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PHM 702: Pulm and ToXXX > Allergic Rhino > Flashcards

Allergic Rhino Flashcards

(44 cards)

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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

Study These Flashcards
A

onset: hours - days

peak response: 2-3 weeks

ROUTINE USE

19
Q

What allergic rhinitis s/s do intranasal corticossteroids treat?

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

Intranasal corticosteroid AE

Study These Flashcards
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

Study These Flashcards
A
  • pseudoephedrine
  • phenylephrine
22
Q

Topical decongestants used for allergic rhinitis

Study These Flashcards
A
  • phenylephrine
  • tetrahydrozoline
  • naphazoline
  • oxymetazolie
23
Q

MOA of decongestants in allergic rhinitis

Study These Flashcards
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

Study These Flashcards
A

Topical: fast
System: slower

25
What allergic rhinitis s/s do decongestants treat
1. Congestion 2. X 3. X 4. X 5. X
26
Topical decongestants AE
Prolonged use (>3-5 days) → rebound congestion * Sneezing * Burning, stinging * Drying of nasal mucosa
27
Systemic decongestants AE
Increase BP (do NOT use with MAOIs) CNS stimulation - restlessness - insomnia Urinary retention
28
MOA of cromolyn
mast cell stabilizer
29
Cromolyn onset in allergic rhintis
Onset: slow, up to several weeks → routine dosing of 1 spr TID/QID (up to Q4H) SCHEDULED
30
What allergic rhinitis s/s does cromolyn treat
1. Congestion 2. Rhinorrhea 3. Sneezing 4. Nasal itching 5. X
31
Cromolyn AE
- sneezing - nasal irritation
32
Ipratropium MOA in allergic rhitiis
anticholinergic
33
Ipratropium onset in allergic rhintiis
<15 min
34
What allergic rhinitis s/s does ipratropiium treat
1. X 2. Rhinorrhea 3. X 4. X 5. X
35
Ipratropium AE
HA Nosebleeds Nasal dryness AVOID IN: - narrow angle glaucoma - myasthenia gravis - BPH
36
Montelukast MOA
Inhibition of cysteinyl leukotriene receptor
37
Montelukast onset in allergic rhinitis
slow, may not see full effect until after a month of use
38
What allergc rhinnitis s/s does montelukast treat?
1. Congestion (barely) 2. Rhinorrhea (barely) 3. Sneezing (barely) 4. Nasal itching (barely) 5. X
39
Montelukast AE
* HA * Fatigue * GI upset * Nasal congestion * Neuropsychiatric events
40
Omalizumab | xolair
mAb for allergic rhinitis treatment last last line allergy shots that induce tolerance
41
Clincal pearls and treatment notes for allergic rhinitis
- 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
What is considered mild allergic rhinits?
No interference with QOL
43
What is considered moderate to severe allergicrhinits
Interference with QoL
44
What is considered intermittent allergicrhinits
Affects pt < 4 days/week OR <4 weeks/yr

PHM 702: Pulm and ToXXX (14 decks)

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