Exam 2 - Allergic Rhinitis

Question 1

By which age do we see allergic rhinitis begin to diminish

Answer 1

65+ years old

(Medicaid age)

Question 2

Which of the following are risk factors for allergic rhinitis

Higher socioeconomic class
Eczema
Living in northeastern US
Family history

Answer 2

Higher socioeconomic class
Eczema
Family history

(Itchy, predisposed, rich)

Question 2

Which of the following are common allergens

• molds that exist indoors and outdoors
• allergies to chemicals in household cleaners
• animal dander from pets
• plant components like pollen

Answer 2

All of them

Question 2

List some ways to remove allergens from household

Answer 2

• closing windows when pollen counts are high
• having HEPA ventilation in house

Question 3

Symptoms of allergic rhinitis

Answer 3

Congestion
Smell impaired
Nasal discharge
Itchy eyes
Sneezing

(Can’t Stop Sneezing N Itching)

Question 3

Intermittent allergic rhinitis symptoms are defined by which duration

Answer 3

Symptoms persist ≤ 4 days per week OR ≤ 4 weeks

(Allergies 4 days, 4 weeks)

Question 3

(T/F): persistent AR is more easily identifiable than intermittent AR

Answer 3

False

Question 4

Alteration in which two factors define whether allergic rhinitis symptoms are classified as intermittent or persistent

Answer 4

Ability to perform daily activities
Ability to sleep

Question 4

Intermittent allergic rhinitis is AKA

Answer 4

Hay fever

Question 5

Causes of nonallergic rhinitis

Answer 5

Pregnancy
Taking beta blocker
Head trauma
NSAIDs

Question 6

(T/F): when treating AR, using dual therapy is most appropriate

Answer 6

False

Question 6

Which represent non-pharm measures for AR

• have rodents/roaches exterminated
• hand sanitizer w/ alcohol base after touching pets
• use humidifier to add moisture to air
• avoid cigarette smoke

Answer 6

Have roaches exterminated and avoid cigarette smoke

(Takes more than hand sanitizer to get rid of allergens and humidifiers should NOT be used for allergies - they can cause mold)

Question 6

What steps (in order) should be taken to treat allergic rhinitis

Answer 6

Omit allergen
Antihistamine
Steroid
Immunotherapy
Surgery

(OASIS)

(Going from minor to major treatments)

Question 7

3 primary steps for treating AR in order

Answer 7

Avoid allergen
Single entity drugs first
Immunotherapy

Question 7

Which of the following should be limited to 3 days use

Naphazoline
Ketotifen
Olopatadine
Alcaftadine

Answer 7

Naphazoline

Question 7

What class of medication is MOST effective for treating ALL AR symptoms

Answer 7

Intranasal corticosteroids

Question 8

What can happen if you use a topical decongestant for more than 3 days

Answer 8

Rebound congestion

Question 8

Which of the following are 1st generation antihistamines

Diphenhydramine
Clemastine
Cetirizine
Chlorpheniramine

Answer 8

Diphenhydramine
Clemastine
Chlorpheniramine

Question 9

Jordan has just finished law school and has horrible spring allergies with a cough. He wants to sleep. What do you recommend?

Answer 9

Diphenhydramine

(Because it is sedating, an antihistamine, and an antitussive)

Question 9

Which of the following are 2nd generation antihistamines

Brompheniramine
Fexofenadine
Cetirizine
Levocetirizine
Diphenhydramine
Loratadine

Answer 9

Fexofenadine
Levocetirizine
Cetirizine
Loratadine

(Ones you’d be okay taking in the morning because they’re non-sedating)

Question 9

Lisa has AR. She is a mom of 3 and a physician. She also takes Tums regularly. What do you recommend

Answer 9

Loratadine

Question 10

Which antihistamine is in Mucinex Allergy

Answer 10

Fexofenadine

Question 11

Tavist AI

Answer 11

Clemastine

Question 12

What antihistamine is in dimetapp

Answer 12

Brompheniramine

Question 13

Which of the following antihistamines are LEAST likely to cause sedation Loratadine Cetirizine Fexofenadine Diphenhydramine Chlorpheniramine

Answer 13

Loratadine Fexofenadine (L and F are 1st gen so they’re non-sedating; diphenhydramine is 1st gen so it’s sedating; cetirizine and chlorpheniramine are 1st gen BUT are most likely to cause sedation)

Question 14

Larie is working midnights this week. Her allergies are awful. What do you recommend?

Answer 14

Fexofenadine

Question 15

Which combo products are safe to treat AR symptoms. SATA Chlorpheniramine + zyrtec Flonase + benadryl Claratin D + nasacort Rhinocort + allegra Flonase + triamcinolone Astepro + fluticasone

Answer 15

Flonase + benadryl Claratin D + nasacort Rhinocort + allegra Astepro + fluticasone (Others are duplicate therapy)

Question 16

Mr. Rogers is a 70 yr old man w/ glaucoma. He needs something for allergies. What do you recommend

Answer 16

Fexofenadine (1st gen and decongestants will worsen glaucoma)

Question 17

Which symptoms can 1st generation antihistamines cause? SATA Dry mouth Drooling Urinary retention Diarrhea Somnolence (drowsy) Blurred vision

Answer 17

Dry mouth Urinary retention Somnolence Blurred vision (Dry, drowsy, blurry)

Question 18

Which of the following are side effects of intranasal corticosteroids Dry mouth Unpleasant taste Epistaxis (nosebleed) Headache

Answer 18

Unpleasant taste Epistaxis Headache

Question 19

Budesonide is indicated in which age group

Answer 19

older than 6 years

Question 20

Which of the following are systemic decongestants Pseudoephedrine Fluticasone Budesonide Phenylephrine

Answer 20

PSE and phenylephrine (Fluticasone and budesonide are steroids_

Question 21

Hilary is a 64 year old woman w/ a family history of HTN. Which would you recommend for congestion? Phenylephrine Dehumidifier Nasalcrom Humidifier

Answer 21

Humidifier (PE could increase BP, dehumidifier and nasalcrom are for allergies)

Question 22

What class of drug do decongestants interact with

Answer 22

MAOIs

Question 23

Which of the following are contraindicated within 14 days of taking a MAOI? SATA Phenylephrine Guaifenesin Azelastine Dextromethorphan

Answer 23

PE and DM

Question 24

What symptom will oral antihistamines NOT help with

Answer 24

Nasal congestion

Question 25

Jo Jo is a 6 year old boy suffering from moderate to severe AR. What do you recommend?

Answer 25

Flonase

Question 26

What age group is fluticasone furoate indicated in

Answer 26

2 years and older

Question 27

What does cromolyn soidum interact with

Answer 27

Nothing

Question 27

Fluticasone propionate is indicated in which age group

Answer 27

> 4 years

Question 28

Which of the following include groups who should NOT receive OTC for AR? SATA COPD patients Pregnant/lactating 18 years and older Asthma symptoms

Answer 28

COPD Pregnant/lactating Asthma