1. Name of the location of 90% of epistaxis
2. A genetic disorder that forms AV malformations in the skin, lungs, brain etc
3. Name of posterior vascular plexus in the nasal cavity causing posterior epistaxis
4. 1st line treatment for all epistaxis
5. The common brand name for anterior nasal packing
6. Chemical used in cautery sticks
7. Physically scaring complication of posterior nasal packing with foleys catheter
Coming soon..
Nasal steroids
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Administered as a spray or drops
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Bind to glucocorticoid receptors and exert an anti-inflammatory effect.
- decrease activation of macrophages and T cells increase synthesis of annexin-1
- inhibit release of inflammatory mediators such as histamine, prostaglandins, leukotrienes and cytokines
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Reduce swelling, oedema and cause vasoconstriction
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2nd generation steroids (mometasone, fluticasone) are more lipophilic so greater deposition (30%) in respiratory tract tissue. 70% is absorbed systemically and rapidly passes through first pass metabolism.
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Betamethasone (1st generation steroid) administered as drops and has most systemic bioavailability and highest probability of systemic side effects.
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Similar response and effectiveness of all steroids via nasal route
Side effects
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Nasal dryness, epistaxis, irritation in nose & mouth
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Unpleasant taste/smell
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Caution in glaucoma - theoretic risk of raised intraocular pressure, headache. Seek advice of ophthalmology
* pregnancy: risk of systemic effects increase with prolonged use. Use for a short a time as necessary
* children: monitor growth with prolonged use due to increased risk of systemic absorption
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