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Allergies Flashcards

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1
Q

Annual direct costs of allergic rhinitis:

A

$3.4 billion

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2
Q

Indirect costs of allergic rhinitis:

A

$11 billion

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3
Q

Allergies are triggered by…

A

indoor and outdoor environmental allergens

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4
Q

Common outdoor allergens:

A
  • pollen
  • mold spores
  • pollutants (highly populated areas)
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5
Q

Common indoor allergens:

A
  • house dust-mites
  • cockroaches
  • mold spores
  • pet dander
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6
Q

Occupational areoallergens:

A
  • wool dust
  • latex
  • resins
  • biologic enzymes
  • organic dusts
  • various chemicals
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7
Q

4 phases of pathogenesis:

A
  1. sensitization phase
  2. early phase
  3. cellular recruitment phase
  4. late phase
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8
Q

Phase one of pathogenesis: sensitization phase

A
  • occurs on initial allergen exposure

- allergen stimulates beta-lymphocyte mediated IgE production

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9
Q

Phase two of pathogenesis: early phase

A
  • occurs w/in minutes of subsequent allergen exposure
  • rapid release of pre-formed mast cells mediators (histamine and proteases)
  • includes production of additional mediators: prostaglandins, kinis, leukotrienes, neuropeptides
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10
Q

Phase three of pathogenesis: cellular recruitment phase

A

circulating leukocytes are attracted to nasal mucosa and release more inflammatory mediators

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11
Q

Phase four of pathogenesis: late phase

A
  • begins 2-4 hours after allergen exposure
  • symptoms include mucus hypersecretion secondary to submucosal gland hypertrophy and congestion
  • continued persistent inflammation “primes” tissue, results in lower threshold for allergic/nonallergic medicated triggers
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12
Q

Bilateral symptoms are the….

A

worst in the morning, subside during the day, and then worsen at night

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13
Q

Common symptoms:

A
  • frequent, paroxysmal sneezing
  • anterior, watery rhinorrhea
  • frequent itching and conjunctivitis
  • sinus pain
  • throat pain
  • allergic shiners
  • dennie’s lines
  • allergic salute
  • allergic crease
  • allergic gape
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14
Q

Sinus pain is caused by…

A

congestion

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15
Q

Throat pain is caused by…

A

postnasal drip irritation

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16
Q

Allergic shiners are…

A

darkening around eyes due to venous congestion

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17
Q

Dennie’s lines are…

A

wrinkles beneath lower eyelids

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18
Q

Allergic salute is…

A

patient is rubbing tip of the nose upward w/ the palm of their hand

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19
Q

Allergic crease is…

A

the horizontal crease above bulbar portion of nose secondary to “salute”

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20
Q

Allergic gape:

A

open-mouth breathing due to nasal obstruction

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21
Q

T/F: allergic rhinitis can be cured

A

F, can only reduce symptoms and improve patient’s functional status

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22
Q

Treatment should be _______ to provide optimal symptomatic relief and/or control

A

individualized

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23
Q

Three steps for treatment:

A
  1. allergen avoidance
  2. pharmacotherapy
  3. immunotherapy
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24
Q

T/F: immunotherapy is only provided by PCP

A

T

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25
T/F: Allergy avoidance is typically not sufficient for complete relief
T
26
Avoidance of allergens:
- primary nonpharmacologic measure | - depends on specific allergens
27
House dust mites:
- found in all but driest regions of US | - thrives in warm and humid environments
28
How to reduce # of house dust mites:
- lower household humidity to less than 40% - apply acaricides - reduce mite-harboring dust by removing items such as: carpet, upholstered furniture, stuffed animals, bookshelves
29
Outdoor mold spores:
- prevalent in late summer and fall (especially on calm, clear, dry days) - avoid activities that disturb decaying plant material
30
Indoor mold spores:
- lower household humidity - remove houseplants - venting food preparation areas and bathrooms - repairing basements or crawlspaces - frequently applying fungicide to moldy areas
31
Cat derived allergens:
get allergen free cats :)
32
How to reduce # of cockroaches:
- keep kitchen areas clean - keep food sealed - treat infested areas w/ baits or pesticides
33
If patients are triggered by pollutants, they need to be aware of...
air quality index (AQI) | - plan for activities when AQI is low
34
Nasal wetting agents are used to relieve...
- nasal mucosal irritation and dryness
35
Nasal wetting agents help decrease...
- nasal stuffiness - rhinorrhea - sneezing
36
Nasal wetting agents aids in the removal of ____ from nose
- dried - encrusted - thick mucus
37
Nasal wetting agents include:
- saline - propylene - polyethylene glycol sprays - gels
38
Nasal irrigation should only be used with...
distilled, sterile, or boiled water
39
Intranasal corticosteroids are good for...
intermittent/occasional
40
Intranasal corticosteroids are also known as...
glucocorticords | - considered primary line therapy
41
Intranasal corticosteroids are effective for treatment of nasal symptoms such as...
- itching - congestion - rhinitis - sneezing
42
Intranasal corticosteroids inhibit...
multiple cell types and mediators | - stops allergic cascade
43
Intranasal corticosteroids have low systemic ____
absorption
44
Adverse effects of Intranasal corticosteroids:
- usually minor - nasal discomfort - bleeding - sneezing - cough - pharyngitis
45
Longterm use of Intranasal corticosteroids has been linked to changes in...
- vision - glaucoma - cataracts - increased risk of infection - growth inhibition in children
46
Drug interactions of Intranasal corticosteroids w/...
- protease inhibitors (ritonavir, tipranavir, telaprevir) - increases serum [ ] of steroids - avoids combination
47
Antihistamines are used to relieve...
symptoms of allergic rhinitis - itching - sneezing - rhinorrhea
48
Mechanism of action of antihistamines:
- compete at central and peripheral histamine-1 receptor sites - prevents histamine receptor interaction and subsequent mediator release - 2nd generation antihistamines inhibit release of mast cell mediators as well - may decrease cellular recruitment
49
Two classes of antihistamines:
- 1st gen | - 2nd gen
50
1st generation of antihistamines:
- crosses blood brain barrier - sedating - nonselective for H1 receptors - lipophilic
51
2nd generation of antihistamines:
- doesn't cross blood brain barrier - nonsedating - peripherally selective for H1 receptors - lipophobic
52
Overdose of antihistamines have two effects:
- sedating | - nonsedating
53
Sedation effects of antihistamines are...
- cardiac symptoms: tachycardia, conduction abnormalities | - CNS signs and symptoms: psychosis, hallucinations, agitation, lethargy, insomnia
54
Nonsedation effects of antihistamines are...
- drowsiness - restless/hyperactivity - tachycardia
55
Adverse effects of antihistamines:
- primary effects are CNS effects and anticholinergic effects - mainly seen with 1st gen, rarely with 2nd gen - anxiety - hallucinations - appetite stimulation
56
Anticholinergic adverse effects:
- dryness of eyes and mucous membranes - blurred vision - urinary hesitancy and retention - constipation - reflex tachycardia
57
Drug interactions w/ antihistamines:
- amiodarone - antacids - CNS depressants - metoprolol - phenytoin - potassium chloride
58
Effect of amiodarone and antihistamines:
increased risk of QT prolongation
59
Effect of antacids and antihistamines:
decrease efficacy
60
Effect of CNS depressants and antihistamines:
increased sedation
61
Effect of metoprolol and antihistamines:
increased metoprolol serum [ ] | - risk of hypotension
62
Effect of phenytoin and antihistamines:
decreased phenytoin elimination
63
Effect of potassium chloride and antihistamines:
increased risk of ulcers
64
Contraindicatoins for antihistamines:
- newborns/premature infants - lactating women - narrow-angle glaucoma - stenosing peptic ulcer - symptomatic prostatic hypertrophy - bladder neck and pyloroduodenal obstruction
65
Combination products of antihistamines:
- marketed w/ decongestants and analgesics | - use w/ caution because of increased risk of adverse effects
66
Indication for decongestants:
- temporary relief of nasal and eustachian tube congestion and for cough associated w/ postnasal drip - OTC of this are not approved by FDA
67
Mechanism of action for decongestants:
- stimulation of alpha adrenergic receptors results in constriction of blood vessels - decreases sinusoid vessel engorgement and mucosal edema
68
Three types of decongestants:
- direct-acting: bind directly to adrenergic receptors - indirect-acting: displace norepinephrine from storage vesicles in prejunctional nerve terminals - mixed: have both direct and indirect activity
69
Special populations include:
- pregnant women - lactating women - children < 12 - elderly patients
70
First line medication for pregnant women:
intranasal cromolyn
71
Medications w/ no risk for pregnant women:
- diphenhydramine | - chlorpheniramine
72
Medications that have low risk of adverse fetal effects:
- levocetirizine - loratadine - cetirizine
73
Medication that has moderate risk of adverse fetal effets:
fexofenadine
74
T/F: INCS are considered compatible
T
75
Budenoside and triamcinolone have been linked to...
- cleft lip and palate | - low birth weight
76
Medications for lactating women:
- intranasal cromolyn - short acting chlorpheniramine, fexofenadine, or loratadine (best option) - take dose at bedtime after last feeding of the day
77
Children < 12 should be referred to PCP for possible...
undiagnosed asthma
78
Elderly patients should avoid...
sedating histamines
79
Why should elderly patients avoid sedating histamines?
- increased risk of CNS depressive adverse effects (confusion/hypertension) - more likely to be taking meds w/ anticholinergic properties
80
Drugs of choice for elderly patients:
- loratadine | - intranasal cromolyn
81
Many patients achieve symptomatic relief w/in...
3-4 days of therapy | - complete relief: 2-4 weeks

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