Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Local Anesthetics, Amides
Class Summary
Local anesthetics block the initiation and conduction of nerve impulses. Anesthetics used for the cystoscopy include lidocaine.
Lidocaine (Xylocaine)
Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. Topical 2% or 4% lidocaine (Xylocaine) is a commonly used anesthetic. Administer local lidocaine sprays into the nostril. Its onset of action is 1-5 minutes and duration of action is 15-30 minutes. One to two sprays per nostril may be applied.
Topical Vasoconstrictors
Class Summary
Topical vasoconstrictors act on alpha-adrenergic receptors in the nasal mucosa, causing vessels to constrict.
Oxymetazoline 0.05% (Afrin, Dristan 12Hr, Duramist Plus, Nostrilla, Vicks Sinex 12 Hr)
Oxymetazoline is applied directly to mucous membranes, where it stimulates alpha-adrenergic receptors and causes vasoconstriction. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation.
Oxymetazoline may be used in combination with lidocaine 4% to provide effective nasal anesthesia and vasoconstriction. It may be useful to examine the native nose prior to application and then again after decongestion.
If epistaxis is evoked by the procedure, 2-3 sprays/nostril of oxymetazoline nasal spray should be sprayed into the nose and firm nasal pressure applied for 10-15 minutes.
Antibiotics
Class Summary
If a patient requires nasal packing, an antibiotic with gram-positive coverage such as cephalexin (Keflex) or clindamycin (Cleocin) (if penicillin allergic) should be prescribed while the packing is in place, as cases of toxic shock syndrome due to nasal packing have been reported.
Cephalexin (Keflex)
Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. Cephalexin's primary activity is against skin flora; the drug is used for skin infections or prophylaxis in minor procedures.
Clindamycin (Cleocin HCl)
Clindamycin is a lincosamide used for treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). It inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
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Example of flexible rhinoscopy through the left nasal passage.
