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Otic and Oral Conditions - 2.14.20 PDF
Otic and Oral Conditions - 2.14.20 PDF
CONDITIONS
Caroline Horner, PharmD, MBA
February 14, 2019
PMRP 3270: Nonprescription Pharmacotherapy, Natural Medicines, and Self-Care I
Objectives
• Differentiate patients who are not candidates for self-care
• Describe the symptoms related to each otic or oral condition
• Identify when nonpharmacological therapy can be utilized to
treat patients symptoms
• Plan appropriate regimens based on patient characteristics
OTIC CONDITIONS
• Excessive and impacted cerumen
• Water-clogged ears
Anatomy of the Ear
• Self-care is limited to outer ear
disorders
• Children and geriatric are more
prone
Exclusions to Self Care: Otic Conditions
Presence of
Bleeding or signs
Signs of infection ruptured tympanic
of trauma
membranes
Incapable of Hypersensitivity to
following proper recommended >12 years of age
instructions agents
Excessive/Impacted Cerumen
Pathophysiology Symptoms Risk factors
2. Place open end of syringe in ear canal with tip pointed slightly upward
To dry the ear the ear using a safe and effective agent
To prevent recurrences in those prone to retaining
moisture in the ears
Nonpharmacological Therapy
• Tilt the ear downward and gently
manipulate the auricle to help expel
excessive water from the ear
• Use a blow dryer on a low-heat setting
around the ear (not directly in it)
• Water absorbing ear plugs for those
age 17 and up
Isopropyl Alcohol
• Isopropyl alcohol 95% in anhydrous glycerin
• Alcohol acts as a drying agent
• Glycerin acts as solvent, emollient, and hygroscopic
agent
• Counseling Points:
• Discard after use, do not keep
• Only white vinegar, not cider vinegar
Advise patients to contact their primary care provider if symptoms worsen or do not
improve by 4 days or if signs and symptoms of infection
Avoid use of cotton swabs, fingernails, or other devices to relieve itching or removing
cerumen from the ear
Presence of fever
Bleeding Trauma
or swelling
Non-Pharmacologic Therapy
• Identification and elimination of predisposing factors
• Avoid harsh tooth brushing technique
• Brush teeth less vigorously
• Use soft-bristled brush
• Avoid brushing teeth within 30-60 minutes after consuming acidic foods or
beverages
Potassium Nitrate 5%
• Mechanism: diffuses along dentin tubules to decrease the excitability of nerves
and alter the membrane potential
• Single application is not effective, use 2-4 weeks or as dentist recommends
• If hypersensitivity is not relieved within 14-21 days of using desensitizing
toothpaste, refer to dentist
Recurrent Aphthous Stomatitis
Precipitating
Pathophysiology Symptoms
Factors
• Unknown cause • Epithelial • Local trauma
• Possibly due to ulceration of • Immunologic
streptococci or movable mouth • Genetic
varicella zoster parts
• Food allergy
• Round or oval
• Hormonal
• Flat or crater-like changes
• Erythematous
halo of inflamed
tissue
Natural Process
• Some patients may experience pain in area
prior to lesion occurance
• Lesion may worsen with eating or drinking
and may inhibit these activities
• Most lesions persist for 5-14 days and heal
spontaneously
Goal of Therapy
Lesion associated
Lesion present Frequently
with underlying
≥14 days recurring lesions
pathology
Failure of prior
Symptoms of
appropriate self-
systemic illness
treatment
Non-Pharmacologic Therapy
• Address precipitating causes
• Tooth brushing technique
• Stress reduction
• Nutritional deficiency or food allergy, if identified
• Oral rinses
• Mouthwashes like Listerine
• Saline rinses – 1-3 tsp of salt in 4-8 oz warm water
• Systemic analgesics
• Aspirin
• NSAIDs
• Acetaminophen
Topical CAM
Clove Oil Lavender Oil
• Insufficient evidence • Possibly effective
• Mild anesthetic, analgesic, • Reduces pain, swelling, and redness
antibacterial
• Can cause GI side effects
• Harmful in large doses
• Rarely endocrine disturbances
Referral to Primary Care Provider
• Symptoms do not improve after 7 days of treatment
• Lesions do not heal within 14 days
• Symptoms worsen during self treatment
• Symptoms of systemic infection
• Fever
• Rash
• Swelling
Patient Counseling
• Cleansing or rinsing agents should be used prior to application of topical
anesthetics
• Reassess symptoms in 7 days of therapy
• Gels are preferred drug delivery application
• Easy to apply
• Not easily washed away
Herpes Simplex Labialis
Pathophysiology Symptoms Precipitating Factors
Increased Lesion
Compromised
frequency of present ≥14
immunity
outbreaks days
No previous
Symptoms of
diagnosis of a
infection
cold sore
Non-Pharmacologic Therapy
• Avoid precipitating causes
• Keep lesions clean by washing gently with mild soap
• Handwashing to prevent lesion contamination and autoinoculation
• Keep lesions moist to prevent drying and fissuring
• Avoid factors that delay healing
Docosanol 10% (Abreva)
• Reduce severity and duration of symptoms
• Mechanism: inhibits fusion between herpes virus
and the human cell plasma membrane to prevent
viral replication
• Begin use at first signs of outbreak
• Dose: apply 5 times daily up to 10 days until lesion
is healed
• Indicated for those age ≥12 years of age
Other Pharmacologic Options
• Topical Oral Protectants
• Prevent over drying of lesions
Severe pain
triggered or
Trauma to teeth Bleeding gums
worsened by hot,
cold, or chewing
Non-Pharmacologic Therapy
• Avoid substances that reduce salivation
• Tobacco
• Caffeine
• Hot spicy foods
• Alcohol, including mouth rinses