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Pharm Spring 2023 > Allergic Rhinits > Flashcards

Allergic Rhinits Flashcards

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1
Q

What is the first line treatment for allergic rhinitis

A

INCS

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2
Q

What is the second line treatment for allergic rhinitis

A

Oral anti-histamine (2nd gen)

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3
Q

When should someone consider medication after treating AR non-pharmacolgically

A

After 2-4 weeks of self-treatment

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4
Q

What do all antihistamines block?

A

Block H1 receptors
*which is the main target for early phase allergic response

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5
Q

Why are 1st generation oral antihistamines not preferred in the treatment of AR

A
  1. They are sedating
    *anticholinergic (ANTI-DUMBBELLS)
  2. Added effects are not useful in treating AR and contribute to more SE
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6
Q

Why are 2nd generation oral antihistamines preferred in the treatment of AR

A
  1. Inhibit release of mast cell mediators, minimal to no effect on cholinergic receptors (less sedating)
  2. Fewer SE
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7
Q

When should you take a 2nd gen oral antihistamine for AR

A

At least 1 week prior to expected allergy exposure

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8
Q

What are the SE of oral antihistamines

A

CNS depression
1. Impaired driving
2. In coordination
3. Impaired information processing
4. Sedation
ANTI-DUMBBELLS
*common with 1st generation AH

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9
Q

What is the least sedating 1st gen AH

A

Chlorpheniramine
*but still more sedating than 2nd gen AH

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10
Q

What 2nd gen AH may cause mild sedation

A
  1. Cetirizine
  2. Levocetirizine
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11
Q

What are the CI of 1 gen Antihistamines

A
  1. New born
  2. Breastfeeding
  3. Narrow angle / angle closure glaucoma
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12
Q

What are the warnings of 1st gen and 2nd gen oral antihistamines

A
  1. Combination with other sedating medication or tranquilizers
  2. Elderly (fall risk with sedation)
  3. Prostate enlargement (BPH)
  4. Fexofenadine with fruit juice
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13
Q

Which drugs can cause paradoxical excitiation

A

Oral antihistamine
*in children and elderly

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14
Q

What is the indication for Azelastine

A

Intranasal antihistamine
1. Temporary relief of nasal congestion, runny nose, sneezing and itchy nose

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15
Q

How many sprays to use of Azelastine (Intranasal antihistamine)

A

12 and + = 2 sprays in each nostril or 1 to 2 sprays in each nostril every 12 hours
6 to 11 = 1 spray each nostril every 12 hours

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16
Q

What are the SE of Azelastine

A
  1. Bitter tastes, headache, sedation
  2. Avoid taking with alcohol or other sedatives
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17
Q

What is the role of Azelastine in the treatment of AR

A
  1. Fewer side effects compared to oral AH
  2. Fast acting
  3. May be used if oral AH are ineffective or in combination with INCS
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18
Q

What is the indication of Intranasal corticosteroids (INCS)

A
  1. Treatment of nasal allergy symptoms
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19
Q

What is the MOA of INCS

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A
  1. Suppress the immune system by reducing activity and volume of the lymphatic system
    *inhibits early phase and late phase process of the immune response, decreasing inflammation
20
Q

When should INCS be started

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A

At least 1 week prior to known allergen exposure

21
Q

What are the different types of INCS

Study These Flashcards
A
  1. Triamcinolone 55mcg/ACT
  2. Fluticasone
  3. Budesonide
22
Q

What is the adults and pediatric dosing of INCS

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A

Adult
*2 sprays
Peds
*1 spray bc of the risk of growth stunting

23
Q

What are the SE of INCS

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A
  1. Nasal discomfort
  2. Bleeding
  3. Sneezing
24
Q

What are the CI of INCS

Study These Flashcards
A
  1. Nose surgery not fully healed
25
What are the warnings of INCS
1. Possible growth inhibition in children 2. Cataracts 3. Glaucoma
26
When is montelukast used?
Last line treatment of AR if antihistamines and INCS didn’t work 1. Prescription only 2. For perennial and season rhinitis
27
Why is montelukast not used anymore
Users can experience 1. Anxiety 2. Depression
28
What is chromolyn sodium used for/MOA? (Mast cell stabilizer)
1. Treatment of allergic rhinitis *protects mast cells from activation in early phase preventing and treating symptoms of allergic rhinitis *start 1-2 weeks prior (takes 2-4 weeks to work)
29
What are the SE and role in therapy of cromolyn sodium
SE 1. Sneezing 2. Nasal stinging 3. Burning Role in therapy 1. Last line 2. for patients with CI to AH or INCS
30
What should be used in Peds population dealing with AR
1. 2nd gen oral AH *1st gen oral AH are no preffered 2. INCS *safe (1 spray) 3. Mast cell stabilizer *safe (2 and up)
31
What should be used during pregnancy when dealing with AR
Preferred AH 1. Pregnant *loratadine *cetirizine *levocetirizine *chlorpheniramine 2. Breastfeeding *2nd generation AH
32
Are INCS and cromolyn sodium CI during pregnancy and lactation
No
33
What ages can used nasal saline spray / irrigation?
1. Any age *nasal sprays are preferred for infants and toddlers due to nasal irrigation being difficult for them to tolerate
34
What type of water should you use for nasal saline irrigation
1. Use distilled, sterile, filtered or boiled water *tap water increases the risk of infection
35
What is the indication of decongestants (PO)
1. Provide temporary relief of nasal and Eustachian tube congestion and cough associated with PND
36
What is the MOA of decongestants
1. Alpha receptors agonist that causes contraction of blood vessels in nose / sinuses which will decrease inflammation and muscosal edema
37
What is the difference between pseudoephedrine and phenylephrine
Pseudo *more effective than PE, but has higher incidence of ADRS *longer acting *available behind the counter Phenyl *less effective than PSE, but has lower potential for ADRS *short acting *OTC
38
What are the different types of topical decongestants
1. Sprays / drops *phenylephrine *oxymatzoline 2. Nasal inhalers *propylhezedrine *levmetamfetamine
39
Why should you not use topical decongestants for more than 3 to 7 days
1. Can cause rhinitis meticamentosa *rebound congestion *nasal congestion w/o runny nose or sneezing following several days of nasal decongestant use
40
What are the SE of decongestants (Cardiovascular)
Oral > topical 1. Cardiovascular stimulation *increase BP/HR/palpitations *precipitation of underlying arrhythmia
41
What are the SE of decongestants (CNS stimulation)
2. CNS stimulation *restlessness *anxiety *irritability *tremor
42
What are the SE of decongestants (rebound congestion)
only with topical
43
What are the CI of decongestants
1. Use of MAOI within 14 days
44
What are the warnings of decongestants
1. Cardiovascular disease *May worsen HTN, arrhythmias, ischemic heart disease 2. Prostate enlargement 3. Angle closure glaucoma 4. Pregnancy
45
Dosage of oral decongestant (pseudo and phenyl)
Phenyl *adult 10mg *children (6 to 12) 5mg *children (4 to 6) 2.5mg Pseudo *adult 60mg *children (6 to 12) 30mg *children (4 to 6) 15mg
46
Which of the these decongestants has the lowest potential to increase blood pressure? Neo-Synephrine Nasal Spray (phenylephrine) Sudafed PE Tablets (phenylephrine) Sudafed Tablets (pseudoephedrine) Nexafed Tablets (pseudoephedrine)
Neo-Synephrine Nasal Spray (phenylephrine)

Pharm Spring 2023 (27 decks)

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