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Flashcards in COPD & Allergy Deck (44):
1

pathophys of COPD

not fully reversible airflow limitation; chronic lung and airway inflammation w mucus hypersecretion and gas exchange abnormalities

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Treatment strategies for COPD

B2-R agonist
anti-ACh inhalers
bronchodilators
long-acting inhaled bronchodilators
Combined therapy of bronchodilators

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ADR of inhaled corticosteroids in COPD

increased risk of osteoporosis with extended use

4

roflumilast

oral PDE4 inhibitor
used in pts with severe COPD with bronchitis and history of exacerbation to dec exacerbations

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ADR roflumilast

nausea, diarrhea, insomnia, weight loss
interaction with CYP 3A4 inhibitors and inducers

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Meds to use for COPD exacerbations

inhaled bronchodilators (B2-ag or anti-ACh), theophylline, systemic corticosteroids, +/- roflumilast
antibiotics if infection present

7

Tx of COPD

stop smoking, bronchodilators, steroids (?), antibacterials (frequent infection)

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etiology of allergic rhinitis

Seasonal (SAR) - repetitive predictable symptoms in spring/fall, acute and triggered by allergens
perennial (PAR) - chronic, triggered by non-seasonal allergens
*Can have both

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Sx of allergic rhinitis

ocular: venous congestion -> "allergic shiners", pruritus, watery red eyes or SAR conjunctivitis
Nasal: clear rhinorrhea, sneezing, congestion, pruritus, post-nasal drip
systemic: fatigue, irritability, cognitive impairment

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Drug categories for allergic rhinitis

Anti-histamines/ H1-R antagonist
decongestants
corticosteroids

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MOA of antihistamines

antagonize capillary permeability, wheal and flare formation, pruritus
anti-ACh properties reduced nasal, salivary, lacrimal gland secretions

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Brompheniramine

1st gen oral antihistamine

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chlorpheniramine

1st gen oral antihistamine

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clemastine

1st gen oral antihistamine

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diphenhydramine

1st gen oral antihistamine

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1st vs. 2nd gen oral antihistamines

1st gen penetrates CNS -> sedation/ cognitive impairment; OTC
2nd gen Rx and OTC; peripherally selective = "non-sedating"

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cetirizine

2nd gen oral antihistamine

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levocetirizine

2nd gen oral antihistamine

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fexofenedine

2nd gen oral antihistamine
*really low CNS penetration

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loratadine

2nd gen oral antihistamine

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desloratadine

2nd gen oral antihistamine

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ADR of oral antihistamines

1st gen: anti-ahc effects = dry mouth/nose/eyes, blurred vision, urinary retention, constipation, tachycardia
CNS depression = sedation, impaired performance

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azelastine

fast-acting intranasal antihistamine, peaks at 3 hours
relieves sneezing, pruritus, rhinorrhea, reduces nasal congestion

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ADR intranasal antihistamine

bitter taste, sedation, local irritation

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oral decongestant MOA

A-adrenergic agonist -> vasoconstriction of vessels in mucosa = temporary relief of nasal congestion

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phenylephrine

direct-acting oral decongestant
also short-acting intranasal decongestant

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pseudoephedrine

indirect-acting/mixed oral decongestant
slower onset, longer duration, more effective than direct acting phenylephrine

28

ADR of oral decongestants

more likely in young/old: cardiac stimulation -> increased BP and HR, arrhythmia, palpitations; CNS stimulation -> insomnia, anxiety, tremors; if taken with MAOI increases BP further

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Precautions with oral decongestants

hypersensitivity, idiosyncratic reactions, MAOI use
may exacerbate hyperthyroidism, glaucoma, HTN, BPH

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naphazoline

intermediate acting intranasal decongestant

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tetrahydrozoline

intermediate acting intranasal decongestant

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oxymetazoline

long-acting intranasal decongestant

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Rhinitis medicamentosa & tx

rebound nasal congestion with more than 3 days use of decongestant
Tx: withdraw decongestant 1 nostril at a time, use intranasal corticosteroid, normalizes in 1-2 weeks

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MOA of intranasal corticosteroid

anti-inflammatory action on cells and mediators involved with inflammation

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DOC for allergic rhinitis & effects

intranasal corticosteroid (most effective)
relieves sneezing, rhinorrhea, pruritus, nasal congestion
max benefit in 7 days

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ADR of intranasal corticosteroid

sneezing, stinging with administration
headache
epistaxis

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beclomethasone

intranasal corticosteroid

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budesonide

intranasal corticosteroid

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flunisolide

intranasal corticosteroid

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fluticasone

intranasal corticosteroid

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mometasone

intranasal corticosteroid

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triamcinolone

intranasal corticosteroid

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Use of inhaled corticosteroids in COPD

patients with FEV1 less than 50% expected and exacerbations for 3 years

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categories of intranasal decongestants

short-acting (less than 4 hr)
intermediate acting (4-6 hr)
long-acting (up to 12 hr)