Dr. Yasser A. Nour M.D, FRCSEd Dr. Yasser A. Nour M.D, FRCSEd Fellow of the Royal College of Surgeons of Edinburgh.Fellow of the Royal College of Surgeons of Edinburgh.
Lecturer of Otolaryngology – Head & Neck Surgery.Lecturer of Otolaryngology – Head & Neck Surgery.
PHARMACOTHERAPY FOR PHARMACOTHERAPY FOR DISEASES OF THE NOSEDISEASES OF THE NOSE
Common ColdCommon Cold
Rhinovirus Coronavirus
The commenst viral infection in human
Mode of TransmissionMode of Transmission
Clinical PictureClinical Picture
Clinical picture:• Fever, headache,malaise.• Dryness of nose.• Sore throat.• Sneezing.• Nasal obstruction.• Watery rhinorrhea.• Mucopurulent Rhinorrhea.• Resolution within 5-10 days.
Complications:• Sinusitis.• Pharyngitis.• Adenoiditis. • Tonsillitis.• Otitis media.• Laryngotrachitis.• Bronchitis.• Pneumonia.• Nephritis.• Rheumatic fever.
Treatment: Bed rest. Vitamins. Fluids. Analgesic. Antipyretics. Antihistaminics. Anticholenergic. Decongestant. Antibiotics.
InfluenzaInfluenza
One of the most common infectious diseases in human.
It is caused by influenza virus that is classified as type A, B & C.
InfluenzaInfluenza
It may occur in epidemics.
Spanish flu epidemic 1918 killed 20 millions all over the world.
• People were struck with illness on the street and died People were struck with illness on the street and died rapid deaths. Four women were playing bridge together rapid deaths. Four women were playing bridge together late into the night. Overnight, three of the women died late into the night. Overnight, three of the women died from influenza. from influenza.
• One physician writes that patients with seemingly One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate,“.simply a struggle for air until they suffocate,“.
Spanish Flu Epidemic Spanish Flu Epidemic
InfluenzaInfluenza
Two types of influenza virus.
Human influenzaAvian influenza
InfluenzaInfluenza
Two types of influenza virus.
Human influenza A person infected with a particular flu virus strain develops antibody against that virus.
As newer virus strains appear through antigenic shift and drift , the antibodies against the older strains no longer recognize the "newer" virus, and infection with a new strain can occur.
FeaturesFeatures InfluenzaInfluenza Common coldCommon cold
OnsetOnset AbruptAbrupt More gradualMore gradual
FeverFever Common up to 40.0°C Common up to 40.0°C Uncommon only 0.5°C Uncommon only 0.5°C
MyalgiaMyalgia Severe, common Severe, common Uncommon Uncommon
ArthralgiaArthralgia Severe, common Severe, common Uncommon Uncommon
AnorexiaAnorexia Common Common Uncommon Uncommon
Headache Headache Severe, common Severe, common Severe, common Severe, common
Cough (dry) Cough (dry) Common, severe Common, severe Mild to moderate Mild to moderate
Malaise Malaise Severe Severe MildMild
Fatigue, weakness Fatigue, weakness More common More common Very mild, short lasting Very mild, short lasting
Chest discomfort Chest discomfort Common, severe Common, severe Mild to moderate Mild to moderate
Stuffy nose Stuffy nose OccasionalOccasional Common Common
Sneezing Sneezing OccasionalOccasional Common Common
Sore throat Sore throat OccasionalOccasional Common Common
CommonCommon UncommonUncommon
Pneumonia Pneumonia
Otitis media Otitis media
Tracheobronchitis Tracheobronchitis
Acute sinusitisAcute sinusitis
Reye's syndrome Reye's syndrome Pericarditis Pericarditis
Myositis Myositis
Myoglobinuria Encephalitis Myoglobinuria Encephalitis
Transverse myelitis Transverse myelitis
Guillain-Barré syndrome Guillain-Barré syndrome
RhabdomyolysisRhabdomyolysis
ComplicationsComplications
• Healthy children six to 23 months of age.
• Adults 65 years and older.
• Persons six months to 64 years with cardiopulmonary, respiratory, renal, metabolic, or immunodeficient conditions.
• Pregnant women
• Children aged 6–23 months. Children aged 6–23 months. • Adults aged ≥50 years. Adults aged ≥50 years. • Persons aged 2–64 years with underlying Persons aged 2–64 years with underlying
chronic medical conditions. chronic medical conditions. • Women who will be pregnant during the Women who will be pregnant during the
influenza season. influenza season. • Residents of nursing homes and long-term Residents of nursing homes and long-term
care facilities. care facilities. • Children aged 2–18 years on chronic Children aged 2–18 years on chronic
aspirin therapy. aspirin therapy. • Health-care workers involved in direct Health-care workers involved in direct
patient care; and patient care; and • Out-of-home caregivers and household Out-of-home caregivers and household
contacts of children aged <6 months. contacts of children aged <6 months.
VaccinationVaccination
Allergic RhinitisAllergic Rhinitis
Dr. Yasser A. Nour, M.D., Dr. Yasser A. Nour, M.D., FRCSEdFRCSEd
Lecturer of Otolaryngology – Head & Neck Surgery. Lecturer of Otolaryngology – Head & Neck Surgery. Alexandria UniversityAlexandria University
Fellow of the Royal College of Surgeons of EdinburghFellow of the Royal College of Surgeons of Edinburgh
Allergic rhinitis is an IgE mediated hypersensitivity of nasal mucous membrane characterized by sneezing, itching, watery
rhinorrhea and a sensation of nasal obstruction. It may also involve the lining of paranasal sinuses.
Allergic rhinitis occurs in atopic individuals who
are exposed to common aeroallergens
Allergens:
• Seasonal rhinitis
• Perennial allergic rhinitis
• Occupational allergens
• Food and drug induced rhinitis
• Role of pollution
Grass Pollen
Allergens:
• Seasonal rhinitis
• Perennial allergic rhinitis
• Occupational allergens
• Food and drug induced rhinitis
• Role of pollution
House dust mites
Allergens:
• Seasonal rhinitis
• Perennial allergic rhinitis
• Occupational allergens
• Food and drug induced rhinitis
• Role of pollution
Domestic animals
Allergens:
• Seasonal rhinitis
• Perennial allergic rhinitis
• Occupational allergens
• Food and drug induced rhinitis
• Role of pollution
Allergens:
• Seasonal rhinitis
• Perennial allergic rhinitis
• Occupational allergens
• Food and drug induced rhinitis
• Role of pollution
Allergens:
• Seasonal rhinitis
• Perennial allergic rhinitis
• Occupational allergens
• Food and drug induced rhinitis
• Role of pollution
Pathogenesis
Pathogenesis
Early, or immediate, phase of the reaction
Pathogenesis
Late-phase response
Vasodilatation. Increase vascular permeability. Increase plasma exudation. Chemoattractants for eosinophils and neutrophils. Potent mucus secretogogue. Histamine also increases the release of acetylcholine. This may account more for increased mucus production in allergic rhinitis than do mast cell-derived mediators.
The biological properties of these mediators include:
Clinical PictureClinical PictureSeasonal Seasonal
allergic rhinitisallergic rhinitisPerennial Perennial
allergic rhinitisallergic rhinitis
• Sneezing & Sneezing & ItchingItching• RhinorrheaRhinorrhea
• Loss of taste Loss of taste and smelland smell• Associated Associated sinusitis sinusitis and and Eustachian Eustachian DysfunctionDysfunction
++++++++
WateryWatery
++
++
++
Mucoid + PNDMucoid + PND
++++++
++++++
Positive personal and family history of other atopic diseasesPositive personal and family history of other atopic diseases
External signs
• Allergic salute.
• Mouth breathing.
• Allergic shiners.
Allergen Avoidance
Mites control
Mattress covers
Allergen Avoidance
Mites control
Mattress covers
Air conditioner
Dehumidifier
Allergen Avoidance
Mites control
Mattress covers
Dust & Pollen mask
Food avoidance
Pets control
Antihistamines
First generationFirst generation Second generationSecond generation
Diphenhydramine
Brompheniramine
Hydroxyzine
Fexofenadine
Cetirizine
Loratadine
Side effectsSide effects
Central nervous system Gastrointestinal Gastrointestinal Anticholinergic Anticholinergic effectseffects
Drowsiness
Cognitive impairment
Impaired reflexes
Constipation
GI upsetGI upset
Blurred visionBlurred vision
Dry mouthDry mouth
Urinary retentionUrinary retention
Intra-Nasal Antihistamine (Azelastine nasal spray)
DrivingUsing machines
GlaucomaProstatic hypertrophy
Decongestants
IntranasalIntranasal SystemicSystemic
Oxymetazoline Pseudoephedrine
Side effectsSide effects
LocalLocal SystemicSystemic
Burning
Sneezing
Increased discharge
Rebound congestion
Tachycardia Palpitations
Nervousness Headache
Urine retention
DrowsinessInsomniaDizzinessWeakness
Acute glucoma
Care should be taken in those with:Heart diseaseHypertension
GlaucomaProstatic hypertrophy
Diabetes mellitus
Steroids
IntranasalIntranasal SystemicSystemicFluticasone
Beclomethasone
Budesonide
Prednisone (oral)Prednisone (oral)
Trimacinolone (injection)Trimacinolone (injection)
Side effectsSide effects
LocalLocal SystemicSystemicEpistaxis
Burning sensation
Crusting, dryness
Pharyngitis
Septal perforation
Upset stomach Skin rash Swollen faceMuscle weakness Increased appetite
Bone and muscle problems Growth problems in children Increased sugar in the blood
Others
Intra-Nasal Mast Cell Stabilizers
Cromolyn sodium
Intra-Nasal Anticholinergic
Ipratropium bromide
Epistaxis
Nasal irritation: burning, sneezing
IMMUNOTHERAPYIMMUNOTHERAPY
Others
SINGULAIR is indicated for relief of symptoms of allergic rhinitis (seasonal allergic rhinitis in adults and children aged 2 years and older and perennial allergic rhinitis in adults and children aged 6
months and older).
SinusitisSinusitisSinusitis is the
inflammation/infection of 1 or more paranasal sinuses
and occurs with obstruction of the normal drainage
mechanism. It is traditionally subdivided into acute (symptoms lasting <3 wk), subacute (symptoms lasting 3 wk to 3 mo), and
chronic (symptoms lasting > 3 mo).
Several factors may contribute to obstruction: mucosal
swelling, abnormalities of the cilia, structural abnormalities
and overproduction of secretions. Preceding viral
infection or epithelial damage weakens mucosal defenses and
facilitates penetration of bacteria into the sinus mucosa. Although nasal allergies also
contribute to edema and swelling of the nasal mucosa.
A diagnosis of ABS can be made when a viral upper respiratory tract infection
(URI) fails to improve after 10 days or worsens after 5–7 days
and is accompanied by symptoms of persistent anterior and posterior
rhinorrhea, nasal congestion, facial pressure/pain, post-nasal
drainage, reduced sense of smell, fever, cough, fatigue, dental pain in the jaw, or ear
pressure/fullness.
Symptoms associated with acute bacterial rhinosinusitis
Key diagnostic symptomsNonspecific/infrequent
symptoms
Purulent anterior nasal or postnasal discharge
Malaise/fatigue
Unilateral maxillary sinus tenderness
Halitosis
Maxillary tooth or facial pain (especially when unilateral)
Nasal congestion
“Double-sickening” history† Hyposmia/anosmia
Fever
Cough
The most common bacterial pathogens in acute sinusitis are Streptococcus pneumoniae (30-40%),
Haemophilus influenzae (20-30%) Moraxella catarrhalis (12-20%).
Anaerobic organisms have been found in fewer than 10% of patients with acute bacterial
sinusitis, despite the ample environment available for
their growth.
First-line therapy at most centers is usually amoxicillin or a macrolide antibiotic in patients allergic to penicillin because of the low cost, ease of administration, and low toxicity of
these agents.
Antibiotic Dosage
Amoxicillin 500 mg PO tid
Clarithromycin 250-500 mg PO bid
Azithromycin500 mg PO first day, then
250 mg/d PO for 4 days
Patients who live in communities with a high incidence of resistant organisms, those who fail to respond within 48-72
hours of commencement of therapy, and those with persistence of symptoms beyond 10-14 days should be considered for
second-line antibiotic therapy.
Antibiotic Dosage
Amoxicillin/clavulanate 500 mg PO tid
Cefuroxime 250-500 mg PO bid
Cefpodoxime+
cefixime
200 mg PO bid 400 mg/d PO
Ciprofloxacin 500-750 mg PO bid
Levofloxacin 500 mg/d PO
Trovafloxacin 200 mg/d PO
Clindamycin 300 mg PO tid
PHARMACOTHERAPY FOR PHARMACOTHERAPY FOR DISEASES OF THE EARDISEASES OF THE EAR
External Ear
Otitis ExternaOtitis Externa
Otitis externa is a spectrum of Otitis externa is a spectrum of infection of the external infection of the external auditory canal. Although auditory canal. Although
commonly called swimmer’s commonly called swimmer’s ear, it may be caused by ear, it may be caused by
anything that results in the anything that results in the removal of the protective lipid removal of the protective lipid film from the canal, allowing film from the canal, allowing
bacteria to enter the bacteria to enter the apopilosebaceous unit. apopilosebaceous unit.
Otitis ExternaOtitis Externa
• ItchingItching
• Itch/scratch cycleItch/scratch cycle• PainPain• Purulent dischargePurulent discharge• Hearing lossHearing loss• Pain on palpation of the tragusPain on palpation of the tragus
• Edema and redness of the ear canal
• Cellulitis of the face or neck or lymphadenopathy of the unilateral neck
The most common pathogen is Pseudomonas aeruginosa, followed by Staphylococcus aureus,
then other gram-negative organisms.
There are four fundamental principles in the There are four fundamental principles in the treatment of external otitistreatment of external otitis
Frequent and thorough cleaning Frequent and thorough cleaning Judicious use of appropriate antibiotics Judicious use of appropriate antibiotics Treatment of associated inflammation and pain Treatment of associated inflammation and pain Recommendations regarding the prevention of future Recommendations regarding the prevention of future
infections infections
TreatmentTreatment
In the absence of purulence, a brief course of an acidifying In the absence of purulence, a brief course of an acidifying drop such as drop such as Acetic acid in aluminium acetateAcetic acid in aluminium acetate is efficacious in is efficacious in
discouraging bacterial or fungal growthdiscouraging bacterial or fungal growth
Mild StageMild Stage
An antibiotic otic dropAn antibiotic otic drop Neomycin, polymyxin, Neomycin, polymyxin,
dexamethasonedexamethasone (Isoptomaxitrol)(Isoptomaxitrol) Neomycin, polymyxin B, Neomycin, polymyxin B,
dexamethasonedexamethasone (Dexapolyspectran (Dexapolyspectran Otic)Otic)
Tobramycin and dexamethasoneTobramycin and dexamethasone ((Tobradex)Tobradex)
Ciprofloxacin Ciprofloxacin (Ciloxan, Cipro HC (Ciloxan, Cipro HC Otic) Otic)
Ofloxacin Ofloxacin (Floxin otic)(Floxin otic)
TreatmentTreatment
Moderate StageModerate Stage In the moderate stage of In the moderate stage of
inflammation, edema of the canal inflammation, edema of the canal
may interfere with the instillation may interfere with the instillation
of drops. The physician should of drops. The physician should
then insert a gauze strip or wick then insert a gauze strip or wick
into the canal with antibiotic into the canal with antibiotic
ointment and instill drops on it. ointment and instill drops on it.
TreatmentTreatment
Severe StageSevere Stage : : Infection often extends beyond the limit of the Infection often extends beyond the limit of the canal. An oral antibiotic with broad-spectrum coverage is needed. canal. An oral antibiotic with broad-spectrum coverage is needed.
TreatmentTreatment
Drug Name
Ciprofloxacin (Cipro) -- Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, S epidermidis, and most gram-negative organisms but with no activity against anaerobes.
Adult Dose 250-500 mg PO bid
Pediatric Dose >18 years: Not recommended
PrecautionsIn prolonged therapy, periodically evaluate organ system functions (eg, renal, hepatic, hematopoietic)
Instruct the patient to avoid future infections by not Instruct the patient to avoid future infections by not placing any object or instrument into the canal. placing any object or instrument into the canal.
Patients who have repeated infections are best Patients who have repeated infections are best advised to use an acidifying drop composed of equal advised to use an acidifying drop composed of equal measures of measures of vinegar and watervinegar and water, or , or ethyl alcohol and ethyl alcohol and waterwater, when exposed to high humidity. , when exposed to high humidity.
Custom-made Custom-made ear moldsear molds are useful for these patients. are useful for these patients.
PreventionPrevention
OtomycosisOtomycosis
Otomycosis is a fungal Otomycosis is a fungal infection of the skin of the infection of the skin of the external canal. external canal.
All fungi have three basic All fungi have three basic growth requirements: growth requirements:
- MoistureMoisture- WarmthWarmth- DarknessDarkness
OtomycosisOtomycosis
AspergillusAspergillus species are species are most common, and most common, and pruritus pruritus is the primary is the primary clinical manifestation. clinical manifestation.
Physical examination Physical examination commonly shows a commonly shows a white, black, or dotted white, black, or dotted gray membrane.gray membrane.
OtomycosisOtomycosis
MANAGEMENT:MANAGEMENT:
1.1.Thorough cleaning with removal of the matted fungal Thorough cleaning with removal of the matted fungal debris is supplemented by the topical application of an debris is supplemented by the topical application of an acidifying solution acidifying solution
2% Acetic acid in aluminium acetate 3% Boric acid in 70% alcohol.2.2.Topical Antifungal:Topical Antifungal:Clotrimazole cream or solution (Canestin or dermatin).Clotrimazole cream or solution (Canestin or dermatin).Nystatin drops (Mycostatin)Nystatin drops (Mycostatin)
OtomycosisOtomycosis
FurunculosisFurunculosis
Acute localized otitis externa, also known as furunculosis, is associated with infection of a hair
follicle.
• Analgesics, ant-inflammatory
• Antibiotics
• Ear wick
Wax impactionWax impaction
Cerumen impaction is the most common abnormality found on otoscopic examination. It is the most common cause of hearing loss.
Ceruminolytic agents:
• 3% Hydrogen Peroxide solution
• Triethanolamine (Ceruminex)
• Carbamide peroxide in glycerol
• Olive oil, Mineral oil or Baby oil
MIDDLE EARMIDDLE EAR
Acute Otitis MediaAcute Otitis Media
Otitis media (OM) is the second most common Otitis media (OM) is the second most common disease of childhood after upper respiratory disease of childhood after upper respiratory
tract infections and is one of the most common tract infections and is one of the most common reasons for a child to visit the pediatrician’s reasons for a child to visit the pediatrician’s
office.office.
Acute otitis media usually arises as a complication of
a preceding viral upper respiratory infection
(URI).
Risk factors for otitis media: - Host risk factors include age, prematurity, race, allergy,
craniofacial abnormalities, gastroesophageal
reflux, presence of adenoids, and genetic predisposition.
- Daycare center attendance increases risk of development
of AOM.
- Bottle-feeding increases the incidence compared with
breastfeeding.
- Smoking in the household.
Acute Otitis MediaAcute Otitis Media
Pneumococcus species, Haemophilus influenzae, and Moraxella species are the bacteria most
commonly involved in otitis media.
• Earache
• Fever (not required for the
diagnosis)
• Accompanying or precedent URI
symptoms (very common)
• Decreased hearing
• Injected tympanic membrane
Acute Otitis MediaAcute Otitis Media
TreatmentTreatment
"Wait-and-see prescription“ for antibiotics in AOM
The observation option is a 48- to 72-hour period of symptomatic treatment with
analgesics and without antibiotics, followed by reexamination.
TreatmentTreatment
Drug Name Amoxicillin (Amoxil, Biomox)
Adult Dose 250-500 mg PO q8h
Pediatric Dose80-90 mg/kg/d PO divided q8h for 10 d
in younger children and in patients with severe disease
PrecautionsAdjust dose in renal impairment; use in
Ebstein-Barr viral mononucleosis increases risk of severe rash
Drug NameAmoxicillin and clavulanate potassium
(Augmentin)
Adult Dose500-875 mg PO q12h PO or 250-500 mg PO
q8h
Pediatric Dose
90 mg/kg (amoxicillin) with 6.4 mg/kg (clavulanate) divided PO q12h
Precautions
Give for minimum of 10 d to eliminate organism and prevent sequelae (eg,
endocarditis, rheumatic fever); after treatment, perform cultures to confirm eradication of
streptococci
TreatmentTreatment
Drug Name Cefuroxime
Description
Second-generation cephalosporin maintains gram-positive activity of first-generation
cephalosporins; adds activity against Proteus mirabilis, H influenzae, Escherichia coli,
Klebsiella pneumoniae, and M catarrhalis. Condition of patient, severity of infection, and
susceptibility of microorganism determines proper dose and route.
Adult Dose 125-500 mg PO q12h
Pediatric Dose 30 mg/kg PO q12h
TreatmentTreatment
Ceftriaxone 50 mg/kg/d is recommended for
children who are unable to take oral antibiotics and for patients with
compliance problems.
TreatmentTreatment
Bell’s palsyBell’s palsy
The term The term Bell’s palsyBell’s palsy has been used to has been used to describe a facial describe a facial
paralysis of acute onset paralysis of acute onset and limited duration, the and limited duration, the etiology of which was etiology of which was deemed idiopathic.deemed idiopathic.
Bell’s palsyBell’s palsy
• Steroids• Antiviral agents
• Eye care: Artificial tears Lubricants Eye glasses or shields
Drug Name Prednisone (Hostacortin)
Adult Dose 1 mg/kg/d PO for 7 d
Precautions
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic
ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may
occur with glucocorticoid use
Bell’s palsyBell’s palsy
Bell’s palsyBell’s palsy
Drug Name
Acyclovir (Zovirax) -- Has demonstrated inhibitory activity directed against both HSV-1 and HSV-2, and infected cells selectively take
it up .
Adult Dose 4000 mg/24 h PO for 7-10 d
Pediatric Dose>2 years: Not recommended
>2 years: 1000 mg PO divided qid for 10 d
PrecautionsCaution in renal failure or when using
nephrotoxic drugs
INNER EARINNER EAR
VertigoVertigo
Subjective sensation of disturbed Subjective sensation of disturbed relationship between the individual and his relationship between the individual and his environment in which either the patient or environment in which either the patient or
his environment is moving.his environment is moving.
Meniere’s diseaseMeniere’s disease Vestibular neuronitisVestibular neuronitis
Drug Name Meclizine (Antivert)
Description
Decreases the excitability of the middle ear labyrinth and blocks conduction in the middle ear vestibular-cerebellar pathways. These effects are associated with its therapeutic effects in vertigo.
Adult Dose 25-50 mg PO q4-6h
Precautions
Caution in angle-closure glaucoma, prostatic hypertrophy, pyloric or duodenal obstruction, and bladder neck obstruction
Meniere’s diseaseMeniere’s disease
Meniere’s diseaseMeniere’s disease
Drug Name Dimenhydrinate (Dramamine)
Description
Used for treatment and prophylaxis of vestibular disorders that may cause nausea and vomiting. Through its central anticholinergic activity, it diminishes vestibular stimulation and depresses labyrinthine function.
Adult Dose 50 mg PO/IM q4-6h or a 100-mg suppository q8h
Pediatric Dose
Neonates: Do not administer2-6 years: 12.5-25 mg q6-8h; not to exceed 75 mg/d6-12 years: 25-50 mg PO q6-8h; not to exceed 150 mg/d
Drug Name Diazepam (Valium)
Description
Depresses all levels of the CNS, including limbic and reticular formation, possibly by increasing GABA activity, which is a major inhibitory neurotransmitter.
Adult Dose 5-10 mg PO/IV/IM q4-6h
Meniere’s diseaseMeniere’s disease
Drug Name Promethazine (Phenergan)
DescriptionAntidopaminergic agent effective in the treatment of emesis.
Adult Dose 25-50 mg PO/IM/PR q4-6h
Pediatric Dose<2 years: Contraindicated>2 years: 0.5 mg/kg q4-6h
Precautions
Can be associated with CNS depression, dry mouth, extrapyramidal symptoms, hypertension, hypotension, and rash; caution in patients with cardiovascular or hepatic disease
Meniere’s diseaseMeniere’s disease
• Low-sodium diet (1–1.5 g Na+/day)Low-sodium diet (1–1.5 g Na+/day)• Diuretic:-Diuretic:--Triamterene and hydrochlorothiazide Triamterene and hydrochlorothiazide (Dyazide)(Dyazide)-Acetazolamide (Diamox)Acetazolamide (Diamox)-HydrochlorothiazideHydrochlorothiazide
• Betahistine ( Betaserc)Betahistine ( Betaserc)
Meniere’s diseaseMeniere’s disease
DRUGS USED IN VERTIGO AND DRUGS USED IN VERTIGO AND DIZZINESSDIZZINESS
Betahistine (Betaserc,Microserc 8,16 mg ,Verserc 24 mg)
H3 receptor agonist. It dilates blood vessels in H3 receptor agonist. It dilates blood vessels in the inner ear.the inner ear.
Increases serotonin in brain stem leading to Increases serotonin in brain stem leading to decrease in activity of vestibular nuclei.decrease in activity of vestibular nuclei.
Cinnarizine (Stugeron 25 mg): (Stugeron 25 mg):
Calcium channel blocker that decreases Calcium channel blocker that decreases contraction of vascular smooth muscles.contraction of vascular smooth muscles.
Vincamine (Oxybral 30 mg):(Oxybral 30 mg):
Peripheral vasodilator that increases blood Peripheral vasodilator that increases blood supply to the brain.supply to the brain.
DRUGS USED IN VERTIGO AND DRUGS USED IN VERTIGO AND DIZZINESSDIZZINESS
Almitrine besmesylate (duxil): (duxil):
Acts on chemoreceptors of the carotid bodies Acts on chemoreceptors of the carotid bodies leading to increase in the arterial oxygen leading to increase in the arterial oxygen tension.tension.
Piracetam (Nootropil): (Nootropil):
It increases blood flow and oxygen consumption It increases blood flow and oxygen consumption in the brainin the brain
DRUGS USED IN VERTIGO AND DRUGS USED IN VERTIGO AND DIZZINESSDIZZINESS
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