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Notes/Facts/Brand vs Generic > Allergic Rhinitis, Cough and cold > Flashcards

Allergic Rhinitis, Cough and cold Flashcards

1
Q

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

class:

Indications:

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

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2
Q

Allergic rhinitis:

Background: when patient has an allergy to an _________

Symptoms include:

A

allergen (pollen, dust, pet dander)

  • sneezing
  • itchy nose
    -itchy eyes
  • itchy throat
  • thin, clear mucus
  • wheezing
  • red watery eyes
  • nasal congestion
  • rhinorrhea “ runny nose”
    -postnasal grip (when laying down, nasal thin mucus is dripping down the back of throat, which can cause itchy throat or throat irritation)
  • symptoms can last for days or months after contact with allergens
  • as long as allergen is present you are going to have those symptoms
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3
Q

Allergic rhinitis is sometimes also called _________

A

hay fever or simply “allergies”

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4
Q

The symptoms of allergic rhinitis are very similar to the symptoms of a cold. So it is very important to be able to differentiate between the to.

Symptoms of a Cold: include

-
-

A

With a Cold we see

  • a more thick dark mucus
  • going to sound like they are very congested plugged
  • have a harder time breathing
  • have more of a sore throat
  • have body aches
  • with a cold, it is a virus, you catch it and then it goes away after about a week
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5
Q

Allergic rhinitis can be

intermittent-

chronic-

A

intermittent- (exposure to animal dander when visiting a friends home)

chronic- (symptoms that last for months whenever the pollen count is elevated)

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6
Q

Non-drug Treatment for Allergic rhinitis includes:

-
-

A
  • recognize allergens and avoid exposure
  • High-efficiency particular air (HEPA) filters may help
  • Weekly vacuuming of carpets, drapes, upholstery with a HEPA vacuum cleaner

— For Dust mites: remove carpets and upholstered furniture, encase mattresses, pillows, box springs in allergen-impermeable covers, wash bedding and soft toys in hot water every 1-2 weeks

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7
Q

What can be used to determine patient specific allergens?:

A

an IgE-mediated skin prick test or blood test:

common allergens include:

  • pollens from trees, grasses and weeds
  • molds, both indoor and outdoor
  • dust mites that live in bedding, carpeting and other items that hold moisture
  • animal dander from furred animals such as cats and dogs, horses and rabbits
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8
Q

Other things we can do for allergic rhinitis include:

A

Nasal Irrigation: just cleaning out the nasal passages

Wetting agents: helps keep nasal passages wet

Both provide symptom relief by reducing nasal stuffiness, runny nose and sneezing.

Nasal gels with petrolatum can be applied around the nostrils to physically block pollens and allergens from entering the nose.
These products are considered safe for most populations, including children and pregnant women.

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9
Q

Wetting agents are commercially available and contain saline, propylene or polyethylene glycol, which provide moisture and reduce irritation to the nasal passages.

examples:

A

Ocean
Little remedies
Simply Saline

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10
Q

Nasal Irrigation uses an isotonic (0.9%) or hypertonic (2-3.5%) saline solution, made with salt and water, to rinse out allergens and mucus, improve ciliary function and reduce swelling.

examples:

A

Neil Med Sinus Rinse

-Nasal irrigations can be administered using a syringe or Netipot (the prepared saline solution is then poured into one nostril and drained out of the other nostril)

the water used for nasal irrigation should be boiled and cooled OR used with distilled water to prevent passage of infection.

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11
Q

Drug Treatment for Allergic rhinitis:
- depends on severity of illness and symptoms (Mild Moderate Severe, if acute or chronic)
- is it more of an eye symptom vs. nose symptom

-
-
-

A
  • intranasal steroids (1st line for moderate to severe symptoms, chronic)
  • 1st generation antihistamines (milder symptoms)
  • 2nd generation antihistamines (milder symptoms)
  • decongestants (can be used if congestion is present)
  • mast cell stabilizer
  • leukotriene receptor antagonist (reserved for last time patients who can use other options)
  • immunotherapy (severe allergies)
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12
Q

Intranasal steroids work by __________.

They are effective __________

We use in ___________

A

-decreasing inflammation.

  • in reducing the nasal symptoms for allergic rhinitis ( sneezing, itching, rhinorrhea, congestion).
  • they don’t work right away, will have some affect, but take a little bit of time to build up.
  • chronic allergic rhinitis

** Note the same steroids used to treat allergic rhinitis and asthma have different Brand Names AND Delivery systems**

Allergic rhinitis - Steroids - Intranasal

ex. fluticasone for allergic rhinitis comes as intranasal inhaler as Flonase.

Asthma - Steroids - oral Inhaler

ex. fluticasone for asthma comes as oral inhaler as Flovent.

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13
Q

Antihistamines 1st generation

work by __________.

They are effective __________

We use in ___________

Examples:

A

“pretty sedating”

use more for intermittent symptoms. They work right away.

Benadryl

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14
Q

Antihistamines 2nd generation

work by __________.

They are effective __________

We use in ___________

Examples:

A

usually preferred since less sedation

use more for intermittent symptoms. They work right away.

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15
Q

Rhinocort Allergy -rhin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

-preferred in pregnancy!

A

budesonide

class: corticosteroid

Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis

MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.

Dosage forms: intranasal steroid

Dosing:

Max dose:

Contraindications:

Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use

Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation

Monitoring:

Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?

  • effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)

Drug-Drug/Food interactions:

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16
Q

What oral inhaler form of budesonide is indicated for Asthma Treatment?

A
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17
Q

Flonase Allergy Relief -nas

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

fluticasone

class: corticosteroid

Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis

MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.

Dosage forms: intranasal steroid

Dosing:

Max dose:

Contraindications:

Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use

Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation

Monitoring:

Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?

  • effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)

Drug-Drug/Food interactions:

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18
Q

what oral inhaler form of fluticasone is used for Asthma Treatment?

A

Flovent

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19
Q

Nasacort Allergy 24HR -nas

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

triamcinolone

class: corticosteroid

Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis

MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.

Dosage forms: intranasal steroid

Dosing:

Max dose:

Contraindications:

Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use

Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation

Monitoring:

Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?

  • effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)

Drug-Drug/Food interactions:

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20
Q

what oral inhaler form of triamcinolone is used for Asthma Treatment?

A
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21
Q

Beconase AQ -nas

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

beclomethasone

class: corticosteroid

Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis

MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.

Dosage forms: intranasal steroid

Dosing:

Max dose:

Contraindications:

Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use

Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation

Monitoring:

Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?

  • effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)

Drug-Drug/Food interactions:

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22
Q

Qnasl -nas

A

beclomethasone

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23
Q

what oral inhaler form of beclomethasone is used for Asthma Treatment?

A
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24
Q

Zetonna

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

ciclesonide

class: corticosteroid

Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis

MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.

Dosage forms: intranasal steroid

Dosing:

Max dose:

Contraindications:

Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use

Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation

Monitoring:

Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?

  • effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)

Drug-Drug/Food interactions:

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25
Q

Omnaris

A

ciclesonide

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26
Q

what oral inhaler form of ciclesonide is used for Asthma Treatment?

A
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27
Q

Nasonex -nas

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

mometasone

class: corticosteroid

Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis

MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.

Dosage forms: intranasal steroid

Dosing:

Max dose:

Contraindications:

Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use

Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation

Monitoring:

Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?

  • effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)

Drug-Drug/Food interactions:

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28
Q

what oral inhaler form of mometasone is used for Asthma Treatment?

A
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29
Q

What are the preferred nasal steroids in pregnancy?

A

budesonide & beclomethasone

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30
Q

Benadryl

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

diphenhydramine

class: 1st- generation antihistamines

Indications: Mild-Moderate symptoms, Intermittent, of Allergic Rhinitis

MOA: works by blocking histamine at the histamine-1 (H1) receptor site. Reduces symptoms of itching, sneezing, runny nose BUT NOT congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications: neonates or premature infants, breastfeeding

Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation

Side Effects:

Monitoring:

Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death

Drug-Drug/Food interactions:

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31
Q

Chlor-Trimeton

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

chloropheniramine

class: 1st- generation antihistamines

Indications: Mild-Moderate symptoms, Intermittent of Allergic Rhinitis

MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications: neonates or premature infants, breastfeeding

Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation

Side Effects:

Monitoring:

Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death

Drug-Drug/Food interactions:

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32
Q

Aller-Chlor

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

chloropheniramine

class: 1st- generation antihistamines

Indications: Mild-Moderate symptoms of Allergic Rhinitis

MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications: neonates or premature infants, breastfeeding

Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation

Side Effects:

Monitoring:

Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death

Drug-Drug/Food interactions:

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33
Q

Unisom (for sleep)

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

doxylamine

class: 1st- generation antihistamines

Indications: Mild-Moderate symptoms of Allergic Rhinitis

MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications: neonates or premature infants, breastfeeding

Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation

Side Effects:

Monitoring:

Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death

Drug-Drug/Food interactions:

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34
Q

Dayhist Allergy 12 HR relief

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

clemastine

class: 1st- generation antihistamines

Indications: Mild-Moderate symptoms of Allergic Rhinitis

MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications: neonates or premature infants, breastfeeding

Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation

Side Effects:

Monitoring:

Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death

Drug-Drug/Food interactions:

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35
Q

Karbinal ER

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

carbinoxamine

class: 1st- generation antihistamines

Indications: Mild-Moderate symptoms of Allergic Rhinitis

MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications: neonates or premature infants, breastfeeding

Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation

Side Effects:

Monitoring:

Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death

Drug-Drug/Food interactions:

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36
Q

Ryvent

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

carbinoxamine

class: 1st- generation antihistamines

Indications: Mild-Moderate symptoms, Intermittent of Allergic Rhinitis

MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications: neonates or premature infants, breastfeeding

Warnings:
- Caution in elderly patients with Prostate Enlargement (BPH), Glaucoma, Sjogren’s Syndrome, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation

Side Effects:

Monitoring:

Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death

Drug-Drug/Food interactions:

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37
Q

also a 1st generation antihistamine

A

hydroxyzine

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38
Q

also a 1st generation antihistamine

A

meclizine

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39
Q

also a 1st generation antihisamine

A

promethazine

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40
Q

diphenhydramine in pharmacy is everywhere!

It has many indications which include:

-
-
-

A
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41
Q

Zyrtec

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

class: 2nd-generation antihistamine (preferred over 1st generation due too less sedation)

Indications:

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- response is patient specific

Drug-Drug/Food interactions:

42
Q

All Day Allergy

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

certirizine

43
Q

Xyzal Allergy 24HR

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

levocertirizine

44
Q

Allegra Allergy

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:

Pearls/Notes:
- take with water (NOT fruit juice due to decreased absorption), Avoid administration with aluminum or magnesium containing products

Drug-Drug/Food interactions:
- Avoid use with erythromycin and ketoconazole

A

fexofenadine

45
Q

Claritin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

loratadine

46
Q

Alavert

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

loratadine

47
Q

Clarinex

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

desloratadine

48
Q

Astepro

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

azelastine

49
Q

Astelin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

azelastine

50
Q

Dymista

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

azelastine + fluticasone

51
Q

Patanase

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

olopatadine

52
Q

-
-
What age cut off can individuals use these?

A

Astelin
Astepro

5 years and older

53
Q

Which 2nd generation antihistamines are preferred in pregnancy?

A

cetirizine and levocetirizine

54
Q

Which 2nd generation antihistamines have formulation which can have phenylalanine AND that we would want to avoid in patients with PKU?

A

fexofenadine, loratadine, desloratadine

55
Q

Within the class of 2nd generation antihistamines, which are more sedating compared to the others?

A

cetirizine & levocetirizine

56
Q

Oral Decongestants include:

A
  • (PE) phenylephrine
  • (PSE) pseudoephedrine
57
Q

Sudafed PE

class:
Indications:
MOA:
Dosage forms:
**Dosing:
**Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:

Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
- has low bioavailability (< or = 38%)

Drug-Drug/Food interactions:

A

phenylephrine

class: decongestant, alpha-adrenergic agonist (sympathomimetic)

Indications: For Nasal Congestion in allergic rhinitis or due to cold

MOA: works by causing vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications:
**DO NOT USE within 14 days of MAO inhibitors.

Warnings:
** Avoid in children < 2 years old (FDA), < 4 years (according to package labeling)
** Use with caution in patients with *CV disease and uncontrolled hypertension (can increase BP), hyperthyroidism (can worsen), diabetes (can increase BG), bowel obstruction, glaucoma (can increase IOP) *BPH (can cause urinary retention), the elderly

Side Effects:
- cardiovascular stimulation *(tachycardia, palpitations, increase blood pressure),
- CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations)
*- decrease appetite,

Monitoring:

Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
-pseudoephedrine is more effective
- Onset of 15-60 minutes

Drug-Drug/Food interactions:

58
Q

Zephrex-D

class:
Indications:
MOA:
Dosage forms:
**Dosing:
**Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

pseudoephedrine

class: decongestant, alpha-adrenergic agonist (sympathomimetic)

Indications: For Nasal Congestion in allergic rhinitis or due to cold

MOA: works by causing vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications:
**DO NOT USE within 14 days of MAO inhibitors.

Warnings:
** Avoid in children < 2 years old (FDA), < 4 years (according to package labeling)
** Use with caution in patients with *CV disease and uncontrolled hypertension (can increase BP), hyperthyroidism (can worsen), diabetes (can increase BG), bowel obstruction, glaucoma (can increase IOP) *BPH (can cause urinary retention), the elderly

Side Effects:
- cardiovascular stimulation *(tachycardia, palpitations, increase blood pressure),
- CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations)
*- decrease appetite,

Monitoring:

Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
-pseudoephedrine is more effective
- Onset of 15-60 minutes

Drug-Drug/Food interactions:

59
Q

Nexafed

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

pseudoephedrine

class: decongestant, alpha-adrenergic agonist (sympathomimetic)

Indications: For Nasal Congestion in allergic rhinitis or due to cold

MOA: works by causing vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications:
**DO NOT USE within 14 days of MAO inhibitors.

Warnings:
** Avoid in children < 2 years old (FDA), < 4 years (according to package labeling)
** Use with caution in patients with *CV disease and uncontrolled hypertension (can increase BP), hyperthyroidism (can worsen), diabetes (can increase BG), bowel obstruction, glaucoma (can increase IOP) *BPH (can cause urinary retention), the elderly

Side Effects:
- cardiovascular stimulation *(tachycardia, palpitations, increase blood pressure),
- CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations)
*- decrease appetite,

Monitoring:

Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
-pseudoephedrine is more effective
- Onset of 15-60 minutes

Drug-Drug/Food interactions:

60
Q

Sudafed

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

pseudoephedrine

class: decongestant, alpha-adrenergic agonist (sympathomimetic)

Indications: For Nasal Congestion in allergic rhinitis or due to cold

MOA: works by causing vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion.

Dosage forms:

Dosing:

Max dose:

Contraindications:
**DO NOT USE within 14 days of MAO inhibitors.

Warnings:
** Avoid in children < 2 years old (FDA), < 4 years (according to package labeling)
** Use with caution in patients with *CV disease and uncontrolled hypertension (can increase BP), hyperthyroidism (can worsen), diabetes (can increase BG), bowel obstruction, glaucoma (can increase IOP) *BPH (can cause urinary retention), the elderly

Side Effects:
- cardiovascular stimulation *(tachycardia, palpitations, increase blood pressure),
- CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations)
*- decrease appetite,

Monitoring:

Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
-pseudoephedrine is more effective
- Onset of 15-60 minutes

Drug-Drug/Food interactions:

61
Q

Afrin

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

oxymetazoline

class: topical nasal decongestant

Indications: For Nasal Congestion in allergic rhinitis or due to cold

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:
- DO NOT USE FOR MORE THAN 3 DAYS! (Can cause Rhinitis medicamentosa “rebound congestion”. It will make the original congestion even worse.

Warnings:
- Do NOT use with MAO inhibitors or if patients have closed angle glaucoma

Side Effects:

Monitoring:

Pearls/Notes:
Fast onset = (5-10 minutes)

Drug-Drug/Food interactions:

62
Q
A
63
Q

Combat Methamphetamine Epidemic Act 2005:

A
  • Limits sales of PSE to 3.6 grams/ day (120 tablets of 30mg tabs) and 9 grams per 30-day period (EXCEPTION: 60mg single pack)
  • Behind the counter or in a locked cabinet, requires ID and signature
64
Q

To combat the methamphetamine epidemic, there are restricted sales of non-prescription products containing: ________

A
  • pseudoephedrine
  • phenylpropanolamine
  • ephedrine

“since these can all be easily converted to methamphetamine”

65
Q

NasalCrom

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

cromolyn

class: Intranasal mast cell stabilizer

Indications: For Tx and Prophylaxis of allergic rhinitis

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
OTC
- start using at onset of allergy season
- dosed every 6-8 hours regularly (not as needed)
- symptom improvement can be seen within 4-7 days but maximal effect in 2-4 weeks
- good safety profile: can be used in children > or = 2 years old and in pregnancy

Drug-Drug/Food interactions:

66
Q

Singulair

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

montelukast

class: leukotriene receptor antagonist

Indications: For both Allergic rhinitis & Asthma
- For Allergic rhinitis, it should be reserved for those who are unable to be treated effectively with other medications.

MOA:

Dosage forms: oral tablet

Dosing: Is dosed once daily

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- commonly used in children
- is the only leukotriene modifying agent

Drug-Drug/Food interactions:

67
Q

Atrovent

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

ipratropium bromide

class:

Indications:

MOA:

Dosage forms: intranasal

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- useful to decrease rhinorrhea but not effective for other nasal symptoms

Drug-Drug/Food interactions:

68
Q

For very severe allergies patients can receive ______

A

immunotherapy: is a preventative treatment for allergies either SC or SL. They work by slowly increasing exposure to the allergen, making the immune system less sensitive to the substance.

recommended treatment is minimum for 3 years.

69
Q

what are the 4 FDA approved SL treatments for allergic rhinitis that are tailored to specific allergens?

A

Oralair
Grastek
Ragwitek
Odactra

*very first dose must be given in a doctors medical office

70
Q
A
71
Q

Cough and Cold is commonly caused by __________

A

viruses (rhinovirus, coronavirus, influenza)

72
Q

The common cold, a viral infection of the upper respiratory tract, is transmitted by _________.

Transmission is best prevented by _________

A

mucus secretions (via patients’ hand) or by the air (from coughing or sneezing)

frequent hand washing

73
Q

Cold

  • No fever, some body aches
  • cough, if present, is due to post-nasal drip
  • More nasal symptoms (runny or clogged nose)
A
74
Q

coughs that are associated with colds are usually ____________

A

nonproductive, dry coughs

75
Q

Drug treatment: with natural products- “ that are “possibly effective” for Colds include:

-
-

A

-Zinc: For treatment -
start within 48 hours and use as directed (every 2 hours while awake)
Do Not Use > for longer than 5-7 days (can cause copper deficiency)
Do Not Use zinc nasal swabs or sprays (can cause loss of smell)

  • vitamin C (ascorbic acid): For treatment- (1-3 grams/day)
    may reduce duration of cold
  • Echinacea: For treatment
    may reduce duration of cold
  • Airborne & Emergen-C - vitamin C, E, zinc, echinacea - No known benefit
76
Q

Zinc lozenges can cause

A

mouth irritation, a metallic taste and nausea

Zinc nasal formulations were removed from market due to causing loss of smell

77
Q

vitamin C doses of 4 grams or more can cause

A

diarrhea and possibly kidney stones

78
Q

Drug treatment for Colds includes classes of

-

A

expectorants

cough suppressants

decongestants

analgesics/antipyretics

79
Q

Mucinex

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

guaifenesin

class: expectorant/mucolytic

Indications: used to treat a productive, Wet cough

MOA: thins out mucus and makes it easier to cough phlegm out of airway tract

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

80
Q

Robitussin Mucus + Chest Congestion

A
81
Q

Robafen

A
82
Q

Robafen DM

A

dextromethorphan (DM) + guaifenesin

83
Q

Robitussin DM

A

dextromethorphan (DM) + guaifenesin

84
Q

Delsym

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

dextromethorphan (DM)

class: cough suppressant

Indications: Indicated for dry, nonproductive cough

MOA: it blocks the cough reflex center in the brain. “has a high affinity for the medullary cough center”
- also acts as a serotonin reuptake inhibitor –> risk of serotonin syndrome

-High doses then it also acts as a NMDA-receptor blocker –> euphoric & hallucinogenic properties

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:
- product has been abused for euphoric properties
- 2012 - CA banned sales to minor (must be > or = 18 years old to purchase)
Max dose is 120mg/day

Drug-Drug/Food interactions:

85
Q

Codeine

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

C-II, when given by itself

class: cough suppressant

Indications: For dry, non-productive cough

MOA: acts centrally on respiratory center in the medulla to increase the cough threshold

Dosage forms:

Dosing:
Adult - 7.5-120mg PO as a single dose or divided doses

Max dose:

Contraindications:
- *DO NOT USE in children < 12 years of age (any indication) or in children < 18 years of age after tonsillectomy and/or adenoidectomy

Warnings:
- *Respiratory depression and death have occurred in children who receive codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to CYP2D6 polymorphism
- *deaths have also occurred in nursing infants after being exposed to high concentrations of morphine from mothers who were ultra rapid metabolizers

Side Effects:

Monitoring:

Pearls/Notes:
- ** The FDA recommends to AVOID codeine-containing cough and cold products for patients < 18 years of age

Drug-Drug/Food interactions:

86
Q

what schedule is codeine as a single entity?

A

Schedule C-II

87
Q

what schedule is codeine as a combination product?

A

Schedule C-V

88
Q

Codeine products containing one or more non-codeine active ingredients and no more than 200mg of codeine per 100mL are scheduled ____

A

C-V drugs

88
Q

Tessalon Perles

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

A

benzonatate

class: cough suppressant/topical anesthetic

Indications:

MOA: suppresses cough by a topical anesthetic action on the respiratory stretch receptors

Dosage forms:

Dosing: 100-200mg PO TID PRN

Max dose: 600mg/day

Contraindications:

Warnings: DO NOT USE in children < 10 years if age; accidental and fatal overdose has been reported

Side Effects: somnolence, confusion, hallucinations

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

89
Q

the abbreviation DM means the product has

A

dextromethorphan

90
Q

Cough Suppressants are used for ____________

A

dry, nonproductive cough or to suppress cough at night to allow for restful sleep.

91
Q

the abbreviation D means the product has a

A

decongestant

92
Q

the abbreviation AC means the product has

A

codeine

93
Q

the abbreviation PE, means the product has

A

phenylephrine

94
Q

Pediatric Cough and Cold treatment:

For Children < 2 years old,

A

AVOID OTC cough and cold products (FDA)

AVOID promethazine (FDA)

AVOID topical menthol and camphor (package labeling)

95
Q

Pediatric Cough and Cold treatment:

For children < 4 years old,

A

AVOID OTC cough and cold products (package labeling)

96
Q

Pediatric Cough and Cold treatment:

For children < 18 years old

A

AVOID codeine and hydrocodone-containing cough and cold products (FDA)

97
Q

Pediatric Cough and Cold treatment:

For children < 12 years of age

A

AVOID codeine-containing products (FDA)

98
Q

Dosing of Tylenol in pediatric patients

A
  • 10-15mg/kg every 4-6 hours
  • Do NOT EXCEED 5 doses in 24 hours
  • infant drops/children’s liquid = 160mg/5mL
  • use measuring device that comes with the medication
99
Q

Dosing of Ibuprofen in pediatric patients

A
  • 5-10 mg/kg every 6-8 hours
  • DO NOT EXCEED 40mg/kg/day
  • infant drops = 50mg/1.25mL
  • children’s liquid = 100mg/5 mL
  • use measuring device that comes with the medication
100
Q

We do NOT want to use aspirin in pediatric patients/children because of the risk of inducing __________

A

Reyes Syndrome

Never Aspirin in less than 16 years old

101
Q
A

Notes/Facts/Brand vs Generic (23 decks)

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