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CDM1 > Exam 3: AR > Flashcards

Exam 3: AR Flashcards

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1
Q

AR Def

A

IgE-mediated hypersensitivity rxn triggered by allergens

More localized to nose

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2
Q

Classification of AR: Episodic

A

Symtpoms occur when exposure to allergen outside of normal routine

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3
Q

Classification of AR: Intermittent

A

Symptoms occur ≤4 days/week or ≤4 weeks

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4
Q

Classification of AR: persistent

A

Symptoms occur >4 days/week AND >4 weeks

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5
Q

Classification of AR: Mild-moderate

A

symptoms not bothersome, do not interfere with daily activities or sleep

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6
Q

Classification of AR: Moderate-severe

A

Symptoms are bothersome, interfere with daily activities or sleep

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7
Q

S/Sx: Allergic shiners

A

dark circles caused by changes in blood flow due to nasal congestion

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8
Q

S/Sx: allergic salute/crease

A

pushing nose up

creases nose

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9
Q

S/Sx: allergic gape

A

breathing thru mouth bc nose is running

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10
Q

S/Sx: Conjunctival injection

A

Red eyes caused by inflammation of small capillaries in eyes

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11
Q

Complications of untreated AR

A

Sinusitis
Otitis media
Asthma linked to allergies
Speech or dental abnormalities

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12
Q

Self-treatment exclusions

A 
Child <12 yo
Pregnant/lactating
Hx of non-allergic rhinitis
symptoms of upper respiratory tract infection or lower pathology
Hx of symptoms unresponsive to OTC
Unacceptable adverse effects
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13
Q

Treatment options

A

Allergen avoidance, non-pharmacological therapy (NaCl nasal spray, irrigation, drops), or pharmacotherapy

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14
Q

T/F taking meds episodically is better than ~1 week anticipated allergen exposure

A

False - Recommend taking meds ~1 week prior to anticipated allergen exposure to prevent/reduce rxn

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15
Q

T/F: INCS + 1st gen antihistamine is recommended

A

False - INCS monotherapy is recommended (add on causes more side effects, not more effective)

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16
Q

For pts >12yo with moderate-severe symptoms consider initial treatment combo of ____

A

INCS + Intranasal antihistamine

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17
Q

INCS Examples

A 
Fluticasone propionate (Flonase)
Triamcinolone (Nasacort)
Budesonide (Rhinocort) 
Beclomethasone (QNASL, Beconase AQ)
Mometasone furoate (Nasonex)
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18
Q

Fluticasone propionate brand

A

Flonase

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19
Q

Triamcinolone brand

A

Nasacort

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20
Q

Budesonide brand

A

Rhinocort

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21
Q

Beclomethasone brand

A

QNASL, Beconase AQ

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22
Q

Mometasone furoate brand

A

Nasonex

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23
Q

INCS MOA

A

Broad anti-inflammatory properties that reduce inflammation by:
- reducing mediator release
- suppressing neutrophil chemotaxis
- reducing intracellular edema
- mildly vasoconstricting
- inhibiting mast cell-mediated late phase rxn
(tamp down entire immune response)

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24
Q

INCS ADRs/DDI

A

Well tolerated
Epistaxis (nose bleeds), stinging, itching, headache
Nasal septum separation (RARE)

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25
INCS: Counseling
Shake before use, prime before first use and if not used >1 week to ensure accurate dosing
26
2nd Gen Antihistamines Examples
Cetirizine (Zyrtec) Fexofenadine (Allegra) Loratadine (Claritin)
27
Cetirizine brand and notes
Zyrtec - most sedating 2nd gen
28
Fexofenadine brand and notes
Allegra - grapefruit/orange/apple juice can inhibit absorption, separate by ≥4 hrs
29
Loratadine brand and notes
Claritin - preferred in pregnancy and pediatrics
30
2nd Gen Antihistamines: ADE
headache, dry mouth, drowsiness (not as much as 1st gen)
31
___ interfere with fexofenadine absorption
Antiacids
32
Additive CNS depression possible with sedative agents and (2nd gen antihistamine)
Cetirizine
33
Precaution for 1st gen and cetirizine
``` Infants/breastfeeding mothers Narrow-angle glaucoma Symptomatic BPH GI/GU obstruction Elderly ```
34
Intranasal Antihistamine Examples
Azelastine Olopatadine *guidelines recommend before oral antihistamines due to less ADEs but require rx and costly -- often try AFTER oral can taste bad
35
Ophthalmic Antihistamine Examples
Ketotifen (Zatidore) Olopatadine (Pataday) Azelastine (Optivar)
36
Ketotifen brand
Zatidor
37
Olopatadine brand
Pataday
38
Azelastine brand
Optivar
39
Mast cell stabilizer example
Cromolyn Sodium (NasalCrom)
40
Cromolyn Sodium brand
NasalCrom
41
Mast Cell Stabilizer MOA
Stabilizes mast cells by interfering with chloride channel fxn -- inhibits mast cell activation and subsequent release of mediators from eosinophils/epithelial cells Inhibits acute response to exercise and cold air
42
Mast Cell Stabilizer ADE/DDI
Well tolerated, may cause sneezing, nasal stinging/burning, unpleasant taste
43
Mast Cell Stabilizer: Counseling
Most effective if started PRIOR to symptom onset (may take up to 7 days for improvement and 2-4 weeks for full effect) **does not treat pre-existing symptoms (more for PREVENTION vs treat)
44
Oral decongestants examples
Pseudoephedrine (Sudafed) | Phenylephrine (Sudafed PE)
45
T/F: Pseudoephedrine more effective than phenylephrine
True
46
Oral decongestants: MOA
Sympathomimetic - agonists at adrenergic receptors in nasal mucosa, causing vasoconstriction Phenylephrine - directly on sympathetic receptors Pseudoephedrine - mixed effect some direct some displacement of NT from storage vesicles
47
Oral decongestants: ADE/DDIs
CV stimulation and increase in CV event risk CNS stimulation Urinary retention, worsen narrow angle glaucoma DDI: MAOis and TCAs (dangerous increase in BP, concurrent use CI)
48
Intranasal Decongestants Examples
Oxymetazoline 0.05% (Afrin) | Phenylephrine 0.25% or 0.5% (NeoSynephrine)
49
Oxymetazoline 0.05% brand
Afrin
50
Phenylephrine 0.25% or 0.5% brand
Neo-Synephrine
51
Intranasal decongestants: MOA
Agonist at local alpha adrenergic receptors in nasal mucosa
52
Intranasal decongestants: ADE/DDI
Local irritation, burning stinging, mild systemic effects if any DDI: MAOis and TCAs (dangerous increase in BP, concurrent use CI)
53
Intranasal decongestant use for >3-5 days may cause ____
rhinitis Medicamentosa (rebound congestion) Slowly withdraw and taper off Reversible
54
Decongestants Warnings
Avoid in pts taking MAOis TCAs May exacerbate DM or worsen glucose control May worsen hyperthyroidism, CHD, ischemic HD, glaucoma, BPH Avoid in HTN Decongestants are considered illegal or "doping" agents in organized sports Large quantities of pseudoephedrine used in manufacture of methamphetamine
55
____ considered illegal or "doping" agents in organized sports
decongestants
56
___ sold behind the counter
Pseudoephedrine
57
Antihistamine + Decongestant Combo Examples
Zyrtec D Allegra D Claritin D (antihistamine + pseudoephedrine) generally better to give separately
58
Intranasal Anticholinergic Example
Ipratropium 0.03% or 0.06%
59
Intranasal Anticholinergic Spray: MOA
Anticholinergic = antisecretory - Dries nasal secretions - Relieves rhinorrhea from any cause
60
Intranasal Anticholinergic Spray: ADEs/DDI
Bitter taste in mouth, dry nasal mucosa, dry mouth
61
Leukotriene Receptor Antagonist Examples
Monteluakst (Singulair)
62
Montelukast brand
Singulair
63
Leukotriene Receptor Antagonist: MOA
Blocks action of LT at their reecptors, prevents inflammation, edema, and sm. m. contraction
64
Leukotriene Receptor Antagonist ADE/DDI
Headache | - BBW concerns for psychiatric ADRs
65
For AR, ____ should be reserved for those who are not treated effectively with or cannot tolerate other allergy meds
Leukotriene Receptor Antagonist
66
Treatment Summary: For all pts
Allergen avoidance | Nasal saline
67
Treatment Summary: Mild symptoms
INCS | - takes a while to reach full effect, best when used consistently, can help w ocular symptoms
68
Treatment Summary: Mod-severe symptoms
INCS + INAH
69
Treatment Summary: Rhinorrhea
Antihistamine or ipratropium nasal spray
70
Treatment summary: Itching/sneezing
antihistamine
71
Treatment summary: Nasal congestion
Intranasal decongestant (limit 3-5 days) or oral
72
Treatment summary: Ocular
INCS fluticasone furoate and propionate have FDA approval for ophthalmic symptoms, ocular antihistamines
73
Treatment summary: for minimal systemic side effects
Intranasal cromolyn
74
Treatment summary: If symptoms persist
Immunotherapy or brief course of oral steroid
75
Spec pop AR: Pregnant
Intranasal cromolyn 1st line for AR 1st gen antihistamines considered safe, 2nd gen loratadine is preferred oral corticosteroids have caused birth defects but INCS safe Oxymetazoline preferred decongestant
76
Spec Pop: Breastfeeding
Intranasal cromolyn considered safe Avoid first gen antihistamines 2nd gen use short-acting and take at bedtime after last feed
77
Spec pop: Peds
<12yo refer to pediatrician to assess for asthma Loratadine antihistamine of choice May experience paradoxical excitation with antihistamines INCS > 2 months linked with growth inhibition
78
Spec Pop: Geriatrics
avoid 1st gen antihistamines | Drugs of choice: intranasal cromolyn + loratadine/fexofenadine

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