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PHM 702: Pulm and ToXXX > Allergic Rhino > Flashcards

Allergic Rhino Flashcards

1
Q

What is considered intermittent allergic rhintis

A

Affects pt < 4 days/week OR <4 weeks/yr

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2
Q

What is considered persistent allergic rhinitis

A

Affects pt >4 days/week AND >4 weeks/yr

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3
Q

Non-pharm allergy treatment

A
  • allergen avoidance
  • nasal saline irrigations
  • adhesive nasal strips
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4
Q

Intranasal corticosteroids used for allergic rhinitis

A
  • Beclothasone
  • Budesonide
  • Flunisolide
  • Fluticasone
  • Mometasone
  • Triamcinolone
  • Ciclesonide
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5
Q

Intranasal antihistamines used for allergic rhinitis

A
  • Azelastine
  • Olopatadine
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6
Q

Opthalmic antihistsamies used for allergic rhinitis

A
  • Ketotifen
  • Azelastine
  • Olopatadine
  • Alcaftdadine
  • Emedastine
  • Epinastine
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7
Q

Systemic antihistsamies used for allergic rhinitis

A

First gen:
- Chlorpheniramine
- Benadryl

Second gen:
- Cetirizine
- Levocetirizine
- Loratadine
- Desloratadine
- Fexofenadine

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8
Q

MOA of antihistamines (all) in allergic rhiitis

A

Competitively antag H1 receptors → prevent receptor activation

  • intranasal more targeted and can be effective in pts who failed PO
  • opthalmic for conjunctiviits
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9
Q

What allergic rhinitis s/s do opthalmic antihistamines treat?

A
  1. X
  2. X
  3. X
  4. X
  5. Ocular s/s
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10
Q

Intranasal antihistamine onset in allergic rhinitis

A

15-30min

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11
Q

What allergic rhinitis s/s do intranasal antihistamines treat?

A
  1. Congestion
  2. Rhinorrhea
  3. Sneezing
  4. Nasal itching
  5. X
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12
Q

Systemic antihistamine onset in allergic rhinitis

A

take 1-2 hr prior to anticpated eposure

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13
Q

opthalmic antihistsamines AE

A

HA
Blurred vision
Burning/stinging of eyes
Discomfort
Bitter taste
Pharyngitis

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14
Q

intranasal antihistsamines AE

A

Less systemic AE than PO

Bitter taste
Nasal burning
Epistaxis
HA
Somnolence

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15
Q

What allergic rhinitis s/s do systemic antihistamines treat?

A
  1. X
  2. Rhinorrhea
  3. Sneezing
  4. Nasal itching
  5. Ocular s/s
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16
Q

systemic antihistsamines AE

A

Change in appetitie
GI discomfort

First gen: cross BBB →
- anticholinergic: urinary, retention drying, constipating
- sedating
- slowed GI motility
- narrow-angle glaucoma

Second gen: less likely to cross CNS but some can still be sedating (cetirizine and levocetirizine)

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17
Q

MOA of intranasal corticosteroids in allergic rhiitis

A

Suppress mediator, cytokine release and neutrophil recruitment → reduce inflammation

Reduce antigen-induced hyperresponsiveness of nasal mucosa

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18
Q

Intranasal corticosteroid onset in allergic rhinitis

A

onset: hours - days

peak response: 2-3 weeks

ROUTINE USE

19
Q

What allergic rhinitis s/s do intranasal corticossteroids treat?

A
  1. Congestion
  2. Rhinorrhea
  3. Sneezing
  4. Nasal itching
  5. Ocular s/s
20
Q

Intranasal corticosteroid AE

A
  • HA
  • Dryness
  • Burning, stinging → avoid in pts with septum ulcers or recent nasal surgery/trauma
  • Blood tinged secretions
  • Epistaxis

Growth suppression in children (mixed results, no effet with fluticasone, mometasone, triamcinolone)

21
Q

Systemic decongestants used for allergic rhinitis

A
  • pseudoephedrine
  • phenylephrine
22
Q

Topical decongestants used for allergic rhinitis

A
  • phenylephrine
  • tetrahydrozoline
  • naphazoline
  • oxymetazolie
23
Q

MOA of decongestants in allergic rhinitis

A

Sympathomimetic agents: target adrenergic receptors in the nasal mucosa → vasoconstriction

Reduce swollen nasal mucosa and improve ventilation

24
Q

Decongestants onset in allergic rhinitis

A

Topical: fast
System: slower

25
Q

What allergic rhinitis s/s do decongestants treat

A
  1. Congestion
  2. X
  3. X
  4. X
  5. X
26
Q

Topical decongestants AE

A

Prolonged use (>3-5 days) → rebound congestion

  • Sneezing
  • Burning, stinging
  • Drying of nasal mucosa
27
Q

Systemic decongestants AE

A

Increase BP (do NOT use with MAOIs)

CNS stimulation
- restlessness
- insomnia

Urinary retention

28
Q

MOA of cromolyn

A

mast cell stabilizer

29
Q

Cromolyn onset in allergic rhintis

A

Onset: slow, up to several weeks → routine dosing of 1 spr TID/QID (up to Q4H) SCHEDULED

30
Q

What allergic rhinitis s/s does cromolyn treat

A
  1. Congestion
  2. Rhinorrhea
  3. Sneezing
  4. Nasal itching
  5. X
31
Q

Cromolyn AE

A
  • sneezing
  • nasal irritation
32
Q

Ipratropium MOA in allergic rhitiis

A

anticholinergic

33
Q

Ipratropium onset in allergic rhintiis

A

<15 min

34
Q

What allergic rhinitis s/s does ipratropiium treat

A
  1. X
  2. Rhinorrhea
  3. X
  4. X
  5. X
35
Q

Ipratropium AE

A

HA
Nosebleeds
Nasal dryness

AVOID IN:
- narrow angle glaucoma
- myasthenia gravis
- BPH

36
Q

Montelukast MOA

A

Inhibition of cysteinyl leukotriene receptor

37
Q

Montelukast onset in allergic rhinitis

A

slow, may not see full effect until after a month of use

38
Q

What allergc rhinnitis s/s does montelukast treat?

A
  1. Congestion (barely)
  2. Rhinorrhea (barely)
  3. Sneezing (barely)
  4. Nasal itching (barely)
  5. X
39
Q

Montelukast AE

A
  • HA
  • Fatigue
  • GI upset
  • Nasal congestion
  • Neuropsychiatric events
40
Q

Omalizumab

xolair

A

mAb for allergic rhinitis treatment

last last line

allergy shots that induce tolerance

41
Q

Clincal pearls and treatment notes for allergic rhinitis

A
  • Intranasal corticosteroids better than PO antihistamines for nasal symptoms with little benefit to combining the two
  • Montelukast isn’t great → last line unless pt also has asthma
  • Intranasal antihistamines faster than intranasal steroids with similar efficiacy
  • Short course of systemic corticosteroids is NOT better than intranasal corticoisteroids
42
Q

What is considered mild allergic rhinits?

A

No interference with QOL

43
Q

What is considered moderate to severe allergicrhinits

A

Interference with QoL

44
Q

What is considered intermittent allergicrhinits

A

Affects pt < 4 days/week OR <4 weeks/yr

PHM 702: Pulm and ToXXX (14 decks)

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