Therapeutics - Allergic Rhinitis

Question 1

when treating allergic rhinitis, it’s important to look at chronic comorbidities such as…

Answer 1

if the patient has asthma or not

Question 2

education on ____ is very important in AR patients

Answer 2

ALLERGEN AVOIDANCE

Question 3

2 nonpharm treatments for AR

Answer 3

allergen avoidance!

supportive treatment like irrigation with normal saline

these should be done 1st!

Question 4

2 classes of drugs that are the MAINSTAY of allergic rhinitis treatment

Answer 4

intranasal corticosteroids and antihistamines (both oral and intranasal)

Question 5

can decongestants be used in AR patients

Answer 5

yes - if needed

Question 6

goal/benefits of SALINE PRODUCTS in allergic rhinitis patients

Answer 6

goal is to remove the mucus/pollen and other irritants and enhance ciliary clearance

reduces the symptoms both alone AND as an adjunct

Question 7

dosage forms of saline products and when they might be used for AR

Answer 7

sprays/drops/gels - more drying

ointment - for bedtime use. more moisturizing

Question 8

***1st line for MILD AR

***1st line for moderate-severe AR

Answer 8

mild: intranasal corticosteroid (monotherapy)

moderate-severe: intranasal antihistamine and/or intranasal corticosteroid

Question 9

true or false

between all of the different intranasal corticosteroids, there is no significant differences in efficacy between the agents

Answer 9

true

therefore, select based on pt preference and adherence

Question 10

if the patient has mostly NASAL AR symptoms, there is better control with ______ rather than _____

Answer 10

better control with intranasal corticosteroids rather than antihistamins

Question 11

true or false

for intranasal corticosteroids, if they are used continuously they will work better than if they are used intermittently

Answer 11

true

Question 12

***for intranasal corticosteroids, when is efficacy reached

Answer 12

after 1 WEEK OF THERAPY - prolly wont work right away!

if no effect is seen after 1 week - may be ineffective

Question 13

can patients used intranasal corticosteroids prophylactically for allergies?

Answer 13

YES

can start several days before pollen season so that it starts to work when pollen season begins

or another example is to use a few days before you’re going to be going to a house with a dog/cat

Question 14

name some concerns/AE of intranasal corticosteroids

Answer 14

adherence due to aftertaste, smell, med dripping into throat

dry, burn, sting

VERY LIMITED growth suppression but parents might still be concerned about this

Question 15

true or false intranasal corticosteroids show significant increases in glaucoma and cataracts

Answer 15

FALSE - no significant increases

Question 16

true or false

intranasal corticosteroids have NO EFFECT on the hypothalmic-pituitary axis

Answer 16

true

Question 17

true or false

in treating allergic rhinitis, oral corticosteroids are superior to intranasal in managing symptoms

Answer 17

FALSE - NOT SUPERIOR. JUST HAS MORE SIDE EFFECTS!!!!! USE INTRANASAL. 1ST LINE

Question 18

TRUE OR FALSE

when a patient is using a nose spray they should tilt their head back

Answer 18

FALSE - do not tilt back

Question 19

what to say to a patient if they complain that their nasal spray is causing mucus crusting

Answer 19

rinse with a saline nasal spray or irrigation before you give the drug

not only uncomfy for pt to have crusting - but the med may not work

Question 20

can a patient use an intranasal corticosteroid if they have an obstructed nasal passage?

Answer 20

THE DRUG WONT PENETRATE SIGNIFICANTLY!!!!

give an intranasal or oral decongestant 10 mins before the intransal corticosteroid

but note: DONT USE THE INTRANASAL DECONGESTANT FOR MORE THAN 5 DAYS!!!!!!! rebound vasoconstriction

Question 21

patient needs rapid relief of allergic rhinitis symptoms. what to do

Answer 21

follow same as if they have severe mucosal edema (congestion)

give intranasal decongestant or oral decongestant beforeheand

(but don’t use intranasal for more than 5 days)

Question 22

oral decongestants are _____ agents

Answer 22

sympathomimetics

Question 23

MOA of oral decongestants and name 2

Answer 23

pseudoephedrine and phenylephrine

a1 and a2 agonists - causing vasocnstrcition

Question 24

precautions of oral decongestants

Answer 24

hypertension, CV disease
hyperthyroidism
BPH
closed angle glaucoma

Question 25

oral decongestants must be avoided in patients that are being treated with.....

Answer 25

MAO inhibitors hypertensive crisis!

Question 26

pseudoephedrine is not recommended in under what age

Answer 26

not recommended in 6 and younger ONLY can be used in kids older than 6

Question 27

name 5 TOPICAL decongestants

Answer 27

phenylephrine naphazoline tetrahydrozoline oxymetazoline xylometazoline

Question 28

topical decongestants don't have the same systemic side effects as oral decongestants. however.....

Answer 28

topical have the issue of rebound vasoconstriction. don't use for more than 5 days!

Question 29

medical term for rebound congestion

Answer 29

rhinitis medicamentosa

Question 30

rebound congestion is due to the overstimulation of.....

Answer 30

alpha adrenergic adrenoceptors

Question 31

topical decongestants cannot be used for more than.....

Answer 31

3-5 days

Question 32

when is most benefit observed from using topical decongestants

Answer 32

use for a few days to relieve severe nasal obstruction before using intranasal corticosteroids

Question 33

patient counseling when they use a topical decongestant

Answer 33

use as little as possible and only when absolutely necessary for a limited time

Question 34

4 common AE of topical decongestants

Answer 34

burning, dryness, stinging, mucosal ulceration

Question 35

ORAL ANTIHISTAMINES are ideal for AR patients that complain of what symptoms

Answer 35

sneezing, itching, and rhinorrhea (nose running)

Question 36

1st vs 2nd gen oral antihistamines

Answer 36

1st gen is more lipophilic and crosses BBB. has antimuscarinic (anticholinergic) AE 2nd gen are highly selective for H1 in the periphery and barely cross the CNS. are minimally sedating

Question 37

true or false we should never give 1st gen antihistamines for AR

Answer 37

true

Question 38

what is the most sedating of the oral 2nd gen antihistamines

Answer 38

cetirizine

Question 39

true or false if the patient does not respond to one oral antihistamine, it is not worth trying a different one

Answer 39

FALSE- it is worth trying something different. they may respond

Question 40

true or false cetirizine is the most superior 2nd gen oral antihistamine

Answer 40

FALSE - there is no superior one. all are equal. just depends how each patient responds

Question 41

true or false oral antihistamine + intranasal corticosteroid is a highly effective combination

Answer 41

FALSE - not benefit observed. both are effective. combining them just gives more SE with no added benefit

Question 42

true or false oral antihistamines are only effective when used continuously

Answer 42

FALSE - mainly when used continuously, but still can be effective as needed

Question 43

true or false oral antihistamines are not effective alone to treat nasal congestion

Answer 43

true

Question 44

when a patient is taking an oral antihistamine, they should be warned against taking other......

Answer 44

CNS depressants

Question 45

can a patient use more than 1 antihistamine at a time

Answer 45

no

Question 46

which has a faster onset - oral or intranasal antihistamines

Answer 46

intranasal but they both have similar efficacy, intranasal just works faster

Question 47

how long do intranasal antihistamines take to work

Answer 47

15-30 mins

Question 48

name 2 intranasal antihistamines

Answer 48

olopatadine azelastine

Question 49

ocular antihistamines are recommended for the treatment of....

Answer 49

allergic conjunctivits

Question 50

are ocular anthistamines used chronically?

Answer 50

no - only PRN for immediate relief. only treats local symptoms in the eye

Question 51

ketotifan

Answer 51

ophthalmic antihistamine

Question 52

oral of oral leukotriene receptor antagonists in allergic rhinitis

Answer 52

not recommended unless the patient also has asthma and they dont want to/cant take steroids. if they are already on it tho and they tolerate - it's fine. not like we have to take them off

Question 53

montelukast is FDA approved for....

Answer 53

seasonal and perennial (indefinite) allergic rhinitis in adult and pediatric patients

Question 54

name a mast cell stabilizer

Answer 54

cromolyn

Question 55

what is a disadvantage of cromolyn

Answer 55

dosed QID - adherence concern also has a long onset of action - 1-2 weeks. start 1-2 weeks prior to allergen exposure (however, will see SOME symptom improvement in 1-3 days)

Question 56

true or false cromolyn has minimal AE

Answer 56

true - this is a benefit

Question 57

when using cromolyn for PREVENTION, use up to _____ before contact with the allergen

Answer 57

1 week

Question 58

cromolyn patient counseling point and AE

Answer 58

it has to coat the whole nasal lining also, has AE of sneezing, irritation, and unpleasant taste - but generally very well tolerated

Question 59

cromolyn indication is it OTC

Answer 59

yes OTC indicated for seasonal and perennial AR

Question 60

when to use ophthalmologic mast cell stabilizers (ie - cromolyn)

Answer 60

if symptoms only ocular