540 - Drug Delivery Systems - Exam Iv - Otic Delivery

Front 1

What parts make up the outer ear?

Back 1

1) Pinna
2) External auditory canal

Front 2

What parts make up the middle ear?

Back 2

1) Tympanic Membrane (Ear Drum)
2) Auditory Ossicles
3) Middle Ear Cavity
4) Eustachian Tube

Front 3

What parts make up the middle ear?

Back 3

1) Oval Window
2) Round Window
3) Cochlea
4) Semi-circular canals

Front 4

What are the bones that make up the auditory ossicles?

Back 4

Malleus, Incus, Stapes

Front 5

What is the pinna?

Back 5

The skin-lined outer structure that funnels sound into the ear canal

Front 6

What is another name for the external auditory canal?

Back 6

The ear canal

Front 7

What are some facts pertaining to the ear canal?

Back 7

1) 2.5 cm in length --> Ends at ear drum
2) Skin lining is very thin, small amount of inflammation leads to increased pain sensitivity
3) Has glands which secrete ear wax
4) Easily accessible for drug delivery

Front 8

What is serete cerumen?

Back 8

Ear wax

Note: Not for consumption over the age of 6

Front 9

What is the purpose of the ossicles?

Back 9

To amplify and transmit sound into the inner ear

Front 10

What are some facts pertaining to the middle ear?

Back 10

1) It is a small, pea-sized chamber
2) It is filled with air, connected to the nasopharynx by eustachian tubes to equilibrate air pressure
3) Accessible to drug delivery only through the ear drum

Front 11

How does the cochlea work?

Back 11

A snail shaped organ, full of fluid and cilated hair cells with are stimulated via fluid movement from sound vibrations. An electrical signal is then transmitted to the brain.

Front 12

What happens when one has hearing loss?

Back 12

It is a loss of hair cells due to excessive noise, drug toxicity and aging

Front 13

What are some advantages to otic drug delivery?

Back 13

1) Significantly higher concentration of drug at infection site
2) Avoids first pass effect
3) No systemic effect because of small dose administered
4) Less expensive
5) Patient compliance

Front 14

What are some disadvantages to otic drug delivery?

Back 14

1) Effective delivery to the infected site may be difficult or impossible
2) Possible ototoxicity within the middle and/or inner ear
3) Sensitivity at the site of administration

Front 15

What are the classes of drugs used for ear infections and inflammations?

Back 15

Antibiotics, Corticosteroids, Analgesics

Front 16

Where does ear wax come from?

Back 16

Dead skin and other debris combine with secretions from sebaceous and modified sweat glands to create earwax

Front 17

What is the purpose of ear wax?

Back 17

1) Lubricates ear canal
2) Removes debris and germs ("Self-Cleaning")

Front 18

What causes a buildup of ear wax?

Back 18

1) Excessive accumulation due to overactive glands, narrow ear canal, excess hair in ear canal or inefficient chewing or talking (elderly)
2) Improper removal with q-tips, etc which push wax further into the ear canal

Front 19

What are some ear wax softening agents?

Back 19

1) Carbamide Peroxide (releases oxygen --> Loosens wax)
2) Olive oil, mineral oil, glycerin, baking soda
3) Cerumenolytics - for severely impacted ear wax

Front 20

What is Otitis Externa?

Back 20

"Swimmer's Ear" - Inflammation of the external ear canal caused by water accumulation, hot weather and humidity. Softening and swelling of the ear wax occurs which lowers its protective functions while increasing pH leading to bacterial invasion.

Front 21

What is the organism which usually causes Otitis Externa?

Back 21

Pseudomonas aeruginosa

Front 22

What are the symptoms of Otitis Externa?

Back 22

1) Itching
2) Pain
3) Discharge
4) Loss of hearing

Front 23

What is the treatment for Otitis Externa?

Back 23

*No OTC Treatment*
Rx antibiotic/steroid combination, analgesics, local anesthetic

Front 24

How do you prevent Otitis Externa?

Back 24

1) Drain water out of ear after swimming/showering
2) Use ear plugs if frequent occurrence
3) Dry ear with 50/50 solution of isopropyl alcohol and white vinegar

Front 25

What is Otitis Media?

Back 25

An infection of the middle ear. It is the most common infection in children after the common cold.

Front 26

What organism(s) typically causes Otitis Media?

Back 26

S. pneumoniae and H. influenzae - most frequent upper respiratory organisms eater middle ear via eustachian tubes

Front 27

What are the symptoms of Otitis Media?

Back 27

1) Pain
2) Fever
3) Discharge
4) Decreased hearing

Front 28

What is the treatment for Otitis Media?

Back 28

Oral antibiotics - Local administration not possible due to tympanic membrane

Front 29

What is the eustachian tube?

Back 29

Normalizes pressure on both sides of the ear drum.

Front 30

What is the problem with eustachian tubes in children?

Back 30

It is more horizontal limiting the movement of air and fluid. This allows it to trap bacteria, swell and push on the ear drum causing it to become red, swollen and painful.

Front 31

What are nine facts to remember about ear drop solutions?

Back 31

1) Ease of use, inexpensive
2) Poor residence time --> The drops drain out
3) pH, viscosity, tonicity influence bioavailability
4) Wide pH range (3.5-7.5)
5) Increase viscosity with propylene glycol, oils, polymers
6) Isotonicity not required, but preferred
7) Sterility to minimize risk of spreading infection
8) Preservatives for multi-dose products
9) Warm solution in hands to prevent vertigo

Front 32

What are other options for otic delivery?

Back 32

1) Suspensions - For external infections
2) Ointments and powders Not common due to discomfort, irritation and hearing loss
3) Injection of drugs into the middle ear cavity
4) Fully implantable pumps
5) Biodegradable polymers

Front 33

What drugs can cause ototoxicity?

Back 33

Aminoglycoside Antibiotics - Gentamicin, streptomycin, kanamycin, tobramycin, neomycin

Front 34

Which drugs are toxic to the vestibular (Balance) portion of the inner ear?

Back 34

Gentamicin and Streptomycin

Front 35

What drug(s) are used to treat Meniere's Disease and how do they work?

Back 35

Gentamicin - ablate hair cells to improve balance

Front 36

Which drug(s) are toxic to the cochlear part of the inner ear?

Back 36

Neomycin

Front 37

What other component of otic drugs are ototoxic?

Back 37

Formulation solvents (propylene glycol)

Front 38

Describe the pain, hearing loss, bilateral symptoms and whether or not to self-medicate for impacted cerumen (ear wax)

Back 38

Pain - Rarely
Hearing loss - Often
Bilateral Symptoms - Rarely
Self-Medication - Yes - Carbamide Peroxide

Front 39

Describe the pain, hearing loss, bilateral symptoms and whether or not to self-medicate for bacterial external otitis

Back 39

Pain - Often
Hearing loss - Possibly
Bilateral Symptoms - Possibly
Self-Medication - Never

Front 40

Describe the pain, hearing loss, bilateral symptoms and whether or not to self-medicate for suppurative otitis media

Back 40

Pain - Usually
Hearing loss - Possibly
Bilateral Symptoms - Occasionally
Self-Medication - Never