Cold, Flu, and Allergy Meds

Question 1

Topical sympathomimetic drugs

Answer 1

Decongestants— Nasal Sprays
Phenylephrine and oxymetazoline ( longer-acting)
NO longer use than 3 days

Afrin– Oxymetazoline HCl (Caution- rhinitis medicamentosa, robound congestion, Afrin addiction).

Neo-Synephrine (Phenylephrine HCl)

Question 2

Phenylephrine MOA and medications

Answer 2

Sympathomimetics- decongestant

In Nasal spray (topical) effective as neo-synephrine (for 3 day use)

In Oral medications- completely ineffective! Seen in “PE” (i.e. zyrtec-PE or Sudafed PE)

Question 3

Pseudophedrine medications and MOA

Answer 3

Oral sympathomimetic
Found in combo with antihistamines
Claritin-“D” or Zyrtec-“D”

Question 4

Purpose of phenylephrine

Answer 4

Rhinitis treatment, allergic and non-allergic

Question 5

Your patient is taking ipatropium bromide. What is the MOA/Class and function

Answer 5

Nasal/Topical Anticholinergic, inhbits secretions
For NON-Allergic rhinitis (less effective than corticosteroids for allergic).
RX only

Question 6

What are the topical corticosteroids

Answer 6

Nasal sprays for allergic rhinitis
Flonase ( Fluticasone)
Rhinocort ( Budesonide)
Nasacort (Triamcinolone)

Use for at least 1 week for the full effect

Question 7

Your patient is on budesonide. What is this medication class and use?

Answer 7

It is Rhinocort, a topical/nasal corticosteroid for allergic rhinitis

Question 8

Your patient is on triamcinolone. What is this medication class and use?

Answer 8

Nasacort, a topical/nasal corticosteroid for allergic rhinitis

Question 9

Your patient is on fluticasone. What is this medication class and use?

Answer 9

Flonase, a topical/nasal corticosteroid for allergic rhinitis

Question 10

Name the oral antihistamines in the 1st generation and 2nd generation, along with their respective shelf names.

Answer 10

1st generation:
Benadryl (diphenhydramine)

2nd Generation:
Zyrtec (Cetirizine)
Allegra ( fexofenadine)- least sedating old option
Xysal (levocetirizine)– most effective, double H1 receptor binding, less sedating.
Claritin ( loratadine)

Question 11

Your patient is on fexofenadine. What is this medication class and use?

Answer 11

This is a 2nd generation antihistamine, Allegra. Used as an oral antihistamine for allergic rhinitis

Question 12

Name the Topical antihistamine options

Answer 12

Azelastine (astepro), nasal or opthalmic
Olopatadine (Pataday), nasal or opthalmic

Compete with histamines for H1 receptor sites in blood vessels in respiratory and GI tract

Question 13

Your patient is on cromolyn. What is this medication class and use?

Answer 13

Nasal spray, mast cell stabilizer. Take preventatively to prevent histamine release. Use 1-2 weeks before hand.
NasalCrom

Question 14

Your patient is on ketotifen. What is this medication class and use?

Answer 14

Opthalmic Eye itch relief, mast cell stabilizer. Take preventatively to prevent histamine release. Use 1-2 weeks before hand.
Alaway eye drops

Question 15

Your patient comes to the ED complaining of serious adgitation, sleep disturbance, and SI. They affirm being on an anti rhinitis drug. Which drug are they likely on?

Answer 15

They are probably on the leukotriene receptor antagonist Montelukast (Singulair). BBW for neuropsych SIs and SI.

Question 16

Your patient is on Robitussin. What is this medication class and use?

Answer 16

Guiafenesin, expectorant, thins and loosens mucus.
Short term management of productive coughs.
Likely mixed with Codeine, DM, or PE, so check which specific drug they are on.

Question 17

OTC topical agents that are antitussives

Answer 17

Menthol
Benzocaine (Cepacol)- local anesthetic
Camphor (Vick’s) vapors, help with cough and congestion

Question 18

What are the guaifenesin drugs?

Answer 18

Mucinex, Robitussin

Question 19

Your patient is on Delsym. What is this medication class and use?

Answer 19

Dextromethorphan (DM)
Anti-cough
Acts centrally on medulla, increases cough threshold. Analog of a codine analog.

Question 20

Which drug is associated with skittling and robotripping?

Answer 20

DM- dextromethorphan. Seen in Mucinex DM or Delsym, or other drugs.
Warn patients who are fall risks
Cause visual hallucinations and similar effects to PCP or ketamine if OD

Question 21

Which drug is associated with Sizzurp/purple drank?

Answer 21

Codeine- seen in combination with other drugs such as Robitussin AC ( Guaifenesin-codine)

Question 22

SI’s of benzocaine and camphor

Answer 22

Benzocaine- Methemoglobinemia
Camphor- If ingested, serious CNS side effects

Question 23

Your patient is on Tessalon. What is this medication class and use?

Answer 23

Benzonatate- anesthetic- prevents cough reflex
RX only
Local anesthetic effects on respiratory stretch receptors

Question 24

Phenergan is used for

Answer 24

Nausea and vomitting
Promethzine alone is Phenergan, which is anti N/V. BUT, for cough and congestion, given with codeine or DM/PE to reduce edema and congestion

Question 25

Robitussin AC and Tussionex have what similar compound in them

Answer 25

Codeine Acts centrally on medulla to increase cough threshold Contraindicated in kids <12 Promethazine-Codeine is no longer carried in pharmacies becauase of drug abuse

Question 26

Which drugs to avoid in HTN, CVD, or Pregnancy

Answer 26

-- Pseudophedrine/ PO Decongestants, they can increase HTN which is bad for HTN pts or pregnancy (decrease Blood Flow to fetus). --NSAIDs Instead, use saline, acetaminophen, guaifenesin, DM, 2nd gen antihistamines

Question 27

Which drugs to avoid in children

Answer 27

- Any Codine Analogs (Codine, DM) - Use Vick's rubs or honey instead if >1 year old

Question 28

Which drug increases the risk of an acute MI by 3 times in patients who have an active URI?

Answer 28

NSAIDs(Aspirin, ibuprophen, neproxin)-- caution in GI ulcers, CVD, pregnancy.