50 - Allergic Rhinitis Flashcards

1
Q

non-pharms

A

avoid exposure to triggers, wash bedding, carpets, shower, don’t have pets in the bedroom

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2
Q

Describe topical pharmacological options

A
  • use saline nasal spray to wash out mucus and allergen

- lubricant eye drops or cold compresses can reduce conjunctival symptoms

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3
Q

What symptoms do antihistamines relieve?

A

relieve most symptoms such as sneezing, rhinorrhea, nasal itch and conjunctivitus

not congestion

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4
Q

Which antihistamine may relieve congestion?

A

desloratidine - may relieve congestion and is indicated for congestion

fexofenadine - may help but it is not indicated for this symptom

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5
Q

Antihistamines are most effective if used ______

A

prophylactically

*but onset of action is fast enough so they are still effective when used PRN

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6
Q

Of the less-sedating AH’s, which one is more likely to cause some sedation, esp at higher doses?

A

cetirizine

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7
Q

Decongestants are _____ _____

A

alpha agonists

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8
Q

_______ (decongestant) effectiveness has not been well established

A

phenylephrine

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9
Q

Which decongestant is available as a single entity product or in combo with less-sedating AH’s?

A

pseudoephedrine

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10
Q

Decongestants have _____ side effects

A

stimulant

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11
Q

Avoid decongestants if taking ____

A

MAOi

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12
Q

Who should you caution decongestants in?

A

in those with HTN, hyperthyroidism or ischemic heart disease, though evidence of risk is weak when used at recommended doses

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13
Q

What are topical decongestants?

A
  • oxymetazoline

- xylometazoline

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14
Q

Use of topical decongestants for more than ____ days may result in rebound congestion

A

3-7

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15
Q

Concomitant use of an intranasal _____ may mitigate rebound congestion

A

corticosteroid (ex. fluticasone)

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16
Q

What is the mainstay of treatment for moderate-severe rhinitis symptoms?

A

intranasal corticosteroids

17
Q

May need _____ week trial for corticosteroids to benefit

A

2-4

18
Q

_____ is an intranasal corticotseroid that comes as DPI for those who don’t like aqueous sprays

A

budesonide

19
Q

Advantage of intranasal corticosteroids over oral corticosteroids?

A

does not cause adrenal suppression @ therapeutic doses

20
Q

What is Levocabastine?

A

An antihistamine nasal spray

-less potent than INCS and is not effective for treatment of congestion

21
Q

Intranasal ipratropium is only good for ______

A

rhinorrhea

22
Q

What is a LTRA that has a modest effect on allergic rhinitis?

A

montelukast

23
Q

points about ophthalmic mast cell stabilizers?

A
  • require several days for onset of effect

- QID dosing

24
Q

why is regular use of topical vasoconstrictors for the eyes not recommended?

A

bc of the development of rebound vasodilation

25
Q

Immunotherapy is useful when symptoms caused by what?

A

pollen or dust mites

26
Q

Immunotherapy is indicated when there is evidence of ____ sensitivity to a specific antigen

A

IgE

27
Q

What is drug of choice in kids?

A

oral antihistamines

can also use intranasal corticosteroids

28
Q

Choices in pregnancy?

A
  • second gen AHs more safe than 1st gens
  • montelukast safe
  • INCS are also safe
  • can use pseudoephedrine but avoid in 1st trimester