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5. Anti-histamines > antihistamines > Flashcards

antihistamines Flashcards

1
Q

Which is the primary site of ocular allergies?

a. conjunctiva
b. lids
c. cornea

A

conjunctiva

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2
Q

Includes the coagulation-kinin sequence and non-classical complement cascade

a. innate immune response
b. adaptive immune response

A

innate immune response

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3
Q

The innate immune response is a first-line response that is _______, acute, ______ memory, and involves both humoral and cell-mediated responses.

a. specific, has memory
b. nonspecific, has memory
c. nonspecific, lacks memory

A

nonspecific, lacks memory

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4
Q

T/F: The classical complement cascade (Ag-Ab) is part of the specific adaptive immune response.

A

True!

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5
Q

All of the following describe the adaptive immune response, except:

a. requires prior exposure of the antigen
b. features both specificity and memory.
c. found exclusively in jawed vertebrates
d. involves memory B and T cells
e. all of the above describes adaptive immune response

A

all of the above

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6
Q

Which is aka “acquired immunity” and is the basis for vaccinations?

a. innate immune response
b. adaptive immune response

A

adaptive immune response

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7
Q

All of the following are involved in the innate immune response, except:

a. Natural killer T cells
b. macrophages
c. B cells
d. monocytes and granulocytes

A

B cells are NOT part of the innate immune response.

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8
Q

The response time for an innate immune response is _____, and _____ for an adaptive immune response.

a. less than 12 hours, 1 day
b. less than 12 hours, 1-2weeks
c. less than 24 hours, 1 day
d. less than 24 hours, 1-2 weeks

A

less than 12 hours, 1-2 weeks

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9
Q

A foreign substance having the capacity to evoke an immunological response.

A

antigen

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10
Q

which is not one of the 3 categories of antigens that can cause an allergic response?

a. environmental
b. biological
c. chemical
d. physical

A

physical

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11
Q

An exaggerated immune response specifically involving an innate or foreign innocuous antigen classified as an “allergen”

A

hypersensitivity

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12
Q

Atopy, asthma, and anaphylaxis are examples of what type of hypersensitivity response?

a. type I
b. type II
c. type III
d. type IV

A

type I

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13
Q

Which types are most commonly associated with ocular reactions?

a. Types I & III
b. Types I & IV
c. Types III & IV
d. Types I and II

A

Types I and IV

I = allergy
IV = Delayed CD4 and/or Cell-mediated CD8
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14
Q

Which type of hypersensitivity reaction is IgE based?

a. Type I only
b. Type II only
c. Types I and II
d. Types I and IV

A

Type I only (allergy)

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15
Q 
Which type of hypersensitivity reaction is "IgM or IgG based"? 
a. Type I only
b. Type II only
c. Types II and III
Types III and IV
A

Types II and III

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16
Q

Atopy, asthma, and anaphylaxis are what type of hypersensitivity response?
Type I, II, III or IV?

A

Type I

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17
Q

Antibody mediated or cytotoxic such as Graves, MG or autoimmune diseases are what type of hypersensitivity response?

A

Type II

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18
Q

Arthritis, nephritis, vasculitis, SLE (lupus) are what type of hypersensitivity response?

A

Type III

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19
Q

Transplant rejection, IDDM (Diabetes), MS, and RA are what type of hypersensitivity response?

A

Type IV

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20
Q

Which type of hypersensitivity is T cell based, antibody independent, and not responsive to antihistamines?

A

Type IV

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21
Q

Itch is an essential symptom of what?

A

ocular allergy

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22
Q

What is the dosing frequency for ocular allergies?

A

every 2 hours to once daily

q2h to Qd

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23
Q

Decongestants, antihistamines, ____ ____ stabilizers, NSAIDS, s_____, allergen avoidance, and cold compresses are all allergy therapies.

A

Mast Cell stabilizers, steroids

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24
Q

Avoid ______ the eyes is the most important piece of advice that an optometrist can give when it comes to allergies.

A

AVOID RUBBING THE EYES!!!

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25
Q

Decongestants are ________ agonists that are imidazole derivatives lacking a saturated ______ ring.

A

adrenergic (alpha), benzene ring.

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26
Q

Why is phenylephrine NOT commonly used to treat allergies? (2 adverse effects)

A

because it causes “rebound congestion” and chronic use can cause “conjunctiva medicamentosa”

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27
Q

What is the general dosing condition for decongestants?

A

BID to QID

2 to 4 times per day

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28
Q

Do NOT give decongestants to which patients?

A

Do NOT give to pts with “angle closure glaucoma” or narrow angles, and be cautious with cardiovascular, hyperthyroidism, and diabetes.

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29
Q

T/F: vasoconstriction reduces hyperemia and edema.

A

True

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30
Q

Phenylephrine, naphazoline, oxymetazoline, and tetrahydrozoline are all _______ ______ (aka decongestants).

a. cholinergic agonists
b. adrenergic agonists
c. cholinergic antagonists
d. adrenergic antagonists

A

adrenergic agonists!!

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31
Q

Which decongestant causes elevated IOP and mydriasis?

a. phenyleprhine
b. naphazoline
c. tetrahydrozoline
d. oxymetazoline

A

naphazoline

32
Q

Which decongestant causes reduced IOP?

a. phenylephrine
b. naphazoline
c. tetrahydrozoline
d. oxymetazoline

A

tetrahydrozoline (longer word)

33
Q

how many histamine receptor types are there?

A

4 types (H1,2,3,4)

34
Q

which histamine receptor type promotes gastric acid production and immune cell activation?

A

H2

35
Q

the eye, stomach, heart, lungs and immune cells have a substantial distribution of which type of histamine receptors?

A

H2

36
Q

immuno-modulation, inflammation, and nociception occur in what histamine receptor type?

A

H4

37
Q

Which histamine receptor type is involved in pre-synaptic feedback inhibition?

A

H3

38
Q

which histamine receptor type is involved in immediate hypersensitivity reactions?

A

H1

39
Q

_______ promotes vascular permeability, which causes runny nose, watery eyes, swollen lids, and papillae.

A

Histamine!! (this is what makes you sneeze… the thing you are allergic to)

40
Q

Topical histamine in the eyes used in experimental animals has additional effects such as _______ IOP, mild miosis, and ________ blood aqueous barrier permeability.

A

increased IOP, increased BAB permeability.

41
Q

histamine induces vaso________, smooth muscle ________, broncho_______, and stimulates sensory nerves causing pain, itching and sneezing.

A

vasoDILATION, smooth muscle CONTRACTION, and bronchoCONSTRICTION. (VD, BC)

42
Q

It was long perceived that H1 and H2 anti-histamines were “histamine receptor antagonists”, but it has been found that they are actually “________ agonists”

A

INVERSE agonists

43
Q

______ agonists bind to the same receptor site as agonists but cause the opposite effect. They cause the reversal of ________ receptor activity.

A

INVERSE agonists, constitutive

44
Q

H2 anti-histamine therapy is also used to treat ___________.

A

GERD and peptic ulcers

45
Q

If a patient presents with a deeper ocular condition, such as moderate to severe eyelid edema, what kind of therapy would be most effective?

A

Oral therapy

46
Q

Antihistamines are usually either once a day, every 2 hours, or every 4 hours.

A

True! (QD, BID, QID)

47
Q

Which of the following is NOT an indication for anti-histamine use?

a. itchy and watery eyes
b. mild to mod. allergic conjunctivitis
c. myokymia
d. intra-operative anti-mydriatic
e. allergic rhinitis

A

intra-operative anti-mydriatic. it should be miotic!!!!

48
Q

OTC and prescription anti-histamines often cause drowsiness because they are _______ and _____ enter the CNS.

a. cholinergic, readily
b. cholinergic, do not
c. anticholinergic, readily
d. anticholinergic, do not

A

anticholinergic, readily (easily)

49
Q

if your patient comes in with a red eye, what should you always ask to rule out systemic cause?

A

ask if the patient has any upper respiratory problems or rhinitis, to rule out systemic causes.

50
Q

What are the 2 common antihistamine-decongestion drugs called?

A

Naphcon-A (visine) and Vasocon-A.

“con” refers to the decongestant and “A” refers to antihistamine. Both of these are 1st generation antihistamines

51
Q

T/F? Vasocon-A = antazoline phosphate + Naphazoline HCl; Naphcon-A= Pheniramine maleate + Naphazoline HCl.

A

True!!!

Mnemonic: “VA hospitals have a lot of NPs (Nurse Practitioners)”

52
Q

the suffix “-zoline” is indicative of what type of drug?

a. antihistamine
b. decongestant
c. antibiotic

A

b. decongestant!!!

53
Q

Which of the following are adverse effects of topical antihistaminics/decongestants?

a. mydriasis
b. anisocoria
c. reactive hyperemia
d. vasoconstriction
e. all of the above

A

all of the above!

54
Q

Why are MAOI and EtOH considered contraindications for topical antihistaminics?

A

MAOI blocks degradation and metabolism of catecholamines, which can dangerously elevate catecholamine levels; EtOH is a CNS depressant, which causes sedation. Therefore, it can have an additive effect if the patient is taking EtOH.

55
Q

Mast cell stabilizers are useful against type I hypersensitivity reactions, but are NOT USEFUL for which type?

a. type 1
b. type 2
c. type 3
d. type 4

A

useless for type 4 hypersensitivity rxns. WHY??? Recall that type 4 includes medicamentosa, which does NOT involve degranulation. The whole point of using a Mast Cell Stabilizer is to inhibit degranulation.

56
Q

How do “mast cell stabilizers” function as a type of allergy treatment?

A

Mast cell stabilizers are oral agents that block Ca2+ influx, which inhibits degranulation.

57
Q

If a patient presents with Vernal Keratoconjunctivitis or Giant Papillary Conjunctivitis (GPC), which would be the best treatment?

a. Antihistamine
b. Decongestant
c. Mast Cell Stabilizer
d. NSAID
e. Steroid

A

Mast Cell Stabilizer would be BEST!!

58
Q

Which topical mast cell stabilizer is the FASTEST acting in its class (15-30 min) and the ONLY one that is BID dosing?

a. permirolast (alamast)
b. nedocromil (alocril)
c. lodoxamide (alomide)
d. cromolyn (crolom)

A

nedocromil (alocril)

59
Q

T/F: Mast Cell Stabilizers (MCS) are better suited than Decongestants for use in younger children.

A

true!!!

MCS’s can be used in 2,3,4 year olds. while decongestants can only be used in 6yr and older.

60
Q

Which Topical Mast Cell Stabilizer can be used in a 2 yr old child?

a. permirolast
b. nedocromil
c. lodoxamide
d. cromolyn

A

lodoxamide (alomide)

61
Q

T/F: A typical treatment course using Mast Cell Stabilizers is 7-days QID followed by BID maintenance.

A

True!!

62
Q

Out of the four topical mast cell stabilizers: ________ has the most adverse effects, while ________ has the least.

a. nedocromil, lodoxamide
b. lodoxamide, cromolyn
c. lodoxamide, nedocromil
d. nedocromil, permirolast

A

c. lodoxamide, nedocromil

63
Q

Which topical Antihistaminic/Mast cell stabilizer combo drug is available OTC?

a. Ketotifen (ALAWAY)
b. Epinastine (ELESTAT)
c. Alcaftadine (LASTACAFT)
d. Olopatadine (PATADAY)

A

Ketotifen (ALAWAY) is the ONLY Antihistaminic/MCS combo drug that is available OTC. (Claritin Eye, Refresh, Zatidor).
It is given BID.

64
Q

Which topical Antihistaminic/ Mast cell stabilizer combo drug has anti-H2 receptor properties and can cause upset stomach?

a. Ketotifen (ALAWAY)
b. Epinastine (ELESTAT)
c. Alcaftadine (LASTACAFT)
d. Olopatadine (PATADAY)

A

Epinastine (ELESTAT)

65
Q

Which TWO antihistaminic/Mast cell stabilizer combo drugs are taken QID (every 4 hours)?

a. Ketotifen (ALAWAY)
b. Epinastine (ELESTAT)
c. Alcaftadine (LASTACAFT)
d. Olopatadine (PATADAY)

A

Alcaftadine (LASTACAFT)

Olopatadine (PATADAY)

66
Q

NSAID’s work as an _____________ agent, not as an antihistamine or Mast cell stabilizer.

A

anti-inflammatory agent

67
Q

Ketorolac tromethamine (Acular) is a __________ approved to treat Seasonal Allergic Conjunctivitis (SAC)

a. antihistaminic
b. decongestant
c. mast cell stabilizer
d. NSAID
e. steroid

A

NSAID

68
Q

T/F: Loteprednol etabonate (lotemax) is safe for long term therapy of SAC and VKC.

A

True!!!

69
Q

T/F: If a patient has a cold or an upper respiratory infection, it is better to use an oral drug rather than a topical.

A

True!!

70
Q

T/F: Topical antihistaminics required dosing may be _____ frequent than oral therapy.

a. more
b. less

A

Topical = more frequent

71
Q

First generation oral antihistaminics (classic) cause drowsiness, while second generation ones are non-drowsy.

A

True!

72
Q

Second generation oral antihistaminics are non-drowsy because they have poor _________ character and thus do NOT enter the CNS.

a. lipophobic
b. lipophilic

A

poor lipophilic character

73
Q

cimetidine, famotidine, nizatidine, and ranitidine are all examples of ________?

A

oral anti-H2 antihistamines

74
Q

Diphenhydramine, aka ________ OTC, is a first generation oral antihistaminic that causes drowsiness and can sometimes be used specifically as a sedative.

A

BENADRYL!!!

75
Q

Fexofenadine (Allegra) is a second generation oral anti-histaminic that has the least CNS effects (least drowsy)

A

True!

76
Q

Which is the MOST POTENT second generation oral anti-histaminic, but is the most sedating one as well?

a. fexofenadine (ALLEGRA)
b. claritin (loratadine)
c. clarinex (desloratadine)
d. zyrtec (cetirizine)

A

Zyrtec (cetirizine)

5. Anti-histamines (1 decks)

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