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NAPLEX 25 > Chapter 37: Allergic Rhinitis, Cough & Cold > Flashcards

Chapter 37: Allergic Rhinitis, Cough & Cold Flashcards

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1
Q

What are the flu-like symptoms of allergic rhinitis?

A
  • Rhinorrhea (runny nose)
  • Sneezing
  • Itchy eyes
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2
Q

What can determine patient-specific allergens?

A

IgE-mediated skin prick test

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3
Q

Examples of wetting agents that are commercially available for allergic rhinitis?

A

Ocean, Little Remedies

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4
Q

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

A

Isotonic (0.9%) or hypertonic (2-3.5%)

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5
Q

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

A

Intranasal steroids

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6
Q

Mild, intermittent symptoms of allergic rhinitis can be treated with?

A

oral antihistamines

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7
Q

How does internasal steroids work for allergic rhinitis?

A

decreasing inflammation

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8
Q

Budesonide brand name for allergic rhinitis?

A

Rhinocort Allergy

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9
Q

Fluticasone brand name for allergic rhinitis?

A

Flonase Allergy Relief, Flonase Sensimist, Children’s Flonase

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10
Q

Triamcinolone brand name for allergic rhinitis?

A

Nasacort Allergy 24H, Nasacort Allergy 24H Children

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11
Q

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

A

up to 1 week

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12
Q

What are the preferred nasal steroids in pregnancy for allergic rhinitis?

A

Budesonide and Beclomethasone

remember B for baby

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13
Q

What are the side effects for intranasal steroids?

A
  • Epistaxis (nose bleeds)
  • Headache
  • Dry nose
  • Unpleasant taste
  • Localized infection
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14
Q

T/F: Antihistamines work well for nasal congestion?

A

False

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15
Q

Antihistamines MOA?

A

block histamine at H1 receptor site

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16
Q

Which group of antihistamines cause more sedation?

A

First-generation

second generation are preferred

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17
Q

Which drugs are first generation oral antihistamines?

A
  • Benadryl,
  • Chlorpheniramine,
  • Doxylamine
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18
Q

First generation antihistamines should be avoided in which patient population?

A

Elderly (due to sedation and cognitive impairment)

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19
Q

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

A

CV, Prostate enlargement and glaucoma

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20
Q

What are the side effects of 1st gen antihistamines?

A
  • Somnolence
  • Cognetive impairment
  • Strong anticholinergic effects (dry mouth, blurred vision, urinery retention, constipation)
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21
Q

What age group should not use OTC benadryl without provider advise?

A

Less than 6 years old

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22
Q

What is the adult dosing of Benadryl?

A

25mg PO q4-6h
OR
50mg PO q6-8h

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23
Q

Cetirizine brand name?

A

Zyrtec

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24
Q

Levocetirizine brand name?

A

Xyzal

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25
Fexofenadine brand name?
Allegra
26
Loratadine brand name? ## Footnote Loratadine + pseudoephedrine?
Claritin ## Footnote Claritin-D
27
Which second generation antihistamine should be taken with water only and NOT juice due to decreased absorption?
Fexofenadine
28
Which second generation antihistamines should be used in pregnancy?
Loratadine or cetirizine (Claritin or Zyrtec)
29
Which second generation antihistamines have a fast onset and may work best for some patients?
Cetirizine and levocetirizine (Zyrtec and Xyzal)
30
Which two second generation antihistamines are more sedating?
Cetirizine and levocetirizine
31
Which two second generation antihistamines are least sedating?
Fexofenadine and loratadine
32
Which drug class can be combined with an intranasal steroid to help with congestion?
Intranasal antihistamines (Azelastine and Olopatadine)
33
Decongestant MOA?
Alpha-adrenergic agonists that cause vasoconstriction, which decreases sinus vessel engorgement and mucosal edema
34
Which decongestant has poor oral absorption?
Phenylephrine (comes as a nasal inhaler, but lasts for a shorter time & causes more SE than oxymetazoline inhalers)
35
Pseudoephedrine is a precursor to which drug?
methamphetamine
36
Under federal law, the max amount of PSE products allowed for purchase in a day & in a 30-day period is?
3.6 g per day 9 grams in a 30-day period ## Footnote remember: 3-6-9
37
Phenylephrine brand name?
Sudafed PE
38
Pseudoephedrine brand names?
Sudafed, Nexafed, Zephrex-D
39
Oxymetazoline brand name?
Afrin (nasal spray)
40
Systemic decongestants CI?
Do not use within 14 days of MAOi
41
Systemic decongestants should be avoided in children < __ years (FDA) and < __ years (package labeling)?
2 4
42
Systemic decongestants should be used with caution in patients with?
CV disease, BPH (can cause urinary retention)
43
Systemic decongestant SE?
Tachycardia, palpitations, increased BP, insomnia, decreased appetite
44
Oxymetazoline can cause rhinitis medicamentosa (rebound congestion) if used longer than?
3 days
45
Intranasal cromolyn (NasalCrom) MOA?
OTC mast cell stabilizer for tx and ppx of allergic rhinitis
46
In order for intranasal cromolyn to be effective, it must be started at the onset of allergy season and:
used regularly (not PRN)
47
Which patient groups can benefit from intranasal cromolyn?
Children >/= 2 years old and **pregnancy**
48
Montelukast brand name?
Singulair
49
Montelukast is the only leukotriene modifying agent indicated for both?
allergic rhinitis and asthma
50
Montelukast is commonly used in which patient population?
children
51
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:
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)
52
How is the common cold transmitted?
Mucus secretions or by air
53
T/F: the common cold is a bacterial infection?
False - viral
54
Which natural products can be used for cold symptoms?
Zinc for cold prevention and treatment Vitamin C (ascorbic acid) decreases duration of cold Echinacea is possibly effective for treatment
55
What can be used if a productive cough is present?
Expectorants to thin mucus
56
Which drugs are expectorants?
* Guaifenesin (Mucinex, Robitussin Mucus + Chest Congestion, Robafen) * Guaifenesin + dextromethorphan (Robafen DM, Robitussin DM)
57
Which drugs are cough suppressants?
Dextromethorphan (Delsym, Robafen Cough, Robitussin Cough) Codeine Benzonatate (Tessalon Perles) Diphenhydramine
58
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?
II V
59
Dextromethorphan CI?
Do not use within 14 days of MAOi
60
Dextromethorphan SE?
serotonin syndrome
61
Codeine BW?
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)
62
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?
12 18
63
Dextromethorphan at high doses acts as a(n)?
NMDA-receptor blocker leading to euphoria and hallucinations
64
Promethazine/codeine drug schedule?
C-V
65
Chlorpheniramine/hydrocodone (TussiCaps, Tussionex) drug class?
C-II
66
Children < __ years should avoid OTC cough and cold products per package labeling?
4
67
Children < __ years should avoid OTC cough and cold products (per FDA), promethazine (per FDA), and topical menthol and camphor (per package labeling)?
2
68
What is the best application site for topical products containing menthol?
Chest and Neck

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