antihistamine, do not cause drowsiness because of a different chemical structure
Antihistamine Drugs azelastine (Astelin) brompheniramine (Lodrane) carbinoxamine (Histex, Pediatex) cetirizine (Zyrtec) chlorpheniramine (Chlor-Trimeton, Efidac) clemastine (Tavist Allergy) desloratadine (Clarinex) cyproheptadine
Antihistamine Drugs dexchlorpheniramine diphenhydramine (Benadryl) fexofenadine (Allegra) levocetirizine (Xyzal) loratadine (Claritan, Tavist) olopatidine (Patanase) phenindamine (Nolahist) promethazine (Phenergan) triprolidine (Zymine)
In Depth First-generation antihistamine drugs, such as diphenhydramine (Benadryl), are nonselective in that they bind to both central histamine (H1) receptors in the brain as well as peripheral H1 receptors in body tissues. This drug action in the brain results in drowsiness and impaired performance while driving or operating machinery.
In Depth Second-generation antihistamine drugs, such as cetirizine (Zyrtec) and loratadine (Claritan), only bind to peripheral H1 receptors in the body tissues; this blocks the action of histamine and relieves the symptoms of redness, inflammation, and itching associated with allergies – without producing drowsiness.
In Depth Hydroxyzine (Vistaril) is also a first-generation antihistamine. However, it is not used to treat allergies. Instead,its typical side effect of drowsiness and dry mouth are used as therapeutic effects when Vistaril is given as a preoperative medication to calm the patient and decrease oral secretions prior to intubation during surgery.
Did You Know? Antihistamines are not effective in treating bacteria or viruses that cause the common cold. Although symptoms of allergies and colds are similar, no release of histamine occurs with the common cold. Nevertheless, drug companies combine antihistamine drugs and decongestant drugs in over-the-counter cold remedies because antihistamine drugs have a drying effect on the mucous membranes that is helpful during a cold.
Figure 19-2 Azelastine (Astelin). This prescription antihistamine drug is administered as a nasal spray. It is used to treat allergic rhinitis, which is characterized by an itchy, runny, stuffy nose.
Figure 19-3 Loratadine (Claritin). This over-the-counter antihistamine drug is used to treat allergy symptoms in the eyes and nose. It is one of the newer antihistamine drugs and does not cause drowsiness. It is advertised in television commercials as helping patients be “Claritin clear,” that is, free of the fogginess or drowsiness associated with older antihistamine drugs. The box also reflects this advertising concept by showing a clear sky with just a single cloud. A RediTab is a thin, flat tablet that dissolves quickly in the mouth.
Drug Alert! Do not confuse the sound-alike generic name antihistamine drugs desloratadine and loratadine. You cannot always associate a particular generic drug with a particular trade name.
Drug Alert! Tavist Allergy contains the generic antihistamine drug clemastine, while Tavist ND (nondrowsy) contains the generic antihistamine drug loratadine. Tavist Allergy/Sinus Headache is a combination drug that contains the antihistamine clemastine plus a decongestant drug and an analgesic drug. Tavist Sinus Maximum Strength is a combination drug that contains a decongestant drug, analgesic drug, but no antihistamine drug.
Historical Notes Terfenadine (Seldane) was introduced in 1985 as the first nonsedating antihistamine drug. This was considered a major breakthrough, as the previous antihistamine drugs had the undesirable side effect of causing moderate-to-severe sleepiness. Another nonsedating antihistamine drug astemizole (Hismanal) was also introduced at that time.
Historical Notes However, both drugs were taken off the market in 1997 after they were found to cause fatal heart arrhythmias in patients who were also taking erythromycin (an antibiotic drug) or ketoconazole (an antifungal drug) or had liver disease.
Historical Notes According to the January/February 2002 issue of the Food and Drug Administration’s FDA Consumer magazine, the FDA knew of these deaths, but allowed the drug to continue to be sold until fexofenadine (Allegra), another nonsedating antihistamine drug, became available in 1997. Allegra’s chemical structure is just a slightly modified version of the chemical structure of Seldane.
Mast Cell Stabilizer Drugs Stabilize the cell membranes of mast cells in the tissues of the nose Prevent them from releasing histamine during the immune response to an antigen Prevents edema of the nasal mucous membranes and sneezing in patients with allergic rhinitis cromolyn (Nasalcrom)
Corticosteroid Drugs Act by inhibiting the body’s immune system Decrease inflammation and edema of the mucous membranes Have no decongestant or antihistamine effect Are not used to treat the common cold
Corticosteroid Drugs These corticosteroid drugs are administered intranasally to treat allergic and nonallergic rhinitis beclomethasone (Beconase) budesonide (Rhinocort) ciclesonide (Omnaris) flunisolide (Nasalide) fluticasone (Flonase, Veramyst) mometasone (Nasonex) triamcinolone (Nasacort)
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Drug Alert! These trade name drugs all sound similar to each other, but are not related Nasacort (corticosteroid drug triamcinolone) Nasalcrom (mast cell stabilizer drug cromolyn) Nasalide (corticosteroid drug flunisolide) Nasonex (corticosteroid drug mometasone)
Figure 19-4 Drug label for budesonide (Rhinocort). Budesonide is a prescription corticosteroid drug that is sprayed into the nose to treat allergy symptoms. The trade name Rhinocort is derived from rhin/o- and -cort. Rhin/o- is a combining form that means nose. Memory tip: It is a rhinoceros that has the large horn on its nose. The suffix -cort is an abbreviation for corticosteroid. Courtesy of AstraZeneca Pharmaceuticals LP.
Figure 19-5 Mometasone (Nasonex). Mometasone (Nasonex) is a corticosteroid drug that is given intranasally to treat allergy symptoms in the nose. All corticosteroid drugs suppress the immune system as they decrease inflammation. However, the nose is an important site where air coming into the lungs is filtered and white blood cells from the immune system normally attack and kill bacteria and viruses. Therefore, a common side effect of intranasal corticosteroid drugs is the development of nasal infections or colds from the suppression of the immune system’s activity in the nose.
Corticosteroid Drugs for the Mouth triamcinolone (Kenalog in Orabase) corticosteroid drug applied topically as a paste used to treat mouth ulcers inflammation
Corticosteroid Drugs for the Ears dexamethasone corticosteroid drug applied topically as a solution in the external ear canal used to decrease inflammation associated with allergies or infections
Antibiotic Drugs Prescribed for colds caused by bacterial infections, particularly streptococci that causes strep throat
Antibiotic Drugs Common cold not effective in because it is usually caused by a virus although they may be prescribed to prevent subsequent superimposed bacterial infections from developing, this practice is not recommended
Antibiotic Drugs oxfloxacin (Floxin Otic) applied topically as a solution to the external ear canal to treat bacterial infections swimmer’s ear external otitis infections of the tympanic membrane (otitis media)
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Did You Know? Most people contract two or more colds per year. There are over 120 different viruses, and most colds are caused by viruses. The common cold is considered the single most expensive illness in the United States in terms of time lost from work and school. No drug is currently available to treat viral common colds; available drugs merely provide temporary relief of various symptoms until the cold has run its course.
Antibiotic Drugs Sulfonamide drugs are a type of anti-infective drug that inhibits the growth of bacteria These drugs are given orally to treat an infected tympanic membrane (otitis media) in the ear sulfadiazine sulfisoxazole (Gantrisin Pediatric)
Antiyeast Drugs Yeasts one-celled organisms that are closely related to fungi grow easily in the warm, moist, dark environments of the mouth especially true in patients whose immune systems are compromised by disease Candida albicans yeast infections of the mouth are also known as oral candidiasis(thrush) or monilia
Antiyeast Drugs Topical antiyeast drugs used to treat a yeast infection in the mouth (oral candidiasis) clotrimazole (Mycelex) nystatin (Mycostatin, Nilstat)
Figure 19-6 Drug label for nystatin (Mycostatin). Nystatin (Mycostatin) is an antiyeast drug used to treat yeast infections in the mouth. This drug comes in the drug form of an oral suspension. Note the instructions on the label to “Shake well before using.” A suspension contains fine, undissolved particles of a drug suspended in a water base. It is important to shake a suspension before measuring the dose so that the drug particles are evenly suspended throughout, rather than settled at the bottom. Bristol-Myers Squibb Company.
Drug Alert! Topical antiyeast drugs used to treat oral candidiasis (thrush) are administered in several unique ways. (1) An infect with oral candidiasis is given an oral suspension of the drug. The entire dose is placed in an unattached nipple, and the infant sucks on the nipple until the dose is gone.
Drug Alert! The drug is not mixed with milk or formula in a bottle because the infant may not drink the entire bottle and would not get the full dose of medicine. Also, the drug should not be diluted with milk or formula because it needs to adhere to the mucous membranes of the oral cavity in order to be effective.
Drug Alert! (2) An adult with oral candidiasis is told to “swish and swallow” the oral suspension. The swishing action helps to coat all areas of the oral cavity, and swallowing ensures that the medication coats the pharynx and esophagus, which can also be infected.
Drug Alert! (3) Alternatively, an adult can suck on a troche that contains the antiyeast drug. A troche is an oblong tablet that dissolves in the mouth like a lozenge. Pastille is another name for a troche. Pastille is a French word that means little lump of bread.