Sympathomimetic Amines: Actions and Uses
Kenneth J. Broadley in Autonomic Pharmacology, 2017
The nasal decongestants are used topically by instillation into the nose as drops or by spray, the latter reaching a greater area. Oral administration is also used to relieve congestion of the nasal passages and of the lower airways in cough and cold remedies. The effectiveness in bronchial congestion is less convincing. Local application has the advantage of minimizing systemic effects such as an increase in blood pressure and CNS stimulant activity. The potential CNS stimulation, improved cardiovascular activity and effects on hostility and competitiveness have led to their misuse in sports. Indeed, there have been several deaths when normal doses of amphetamines have been used under conditions of maximal physical activity. As a consequence, the International Olympic Committee (IOC) Medical Commission considers sympathomimetic amines as stimulants and as such they are banned. This includes all phenylethylamines used as decongestants, however imidazole preparations, such as oxymetazoline, are acceptable for topical use (Badewitz-Dodd 1991).
Human Rhinovirus Infections
Sunit K. Singh in Human Respiratory Viral Infections, 2014
Because there are currently no approved antiviral medications for HRV respiratory tract infections, symptomatic treatment should be considered.204 Anticholinergic medications could be used for the commonly reported symptom, rhinorrhea. Anticholinergic nasal sprays have been reported to reduce rhinorrhea by approximately 30%. Nasal congestion can be alleviated by nasal and systemic decongestants. Several studies have suggested that heated, humidified steam may reduce nasal congestion in common colds, but the data are not conclusive.205 Cough is a common accompanying problem in respiratory viral infections and can be suppressed with nonprescription cough suppressants. Other symptoms such as sore throat, myalgia, fever, or headache can be controlled with nonsteroidal anti-inflammatory drugs. Antibiotics are inappropriate for treating viral infections, although they are frequently prescribed by physicians.
Sinus and Ear Infections in the Elderly
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Also, many geriatric patients have chronic illnesses such as diabetes mellitus, chronic obstructive pulmonary disease, and asthma, which may alter the immune status. These conditions can be severely exacerbated by a suboptimally treated sinus infection. In these cases broader coverage is desired such as with amoxicillin/ clavulanate (Augmentin), the second-generation cephalosporins, or respiratory qui-nolones (Table 3). Antibiotic therapy should be continued for at least 10-14 days. If no clinical improvement is noted after 2-3 days of therapy, an alternate antibiotic should be considered. High-dose amoxicillin (6 g/day) or amoxicillin/clavulanate is currently being used for recalcitrant or subacute sinusitis in younger patients; however, there have been no reports of use in the geriatric population. The doses of amoxicillin and amoxicillin/clavulanate have to be modified in patients with renal insufficiency and monitored for toxicity for patients on methotrexate. Decongestants—oral and/or nasal—along with saline nasal irrigations may help to decrease nasal congestion, promote sinus drainage and mucociliary flow. The role of antihistamines in acute sinusitis remains controversial.
Brimonidine tartrate ophthalmic solution 0.025% for redness relief: an overview of safety and efficacy
Published in Expert Review of Clinical Pharmacology, 2022
Clinical trials using 0.025% brimonidine tartrate have proven the drug to be relatively safe with little systemic and ocular adverse events. The few adverse events identified included pain upon instillation, irritation, and pruritus, all of which were described to be mild to moderate in severity. However, many of the adverse events of concern, especially those that have limited wider uses of previous generations of vasoconstrictors, such as allergic reaction and tachyphylaxis, are known to occur with a long-term continuous use. The 4-week regimen of the 3 trials introduced in this review may not have been sufficiently long enough to identify all possible side effects. Furthermore, although the drug level was negligible in plasma samples of those topically applying the ophthalmic solution, we cannot entirely rule out the possibility of systemic adverse events. Theoretically, the drug might be able to cross immature or damaged blood–brain barrier such as those with previous history of head trauma, cerebral hemorrhage, or intracranial operations in considerable quantities. The vasoconstrictor may act on vessels systemically to aggravate preexisting vascular conditions such as the Raynaud phenomenon or cerebral aneurysm. Surveys of decongestant users have reported side effects such as headache, chest pain, and palpitations. Long-term studies and market surveys are necessary to confirm that brimonidine does not suffer from the same limitations of its predecessors.
“I’m Going to Scope You”—The Balance between Examiner Visualization and Patient Comfort
Published in Journal of Investigative Surgery, 2021
Christina M. Parducci, Jason E. Cohn
The use of topical agents during upper airway visualization has been called into question over the years as numerous studies suggest that their use is not efficacious and may actually contribute to patient discomfort2 .When comparing routinely used topical agents, it has been found that there is little difference in their effectiveness and the side effects of lidocaine make it less appealing when assessing patient comfort [3]. Alternative methods such as visual distractions have shown to be significantly more pleasant for patients than lidocaine4 .However, other studies suggest that lidocaine is effective at decreasing patient discomfort and can be used to avoid general anesthesia [5]. From a physician’s perspective, the use of anesthetic has proven advantageous in both ease and quality of examination when compared to a placebo6 .Different maneuvers used by more experienced physicians can also allow for increased visualization that may otherwise not be attained7 .Topical decongestants may be used in combination with other methods to maximize the efficiency of upper airway procedures and patient comfort. For example, the use of xylometazoline and oxymetazoline has shown to produce less patient discomfort and a subsequent shorter duration of examination [8], especially when combined with a topical anesthetic [9].
Current evaluation and management of patients with chronic rhinosinusitis and nasal polyps
Published in Expert Review of Clinical Immunology, 2022
Juan Carlos Ceballos Cantu, Isam Alobid, Joaquim Mullol
The second line of medical treatment for CRSwNP consists of a group of treatments with positive randomized studies (evidence 1b) and proven efficacy in specific aspects and situations of CRSwNP. Short-Term broad-spectrum antibiotics (Macrolides) exhibits immunomodulatory as well as antibiotic properties, and some mixed evidence exists to support long-term use in selected CRS patients [18,40], sustained by its mechanism of action (suppression of pro-inflammatory cytokines) [41]. Two randomized, placebo-controlled trials have shown that patients with low serum IgE responded best [42]. Another trial using clarithromycin suggested that endotyping may be helpful for treatment selection [43]. Other cohort studies demonstrated a lack of efficacy for macrolides in eosinophilic CRSwNP patients [44,45]. It remains to be studied which patients respond best and whether there are additive effects with other medications (eg, corticosteroids or a biologics). Second-generation antihistamines are effective when there is concomitant and clinically relevant allergic rhinitis. Nasal decongestants are indicated especially when there is nasal blockage and during exacerbations to facilitate the distribution of intranasal corticosteroids. Intranasal use is recommended for periods of less than one week. Nasal capsaicin may be a therapeutic option in cases of severe nasal hyperreactivity. Finally, Aspirin treatment after desensitization (ATAD) is an additional option in patients with N-ERD; the preferred administration is oral, at high doses (600 mg daily), and should be performed in experienced centers [40,46].
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