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Ear wax removal:Carbamide peroxide (Debrox, Dent’s Ear Wax, Murine Ear Wax Removal) softens and emulsifies the wax.3.Respiratory system a.Review asthma, COPD, allergic rhinitis and associated drugs and side effects of drugsAsthma:Recurrent episodes of wheezing, breathlessness, and chest tightnessAirflow obstruction is reversible.Mild intermittent: 2 days/week or less (short-acting beta2)Mild persistent: >2days/week but not daily (Low-dose inhaled corticosteriodsare the mainstay for all age patients (first line treatment)Cromolyn or a leukotriene modifier are alternatives. See dosage charge for low-dose schedule of each inhaled corticosteroid. Moderate persistent: dailySevere persistent: throughout the dayStep 4 therapy Medium-dose inhaled corticosteroids plus long-acting beta agonist Or medium-dose inhaled corticosteroid and a leukotriene modifier or theophyllineStep 5 therapy High-dose inhaled corticosteroids plus long-acting beta agonists Step 6 therapy
High-dose inhaled corticosteroids plus long-acting beta agonists and oral corticosteroidsSevere persistent asthma requires consultation with asthma specialist. Once control is achieved, the patient is seen every 1 to 6 months to determine if a step upor step down in therapy is indicated.Inhaled beta-agonists are drug of choice during pregnancy. Inhaled corticosteroids (eg. Budesonide) are the long-term drug of choice for pregnancyLong-acting beta agonists should not be prescribed singly, need to be combined with an inhaled corticosteroid. Ipratropium (inhaled anticholinergic) for asthma maintenance is 2 to 3 puffs 4 times/day for adults. (Rinse mouth after inhaling medication.)Children under age 12 years: 1 or 2 puffs every 6 hoursIpratropium-albuterol combination (Combivent) is a second-line quick relief medication in the treatment of asthma.Tiotropium and aclidinium are not indicated for the treatment of asthma.Black Box warning: The risks of salmeterol (Serevent) and formoterol (Foradil) outweighed the benefits and should not be used singly in asthmafor all ages.COPD:Ipratropium: 2 puffs (36 µg) 4 times/day (maximum 12 puffs per day)Ipratropium: 1 unit dose via nebulizer 3 to 4 times/day, may be mixed with albuterolIpratropium-albuterol combination (Combivent): 2 puffs 4 times/day
Tiotropium (Spiriva): 2 puffs of a single capsule once/dayAclidinium bromide (Tudorza Pressair): 1 puff twice/dayi.Treatment for mild intermittent asthma vs mild-persistent asthmab.Differentiate between short and long acting beta agonistsBeta 2 receptor agonist action:BronchodilationVasodilation in muscle and liverRelaxation of the uterus muscleRelease of insulinCan cause hyperglycemia in diabetics, arrhythmias, Drug interactions:Digitalis glycosides (eg. Digoxin): increased risk of dysrhythmiaBeta adrenergic blocking agents: direct competition for beta sites resulting in mutual inhibition of therapeutic effectsIncluding beta blocker eye drops