Allergy Pharmacology

Question 1

What are the three major categories of treatment options for allergies?

Answer 1

avoidance of triggers, medications, allergy injections

Question 2

What are the different ways to avoid allergy triggers?

Answer 2

no carpeting or upholstered furniture, bed encasement, no furry or feathered pets, perform maintenance chores, maintain heating/cooling systems, no smoking

Question 3

What is the goal mechanism of action for allergy meds?

Answer 3

decrease the release or inhibiting the effect of histamine release and other mediators

Question 4

What are the different categories of medicines that can be used for allergies?

Answer 4

antihistamines, decongestants, cromolyn sodium, intranasal glucocorticoids, ipratropium, montelukast

Question 5

What features should the ideal drug for allergic rhinities have?

Answer 5

inhibit both early and late phases, be an H1 blocker, counter effects of other mediators, fast-acting, dosing once at night, no SE, manage all symptoms, intranasal admin

Question 6

What are the first generation antihistamines?

Answer 6

diphenhydramine (benadryl), hydroxyzine (atarax), chlorpheniramine (chlor-trimeton)

Question 7

What is the MOA of first generation antihistamines?

Answer 7

block the actions of histamine at H1 receptor sites. Don’t block histamine release

Question 8

What symptoms do first generation antihistamines reduce?

Answer 8

reduce sneezing, itching and rhinorrhea

Question 9

What are the SE of first generation antihistamines?

Answer 9

sedation, anticholinergic effects

Question 10

What are the CI of first generation antihistamines?

Answer 10

lactating mothers, glaucoma, BPH, elderly

Question 11

What the second generation antihistamines?

Answer 11

loratadine (claritan), fexofenadine (allegra), cetirizine (zyrtec)

Question 12

What is the MOA of second generation antihistamines?

Answer 12

inhibit H1 receptors

Question 13

What is the benefit of second generation antihistamines compared to first generation?

Answer 13

less sedating and long acting

Question 14

What are SE of second generation antihistamines?

Answer 14

anticholinergic effects but less than 1st gen. ok for BPH, elderly

Question 15

What is azelastine (Astelin)?

Answer 15

antihistamine nasal spray with some nasal decongestion effect and acts fast

Question 16

What are the decongestant medications?

Answer 16

pseudoephedrine (Sudafed) ora and pseudoephedrine (Afrin) intranasal

Question 17

What is the MOA of decongestants?

Answer 17

alpha-adrenergic agonist

Question 18

What is the effect of decongestants?

Answer 18

vasocontriction restricts blood flow to nasal mucosa that has been dilated by histamine

Question 19

What are the SE of decongestants?

Answer 19

HA, nervousness, irritability, tachycardia, palpitations insomnia

Question 20

What are CI of decongestants?

Answer 20

HTN, cardiovascular disease, hyperthyroidism, glaucoma, co-use with MAOIs

Question 21

What is rhinitis medicamentosa?

Answer 21

prolonged use of topical decongestant may induce rebound congestion upon withdrawal. leads to inflammatory hypertrophy of nasal mucosa

Question 22

What causes rhinitis medicamentosa?

Answer 22

down regulation of alpha-adrenoreceptors—>less sensitive to endogenously released NE and exogenously applied vasoconstrictors

Question 23

What are some combos of antihistamine-decongestants?

Answer 23

fexofenadine/pseudoephedrin (allegra-D), loratadine/pseudoephedrine (claritan-D), cetirizine/pseudoephedrine (zyrtec-D)

Question 24

What is the MOA of cromolyn sodium (nasalcrom)?

Answer 24

mast cell stabilizing agent—>reduces release of histamine and other mediators

Question 25

What are the effects of cromolyn sodium?

Answer 25

reduces nasal pruritis, sneezing, rhinorrhea and congestion

Question 26

What are SE of cromolyn sodium?

Answer 26

no serious effects

Question 27

What is the prophylactic us of cromolyn sodium?

Answer 27

start before pollinosis sx or unavoidable/predicatable exposures

Question 28

What are the benefits of non-steroid nasal sprays (ie cromolyn)?

Answer 28

non-Rx, safe, good for prevention, for kids, and for ppl who have known but unavoidable allergen exposure

Question 29

What are the different intranasal glucocorticoids?

Answer 29

fluticasone proprionate (flonase), mometasone (nasonex), beclomethasone diproprionate aqueous (beconase), budesonide (rhinocort), flunisolide (nasarel), triamcinolone acetonide (nasacort)

Question 30

What are the MOAs for intranasal glucocorticoids?

Answer 30

disabling cells that present antigen to antibody, reduce stimulus for mast cell degranulation, reduce inflammation by limiting late phase response, suppress neutrophil chemotaxis, mildly vasoconstrictive, reduce intracellular edema

Question 31

What are the effects of intranasal glucocorticoids?

Answer 31

reduce nasal blockage, pruritis, sneezing and rhinorrhea

Question 32

What are SE of intranasal glucocorticoids?

Answer 32

nasal irritation, bleeding (nasal septum perforation)

Question 33

What is an anticholinergic nasal spray?

Answer 33

ipratropium bromide (atrovent)

Question 34

What is ipratropium bromide (atrovent) use for and how does it work?

Answer 34

good for runny nose, reduces release of substance P

Question 35

What is a leukotriene inhibitor med?

Answer 35

montelukast (singulair)

Question 36

What is montelukast (singulair) used for?

Answer 36

runny nose/congestion. not first line therapy.

Question 37

What are the different saline intranasal sprays?

Answer 37

NaSal, SeaMist, Ocean, Ayr

Question 38

What are the effects of saline intranasal sprays?

Answer 38

relief from crusting and can be soothing

Question 39

What meds are used for eye allergies?

Answer 39

normal saline, azelastine (optivar), olopatadine (Patanol), naphazoline/pheniramine (Opcon-A)

Question 40

What does azelastine (optivar) do?

Answer 40

inhibits histamine release from mast cells, approved for use as early as 3 yrs

Question 41

What does olopatadine (patanol) do?

Answer 41

inhibits histamine release from mast cells, is approved for as early as 3 yrs

Question 42

What does naphazoline/pheniramine (opcon-A) do?

Answer 42

sympathomimetic which decreases congestion. pheniramine is an antihistamine. approved for use as early as 6 yr

Question 43

When should immunotherapy be considered?

Answer 43

meds insufficiently controls sx or produce undesirable SE, avoidance measures fail, H/O AR for at least 2 seasons, positive skin tests

Question 44

What should be used to treat mild intermittent symptoms of AR?

Answer 44

non-sedating antihistamines or decongestants

Question 45

What should be used to treat persistent mild to moderate symptoms of AR?

Answer 45

intranasal steroid starting 1-2 prior to season, non-sedating antihistamine or decongestant prn, topical ocular antihistamine

Question 46

What should be used to treat severe symptoms of AR?

Answer 46

topical nasal corticosteroids, non-sedating antihistamines or decongestant, short term oral corticosteriods, if no response consider immunotherapy

Question 47

What is anaphylaxis?

Answer 47

acute systemic allergic rxn that is the result of re-exposure to an antigen that elicits IgE. Type I hypersensitivity

Question 48

How does cardiovascular collapse occur due to histamine and other substances?

Answer 48

decreased BP (vasodilation), increased HR, edema (separation of endothelial cells and increased permeability)

Question 49

What are effects of histamine and other substances on respiratory system?

Answer 49

bronchospasm and airway edema

Question 50

What are the effects of histamine and other substances on GI system?

Answer 50

smooth muscle contraction and diarrhea

Question 51

What are the effects of histamine and other substances on skin?

Answer 51

urticaria (hives), flushed appearance

Question 52

What is the treatment for anaphylaxis?

Answer 52

epi, antihistamines (benadryl, maybe an H2 blocker), corticosteroids (decadron), treat HTN with IV fluids, bronchodilators (albuterol), observe for 24 hrs, repeat epi/antihistamines if rebound