Antibiotics, ear drops, antifungals, pain and fever relievers, antihistamines, steroids, decongestants and cough agents on one page.
| Class and examples | Used for | Key adverse effect or caution | Key patient education | Source |
|---|---|---|---|---|
| Amoxicillin, high dose Amoxil — acute otitis media | Acute otitis media, first line (mainstay of therapy) | Higher dose overcomes Streptococcus pneumoniae resistance; step up to amoxicillin-clavulanate for severe or resistant disease or recent antibiotics | Treat 5–7 days, possibly up to 10; 5 days may be too short for severe disease | L5 slide 5 |
| Cefdinir or azithromycin Omnicef; Zithromax | Acute otitis media in penicillin-allergic patients | Up to 50% of Streptococcus pneumoniae is resistant to macrolides (azithromycin) | Complete the course (5–7 days, possibly up to 10) | L5 slide 5 |
| Ceftriaxone Rocephin — failed otitis media therapy | Failed therapy (no improvement in 3 days) or oral drugs not tolerated | Intramuscular or intravenous drug; the intramuscular course needs three visits or injections | Three intramuscular doses, one every 24 hours | L5 slide 6 |
| Amoxicillin-clavulanate Augmentin — rhinosinusitis | Acute bacterial rhinosinusitis, standard therapy (beta-lactamase producing Haemophilus influenzae); penicillin allergy: clindamycin plus cefixime, or levofloxacin | Only call it bacterial after more than 10 days of symptoms or worsening at day 5–6 | Children 10–14 days, adults 5–7 days; saline irrigations can help (use distilled or sterile water) | L5 slide 7 |
| Amoxicillin or benzathine penicillin G pharyngitis; allergy: cephalexin, clindamycin, azithromycin | Group A strep pharyngitis: amoxicillin for 10 days, or one intramuscular benzathine penicillin G injection | Mostly viral (group A strep 15–30%): use a rapid strep test to avoid over-prescribing; a positive test confirms treatment, but a negative rapid test still needs a backup culture because false negatives occur; goal is to prevent acute rheumatic fever | Finish the 10 days of amoxicillin, or accept a single injection | L5 slide 8 |
| Neomycin, polymyxin B, hydrocortisone Cortisporin ear drops | Otitis externa (otitis media is listed for otic drops as a group, but avoid this combination with tubes or a ruptured eardrum) | Neomycin: hypersensitivity. Polymyxin B: not recommended with a ruptured eardrum or tubes in place (cochlear damage, hearing loss) | Check the eardrum first | L5 slide 10 |
| Ciprofloxacin/dexamethasone Ciprodex; ofloxacin | Otitis media and otitis externa (steroid plus antibiotic drops) | Expensive | Cheaper alternative: ofloxacin drops plus ophthalmic dexamethasone | L5 slide 10 |
| Ketoconazole systemic azole antifungal | Systemic fungal infections | QTc (corrected QT interval) prolongation; hepatitis, cirrhosis, hepatic failure; hyperlipidemia; orthostatic hypotension; cytochrome P450 3A4 (CYP3A4) inhibitor | Review all other medicines for interactions | L5 slide 12 |
| Nystatin oral suspension nonabsorbable antifungal | Oral candidiasis (thrush): seen with inhaled steroids, human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS), and chemotherapy | Diarrhea, nausea, stomach pain, vomiting only | Not absorbed, so it treats the mouth and gut only | L5 slide 13 |
| Aspirin — dose ladder acetylsalicylic acid | Antiplatelet (lowest range); antipyretic-analgesic; anti-inflammatory (highest therapeutic range) | Bleeding; gastrointestinal upset and nausea; tinnitus in the anti-inflammatory range; then salicylism (hyperventilation, alkalosis, metabolic acidosis, shock, coma, death) | Ringing in the ears is the warning that exposure is too high | L5 slide 16 |
| ASPIRIN — REYE SYNDROME never for a child with a viral fever | Contraindicated: bleeding disorders, pregnancy, and children with fever from viral disease (chickenpox, influenza) | REYE SYNDROME: increased incidence in children with viral fever | Do not give aspirin to a child with chickenpox, influenza or another viral fever | L5 slide 17 |
| Reye syndrome fatty liver encephalopathy | Follows aspirin given during an upper respiratory infection, influenza or chickenpox | Children under 15; mortality 50%: vomiting, progressive central nervous system damage, hepatic injury, hypoglycemia | Vomiting with lethargy after a viral illness treated with aspirin needs urgent evaluation | L5 slide 18 |
| Aspirin — counseling Bayer | Over-the-counter fever and pain: take if fever is above 100 degrees Fahrenheit | Do not take with anticoagulants (platelet inhibition); do not combine with other nonsteroidal anti-inflammatory drugs | Follow up if fever is not held below 102 or stays above 100 for more than 3 days; follow up if pain worsens or lasts more than 10 days; drink plenty of fluids | L5 slide 20 |
| Ibuprofen Motrin, Advil | Mild to moderate pain (reversible cyclooxygenase inhibitor) | Gastric or duodenal ulcers, perforation, bleeding; edema and fluid retention; acute renal failure | Taken by mouth three to four times daily as needed for pain | L5 slide 21 |
| Naproxen Aleve | Over-the-counter nonsteroidal anti-inflammatory drug | Not listed separately | Longer half-life, so it is dosed less often | L5 slide 23 |
| ACETAMINOPHEN Tylenol | Pain and fever above 100 degrees Fahrenheit (analgesic and antipyretic) | No notable side effects at therapeutic doses, but a fixed daily maximum applies: liver damage when exceeded | Count every product that contains acetaminophen toward the daily maximum | L5 slide 24 |
| ACETAMINOPHEN — LIVER Tylenol with alcohol | — | Alcohol plus acetaminophen increases the risk of liver damage (chronically); allergy is the only contraindication | Ask about regular alcohol use and liver disease | L5 slide 25 |
| H1 antagonists (antihistamines) histamine-1 blockers | Allergic reactions (rhinitis, urticaria, insect bites, drug hypersensitivity); motion sickness, nausea, vestibular disturbances; sleep remedies | Sedation and antimuscarinic effects with first-generation agents; only an adjuvant (add-on) in anaphylaxis | Over-the-counter sleep remedies are first-generation agents | L5 slide 35 |
| First-generation H1 antagonists doxylamine (sleep aid) | Over-the-counter sleep aids (doxylamine) | Sedation is the major side effect, additive with alcohol and other depressants; restlessness and excitation at higher doses, especially in children | Second-generation agents cause much less sedation | L5 slide 32 |
| Promethazine Phenergan | Motion sickness (strongest antimuscarinic actions) | Very sedating, with the strongest antimuscarinic actions of the group (dry mouth, urinary retention, blurred vision); additive with alcohol and other central nervous system depressants | — | L5 slide 34 |
| Azelastine nasal spray Astelin | Allergic rhinitis and vasomotor rhinitis | Bitter taste and epistaxis (nosebleed) | Sprayed twice daily; stop and follow up if a nosebleed develops | L5 slide 38 |
| Nasal spray technique azelastine; the same steps apply to oxymetazoline | — | If a nosebleed develops, stop and follow up immediately; do not use with other nasal sprays | Blow the nose, tilt the head down, angle the spray away from the septum (right hand for the left nostril); do not tilt the head back; clean the tip | L5 slide 39 |
| Nasal corticosteroids beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone | Allergic rhinitis and vasomotor rhinitis | Epistaxis, septal perforation, unpleasant taste (mostly local) | No interaction information is available | L5 slide 43 |
| Nasal steroid names Beconase AQ, Rhinocort, Nasalide, Flonase, Nasonex, Nasacort | — | Many have inhaled versions for asthma | Do not mix up nasal and inhaled products (Flonase is not Flovent) | L5 slide 42 |
| Dexamethasone Decadron | Allergic rhinitis and drug hypersensitivity reactions | Fluid retention, hypertension, glucose intolerance, potassium loss, tendon rupture, eye effects, decreased resistance to infections | Weakens the immune system | L5 slide 44 |
| Dexamethasone — counseling | — | Contraindicated in systemic fungal infections | Do not discontinue abruptly if taken for more than 1 week; it weakens your immune system | L5 slide 46 |
| Prednisone and prednisolone Deltasone; Orapred (liquid) | Allergic rhinitis, allergic conjunctivitis, drug hypersensitivity reactions | Sodium and fluid retention, hypertension, low potassium, tendon rupture, pathologic fractures, cataracts, glaucoma, immune suppression | Prednisolone is the liquid formulation | L5 slide 47 |
| Prednisone — counseling | — | Allergy to the product; avoid in infections, especially fungal (relative or absolute) | Do not stop abruptly (rebound symptoms); immunocompromised: avoid exposure to chickenpox and measles, and avoid live vaccines | L5 slide 48 |
| Oxymetazoline Afrin nasal spray | Nasal congestion (alpha agonist) | Rebound rhinitis (rhinitis medicamentosa) if used more than 3–5 days; hypertension | Do not use for more than 3–5 days | L5 slide 50 |
| Pseudoephedrine Sudafed — oral decongestant | Nasal congestion from a cold, hay fever or allergies; sinus congestion; eustachian tube dysfunction from a viral infection | Tachycardia, hypertension, headache; decreased effect of antihypertensives | Oral decongestant (not a spray) | L5 slide 52 |
| Benzonatate Tessalon — antitussive | Non-productive cough | Local anesthesia of the mouth if the capsule is chewed; contraindicated in allergy to it or related products (tetracaine) | Swallow whole; do not chew, cut or crush | L5 slide 57 |
| Dextromethorphan Robitussin, Delsym — antitussive | Cough (suppresses the medullary cough center) | Confusion, excitement, agitation; serotonin syndrome with other pro-serotonergic drugs; contraindicated with a monoamine oxidase inhibitor (MAOI) taken now or within 2 weeks | Review antidepressants and the MAOI washout period | L5 slide 58 |
| Guaifenesin mucolytic, expectorant | Loosens mucus and decreases its viscosity | Nausea and vomiting; allergy is the only contraindication | No interaction information is available | L5 slide 59 |
| Guaifenesin — counseling | — | — | Drink plenty of fluid; expect an increase in drainage; follow up if symptoms last more than 7 days or worsen | L5 slide 60 |
| Dornase alfa Pulmozyme | Cystic fibrosis: reduces the viscosity of sputum, improves lung function, decreases exacerbations (mild to moderate disease) | — | Nebulized once daily | L5 slide 61 |
| Hypertonic saline 7% inhaled | Improves mucus flow, transport, airway hydration, mucociliary clearance and lung function | — | Inhaled twice daily | L5 slide 62 |
| N-acetylcysteine Mucomyst | Traditional treatment for acetaminophen toxicity; mucolytic when inhaled | Rotten-egg smell (sulfur), nausea and vomiting, bronchospasm | Expect a rotten-egg smell (high sulfur content); report wheezing after nebulization | L5 slide 63 |