-
Allergic Rhinitis
Description: Inflammation of mucous membranes in nose.
Etiology:IgE mediated response to substance. rupture of mast cells, release of histamines, leukotrienes, and prostaglandins. Sources include pollen, grass, trees, weeds, mold, animal dander, dust mites, and smoke.
s/s: dark discolored under eye lids. conjunctival injection. pale, boggy turbines. clear secretions. ST. enlarged tonsils. palpable lymph nodes.
Meds:
saline nasal spray
antihistamines
nasal steroids
leukotriene modifier if asthma present
decongestants
-
Sinusitis
General: inflammation of paranasal sinuses due to bacterial, viral, or fungal infection or allergic reaction.
Etiology:
Bacterial: strep, h. influenza, staph
Viral: rhinovirus, coronavirus, influenza, parainfluenza, RSV
S/S:
fever
nasal congestion
HA
ST
PND
Sinus pressure/pain
cough
halitosis
periorbital edema
nonpharm:
saline irrigation
humidified air
increase fluid intake
Pharm:
abx after 10 days of s/s
5-7 days of treatment is as effective as 10-14 days
oral decongestants better than topical
analgesics oft HA
antipyretics for fever
topical nasal steroids will help symptoms
abx:
1. amoxicillin
2. Augmentin
3. Doxycycline
4. Omnicef
5. Clindamycin
6. Azithromycin
7. Levaquin
8. Avelox
-
Pharyngitis
General:
acute inflammation of the pharyngitis/tonsils.
Etiology:
Viral: rhinovirus, adenovirus, parainfluenza, epstein barr virus
Bacterial: group A beta hemolytic strep, H. influenza, M. pneumonia, N. gonorrhoeae
S/S:
ST and pharyngeal edema
tonsillar exudate
enlarged tonsils
malaise
Strep:
cervical adenopathy
fever
no resp findings
petechiae on soft palate
beefy red tonsils
sandpaper rash
abd pain, HA
distinct breath odor
Viral:
conjunctivitis
nasal congestion
hoarseness
cough
diarrhea
viral rash
Nonpharm:
change toothbrush
increase fluids
pharm:
tylenol
motrin
abx:
1. pcn vk
A: 500mg po bid x 10 days
P: 250 mg po bid-tid x 10 days
2. pcn G benzathine
A: 1.2 mil units IM x 1 dose
P: <27kg: 0.6 mil. units IM x 1
P: >= 27kg: 1.2 mil u IM x 1 dose
3. Amoxil
A: 875mg po bid x 10 d
P: >40kg dose as adult
P: 50mg/kg daily x 10 days
-
Infectious Mononucleosis
General:
Viral illness characterized by malaise and fatigue
Etiology: Epstein-Barr virus (EBV) of the herpes family of viruses
10% of pts are co-infected with strep.
Incubation period is 4-8 weeks.
Spread by contact with oral secretions
S/S:
malaise and fatigue
*Tetrad- Fatigue, Fever, Pharyngitis, Lymphadenopathy*
splenomegaly
headache
tonsillitis
hepatomegaly
palatal petechiae
abdominal pain
nausea
Diagnostic Studies:
-CBC shows lymphocytosis
-monospot positive by 2nd or 3rd week of illness
-EBV titers can be collected for unusual presentation
-liver enzymes often elevated
-US to diagnose and follow enlarged spleen
Nonpharm:
Rest
No vigorous exercise for 2 mo or until spleen is normal
avoid stress
eat well
drink well
Meds:
Tylenol unless LFT elevated
avoid ASA due to Reye's syndrome
Avoid amoxicillin due to increased reaction
Other:
Acute phase lasts about 2 weeks
monospot will always remain positive
students may return to school when afebrile
-
Influenza (Flu)
General:
highly contagious acute viral illness of the respiratory tract. Mostly occurs october-april.
Etiology:
Influenza virus type A and B
H1N1 Swine flu is a variant of influenza A
S/S:
High fever
sudden onset
cough
rhinorrhea
pharyngitis
headache
malaise
myalgia
cervical lymphadenopathy
GI in kids
irritated mm
Diagnostic Studies:
Nasal swab
CBC
CXR if pneumonia suspected
Immunize 6mo and older yearly
careful with egg allergy and flu shot
Antiviral meds:
initiate within 2 days of symptoms
monitor for neuro symptoms
may cause n/v
avoid live vaccine with tamiflu
1. Zanamivir (Relenza)
A: 10mg bid x 5 days. take 2 doses on the first day separated by 2 hrs.
prophylaxis: 10mg daily x 10 days
Avoid in pts with underlying airway dz.
2. Oseltamivir (tamiflu)
A: 75mg bid x 5 days
prophylaxis: 75mg qd x 10 days.
Other:
pt. should follow up if s/s longer than 10 days or if no improvement over 3-5 days.
-
Otitis Externa (Swimmer's Ear)
General:
An infection of the external auditory canal producing much inflammation, itching, and/or pain.
Etiology:
Excessive moisture precipitates otitis externa: removes cerumen and increases pH of external auditory canal and increase bacterial and fungal growth.
Bacterial: pseudomonas, staphylococcus, streptocuccus
Fungal: Aspergillus, candida albicans
S/S:
otalgia
Edema and redness in external canal
itching
purulent discharge
tarsal and/or pinna pain
normal tympanic membrane
Medications:
2% acetic acid drops after swimming for prevention
Antibacterial with and without steroid such as cipro HC otic or ciprodex otic or cortisporin or florin otic. See medication - ear drops card.
Should improve with in 24-48 hours.
-
Otitis Media
General:
Acute otitis media (AOM) is the rapid onset of s/s of inflammation in the middle ear.
Otitis media with effusion (OME) is fluid accumulation in middle ear without evidence of infection, also called middle ear effusion (MME)
Etiology:
Viruses
Streptococcus pneumoniae
H. influenza
M. catarrhalis
Group A beta hemolytic streptococcus
S. aureus
S/S:
otalgia
irritability
erythema of TM
decreased TM mobility
distorted landmarks
displaced light reflex
cloudy, dull, opaque TM
bulging TM
Fever
N
V
decreased hearing
dizziness
Nonpharm Tx:
warm compress
swallowing
Medications:
oral analgesics
-tylenol
-motrin
-narcotic with codeine
Abx for AOM:
I. Penicillin
1. amoxicillin (amoxil)
A: 875mg q 12 hr x 7 days or 1000mg q 12 hr x 7 days.
P (2mo-12): 80-90mg/kg/day in bid dosing. max dose not to exceed adult dose.
<2mo: 30mg/kg/day in bid dosing.
Amoxicillin is not stable in the presence of beta lactamase producing organisms.
Considered first line agent in otitis media unless patient has had antibiotic exposure in the last 90 days.
2. amox/clavulanate (augmentin)
A: 875mg po bid x 10
P(2mo-5yr): 90mg/kg/day bid dosing x 10 days
P(6-12yr):90mg/kg/day bid dosing x 5-10days
First line in AOM with severe illness or recent abx use.
Two 500mg augmentin tablets are not equal to a 1000mg tablet.
Give with food. II. Second generation cephalosporin
1. Cefuroxime (ceftin)
A: 250-500mg po bid
P: 30mg/kg/day bid x 10 days
Do not use in pts with hives with pcn
III. Third generation cephalosporin
1. Cefpodoxime
A: 200-400mg bid x 7-10 days
P: 2mo-5yr. 10mg/kg/day bid dosing x 10 d. 6-12yr: 10mg/kg/day bid dosing x 5-10d. max 400mg/dose.
Again, avoid use in hive pcn allergy.
2. Cefdinir (omnicef)
A: 300mg po bid x 10d.
P: 6mo-5yr. 14mg/kg q12-24hr x 10d.
6-12yr: 14mg/kg q 12 hr x 5-10d OR q24 hr x 10d. Max 300mg/dose or 600mg/day
Avoid antacids within 2 hrs due to absorption interference.
Stools may appear red.
3. ceftriaxone (rocephin)
P: 50mg/kg/day IM or IV x 3 days
Max not to exceed 1000mg/dose
Again, No if true PCN allergy. hives or anaphylaxis.
IV. Extended Spectrum Macrolides
1. azithromycin (zithromax)
A: 500mg daily x 3 days
P: 6 mo: 30mg/kg as single dose. Max 1.5 gms.
OR 10mg/kg daily x 3 days. Max 500mg daily.
OR 10mg/kg on day one, followed by 5mg/kg day 2-5. Max day 1 = 500mg. Max day 2-5 = 250mg.
Considered first line for PCN allergy, but lots of resistance.
2. clarithromycin (biaxin)
A: 500mg po bid x 7 days
P: 2mo-5yr: 15mg/kg/day bid dosing x 10days.
6-12: 15mg/kg/day in bid dosing x 5-10 days. Max: 500mg/dose.
Some medication interactions.
Take with food.
V. Lincosamide
1. Clindamycin (cleocin)
A: 150mg-300mg q 6 hr x 5-10d.
More serious infection: 300-450mg q 6 hr x 5-10days.
P: 2mo-5yr: 30-40mg/kg/day 3 divided doses x 10 days + 3rd generation cephalosporin
6-12: 30-40mg/kg/day in 3 divided doses x 5-10 days + 3rd generation cephalosporin. Not to exceed adult dose.
Save for worse infections.
S/E pseudomembranous colitis, C. Diff.
Take with full glass of water.
Other Drugs:
ear gtts with or without steroid.
tylenol
ibuprofen
Other:
Refer to ENT for 3 occurrences in 6 months.
-
Vertigo
General:
sensation or impression that an individual is moving, or that objects around him are moving, when actually no movement is occurring.
Etiology:
peripheral: otogenic, menieres, myringitis, infection, otitis media, acute labyrinthitis, BPPV
Central: migraine, TIA, postural hypotension
Neuro: MS, seizures, cervial disc, syphilis, demyelination, acoustic tumors, brainstem or cerebellar lesions
S/S:
asymptomatic otherwise
nystagmus
tinnitus
hearing loss
carotid bruit
HA
diplopia
slurred speech
hypotension
Pharm:
1. dramamine
2. meclizine
3. phenergan
4. compazine
|
|
