Rhinitis

Question 0

What is Perennial Rhinitis?

Answer 0

Persistent indoor allergens (ex: House dust mites, Pet Dander, Mold, Cock roaches)

Question 1

What is seasonal Rhinitis

Answer 1

Intermittent allergic rx in the Spring and Fall to outside allergens such as Pollen, Fungi. (Hay Fever, Rose Fever)

Question 2

(General Glucocorticoids) What is the Route?

Answer 2

Nasal

Question 3

(General Glucocorticoids) Action?

Answer 3

Prevent inflammatory Response

Question 4

(General Glucocorticoids) Adverse Affects?

Answer 4

Nasal Irritation/ Possibly effects linear growth in children

Question 5

General Antihistamines-Route?

Answer 5

Nasal/Oral

Question 6

General Antihistamin- Action?

Answer 6

Block H1 receptors

Question 7

General Antihistamine-Adverse Effects?

Answer 7

oral = sedation/Anticholergenic

nasal= bitter taste

Question 8

General Cromolyn- Route?

Answer 8

Nasal

Question 9

General Cromolyn-Action?

Answer 9

Prevents release of inflammatory mediators

Question 10

General sympathomimetics- Route?

Answer 10

Oral/Nasal

Question 11

General sympathomimetics- Action?

Answer 11

Activate vascular alpha 1 receptor

Question 12

General sympathomimetics- Adverse Effects?

Answer 12

Oral- restless, insomnia, and increase in BP

Nasal= rebound nasal congestion

Question 13

General Anticholinergics-Route?

Answer 13

Nasal

Question 14

General Anticholinergics-Action?

Answer 14

Block nasal cholinergic receptors

Question 15

General Anticholinergics- Adverse Effects?

Answer 15

Nasal drying/ irritation

Question 16

General Antileukotrienes- Route?

Answer 16

Oral

Question 17

General Antileuktrienes- Action?

Answer 17

Block leukotriene receptors

Question 18

General Antileukotrienes- Adverse Effects?

Answer 18

RARE but neuropsychiatric effects

Question 19

General Goal of Rhinitis meds?

Answer 19

Reduce inflammation/Nasal symptoms (Patient exhibits no adv effects and can sleep.

Question 20

What drug is the most effective drug when treating both seasonal and perennial rhinitis? And a 1st line therapy?

Answer 20

Intranasal Glucocorticoid: “Rhinocort”; Fluticason (Flonase) Mometasone (Nasonex)

Question 21

How is intranasal glucocorticoids admin? (Flonase, Nasonex, Rhinocort)

Answer 21

Using a metered dose spray

Question 22

When should Intranasal glucocorticoids be started? (Flonase, Nasonex, Rhinocort)

Answer 22

Before the patient has symptoms

Question 23

Should intranasal glucorticoids (Flonase, Nasonex, Rhinocort) be used PRN?

Answer 23

No, best outcomes when used once daily

Question 24

What needs to be done before using intranasal glucorticoids?

Answer 24

Use a topical decongestant agent before spraying in the nose, we need to "unstuff the nose" so the medicine can get into the passage

Question 25

What is a first generation antihistamine?

Answer 25

diphenhydramine (Benadryl)

Question 26

Are first generation antihistamines sedating?

Answer 26

Yes

Question 27

What is an example of a 2nd generation antihistamine?

Answer 27

loratidine (Claritin, Alavert)

Question 28

Are second generation antihistamines sedating?

Answer 28

No

Question 29

What is the MOA of antihistamines?

Answer 29

Selectively blocks the effects of histamine at the histamine receptor site (H1 receptor antagonists)

Question 30

Do antihistamines help with nasal congestion?

Answer 30

No

Question 31

When are antihistamines most effecttive?

Answer 31

When they are taken prophalatically before symptoms appear

Question 32

Some 1st generation antihistamines cause anticholinergic effects, what would some of these effects look like?

Answer 32

Dry mouth Constipation Urinary hesitancy

Question 33

Side effects of intranasal antihistamines?

Answer 33

Solomnence (sleep), nosebleed, unpleasant taste

Question 34

What is the MOA of intranasal Cromolyn Sodium (Nasocrom)?

Answer 34

Suppresses release of histamine and other inflammatory mediators from mast cells

Question 35

What is Nasalcrom best for?

Answer 35

Prophylaxis-not treatment

Question 36

What is an advantage of nasalcrom?

Answer 36

Extremely safe

Question 37

What is a disadvantage of Nasalcrom?

Answer 37

It is only moderately effective

Question 38

What do we need to do prior to admin. Intranasal Cromlyn Sodium?

Answer 38

Use a topical decongestant prior to admin if nasal congestion present

Question 39

What is the dosage of the intranasal cormolyn sodium?

Answer 39

Should be dosed on a regular schedule throughout the allergy season

Question 40

Types of Sympathomimetics (Decongestants)

Answer 40

pseudoephedrine (Sudafed)

Question 41

MOA of sympathomimetic (Sudafed)?

Answer 41

Reduce nasal congestion by activating alpha 1-adrenergic receptors on nasal blood vessels, causing vasoconstriction, shrinking swollen membranes, followed by nasal drainage (ONLY RELIEVES STUFFINESS)

Question 42

What are the adverse effects of sympathomimetics (pseudophedrine?)

Answer 42

``` Rebound congestion CNS stimulation Restlessness Irritability Anxiety Insomnia Cardiovascular effects- r/t widespread vasoconstriction ```

Question 43

How can we prevent rebound congestion with Sudafed?

Answer 43

Do not take for longer than 5 days

Question 44

How should the head be positioned with nasal drops?

Answer 44

tilted back

Question 45

How should the head be positioned with nasal sprays?

Answer 45

Nose to toes (NOT tilted back)

Question 46

What are the benefits of using sympathomimetics and antihistamines together?

Answer 46

Provides relief of itchy eyes, sneezing, and rhinorrhea, along with fixing nasal congestion

Question 47

What are the type of combo meds?

Answer 47

Claritin-D, Allegra-D

Question 48

MOA of Ipratropium and Anticholinergic agents? (Atrovent)

Answer 48

Blocks cholinergic receptors which inhibits glandular secretions, thereby decreasing rhinorrhea (runny nose)

Question 49

Side effects of anticholinergic agent?

Answer 49

Nasal drying and irritation

Question 50

What is the MOA of Leukotriene Antagonist (montelukast; singulair)?

Answer 50

Blocks the binding of leukotrienes to their receptor sites

Question 51

Adverse effects of Leukotriene Antagonist? (singulair)

Answer 51

``` Rare, but serious neuropsychiatric effects such as: agitation aggression hallucinations depression insomnia restlessness suicidal thoughts/behavior ```

Question 52

What is the MOA of Omalizamab (Xolair) injections?

Answer 52

Monoclomal anitbody that inhibits IgE response

Question 53

What is Omalizamab (Xolair) indicated for?

Answer 53

Ragweed induced allergy

Question 54

What is Xolair only approved for at this time?

Answer 54

Asthma