less sedating 1st Gen Antihistamine Bromphe-niramine Chlorphe-niramine Dexbromphe-niramine

MORE SEDATING \> Alkylamine 1st Gen Antihistamine Clemastine Diphenhydramine

39 - Allergic Rhinitis Flashcards by Karlo Sison

Etiology of
PERENNIAL ALLERGIES

WHAT TREATMENT FOR PERENNIAL?

Dust Mites / INDOOR Molds / Occupational Allergens

PET dander / Cockroaches

Cetirizine + Levocetirizine

Desloratadine / Azelastine

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Etiology of
SEASONAL ALLERGIES

WHAT TREATMENT FOR SEASONAL?

FALL + SPRING

Tree / Grass / Pollen / Mold Spores / Ragweed

ALL DRUGS INDICATED FOR SEASONAL

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Environmental Controls

for ALLERGIES

LOWER HUMIDITY <40%

HEPA FILTERS

Vacuum Often / remove Carpets

ALLERGEN COVERS

Wash Clothes / Clean Mold

Elminiate Cockroaches / Keep pets OUT of bedroom / Remove Plants

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Non-Pharmacologic Therapy

Allergies

EXERCISE
increases Sympathetic Tone
effective if produces perspiration for 15-30 min daily

Saline Irrigation
Soothes nasal tissues
<6 y/o = 2-3 drops QID
>6 y/o = 2 sprays QID

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1st Gen Antihistamines

Uses

Prevent & Relieve: Wet Symptoms

does NOT relieve NASAL CONGESTION

*SEDATING -** crosses BBB
*Ethanolamines > alkylamines** in sedation

AC Symptoms

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Alkylamines

less sedating*
*1st Gen Antihistamine**

Bromphe-niramine

Chlorphe-niramine

Dexbromphe-niramine

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Ethanolamines

*MORE SEDATING** > Alkylamine
*1st Gen Antihistamine**

Clemastine

Diphenhydramine

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Loratadine

Indication / Dose / ADR

Seasonal Rhinitis

2y/o +

>6 y/o - 10mg QD

HA / Somnolence / Fatigue / Dry mouth

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Cetirizine

Indication / Dose / ADR

BOTH
seasonal + perennial rhinitis

2 y/o+

>6yo - 10mg QD

DROWSINESS WARNING

tiredness / dry mouth

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Levocetirizine

Indication / Dose / ADR

BOTH
seasonal & perennial rhinitis

IN PM & GOOD FOR 6MONTHS+

6-11 y/o = 2.5 mg daily in PM

12+ = 5mg QD in PM

SLEEPINESS*
*diarrhea / nose bleeds**

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Desloratadine

Indication / Dose / ADR

RX ONLY

BOTH
seasonal & perennial rhinitis

GOOD FOR 6MO+

12 y/o + = 5mg QD

Somnolence*
*pharyngitis / dry mouth / fatigue**

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Fexofenadine

Seasonal Rhinitis Only

2 y/o+

12y/o+ = 60mg BID or 180mg QD

LEAST EFFECTIVE

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Which ORAL Allergy Medications are

CATEGORY C - Pregnancy

FEXOFENADINE // DES-Loratadine

Brompheniramine

most other drugs are CATEGORY B

Lactation:
Recommend to AVOID

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Azelastine = Astepro 0.5%

Type / Indication / ADR

INTRANASAL ANTIHISTAMINE

*BOTH**
*Seasonal + Perennial**

12 y/o +
2 sprays EN QD

Pregnancy CAT C & caution in nursing

ADR:
Bitter Taste / SEDATION / nasal discomfort / epistaxis

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Which INTRANASAL Antihistamines

are PREGNANCY CATEGORY C?

AZELASTINE

OLOPADINE

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Olopatadine = Patanase

Type / Indication / ADR

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Intranasal ANTIHISTAMINE

Seasonal Only

6+ y/o
12 y/o + = 2S EN BID

Pregnancy CAT C & caution in Nursing

BITTER TASTE & SEDATION

Intranasal Decongestants

Drugs / Use / ADR

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-ZOLINE
Naphazoline / Oxymetazoline / Tetrahydrozoline / Xylometazoline
+ Phenylephrine

REDUCE NASAL CONGESTION

ADR:
Nasal Irritation / dryness / Sneezing
REBOUND CONGESTION = RHINITIS MEDICAMENTOSA
Use only for 3-5 Days MAX
Use b4 Intranasal Corticosteroid

Intranasal Decongestants

Drugs & Doses

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*-ZOLINE**
*TNPXO** - 4-6-6-8-12

–Tetrahydrozoline: 3 sprays Q4H

–Naphazoline: 2 sprays Q6H

–Phenylephrine: 2 sprays Q6H

–Xylometazoline: 2 sprays Q8H

–Oxymetazoline: 2 sprays Q12H

Pseudophedrine

Type / Indication / ADR

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Oral Decongestant

2+ y/o
>12 y/o
60 mg Q6H

ADR:
CNS / CV Stimulation
↑BP / HR / IOP

Contraindications:
MAO inhibitors / uncontrolled HT / CAD / Glaucoma

Phenylephrine

Type / Indication / ADR

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Oral Decongestant

> 12 y/o
10mg po q4h
max 60mg qd

CI:
MAOi / uncontrolled HTN / HYPERthyroidism / BPH

Ipratropium Bromide 0.06% = Atrovent

Type / Indication / ADR

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*ANTICHOLINERGIC**
Seasonal Rhinitis Only*

Decreases NASAL MUCUS secretion

Dose: 2S EN QID

ADR: HA + Epistaxis

CI:
Angle closure glaucoma / Prostatic Hypertrophy

Cromolyn Sodium = NasalCrom

Type / Indication / ADR

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*Mast Cell Stabilizer**
not as effective*

PROPHYLACTIC USE
prevents & relieves : sneezing / rhinirrhea + itching

ADR:
sneezing / nasal STINGING / burning / irritation

*Intranasal Corticosteroids**
*for Allergic Rhinitis**

Uses / MoA / ADR

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-NIDE / -LIDE or -SONE / -LONE

ALL SYMPTOMS
sneezing / nasal itching / rhinorrhea / congestion

Mild VasoCONSTRICTION / decrease Leukotrienes & prostoglandins

*DAILY ADMIN** –> 2week for full response
rather than AS NEEDED*

ADR:
local irritation / SNEEZING / mucosal erosion / HA + epistaxis

Triamcinolone = Nasacort

Intranasal Corticosteroid

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2 y/o+
12+ = 2S EN QD –> titrate down to 1S

Scent Free

Alcohol Free

No bitter after taste

**Fluticasone = Flonase** Intranasal Corticosteroid

_4 y/o+_ 4-11 = *GROWTH STUNTING* **12+ = 2S EN QD** --\> 1 week **1-2S EN QD PRN** ***LIGHT FLORAL SCENT*** **_RELIEVES ITCHY & WATERY EYES!_**

**Flonase SENSIMIST** Intranasal Corticosteroid

**_2 y/o+_** ***ALCOHOL FREE*** ***SCENT FREE*** ***VIRTUALLY NO DRIP***

**Budesonide = Rhinocort** Intranasal Corticosteroid

**_2 y/o+_** ***Scent Free*** ***Alcohol Free*** ***_LOWER VOLUME PER SPRAY_*** vs Flonase **Indoor & Outdoor** Allergy

**Which Intranasal Corticosteroid:** **LOWEST VOLUME PER SPRAY**

**_BUDESONIDE_** RHINOCORT

**Monelukast = Singulair** Type / Uses

**_Leukotriene Modifiers_** * *2+ y/o** * *_\>15 yo_** = **10 mg QD** Improves: **Daytime nasal sx** / **Nasal Congestion** / Itching / Sneezing / Runny ose **_Helpful if patient has ASTHMA_**

**IMMUNOTHERAPY** for Allergic Rhinitis

* *SC Injection** * *1-2x / week** --\> until MAX tolerated dose **3-5 Years** For: **Severe / Persistent Symptoms** & pts who CANT avoid allergen exposure

**Oral Immunotherapies** for Allergic Rhinitis

**_GRASTEK_** Grass Allergy // 5-65 yo **_ORALAIR_** Grass Allergy // 10-65 yo **_RAGWITEK_** RAGWEED allergy // 18-65 yo

**Recommendation #1 = STRONG** **Initial Treatment for SEASONAL AR** in **12 y/o+**

**_INTRANASAL CORTICOSTEROID Monotherapy_** *rather than* Intranasal Corticosteroid PLUS Oral AntiHistamine

**Recommendation #2 - STRONG** For **Initial Treatment of SEASONAL AR** in persons **15 y/o +**

**_Intranasal Corticosteroid_** * over a* * *Leukotriene receptor Antagonist (Singulair**)

**Recommendation #3 = *WEAK*** For treatment of: **Moderate - SEVERE Seasonal AR** in those **12 y/o +**

***_WEAK RECOMMENDATION_*** **Intranasal Corticosteroid + Intranasal Antihistamine**

**What are the INTRANASAL ANTIHISTAMINES**

**_-INE_** **_Azelastine = Astepro_** CAT C // BOTH + Perennial / 12yo+ **_Olopatadine = Patanase_** CAT C also // *only seasonal* // 6 y/o+

39 - Allergic Rhinitis Flashcards

(35 cards)