Antihistamines (lauren 🌭)

Question 1

What are the clinical indications for antihistamines

Answer 1

Allergies (nose, skin, eyes)

Hypersensitivity reactions

Anaphylaxis

Hives (acute and chronic)

Motion sickness

Vertigo

Insomnia

Question 2

What are the 6 First Generation H1 blockers you need to know?

Answer 2

Diphenhydramine (Benadryl, Nytol, Sominex)

Chlorpheniramine (Chlor-Trimeton)

Dimenhydrinate (Dramamine)

Promethazine (Phernergan)

Meclizine (Antivert)

Hydroxyzine (Atarax, Vistaril)

Question 3

Which H1 blocker is EXTREMELY SEDATING and would be great for someone who is so itchy that they can’t sleep at night?

Answer 3

Hydroxyzine (Atarax, Vistaril)

Question 4

Name the Second generation H1 blocker you need to know

Answer 4

Loratadine (Claritin)

Cetirizine (Zyrtec)

Fexofenadine (Allegra)

Question 5

Which 2nd generation H1 blocker can be mildly sedating and is NOT OK for pilots 👨🏼‍✈️

Answer 5

Cetirizine (Zyrtec)

Question 6

What are the H2 blockers you need to know?

Answer 6

Ranitidine (Zantac)

Famotidine (Pepcid)

Question 7

What are the 2 nasal antihistamines you (might) need to know

Answer 7

Azelastine (Astelin, Astepro)

Azelastine + Fluticasone (Dymista)

(She really didn’t say anything about this slide)

Question 8

What are the antihistamine eye drops you (probably don’t) need to know?

Answer 8

Azelastine (Optivar)

Ketotifen (Zatidor)

Naphazoline (Naphcon A)

Olopatadine (Patanol)

Question 9

Which class of H1 blockers can cross the BBB and thus, can help with motion sickness and insomnia?

Answer 9

1st generation

Question 10

What are the side effects of antihistamines?

Answer 10

Anticholinergic

RED as a BEET🍠

DRY as a BONE🦴

BLIND as a BAT🦇

MAD as a HATTER🎩

HOT as a HARE🐇

Question 11

What is the 1st line medication for allergic rhinitis?

Answer 11

Nasal steroid sprays

Question 12

If you don’t want to die in a fiery plane crash, what allergy meds should you confiscate from the guy who flies your private jet?🛩

Answer 12

Diphenhydramine (Benadryl)

Cetirizine (Zyrtec)**

Levocetirizine (Xyzal)

Azelastine Nasal Spray (Asteline)

Question 13

What 2 allergy meds are OK to take if you fly an airplane (as long as you did a trial run to make sure they don’t make you act goofy)?✈️

Answer 13

Loratadine (Claritin)

Fexofenadine (Allegra)

Question 14

If you REALLY have to take one of the illegal antihistamines and you are employed as an airplane pilot, how long do you have to wait before you get back behind the wheel? Joysticks? Buttons?

Answer 14

5 times the drug’s half life

For Benadryl, that would be 60 hours you must stay on the ground and not fly

Question 15

What occupations other than a pilot should probably NOT take sedating antihistamines?

Answer 15

Heavy machinery operator 🚀

Construction workers 🚧

Electricians who climb poles 🏗

Light rail driver 🚈 toot toot

Health care providers 👨🏻‍⚕️

PA students 👵🏻🐈🌭

Question 16

If someone has BPH, what kinds of allergy meds probably make it even harder for him to pee?

Answer 16

1st generation antihistamines (anticholinergic effect)

Decongestants like Sudafed

Question 17

If someone has glaucoma, what allergy meds should be avoided because they can increase IOP?

Answer 17

Decongestants

Antihistamines

Steroids (including nasal steroids)

Question 18

Okayyyy so what am i supposed to do if my patient has glaucoma and allergies?

Answer 18

Call their ophthalmologist and let her decide what to do

Immunotherapy (allergy shots) might be their best option

Question 19

If you have a patient who has scabies and he CAN’T SLEEP because of the itching, what meds does he need?

Answer 19

Permethrin cream 5% from neck down for 8-12 hours

Hydroxyzine or Benadryl to help him sleep

(And of course you will tell him about the side effects and risks of being sedated)

Question 20

If a vignette mentions someone has night time itching and “burrow lesions” what do they have

Answer 20

Scabies

Question 21

Acute hives lasts less than ____ weeks

Chronic hives lasts more than ____ weeks

Answer 21

6

6

Question 22

What can sometimes cause chronic hives?

Answer 22

“Autoimmune chronic urticaria”

Question 23

If a patient has autoimmune chronic urticaria, what kind of med may help?

Answer 23

Non-sedating antihistamine

Question 24

What do you need to give to someone with Poison Ivy?

Answer 24

Steroid cream

Non-sedating antihistamine

+/- oral prednisone if needed

Watch out for signs of infection

Question 25

Where can you NOT put high-potency steroid cream?

Answer 25

Face Skin folds like your GENITALS

Question 26

If someone has a PCN allergy, can they take augmentin?

Answer 26

No

Question 27

If someone develops a medication rash because they’re an idiot and they used their friend’s augmentin for their poison ivy even though they are allergic to PCN, what can you do for them?

Answer 27

Shame them Oral antihistamine IM steroids and/or IM antihistamine (don’t drive after antihistamine) +/- oral prednisone (Obviously stop the augmentin too)

Question 28

If someone has hives that are just not responding to any treatment, including antihistamines and prednisone, what is a last ditch effort that you can add on to their treatment?

Answer 28

H2 blockers

Question 29

Can you try using H2 blockers by themselves to treat urticaria?

Answer 29

NO. ONLY AS AN ADJUNCT

Question 30

You give your patient an allergy shot, watch her for 30 minutes and send her on her way. A few minutes later, she develops a tickle in her throat, so she calls your office. Your receptionist should tell her to _____________

Answer 30

Call 911/go to ER

Question 31

If your patient develops a tickle in her throat after gettin an allergy shot in your office, and your receptionist mistakenly tells her to come back to your office, what meds do you need to get ready?

Answer 31

IV Benadryl IV Epinephrine IV/IM Glucocorticoid

Question 32

What is the DRUG of CHCOICE for anaphylaxis?

Answer 32

Epinephrine

Question 33

By definition, anaphylaxis involves _____ body systems at the same time

Answer 33

2+ Ex: Skin and mucosa Respiratory/Airway GI (abdominal pain, vomiting, diarrhea) Cardiac (hypotension, tachycardia, syncope)

Question 34

If you successfully treat someone’s anaphylactic reaction, can you just kick them out the front door empty handed?

Answer 34

NO, need to be aware of rebound possibility. You need to give them an epi pen and a referral to an allergist

Question 35

What drug cocktail was given to that little girl who had an anaphylactic reaction to cashews, and is a good regimen for anyone with anaphylaxis

Answer 35

Benadryl Epinephrine Dexamethasone Famotidine (Pepcid)

Question 36

What route(s) of administration do you use to give meds during an anaphylactic reaction?

Answer 36

IV or IM NOT ORAL (their freakin throat is swelling shut)

Question 37

1st generation or 2nd generation H1 blocker: Longer acting with once daily dosing

Answer 37

2nd gen

Question 38

1st generation or 2nd generation H1 blocker: Crosses blood brain barrier

Answer 38

1st