otic drugs

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Otic Drugs Prepared By : Shvan Mahmoud , Harrs Muhamad & Idrees Ahmed Otic Drugs

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A Brief Introduction About Human Ear The human ear has three main sections, which consist of the outer ear, the middle ear, and the inner ear. Sound waves enter your outer ear and travel through your ear canal to the middle ear. The ear canal channels the waves to your eardrum, a thin, sensitive membrane stretched tightly over the entrance to your middle ear. The waves cause your eardrum to vibrate. It passes these vibrations on to the hammer, one of three tiny bones in your ear. The hammer vibrating causes the anvil, the small bone touching the hammer, to vibrate. The anvil passes these vibrations to the stirrup, another small bone which touches the anvil. From the stirrup, the vibrations pass into the inner ear. The stirrup touches a liquid filled sack and the vibrations travel into the cochlea, which is shaped like a shell. Inside the cochlea, there are hundreds of special cells attached to nerve fibers, which can transmit information to the brain. The brain processes the information from the ear and lets us distinguish between different types of sounds.

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Disorders Facing Human Ear 1) Extrenal Otitis (External) 2) Mastoiditis (Middle) 3) Vestibular Neuronitis(Inner)

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1) External Ear Disorder ( Extrenal Otitis ) External otitis is infection of the ear canal, typically by bacteria (Pseudomonas aeruginosa, Proteus vulgaris, Staphylococcus aureus, or Escherichia coli ) Symptoms include itching, pain, and discharge. Treatment is with topical drugs, including antibiotics, corticosteroids, and acetic acid or a combination.

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Treatment:  Topical antibiotics and corticosteroids are effective. First, the infected skin should be gently removed from the canal with suction or dry cotton . Mild external otitis can be treated by (Acetic acid ) and by relieving inflammation with topical (Hydrocortisone); these are given as 5 drops tid for 7 days. Moderate external otitis requires the addition of an antibacterial solution or suspension, such as (Ciprofloxacin) .

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Ciprofloxacin/Hydrocortisone (Cipro® HC ) Dosage : (Ear drops ) Twice a day, about 12 hours apart, for seven days ( Cover the infected area ) . Ciprofloxacin is a synthetic chemotherapeutic antibiotic of the (fluoroquinolone) second-generation drug class . Mode of action of Ciprofloxacin (CIPRO®) Ciprofloxacin is a broad-spectrum antibiotic active against both Gram-positive and Gram-negative bacteria. It functions by inhibiting DNA gyrase, a type II topoisomerase enzyme necessary to separate bacterial DNA, thereby inhibiting cell division ( Protein synthesis inhibitor ) .

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Ciprofloxacin available as : Tablets (100 mg, 250 mg, 500 mg, 750 mg or 1000 mg) I.V solutions (5% and 10%, 100 mL) Eye and Ear drops . Contraindications : Ciprofloxacin should be avoid in , Epileptic patients , Pregnancy , Pediatric populations .

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Drug Interactions : Cipro reduse the plasma level of (phenytoin) , Methotrexate , Probenecid , Theophylline , Caffeine and Warfarin . Adverse Effects : Headache, Abdominal pain , Tachycardia, Migraine, Hypotension , Dyspnea.

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Hydrocortisone (Cortef® ) or (Cortisol ) Is a corticosteroid, similar to a natural hormone produced by adrenal gland , It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders . Mechanism Of Action : Decreases inflammation by suppression of migration of leukocytes and increase capillary permeability .

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Anti Fungal agents : Clotrimazole Cruex® Generic Available : Cream, solution Uses : Treatment of mucocutaneous, and oral cavity fungal infections normally caused by the Candida species

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Mechanism of Action Binds to phospholipids in the fungal cell membrane altering cell wall permeability resulting in loss of essential intracellular elements Drug Interactions Colchicine , Eplerenone and Salmeterol

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Adverse Reactions Gastrointestinal: Nausea and vomiting may occur in patients on clotrimazole troches Local: Mild burning, irritation, stinging to skin or vaginal area Contraindications Hypersensitivity to clotrimazole or any component of the formulation

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Dosage : TOPICAL SOLUTION, USP 1% 10 mL Apply the cream on the infected area (Cover the infected area) Twice a day, in the morning and evening.

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Nystatin (Mycostatin® ) Generic Available Cream, ointment, powder, suspension, tablet Mechanism of Action Binds to sterols in fungal cell membrane, changing the cell wall permeability allowing for leakage of cellular contents

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Adult Dose for Cutaneous Candidiasis   Apply nystatin topical cream, ointment or powder in a quantity sufficient to cover the affected area and immediately surrounding skin 2 to 4 times a day. The powder formulation is useful for the treatment of moist areas or lesions. Therapy should be continued for 2 to 8 weeks, depending on the nature and severity of the infection.

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Contraindications Hypersensitivity to nystatin or any component of the formulation   Adverse Reactions Dermatologic: Contact dermatitis . Gastrointestinal: Diarrhea, nausea, stomach pain, vomiting Hypersensitivity reactions .

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Drug Interactions Saccharomyces boulardii ( is a tropical strain of yeast , It maintain and restore the natural flora in the large and small intestine) :- Antifungal Agents may diminish the therapeutic effect of Saccharomyces boulardii.

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Treatment : (Ceftriaxone ) ( Rocephin ® ) ; Is a third-generation cephalosporin antibiotic . Mechanism Of Action :  Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) . Doses: Orally , 1 to 2 g (children, 50 to 75 mg/kg) once/day continued for 2 weeks. Side Effect  Rash , Diarrhea , Thrombocytosis, leucopenia .

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Contraindication Not used in hyperbilirubinemic neonates , Hypersensitivity to ceftriaxone. Drug Interaction Warfarin , Calcium salt , Typhoid Vaccine

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Other Uses Of Ceftriaxone : Ceftriaxone is often used in combination, with macrolides(Erythromycin) or aminoglycoside (Gentamicin) antibiotics for the treatment of pneumonia . It is also a choice drug for treatment of bacterial meningitis . It has also been used in the treatment of gonorrhea.

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3) Disorders Of Inner Ear ( Vestibular Neuronitis ) Vestibular neuronitis causes a self-limited episode of vertigo, presumably due to inflammation of the vestibular division of the 8th cranial nerve; some vestibular dysfunction may persist.  Symptoms and Signs Severe vertigo , nausea and vomiting which lasts 7 to 10 days with absence of hearing loss is a hallmark of vestibular neuronitis . Treatment Prochlorperazine or Promethazine

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Treatment : (Prochlorperazine ) (Compazine ® ) , Mechanism of action include blocks postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain, including the chemoreceptor trigger zone; exhibits a strong alpha-adrenergic and anticholinergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones; and emesis .

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Doses : - Oral (tablet): 5-10 mg 3-4 times/day; maximum dose : 40 mg/day - I.M. : 5-10 mg every 3-4 hours; maximum dose: 40 mg/day Drug Interactions : Alcohol , Amphetamine , Opioid , Antipsychotic Agents (Phenothiazines ) , Beta-Blockers ( Except : Atenolol and Nadolol )

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Drug Interaction Alcohol , Amphetamines , Analgesics (Opioid) , Antacids (Sodium Bicarbonate ) , Anticholinergics , Phenothiazines . Side Effect Agitation , Cerebral edema, Dizziness, Drowsiness, Fever (mild ), Headache, Hyperactivity , Insomnia, Restlessness , Euphoria, Excitation, Nightmares, Sedation , Dermatitis, Skin pigmentation , Jaundice .

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Contraindication Hypersensitivity to prochlorperazine , severe CNS depression , Patients in coma , Pediatric surgery , should not be used in children <2 years of age or <9 kg .

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Other Uses Of Prochlorprazine Used for the treatment of psychosis and the manic phase of bipolar disorder. It has a prominent Antiemetic activity and is most often used for the (short-time) treatment of nausea and vomiting . and vertigo

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What would you do If you lost your ears ? Giving up ? Or still Conducting like Beethoven ? Be grateful for what you have ….