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Erica Pharm 2 Exam > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

(42 cards)

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1
Q

What type of cells are the nasal mucosa lined with and what do they release?

A

Mast cells

release histamine

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2
Q

Describe the Antigen-antibody response in allergic rhinitis

A

allergen interacts w/ IgE bound to mast cells –> histamine released –> immune response

(vasodilation, increased vascular permeability,
& production of nasal secretions)

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3
Q

What role does the ANS play in allergic rhinitis?

A

controls rich vascular tissue

SNS: constricts arterioles, reduces mucosal thickness, widens the airway

PNS: dilates arterioles, increases mucosal thickness, incr. stuffiness and runny nose

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4
Q

____ stimulation produces itching.

Sneezing occurs by ____ stimulation pathways.

A

Sensory nerve

vagal

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5
Q

Mast cell mediator: effect of histamine?

A

stimulates irritant receptors, pruritis, vascular permeability, mucosal permeability, smooth muscle contraction

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6
Q

Mast cell mediator: effect of leukotrienes?

A

smooth muscle contraction, vascular permeability, mucus secretion, chemotaxis, neutrophil chemotaxis

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7
Q

Describe the pathophysiology of allergic rhinitis

A

Late phase reaction: 4-8 hrs after initial exposure caused by cytokines primarily released by mast cells

  • Persistent chronic sxs
  • inflamed mucosa become hyper-responsive
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8
Q

What are the evidence-based Level A Tx recommendations for Allergic Rhinitis?

A

nasal steroids
oral antihistamines
intranasal antihistamines
immunotherapy

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9
Q

What medication class is an excellent choice for perennial rhinitis?

A

intranasal corticosteroids

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10
Q

MOA of histamine (H1)-Receptor antagonists

A
  • competitive antagonist of histamine
  • binds to H1 w/o activation and prevents histamine from binding
  • anticholinergic (PNS) properties cause reversal of sxs

**Prophylactic works best

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11
Q

What is the best 1st/2nd generation H1-Receptor antagonist to give a pregnant patient and why?

A

1st gen – Chlorpheniramine (level B) because it has less sedation and anticholinergic affects

2nd gen – Cetirizine (Zyrtec)

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12
Q

histamine (H1)-Receptor antagonists contraindications and drug interactions?

A

contraindicated w/ Hypersensivity to formulation

Interactions - anticholinergics and CNS depressants (Benzos)

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13
Q

histamine (H1)-Receptor antagonists adverse reactions?

A
  • anticholinergic effects - xerostomia, constipation, urinary retention
  • CNS depression
  • Paradoxical excitement
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14
Q

What are some medications under the histamine (H1)-Receptor antagonists drug class?

A

Intranasal and ophthalmic = Azelastine and Olopatadine

Topical = Diphenhydramine

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15
Q

MOA for decongestants

A

stimulates alpha-adrenergic receptors –> vasoconstriction

pseudoephedrine stimulates beta-adrenergic receptors –> increase HR, contractility, and bronchial relaxation

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16
Q

Although topical decongestants are more effective for treating allergic rhinitis, overuse can cause…

A

Rebound congestion

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17
Q

What are some examples of decongestants?

Study These Flashcards
A

intranasal (sprays) & ophthalmic (drops):
- Phenylephrine, Tetrahydrozoline, Naphazoline, Oxymetazoline

Oral: Pseudoephedrine, phenylephrine

18
Q

Contraindications and drug interactions for decongestants?

Study These Flashcards
A

Contraindicated w/ hypersensitivity, and MAOI use w/in 14 days

Interactions: SNRI’s (tachycardia) and
sympathomimetics (enhance ADE’s)

19
Q

ADE’s and monitoring in Decongestants?

Study These Flashcards
A

Rebound congestion w/nasal formula after 3-5 days of use, tachycardia, & HTN

HR and BP

20
Q

MOA for inhaled corticosteroids

Study These Flashcards
A

Reduce mediator release, formation, activity –> reduce inflammation

reverses dilation –> mild vasoconstriction

inhibit mast cell mediated late phase reaction

21
Q

Inhaled Corticosteroid use will show slight improvement of sxs in ____ & peak responses in ____.

Study These Flashcards
A

few days

2-3 weeks

22
Q

What can inhaled corticosteroids also be useful in treating aside from allergic rhinitis?

23
Q

Give examples of inhaled corticosteroids (nasal & inhaled). What are the adverse drug reactions?

Study These Flashcards
A

Beclomethasone, budesonide, flunisolide, fluticasone, mometasone

HA, pharyngitis, cough, epistaxis (nasal formulation)

24
Q

MOA for Leukotriene receptor antagonist

Study These Flashcards
A

inhibition of cysteinyl leukotriene receptor (mast cells release leukotrienes)

LOX inhibitor - Zileuton

25
What drug class do Leukotriene Receptor antagonists need to be combined w/ in order to be effective?
Antihistamines
26
Leukotriene receptor antagonists contraindications and drug interactions?
contraindicated w/ hypersensitivity Interactions w/ CYP3A4 and CYP2C9
27
Leukotriene receptor antagonists adverse reactions and what should you monitor?
Adverse rxns: HA, mental status changes, dyspepsia, dizziness, fatigue Monitor mental status and allergy control
28
Cromyln nasal spray MOA, side effects, and how long until symptomatic relief?
MOA: mast cell stabilizer can cause local irritation 2-4 weeks for sxs relief
29
Ipatropium nasal spray MOA, drug interactions, and how long is it safe to use?
MOA: anticholinergic and inhibits secretions may enhance anticholinergic effects of other agents safety and efficacy beyond 4 days not est.
30
H-2 Receptor antagonist MOA, examples, and what drug can it be combined w/ in allergic reaction, urticaria?
MOA: competitively inhibits H2 receptor, prominent in parietal cells, prevents gastric acid secretion Cimetidine > Ranitidine, Famotidine, Nizatidine (Raniti/famotidine - fewer side effects) Combine w/ H-1 blocker
31
What approach should you take in treating a patient w/ allergic rhinitis?
if environmental controls don't work try single-drug tx based on sxs: Antihistamines - sneezing, itching, rhinorrhea, ocular sxs Decongestants (systemic) - nasal congestion Intranasal steroids - sneezing, itching, rhinorrhea, and nasal congestion
32
Describe the pathophysiology of a cough. - Voluntary vs. involuntary - acute vs. subacute vs. chronic
involuntary - "cough center," medulla oblongata voluntary - cerebral cortex acute (<3 wks) -- commonly viral URI Subacute (3-8wks) -- bacterial or asthma chronic (>8 weeks) -- postnasal drip syndrome, GERD, asthma
33
Hydrocodone/Codeine MOA and examples
MOA: cough suppression, direct central action in the medulla Codeine/Guiafenesin (Robitussin AC) Codeine/Promethazine (Phenergan w/Codeine) Hydrocodone/Chlorpheniramine (Tussionex)
34
Hydrocodone/Codeine contraindications and adverse reactions
contraindicated w/hypersensitivity interactions: CNS depressants, drug abuse/dependency, nausea
35
Hydrocodone/Codeine drug interactions and what should you monitor?
CNS depressants monitor frequency of use
36
MOA of Benzonatate
- suppresses cough by topical anesthetic action on respirator stretch receptors - relative to tetracaine
37
Benzonatate adverse reactions and contraindications?
ADE's mental confusion, visual hallucinations, sedation contraindicated in children under 10yrs d/t increased risk of death
38
MOA of Dextromethorphan (DXM)
Decreases sensitivity of cough receptors | Suppresses medullary cough center
39
What are examples of Dextromethorphan (DMX) and what is it structurally related to?
``` DXM Poylstirex (Delsym) DXM Hydrobromide ``` codeine
40
Contraindications, ADE's and drug interactions of Dextromethorphan (DXM)?
Contraindicated w/ MAOI administration w/in 2 weeks ADE's: confusion, potential serotonin syndrome Interacts w/ SSRIs - enhances the serotonergic effect
41
MOA of Guaifenesin
irritating gastric mucosa and stimulating respiratory tract secretions --> increase respiratory fluid volume and decrease mucous viscosity
42
Guaifenesin: What are the adverse reactions, contraindications, and what should you monitor
ADE's: dizziness, drowsiness, HA, N/V Contraindicated w/ hypersensitivity Monitor hydration status

Erica Pharm 2 Exam (3 decks)

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