Antihistamines and Drugs for Allergic Rhinitis, Cough, and Colds

Question 1

Can you have an initial allergic response to a first time exposure?

Answer 1

No.

Question 2

Histamine receptors are lined where?

Answer 2

Lined through the skin, lungs, GI tract with mast cells and basophils.

Question 3

You will see what with Histamine 1 stimulation?

Answer 3

vasodilation, increased cap. permeability, bronchoconstriction, itching, pain, mucus secretions.

Question 4

You will see what with Histamine 2 stimulation?

Answer 4

Gastric acid secretion on parietal cells in the stomach

Question 5

Allergic Rhinitis is seen as what kind of Histamine stimulation?

Answer 5

Histamine 1

Question 6

Allergic Rhinitis affects what regions of the body?

Answer 6

Upper and lower airways and eyes.

Question 7

What triggers Allergic Rhinitis?

Answer 7

Seasonal hay fever (outdoor allergens)
Perennial (indoor allergies)

Question 8

What triggers Allergic Rhinitis to propagate?

Answer 8

Exposure to indoor or outdoor allergen such as IgE antibody simulation where the attach to mast cells and basophils. This then can produce a re-exposure trigger releasing histamines, leukotrienes, and prostaglandins.

Question 9

Most effective treatment for Allergic Rhinitis?

Answer 9

Intranasal Glucocorticoids preventing an inflammatory response to allergens.

Question 10

1st generation Intranasal glucocorticoids do what?

Answer 10

increased systemic absorption, used in patients 6 years or OLDER.

Question 11

2nd generation Intranasal glucocorticoids do what?

Answer 11

Decrease systemic absorption

Question 12

2nd generation glucocorticoid – Fluticasone propionate used?

Answer 12

4 y/o +

Question 13

2nd generation glucocorticoid – Fluticasone furoate OR mometasone used?

Answer 13

2 y/o +

Question 14

What can be used daily for Allergic Rhinitis?

Answer 14

Metered dose sprays - when symptoms are controlled, revert to lowest dose possible

Question 15

If nasal congestion is present, use what first?

Answer 15

TOPICAL decongestant before intranasal.

Topical decongestants are medications applied directly to the nasal passages to relieve nasal congestion.

Example: VAPOCOOL rub!

Question 16

What RARE a/e can occur with intranasal glucocorticoids?

Answer 16

Adrenal suppression and slow of linear growth.

Question 17

Antihistamines has how many generations?

Answer 17

2 generations!

Question 18

Examples of 1st generation antihistamines?

Answer 18

1. Brompheniramine
2. Diphenhydramine
3. Prometazine
4. Hydroxyzine
5. Cyproheptadine

Question 19

Examples of 2nd generation antihistamines?

Answer 19

1. Cetirizine (Zyrtec)
2. Levocetirizine
3. Fexonfenadine (Allegra)
4. Lortadine (Claritin)
5. Desloratadine (Clarinex)

Question 20

Difference between 1st generation antihistamines and 2nd generation antihistamines?

Answer 20

1st generation ARE lipid soluble thus it easily crossed into the BBB and causes excessive sedation and drowsiness.

2nd generation are NOT lipid soluble thus not causing any effects.

Question 21

Antihistamines are taken for what?

Answer 21

Prophylaxis
Take regularly to prevent histamine receptor activation
it DOES NOT reduce nasal congestion

Question 22

First generation (Diphenhydramine) can be prescribed to who?

Answer 22

Kids under 10kg

Question 23

What are common a/e for Diphenhydramine in kids?

Answer 23

sedation d/t it being highly lipid soluble – can also produce anticholinergic effects.

Question 24

Second generation (Loratadine or cetirizine) can be prescribed to who?

Answer 24

6 y/o and older

Question 25

What is different about Loratadine or Cetirizine in kids?

Answer 25

it CANNOT cross the BBB d/t it being low in lipid solubility thus resulting in little to no sedation

Question 26

Azelastine can be prescribed to children around what age?

Answer 26

5-11 years old = HALF DOSE 12 years old and older = FULL DOSE

Question 27

Promethazine is contraindicated in what age group and why?

Answer 27

In children younger than 2 y/o due to severe RDS, needs to be used with EXTREME caution in ALL children

Question 28

Antihistamines can worsen what in the older generation?

Answer 28

Glaucoma and BPH.

Question 29

Intranasal Cromolyn (antihistamine) helps with what?

Answer 29

reduces s/sx by suppressing the release of histamine, can be used prophylactically with minimal adverse reactions.

Question 30

Oral and Intranasal Sympathomimetics MOA?

Answer 30

Activate alpha 1 adrenergic receptors on nasal blood vessels and reduces nasal congestion by shrinking swollen membranes allowing nasal drainage

Question 31

NASAL Sympathomimetic usage?

Answer 31

Phenylephrine - drops Oxymetazoline - long acting RAPID and INTENSE vasoconstriction

Question 32

ORAL Sympathomimetic usage?

Answer 32

Phenylephrine 4 y/o and up Pseudophedrine 6 y/o and up DELAYED response and PROLONGED

Question 33

What is a common consideration when prescribing sympathomimetics? What are a/e?

Answer 33

**DO NOT USE LONGER THAN 5 CONSECUTIVE DAYS** A/e: rebound congestion, CNS stim, CV effects, stroke

Question 34

Ipratopium Bromide does what?

Answer 34

Is a anticholinergic agent that inhibts secretions of mucus in the nasal mucosa and DOES NOT DECREASE SNEEZING, CONGESTION OR NASAL DRIP!

Question 35

Montelukast does what?

Answer 35

Leukotriene antagonist that relieves nasal congestion with POSSIBLE **neuropsychiatric effects**

Question 36

Omalizumab does what?

Answer 36

Monoclonal antibody directed against IgE and used as OFF LABEL of Allergic Rhinitis.

Question 37

What two groups are available as antitussive (cough) agents?

Answer 37

Opioid Antitussives & NON-Opioid Antitussive

Question 38

Opioid Antitussive Agent MOA and Use

Answer 38

Elevate cough thresholds (less coughing) in the CNS Codeine -- MORE effective Hydrocodone -- MORE potent, higher potential for abuse CAN LEAD TO RDS (opioid)

Question 39

Should not use Opioid Antitussive Agents in what population?

Answer 39

Kids who have reduced respiratory reserve

Question 40

NON-Opioid Antitussive MOA and Use

Answer 40

Dextromethorphan -- blocks N-methly-D aspartate in the brain Diphenhydramine -- suppresses cough with doses that produce prominent sedation Benzonatate -- decreases sensitivity of respiratory tract stretch receptors

Question 41

Guaifensin is used for what?

Answer 41

COUGH renders cough more productive while allowing flow of respiratory tract secretions outwards

Question 42

Mucolytic agents for cough?

Answer 42

Acetylcysteine -- smells like rotten eggs r/t high sulfur content CAN TRIGGER BRONCHOSPASM

Question 43

Pediatric OTC Cold Remedies used with CAUTION with which age groups?

Answer 43

AVOID OTC cold remeides in children younger than 6 y/o