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13 - Drugs Related To ENT - 343 - 63
13 - Drugs Related To ENT - 343 - 63
Department of Pharmacology
Faculty of Medicine
Chiang Mai University
You should be able to
Describe the indications and adverse drug reactions of
the commonly used topical otic drugs
Describe the indications and adverse drug reactions of
vestibular suppressants dawnwomenas
Describe the indications and adverse drug reactions of
drugs used to increase inner ear hemodynamic
IntoningouGulu
Topical otic drugs
Wax softening drops
Antibiotic ear drops
quoin'omoneworou
Acidifying agents notion
epithelium 1/3
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or.oonamiossilaran
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inreguining
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wiabout
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momma
15
Judo dinnermislausoidoon
blini
ansystemicSte non
: P. aeruginosa or S. aureus
Ullevaal
1. Chloramphenicol
2. Quinolone: ofloxacin, levofloxacin
grin
yds awarp
3. Neomycin +/- polymyxin no7loooivin
Avi
steroid (
lidocaine (
www.medrx-education.com
Active agents Main spectrum Side effects
Polymyxin B and E Gram negative bacteria, Less/few
Enterobacter
Neomycin un
ausioninonworn
ni
oinn viaun
Gram positive and negative Contact dermatitis
bacteria (*Staphylococcus*) Inner ear toxicity
mm
Chloramphenicol t Gram positive and negative Inner ear toxicity (animal
bacteria study)
Anaerobe
Gentamicin Gram negative bacteria Inner ear toxicity
Lonahininian
no
Quinolone Gram positive and negative No inner ear toxicity
in
bacteria (*Pseudomonas*) birdman
doo
Nitrofurantoin t Gram positive and negative Contact dermatitis (often)
bacteria Inner ear toxicity
Num shoo N ar ri
9non woriolonnio
to o ti
Alkaline pH is a risk factor for otitis externa (OE) goral
Restoring natural acidity of EAC can inhibit the growth of
pathogenic
Treatment: mild OE with minimal otalgia (
Pains y mm
Side effects: pain to
and local irritation ( compliance)
riote.g., alcohol-vinegar solution, acetic acid in aluminum
wins
now
acetate drops, propylene glycol and acetic acid otic solution
Burow s solution
Aluminum acetate otic drops
Acidifying agents
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Treatment: uncomplicated otomycosis, mild bacterial OE
Steroids
I
immunocompromise hosts aprind
win bactandia
Side effects:
On Otomycosis
O
Inner ear toxicity mowulodririsalsinia
n
p
boring
are
A
un X
00
3% hydrogen peroxide in glycerin
mm
Ionia
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O
Innuluviuriouvon
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am
rioning innoon
won
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a minmoonand
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In lowjt
O :
avioI
unwraps
NIV
innMilosdidMasuru
A hallucination of self- or environmental movement
maps
Most common: feeling of spinning
uninaon a givin
Usually due to a disturbance of vestibular system
wrmiouluwimninv
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Cristina wowounint
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1. Vestibular suppressants
2. Antiemetics pt NNma looks and
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day nwavnriooomomo
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nm
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1. Drugs that reduce nystagmus (eye movements) caused
by a vestibular imbalance
ummm
2. Drugs that reduce motion sickness namrruewoominom
nvm
3
Anticholinergics
Antihistamines
Benzodiazepines
https://www.youtube.com/watch?v=yAe6r_-5Pfw
Afferent input to the Vomiting center
2
monrovia
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3 98818
4
e.g., scopolamine AA
Wurm
Agents with central anticholinergic effects
Increase motion tolerance indowlmatoinow
iii T
oshirioun.ptounsnap
n
Unlike antihistamines, pure anticholinergics are ineffective
if administered after symptoms have already appeared
marina
Side effects: dry mouth, dilated pupils, and sedation
Diphenidol SE:
inn
O O
Used for prevention and symptomatic treatment of
peripheral vertigo and associated nauseaw and vomiting
Mechanism: not fully elucidated (antagonist at M1, M2, M3
and M4 receptors)
9rioo air
D O
block H1 and M receptors at vestibular nuclei
x his sawvertigo Inhi
x
2nd
genAnti
Side effects
Block H1 receptors: sedation
Block M receptors: dry throat, constipation, dysuria,
blurred vision
81 Niern'or urns nor
Impaired vestibular compensation
to ptviavertigo
f or.uiwos
rainornominooniouido
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vertigo s
Gaba
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Ohno15007
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wittallucination
omen
Synaptic input impinging
in the vestibular nucleus
neurons E. Soto et al. Journal of Vestibular Research, 2013
AAdantaHz His winning
4 nite
redshistamined
Hz
Analog of histamine
Mechanism: antagonist on H3 receptors
0
gautoreceptor
winner
p IT
minemomma
wasInm
girl i nnw
Noimiun
Idiopathic endolymphatic hydrops
U
YAI
Symptoms: episodic vertigo 1hr1 in
(20 min to 24 h), fluctuating
sensorineural hearing loss, tinnitus, and aural fullness
Treatment: Teodorooinuirov
In acutely vertiginous patient
NM
Juhi
nishi Diazepam IV or IM
OO
5 2 Vestibulosuppressants and antiemetic drugs are prn used
1
During quiescent phase vido
omvoirn
Diuretic ?
vision
nawin tr
you
slalaninid
Vasodilators: betahistine bd
rfoaidbu.to
a t x
Avoiding trigger substances e.g., salt, chocolate, caffeine,
mm
tobacco, alcohol, stress
x x gindowlaineswordesrons
x
p's
lwieitigouuniununiugowuna c ompensate
user
Tinian'd
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