Chapter 37: Allergic Rhinitis, Cough & Cold

Question 1

____ can determine patient-specific allergens

Answer 1

IgE-mediated skin prick test

Question 2

Examples of wetting agents that are commercially available for allergic rhinitis

Answer 2

Ocean, Little Remedies

Question 3

Nasal irrigation uses ___ or ___ saline solution to rinse out allergens and mucus, improve ciliary function and reduce swelling

Answer 3

Isotonic (0.9%) or hypertonic

Question 4

What is first line for chronic, moderate-severe symptoms of allergic rhinitis

Answer 4

Intranasal steroids

Question 5

Mild, intermittent symptoms of allergic rhinitis can be treated with

Answer 5

oral antihistamines

Question 6

Budesonide brand name for allergic rhinitis

Answer 6

Rhinocort Allergy

Question 7

Fluticasone brand name for allergic rhinitis

Answer 7

Flonase Allergy Relief, Flonase Sensimist, Children’s Flonase

Question 8

Triamcinolone brand name for allergic rhinitis

Answer 8

Nasacort Allergy 24H, Nasacort Allergy 24H Children

Question 9

How long can it take for full relief of symptoms if using an intranasal steroid for allergic rhinitis

Answer 9

up to 1 week

Question 10

What are the preferred nasal steroids in pregnancy for allergic rhinitis

Answer 10

Budesonide and beclomethasone

remember B for baby

Question 11

T/F: Antihistamines work well for nasal congestion

Answer 11

Fasle

Question 12

Antihistamines MOA

Answer 12

block histamine at H1 receptor site

Question 13

Which group of antihistamines cause more sedation

Answer 13

first-generation

second generation are preferred

Question 14

Which drugs are first generation oral antihistamines

Answer 14

Benadryl, chlorpheniramine, doxylamine

Question 15

First generation antihistamines should be avoided in which patient population

Answer 15

Elderly (due to sedation and cognitive impairment)

Question 16

First generation antihistamines should be used with caution in which disease states

Answer 16

Prostate enlargement and glaucoma

Question 17

Cetirizine brand name

Answer 17

Zyrtec

Question 18

Levocetirizine brand name

Answer 18

Xyzal

Question 19

Fexofenadine brand name

Answer 19

Allegra

Question 20

Loratadine brand name

Answer 20

Claritin

Question 21

Which second generation antihistamine should be taken with water only and NOT juice due to decreased absorption

Answer 21

Fexofenadine

Question 22

Which second generation antihistamines should be used in pregnancy

Answer 22

Loratadine or cetirizine (Claritin or Zyrtec)

Question 23

Which second generation antihistamines have a fast onset and may work best for some patients

Answer 23

Cetirizine and levocetirizine (Zyrtec and Xyzal)

Question 24

Which two second generation antihistamines are more sedating

Answer 24

Cetirizine and levocetirizine

Question 25

Which two second generation antihistamines are least sedating

Answer 25

Fexofenadine and loratidine

Question 26

Benadryl dosing for adults

Answer 26

25-50 mg PO Q4-6H

Question 27

Benadryl dosing for age < 6 years

Answer 27

DO NOT USE OTC unless directed by a healthcare provider

Question 28

Which drug class can be combined with an intranasal steroid to help with congestion

Answer 28

Intranasal antihistamines (Azelastine and Olopatadine)

Question 29

Decongestant MOA

Answer 29

Alpha-adrenergic agonists that cause vasoconstriction, which decreases sinus vessel engorgement and mucosal edema

Question 30

Which decongestant has poor oral absorption

Answer 30

Phenylephrine (comes as a nasal inhaler, but lasts for a shorter time & causes more SE than oxymetazoline inhalers)

Question 31

Pseudoephedrine is a precursor to which drug

Answer 31

methamphetamine

Question 32

Under federal law, the max amount of PSE products allowed for purchase in a day & in a 30-day period is

Answer 32

3.6 g per day 9 grams in a 30-day period (remember: 3-6-9)

Question 33

Phenylephrine brand name

Answer 33

Sudafed PE

Question 34

Pseudoephedrine brand names

Answer 34

Sudafed, Nexafed, Zephrex-D

Question 35

Oxymetazoline brand name

Answer 35

Afrin (nasal spray)

Question 36

Systemic decongestants CI

Answer 36

Do not use within 14 days of MAOi

Question 37

Systemic decongestants should be avoided in children < __ years (FDA) and < __ years (package labeling)

Answer 37

2 | 4

Question 38

Systemic decongestants should be used with caution in patients with

Answer 38

CV disease, BPH (can cause urinary retention)

Question 39

Systemic decongestant SE

Answer 39

Tachycardia, palpitations, increased BP, insomnia, decreased appetite

Question 40

Oxymetazoline can cause rhinitis medicamentosa (rebound congestion) if used longer than

Answer 40

3 days

Question 41

Intranasal cromolyn (NasalCrom) MOA

Answer 41

OTC mast cell stabilizer for tx and ppx of allergic rhinitis

Question 42

In order for intranasal cromolyn to be effective, it must be started at the onset of allergy season and:

Answer 42

used regularly (not PRN)

Question 43

Which patient groups can benefit from intranasal cromolyn

Answer 43

Children >/= 2 years old and pregnancy

Question 44

Montelukast brand name

Answer 44

Singulair

Question 45

Montelukast is the only leukotriene modifying agent indicated for both

Answer 45

allergic rhinitis and asthma

Question 46

Montelukast is commonly used in which patient population

Answer 46

children

Question 47

An alternative to immunotherapy (allergy shots), SL treatment can be given. The 4 FDA-approved SL treatments for allergic rhinitis are tailored to specific allergens & the first dose must:

Answer 47

be given in a medical office where the patient can be monitored for at least 30 min after for signs of an allergic reaction (boxed warning)

Question 48

How is the common cold transmitted

Answer 48

Mucus secretions or by air

Question 49

T/F: the common cold is a bacterial infection

Answer 49

False - viral

Question 50

Which natural products can be used for cold symptoms

Answer 50

- Zinc for cold prevention and treatment - Vitamin C (ascorbic acid) decreases duration of cold - Echinacea is possibly effective for treatment

Question 51

What can be used if a productive cough is present

Answer 51

Expectorants to thin mucus

Question 52

Which drugs are expectorants

Answer 52

Gauifenesin (Mucinex, Robitussin Mucus + Chest Congestion, Robafen) + dextromethorphan (Robafen DM, Robitussin DM)

Question 53

Which drugs are cough suppressants

Answer 53

- Dextromethorphan (Delsym, Robafen Cough, Robitussin Cough) - Codeine - Benzonatate (Tessalon Perles) - Diphenhydramine

Question 54

Codeine if used for pain as a single entity is a schedule __ drug & if used in combination products for cough and cold is a schedule ___ drug

Answer 54

II | V

Question 55

Dextromethorphan CI

Answer 55

Do not use within 14 days of MAOi

Question 56

Dextromethorphan SE

Answer 56

serotonin syndrome

Question 57

Codeine BW

Answer 57

respiratory depression and death in children who received codeine following tonsillectomy and/or adenoidectomy and have evidence of being ultra-rapid metabolizers of codeine d/t a 2D6 polymorphism (also in nursing infants)

Question 58

Codeine should not be used in children < __ years for any indication. The FDA recommends to avoid codeine-containing cough and cold products for patients < __ years

Answer 58

12 | 18

Question 59

Dextromethorphan at high doses acts as a(n)

Answer 59

NMDA-receptor blocker leading to euphoria and hallucinations

Question 60

Promethazine/codeine drug schedule

Answer 60

C-V

Question 61

Chlorpheniramie/hydrocodone (TussiCaps, Tussionex) drug class

Answer 61

C-II

Question 62

Children < __ years should avoid OTC cough and cold products per package labeling

Answer 62

4

Question 63

Children < __ years should avoid OTC cough and cold products (per FDA), promethazine (per FDA), and topical menthol and camphor (per package labeling)

Answer 63

2