CTMA 2 Canada’s Trusted Reference for Minor Ailments Sample Chapters for Conference_J.indd 1 6/17/2016 2:35:16 PM Created by Canadian experts for Canadian healthcare practitioners treating Canadian patients CANADIAN CURRENT COMPREHENSIVE CONVENIENT www.pharmacists.ca Sample Chapters for Conference_J.indd 2 6/17/2016 2:35:16 PM iii Table of Contents EditorialAdvisoryCommittee................................................................................................vii Authors...........................................................................................................................viii Reviewers........................................................................................................................ix Editor'sMessage ................................................................................................................x EditorialPolicy,DescriptionandLimitationsofInformation...........................................................xi HowtoUseCompendiumofTherapeuticsforMinorAilments......................................................xii PatientAssessments.........................................................................................................xiii CommunicatingWithPatients 1 EffectivePharmacist-patientInteractions,BarbaraJ.Farrell...................................................1 2 FacilitatingBehaviourChange,LisaDolovich....................................................................12 3 PharmacistAssessmentoftheSelf-treatingPatient,NardineNakhla......................................21 PsychiatricConditions 4 Depression,RicM.ProcyshynandAlasdairM.Barr............................................................27 5 Insomnia,RicM.ProcyshynandAlasdairM.Barr...............................................................38 6 SmokingCessation,KristinePetraskoandManjitBains.......................................................52 CentralNervousSystemConditions 7 Fever,YvonneM.Shevchuk..........................................................................................82 8 Headache,IreneWorthington........................................................................................99 9 Heat-relatedDisorders,DorothyTscheng........................................................................117 10 Tinnitus,YvonneM.Shevchuk.....................................................................................128 11 VertigoandDizziness,YvonneM.Shevchuk...................................................................132 EyeCare 12 AssessmentofPatientswithEyeConditions,AnneM.Friesen............................................139 13 Conjunctivitis,AnneM.Friesen....................................................................................140 14 ContactLensCare,DavidS.WingandKenGellatly.........................................................148 15 DryEye,AnneM.Friesen...........................................................................................162 16 EyelidConditions:Hordeolum,ChalazionandBlepharitis,AnneM.Friesen...........................169 EarConditions 17 AssessmentofPatientswithHearingLoss,EarPainandEarDrainage,YvonneM. Shevchuk................................................................................................................187 18 ComplicationsAffectingtheEar:EarPiercing,ForeignBodiesandBarotrauma,YvonneM. Shevchuk................................................................................................................193 19 ImpactedEarwax,YvonneM.Shevchuk.........................................................................198 CompendiumofTherapeuticsforMinorAilments Copyright©CanadianPharmacistsAssociation.Allrightsreserved. Sample Chapters for Conference_J.indd 3 6/17/2016 2:35:16 PM iv 20 OtitisMediaandOtitisExterna,YvonneM.Shevchuk.......................................................206 RespiratoryConditions 21 AcuteCough,DanielJ.G.Thirion..................................................................................217 22 AllergicRhinitis,JenniferKendrick................................................................................226 23 AssessmentofPatientswithUpperRespiratoryTractSymptoms,DanielJ.G.Thirion..............249 24 ViralRhinitis,Influenza,RhinosinusitisandPharyngitis,DanielJ.G.Thirion...........................254 MetabolicandCardiovascularConditions 25 DiabetesCare,LoriMacCallum....................................................................................273 26 DiabetesCareDevices,RonaldSilver...........................................................................293 27 LifestyleManagementandDiseasePrevention,L.MariaGutschi........................................302 GastrointestinalConditions 28 AssessmentofPatientswithAbdominalPain,PeterThomson............................................323 29 Constipation,JaneBowles-Jordan................................................................................327 30 Diarrhea,AntoniettaForrester......................................................................................353 31 DyspepsiaandGERD,CoQ.D.Pham..........................................................................378 32 GastrointestinalGas,CoQ.D.Pham.............................................................................390 33 Hemorrhoids,JoyceChan...........................................................................................398 34 InfantColic,ShelitaDattani.........................................................................................407 35 IrritableBowelSyndrome,LynetteKosar........................................................................420 36 NauseaandVomiting,ChristineHughes........................................................................429 37 OstomyCare,MarieBerry...........................................................................................448 38 PerianalSymptomAssessment,JoyceChan..................................................................463 39 Pinworms,JoyceChan...............................................................................................465 Nutrition 40 InfantNutrition,JoanBrennan-Donnan..........................................................................472 41 SpecialDiets,ShirleyHeschuk.....................................................................................491 42 SportsNutrition,ShirleyHeschuk..................................................................................506 43 WeightManagement,ShirleyHeschuk...........................................................................519 MusculoskeletalConditions 44 DrugUseandAbuseinSports,LilyLum.........................................................................547 45 LowBackPain,KellyGrindrod,JasonKiellyandCarloMarra.............................................554 46 Osteoarthritis,KellyGrindrod,JasonKiellyandCarloMarra...............................................569 47 Osteoporosis,LalithaRaman-WilmsandAnneMarieWhelan.............................................590 48 SportsInjuries,LilyLum..............................................................................................608 FootConditions Copyright©CanadianPharmacistsAssociation.Allrightsreserved. CompendiumofTherapeuticsforMinorAilments Sample Chapters for Conference_J.indd 4 6/17/2016 2:35:17 PM iv 20 OtitisMediaandOtitisExterna,YvonneM.Shevchuk.......................................................206 RespiratoryConditions 21 AcuteCough,DanielJ.G.Thirion..................................................................................217 22 AllergicRhinitis,JenniferKendrick................................................................................226 23 AssessmentofPatientswithUpperRespiratoryTractSymptoms,DanielJ.G.Thirion..............249 24 ViralRhinitis,Influenza,RhinosinusitisandPharyngitis,DanielJ.G.Thirion...........................254 MetabolicandCardiovascularConditions 25 DiabetesCare,LoriMacCallum....................................................................................273 26 DiabetesCareDevices,RonaldSilver...........................................................................293 27 LifestyleManagementandDiseasePrevention,L.MariaGutschi........................................302 GastrointestinalConditions 28 AssessmentofPatientswithAbdominalPain,PeterThomson............................................323 29 Constipation,JaneBowles-Jordan................................................................................327 30 Diarrhea,AntoniettaForrester......................................................................................353 31 DyspepsiaandGERD,CoQ.D.Pham..........................................................................378 32 GastrointestinalGas,CoQ.D.Pham.............................................................................390 33 Hemorrhoids,JoyceChan...........................................................................................398 34 InfantColic,ShelitaDattani.........................................................................................407 35 IrritableBowelSyndrome,LynetteKosar........................................................................420 36 NauseaandVomiting,ChristineHughes........................................................................429 37 OstomyCare,MarieBerry...........................................................................................448 38 PerianalSymptomAssessment,JoyceChan..................................................................463 39 Pinworms,JoyceChan...............................................................................................465 Nutrition 40 InfantNutrition,JoanBrennan-Donnan..........................................................................472 41 SpecialDiets,ShirleyHeschuk.....................................................................................491 42 SportsNutrition,ShirleyHeschuk..................................................................................506 43 WeightManagement,ShirleyHeschuk...........................................................................519 MusculoskeletalConditions 44 DrugUseandAbuseinSports,LilyLum.........................................................................547 45 LowBackPain,KellyGrindrod,JasonKiellyandCarloMarra.............................................554 46 Osteoarthritis,KellyGrindrod,JasonKiellyandCarloMarra...............................................569 47 Osteoporosis,LalithaRaman-WilmsandAnneMarieWhelan.............................................590 48 SportsInjuries,LilyLum..............................................................................................608 v FootConditions 49 AssessmentofFootSymptoms,AnneMallin...................................................................621 50 Athlete'sFoot,AnneMallin..........................................................................................623 Copyright©CanadianPharmacistsAssociation.Allrightsreserved. CompendiumofTherapeuticsforMinorAilments 51 Corns,Calluses,BunionsandIngrownToenails,AnneMallin..............................................631 52 PlantarWarts,AnneMallin..........................................................................................641 DermatologicConditions 53 ASummaryofCommonSkinConditions,PennyF.Miller...................................................648 54 Acne,DebraSibbald..................................................................................................653 55 Atopic,Contact,andStasisDermatitis,DebraSibbald.......................................................682 56 BacterialSkinInfections:Impetigo,FurunclesandCarbuncles,PennyF.Miller.......................716 57 Burns,NancyKleiman................................................................................................730 58 DandruffandSeborrheicDermatitis,DebraSibbald..........................................................740 59 DiaperDermatitis,DebraSibbald..................................................................................760 60 Dressings,MarieBerry...............................................................................................779 61 Drug-inducedSkinReactions,SandraKnowles...............................................................786 62 DrySkin,NancyKleiman............................................................................................802 63 Frostbite,NancyKleiman............................................................................................809 64 FungalNailInfections(Onychomycosis),PennyF.Miller....................................................818 65 FungalSkinInfections,PennyF.Miller...........................................................................827 66 HairCareandHairGrowth,NancyKleiman....................................................................842 67 InsectBitesandStings,NancyKleiman.........................................................................861 68 MinorCutsandWounds,NancyKleiman........................................................................877 69 ParasiticSkinInfections:LiceandScabies,PennyF.Miller................................................886 70 PerspirationandBodyOdour,NancyKleiman.................................................................904 71 Psoriasis,DebraSibbald.............................................................................................915 72 PreventionandTreatmentofSun-InducedSkinDamage,NancyKleiman..............................939 73 ViralSkinInfections:CommonandFlatWarts,PennyF.Miller............................................956 74 ViralSkinRashes,SandraKnowles...............................................................................968 Reproductive,GynecologicandGenitourinaryHealth 75 BenignProstaticHyperplasiaandAssociatedLowerUrinaryTractSymptoms,CherylA. Sadowski................................................................................................................985 76 Contraception,AnneMarieWhelan...............................................................................999 77 Dysmenorrhea,ThomasE.R.Brown............................................................................1031 78 MaleSexualDysfunction,TomSmiley..........................................................................1041 79 MenopauseandPerimenopause,ThomasE.R.Brown.....................................................1054 80 PregnancyandFertilityTesting,MarieBerry...................................................................1067 81 PremenstrualSyndrome,ThomasE.R.Brown................................................................1074 82 PrenatalandPostpartumCare,CarlaDillon...................................................................1090 83 UrinaryIncontinence,CherylA.Sadowski.....................................................................1132 84 VaginalSymptoms,HygieneandInfections,Laura-LynnPollock.........................................1145 CompendiumofTherapeuticsforMinorAilments Copyright©CanadianPharmacistsAssociation.Allrightsreserved. Sample Chapters for Conference_J.indd 5 6/17/2016 2:35:17 PM vi DentalHealth 85 DentalConditions,MichelleBourassa...........................................................................1167 86 OralHygiene,DentalPlaqueandCaries,MichelleBourassa.............................................1176 87 PeriodontalConditions:GingivitisandPeriodontitis,MichelleBourassa...............................1188 88 Teething,MichelleBourassa.......................................................................................1201 MouthConditions 89 AphthousUlcers(CankerSores),AdelineT.ChauMarkarian.............................................1209 90 ColdSores(HerpesLabialis),JamesS.Conklin.............................................................1220 91 DryMouth,VictoriaKletas..........................................................................................1232 92 Halitosis,ShirinAbadi...............................................................................................1242 93 OralCandidiasis,KarenWlock....................................................................................1249 GeneralAppendices I ComplementaryandAlternativeTherapies,CynthiaRichardandPaulA.Spagnuolo..............1258 II HomeTesting,MarieBerry.........................................................................................1278 III InformationfortheTraveller,MarkKearney....................................................................1289 IV MedicalDevicesandAidstoDailyLiving,MarieBerry......................................................1304 V PregnancyandBreastfeeding:Self-careTherapyforCommonConditions,MylaE. Moretti...................................................................................................................1320 VI NutritionalSupplements,L.MariaGutschi.....................................................................1329 Copyright©CanadianPharmacistsAssociation.Allrightsreserved. CompendiumofTherapeuticsforMinorAilments Sample Chapters for Conference_J.indd 6 6/17/2016 2:35:18 PM 206 EarConditions EarConditions Chapter 20 COhatpitetri2s0 Media and Otitis Externa YvonneM.Shevchuk, BSP,PharmD, FCSHP Otitis Media Pathophysiology Acuteotitismedia(AOM)isaninfectionofthemiddleearcavityandisoneofthemostcommon bacterialinfectionsinchildhood.1Seventy-fivepercentofchildrenexperienceatleast1episodeprior toenteringschool.2TodiagnoseAOM,3criterianeedtobemet:1)signsandsymptomsofmiddleear inflammation2)thepresenceofmiddleeareffusionand3)acuteonset(oftenabrupt)ofsignsand symptomsofmiddleearinflammationandeffusion.1Symptomsincludeacuteearpain(often unilateralanddevelopingoverafewhours),feverandreducedhearing.1Tuggingorpullingontheears isoftendescribed,butthisisaverynonspecificsign.1Childrentooyoungtocomplainofpainor pressureintheearsmaydisplayirritability,excessivefussiness,poorfeedinganddisruptedsleep patterns.Acuteotitismediaismorecommoninthewintermonths.Arecenthistoryofviralupper respiratorytractinfectionisoftenpresent.2ThemicroorganismsmostcommonlyassociatedwithAOM areStreptococcuspneumoniae,HaemophilusinfluenzaeandMoraxellacatarrhalis.1,2 AOMhasahighspontaneousrecoveryrate;80%ofchildrenexperiencespontaneoussymptomatic reliefwithplaceboornodrugtherapy.3,4Forthisreason,theconceptof“watchfulwaiting”is advocatedafterappropriatehealthcarepractitionerassessmentanddiagnosisofAOM.Ratherthan immediateinitiationofantibiotictherapy,appropriatelyselectedchildrenaremanagedwithanalgesic therapyforthefirst24–48hours.Thisincludeschildren>6monthsofagewithnocraniofacial abnormalitieswhohaveuncomplicatedAOM(normalhost,nootorrhea,nohistoryofchronicor recurrentAOM)withoutseverepainorsystemicillness,andwhosecaregiversareabletorecognize severeillness,takethechildforimmediateassessment,andprovideaccesstofollow-upcare.1,2 Goals of Therapy ■ Relievesymptomsoffever,painandirritability ■ Eliminatebacteriafromthemiddleear ■ Ensureappropriatetherapytoreducetheriskofresistantpathogensanddrug-relatedadverseeffects suchasantibiotic-associateddiarrhea ■ Preventcomplications,e.g.,mastoiditis,intracranialinfection,facialparalysis Nonpharmacologic Therapy Comfortmeasures,suchaswarmedoils,warmorcoldcompressesandheatingpadshavebeenusedby parentsandcaregiversforyears,althoughtherearenostudiesevaluatingtheireffectiveness.Iftried, heattherapyshouldbeusedcautiouslyandwithclosesupervisioninchildren,toavoidburns.Ayoung childshouldneversleepwithahotwaterbottleorheatingpad.Questionthecaregiveraboutwhether therehasbeenanydrainagefromtheearpriortorecommendinganytopicaltherapy.Warmedoil shouldnotbeusedifthereisachanceofperforationoranysuspicionofdrainage.Warmingofdrops oroilshouldbedonebyrollingthebottlebetweenthepalms;othermethodssuchasplacingthebottle Copyright©CanadianPharmacistsAssociation.Allrightsreserved. CompendiumofTherapeuticsforMinorAilments Sample Chapters for Conference_J.indd 7 6/17/2016 2:35:18 PM Ear Conditions Chapter20:OtitisMediaandOtitisExterna 207 inaglassofwarmwaterorusingthemicrowaveovenshouldbeavoidedasseriousburnshavebeen reported. Pharmacologic Therapy Formoreinformationonmanagementofacuteotitismedia,consulttheCompendiumofTherapeutic Choices:AcuteOtitisMediainChildhood. ■ Ifantibioticsareused,systemictherapyisrequired;topicalagentsarenotusedinAOM. ■ Adequateanalgesiawithusualdosesofacetaminophenoribuprofenisimportant(seeChapter7: Fever,Table5). ■ Topicalanalgesicsmayprovideshort-termanalgesiainchildrenwithAOM,butshouldnotreplace oralanalgesics.5,6Topicalanalgesicsmaycauselocalhypersensitivityreactions. ■ Decongestantsandantihistamines,whichwererecommendedinthepast,donotspeedthe resolutionofeffusionandcanhavesignificantadverseeffectsinchildrenandthereforeshouldnot beused.7,8 Foramorecompletediscussionofacuteotitismedia,seeSuggestedReadings. Otitis Externa Pathophysiology Otitisexternaisdefinedasinflammationoftheexternalauditorycanal(EAC)andmayalsoinvolve thepinnaortympanicmembrane(TM).Otitisexternaisoftenduetoinfection.9,10,11,12TheEACis warm,darkandpronetobecomingmoist.Thisprovidesanexcellentenvironmentforbacteriaorfungi toproliferate,particularlyiftheEACistraumatized.Otitisexternacanbecategorizedasacutediffuse, acutelocalized,chronic,eczematousornecrotizing.12Themainfocusofthischapterisacutediffuse otitisexterna. AcuteDiffuseOtitisExterna Predisposingfactorsforacutediffuseotitisexternainclude:9,10,11,13 ■ Toolittlecerumen—cerumenprovidesantibacterialactionbyphysicallyprotectingthecanaland maintainingalowpH ■ Toomuchcerumen,whichcanleadtoocclusionandmaceration ■ Moisture(swimming,bathing,watersports,perspiration,increasedhumidity)—macerates underlyingskinandraisespH ■ TraumatoEAC(fingernails,cotton-tippedswabs,otherforeignobjects,overzealouswaxremoval) —abrasionandlacerationallowinginoculationoforganisms ■ Chronicdermatologicdisorders ■ Hearingaids ■ Narrow,hairyearcanal. Themostcommonetiologyofacuteotitisexternaisbacterialinfection.Fungalovergrowthoccurs rarely,andprimarilyinpatientswhohavereceivedpriorantibiotictherapy.The2mostcommon microorganismscausingacuteotitisexternaarePseudomonasaeruginosa(20–60%)and Staphylococcusaureus(10–70%).10,11 Bacterialotitisexternaproducesearpainordiscomfort(otalgia),otorrhea,pruritusandtenderness, especiallyonmanipulationoftheear.10,11Thesesymptomsmaybemoreintensethanthoseseenwith fungalotitisexterna.Cellulitisofthepinnaandregionallymphadenopathymaybepresent.10Fungal CompendiumofTherapeuticsforMinorAilments Copyright©CanadianPharmacistsAssociation.Allrightsreserved. Sample Chapters for Conference_J.indd 8 6/17/2016 2:35:18 PM Chapter 20: Otitis Media and Otitis Externa 208 EarConditions otitisexternamaybeasymptomaticormayproducepruritusandfullnessintheear.Itclassically occursafterprolongedtreatmentofbacterialotitisexternawithantibioticswhichalterthebacterial floraoftheEAC.TheEACmaycontainblack,grey,bluishgreen,yelloworwhitefungalelementsand debris. AcuteLocalizedOtitisExterna(Furunculosis) Thisisanacutelocalized“boil”(infectedhairfollicle)intheearcanalusuallyduetoS.aureus.It produceslocalizedpain,itching,edema,erythemaandpossiblyafluctuanceorabscess.Thepain subsideswhentheboilcomestoaheadandbursts.Topicalmupirocinorfusidicacidcanbeusedfor mildcases.14Incisionanddrainagemayberequiredforsomepatients.Patientsappearingtoneed incisionanddrainageshouldbeseenbyahealthcarepractitionerwithappropriatetraining.Inmore severecases,systemicantibioticsactiveagainstS.aureusshouldbeconsidered.10 ChronicOtitisExterna ChronicotitisexternaischaracterizedasathickeningoftheEACskinsecondarytolow-grade infectionandinflammation.Thereisusuallyunrelentingpruritus,milddiscomfortanddry,flakyskin intheEACwithlackofcerumen.Thisisoftenduetononbacterialcausesincludingallergiccontact dermatitis.9 EczematousOtitisExterna Eczematousotitisexternamaybeduetoavarietyofskinconditions,includingatopic,seborrheicor contactdermatitis,psoriasis,lupuserythematosus,neurodermatitisandinfantileeczema.Lesions typicallyoccurelsewhereonthebody,especiallytheheadandneck,aswellastheauricleandEAC. Appearancemayrangefrommilderythemaandscalingwithatopicdermatitistothetypicaladherent scalesofpsoriasis(seeChapter55:Atopic,Contact,andStasisDermatitis;Chapter58:Dandruffand SeborrheicDermatitis;andChapter71:Psoriasisforamorecompletedescriptionofthelesions).The mostcommonsymptomispruritus,althougherythema,edema,crustingandoozingmaybepresent. Thelesionsmaybecomesecondarilyinfectedwithbacteriaorfungi.Treatmentisprimarily managementoftheunderlyingcondition.15 Necrotizing(Malignant)OtitisExterna Thisisaninfectionthatextendstothemastoidortemporalboneandisusuallyseenin immunocompromisedpatientsorthosewithdiabetes.Urgentreferralandsystemicantimicrobial therapyarerequired.10,11 Thischapterfocusesonthemanagementofacutediffuseotitisexterna. Goals of Therapy ■ Eliminatepathogenicmicroorganisms ■ Controlpain ■ Restorethecanaltonormalhealthsoitresistsinfection—returntonormalacidicpHandadequate cerumen Patient Assessment Acuteotitisexternaischaracterizedbyotalgia(70%ofcases),itching(60%)orfullness(22%)withor withouthearingloss(32%)anddischargeinorcomingfromtheear(otorrhea).10,16Incidencepeaksin childrenage7–12yearsanddeclinesaftertheageof50.16Itisunilateralin90%ofcases.16The discomfortcanrangefrompruritustoseverepain.Thepainisoftenworsewithmotionoftheear Copyright©CanadianPharmacistsAssociation.Allrightsreserved. CompendiumofTherapeuticsforMinorAilments Sample Chapters for Conference_J.indd 9 6/17/2016 2:35:18 PM Ear Conditions Chapter20:OtitisMediaandOtitisExterna 209 (pushingthetragusorpullingthepinna),10includingmovementcausedbychewing.11Determiningthe typeofotitisexterna(infectiousvs.noninfectious)canbeassistedbythedescriptionofthesignsand symptomsaboveandthepresenceofcontributingfactors(e.g.,historyofswimmingortraumatothe EAC),orthepresenceofdermatologicconditionsonareasofthebodyotherthantheEAC. Thedrugmustbedeliveredtotheinfectedtissueiftopicaltherapyistobesuccessful.10,16Cleansing mustbedonebyahealthcarepractitionerwithappropriatetraining.Therefore,ifthereissignificant edemaordebrisintheEAC,thepatientmayneedtobereferredsothatauraltoiletcanbeperformed orforawicktobeplaced.10Inmildcases,atopicalproductmaybeinitiatedwithoutcleansing; recommendationsforpainmanagementareimportant. Nonpharmacologic Therapy Adequatecleansingoftheearcanalwithremovalofdebrismayberequiredfrequentlysothattopical therapycanbeeffective.9,10Ifthecanalisnotpatent,earwicksmaybeinsertedbyahealthcare practitionertoreduceedemaandswellingandprovideamechanismfordrugdeliverytothecanal.10,11 Thesemayremaininplacefor2–5days. Pharmacologic Therapy Forcomparativeingredientsofnonprescriptionproducts,consulttheCompendiumofProductsfor MinorAilments—AnalgesicProducts:InternalAnalgesicsandAntipyretics;OticProducts. Topicaltreatmentisthemainstayoftherapy,althoughinmoreseverecases,wheninfectionhasspread beyondtheEAC,whenotitismediacoexists,orifthepatienthasaconditionsuchasdiabetesor immunodeficiency,systemicantibioticsmayberequired.10Inuncomplicatedcases,systemictherapy doesnotimproveoutcomescomparedwithtopicaltherapyandincreasestheriskofadverseeffectsand antibioticresistanceandtimetoclinicalcure.17Topicaltherapyoptionsincludeacidifyingagents, antibioticsaloneorantibiotic/corticosteroidcombinations(seeTable1).Comparativetrialsshow similaroutcomesamongapproaches;therefore,thechoiceisdeterminedbyhealthcarepractitionerand patientpreference,thesideeffectprofileoftheagentsandcost.10,11,12,18,19Onetrialdemonstratedthat corticosteroiddrops(witheitheraceticacidorantibiotic)aremoreeffectivethanaceticacidaloneand recommendedthataceticacidalonenotbeusedinadultpatients.20Inpatientswhosesymptomslast longerthanaweek,aceticacidmaybelesseffectivethananantibiotic/corticosteroidcombination; efficacyat1weekissimilar.18Advantagesanddisadvantagesofthevariousproductsareoutlinedin Table1. Antibioticdropsareavailableasbothoticandophthalmicpreparations.Bothnonprescriptionand prescriptionproductsareavailable.Oticproductsaremoreacidicthanophthalmicpreparationsand maycauseburningoninstillation.Ifapatientcannottolerateoticpreparations,ophthalmic preparationsmaybemorecomfortable.21Preparationsfortreatmentofotitisexternamaycontain corticosteroids,whichreduceinflammationandedemaandmayresolvesymptomsmorequickly; however,thishasnotbeenshowninallstudiesandcorticosteroidsmayoccasionallybetopical sensitizers.18 Oneparticularconcernwithtopicaltherapyofacuteotitisexternaisthepotentialototoxicityof aminoglycosides.22Thisisadocumentedadverseeffectofsystemicallyadministered aminoglycosides.Ifthetympanicmembraneisintact,theriskwithtopicaladministrationisextremely small.Riskfactorsforototoxicityincluderupturedtympanicmembrane,useoftheproductformore than1weekandcontinueduseafterotorrheahassubsided.Topicalfluoroquinoloneshavenotbeen associatedwithototoxicity. Enoughliquidtofillthecanal(3–4drops)shouldbeinstilled3–4timesdaily(mostproductsexcept fluoroquinolones).Symptomswilllastforapproximately6daysaftertreatmentbegins;however, CompendiumofTherapeuticsforMinorAilments Copyright©CanadianPharmacistsAssociation.Allrightsreserved. Sample Chapters for Conference_J.indd 10 6/17/2016 2:35:18 PM
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