Allergic Rhinitis, Cough & Cold Flashcards
(14 cards)
first line treatment for chroic, mod-severe allergic rhinitis
intranasal steroids (budesonide, fluticasone, triamcinolone)
- can cause nosebleeds
- may take a week to get full relief
- budesonide preferred in preggers
commonly used first gen antihistamines
- diphenhydramine
- chlorpheniramine
- doxylamine
can worsen bph, glaucoma
commonly used second gen antihistaines
- cetirizine
- levocetirizine
- fexofenadine
- loratadine
- loratadine and fexofenadine are less sedating but cetirizine and levocetrizine have a faster onset
- cetirizine and loratadine preferred for preggers
can you take nasal antihistamines and nasal steroids?
yes, youca ncmobine (but it increases cost and ADR)
pseudophedrine purchase limits
- 3.6 g per day
- 9g per month
pseudoephedrine safety stuff
- do NOT use within 14 days of MAOi
- avoid in pts < 2 per FDA and < 4 per package insert
- avoid in pts with CV hx dt hacycardia, palpitations, and increased BP
- also avoid in pts with BPH because it can cause urinary retension
- avoid in pregnant pts in first trimester
all of these also apply to phenylephrine (even though it has poor F)
which nasal spray has a warning of rebound congestion
oxymetazoline
which allergy medication must be started at the beginning of allergy season and is to be taken every day (NOT PRN)
intranasal cromolyn
it is safe in children > 2 years old and in pregannt patients
natural products that can be used for colds
- zinc: possible effective in decreasing cold duration - do NOT exceed 5-7 days because it can cause Cu deficiency
- Vit C: some data to decrease duration of cold, also possibly effective
- echinacea: possibly effective as well
between guaifenesin and dextromethophan, which is the exepctorant and which is the suppresant
- mucinex: expectorant
- dextromethophan: suppresses cough reflex
dextromethorphan safety and adr notes
- MOA is serotonin reuptake inhibitor: can cause serotonin syndrome
- at high doses can cause euphoria and hallucinations
- do NOT use within 14 days of an MAOi
codeine safety and adr notes
- boxed warning for resp depression leading to death in children who had a tonsillectomy and/or adenoidectomy and had evidenc of being an ultra-rapid metabolizer
- boxed warning also for death in nursing infants after being exosed to mothers who were ultrarapid metabolizers
do NOT use in any child under 12, and do NOT use in anyone under 18 who has had a tonsillectomy or adenoidectomy
important cough and cold medicine abbreviations:
- D
- PE
- DM
- AC
- D: decongestant - sudafed or phenylephrine
- PE: phenylephriine
- DM: dextromethorphaan
- AC: codeine
pediatric cough and cold considerations
- if < 18 no codeine or hydrocodone (per FDA)
- if < 4: avoid OTC products (per package insert)
- if < 2: avoid OTC and promethazine (per FDA), and avoid topical menthol (per package insert)
