Allergic Rhinitis, Cough and cold Flashcards
(102 cards)
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Allergic rhinitis:
Background: when patient has an allergy to an _________
Symptoms include:
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
Allergic rhinitis is sometimes also called _________
hay fever or simply “allergies”
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
-
-
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
Allergic rhinitis can be
intermittent-
chronic-
intermittent- (exposure to animal dander when visiting a friends home)
chronic- (symptoms that last for months whenever the pollen count is elevated)
Non-drug Treatment for Allergic rhinitis includes:
-
-
- 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
What can be used to determine patient specific allergens?:
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
Other things we can do for allergic rhinitis include:
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.
Wetting agents are commercially available and contain saline, propylene or polyethylene glycol, which provide moisture and reduce irritation to the nasal passages.
examples:
Ocean
Little remedies
Simply Saline
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:
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.
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
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-
-
- 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)
Intranasal steroids work by __________.
They are effective __________
We use in ___________
-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.
Antihistamines 1st generation
work by __________.
They are effective __________
We use in ___________
Examples:
“pretty sedating”
use more for intermittent symptoms. They work right away.
Benadryl
Antihistamines 2nd generation
work by __________.
They are effective __________
We use in ___________
Examples:
usually preferred since less sedation
use more for intermittent symptoms. They work right away.
Rhinocort Allergy -rhin
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-preferred in pregnancy!
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:
What oral inhaler form of budesonide is indicated for Asthma Treatment?
Flonase Allergy Relief -nas
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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:
what oral inhaler form of fluticasone is used for Asthma Treatment?
Flovent
Nasacort Allergy 24HR -nas
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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:
what oral inhaler form of triamcinolone is used for Asthma Treatment?
Beconase AQ -nas
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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:
Qnasl -nas
beclomethasone
what oral inhaler form of beclomethasone is used for Asthma Treatment?
Zetonna
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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:
