Week 1

Question 1

What is 1st line treatment in allergic rhinitis?

Answer 1

Antihistamine

Question 2

MOA of an ICS:

Answer 2

They help relieve congestion and rhinorrhea by limiting late-phase response and reducing inflammation.

Question 3

Examples of ICS:

Answer 3

Budensonide, Flonase, Nasacort, Nasonex

Question 4

When would a patient see effect of an ICS?

Answer 4

Begin working in 3-12 hours but patients may not experience max effect for 1-2 weeks.

Question 5

When should an ICS be started for allergic rhinitis?

Answer 5

2-4 weeks prior to start of allergy season.

Question 6

Adverse events of ICS:

Answer 6

Irritation, bleeding, septal perforation, can decrease height of children at high doses.

Question 7

Is a mast cell stabilizer that prevents antigen-induced degranulation, decreasing the inflammatory response.

Answer 7

Intranasal cromolyn

Question 8

Most common virus in an URI?

Answer 8

Rhinovirus

Question 9

MOA of topical decongestants:

Answer 9

Stimulate the alpha and beta adrenergic receptors and this causes shrinkage of the tissue and vasoconstriction which relieves congestion and promotes drainage.

Question 10

Example of a topical decongestant and how long to use for?

Answer 10

Afrin

No longer than 3 days d/t rebound congestion

Question 11

Side effects of topical decongestants?

Answer 11

Bradycardia, tachycardia, HTN, and hypotension

Question 12

MOA of oral decongestants:

Answer 12

Vasoconstriction of capillary vessels, theoretically decreasing congestion. They are sympathomimetic (stimulate the sympathetic nervous system).

Question 13

Example of oral decongestants:

Answer 13

Pseudoephedrine (Sudafed)

Phenylephrine

Question 14

What age can not relieve oral decongestants?

Answer 14

Do not give to children under 4.

Question 15

Side effects of oral decongestants?

Answer 15

Tachycardia, HTN, anxiety, restlessness, irritability

Question 16

Contraindications of oral decongestants:

Answer 16

CAD, uncontrolled HTN, narrow angle glaucoma, MAOI within 14 days

Use caution in elderly
Do not use in children under 4

Question 17

Oral decongestants and 1st generation antihistamines Together May cause:

Answer 17

Urinary retention in BPH

Question 18

MOA of expectorants:

Answer 18

Increase the output of respiratory tract fluid by decreasing the adhesiveness and surface tension of the respiratory tract and by facilitating the removal of viscous mucous.

Question 19

Goal is to loosen bronchial secretion so they can be eliminated:

Answer 19

Expectorants

Question 20

What is the best expectorant?

Answer 20

Hydration

Question 21

How long can you use expectorants for?

Answer 21

No longer than 1 week

Question 22

Example of expectorant:

Answer 22

Quaifenensin (robitussin)

Question 23

Side effects of expectorants:

Answer 23

Most common GI upset

Drowsiness, HA, dizziness

Question 24

MOA of antitussives:

Answer 24

Diminish cough reflex by direct inhibition of the cough center in the medulla.

Question 25

When to use antitussives:

Answer 25

Nonproductive, irritating cough

Question 26

Examples of antitussives:

Answer 26

Dextromethorphan Tessalon perles Codeine

Question 27

Dextromethorphan plus what may induce a serotonergic syndrome?

Answer 27

Antidepressants

Question 28

MOA of tessalon perles:

Answer 28

Numbs respiratory tract

Question 29

Tessalon perles are pregnancy category:

Answer 29

C

Question 30

Tessalon perles contraindications:

Answer 30

Do not use in kids under 10 or with an MAOI. Do not use more than 2-3 times daily

Question 31

Do not use ASA in children with viral illness d/t:

Answer 31

Risk of Reye’s syndrome: sudden inflammation and swelling of the liver and brain that is often accompanied by a scaly rash

Question 32

MOA of anticholinergic agents:

Answer 32

Local application to the nasal mucosa that inhibits vagally mediated reflexes by antagonizing the action of acetylcholine at the cholinergic receptor, which inhibits secretions from the serous and seromucous glands lining the nasal mucosa.

Question 33

Example of an anticholinergic agent:

Answer 33

Ipratropium bromide

Question 34

Anticholinergic agents contraindicated in:

Answer 34

Children under 5

Question 35

Most common cause of viral sinusitis:

Answer 35

Rhinovirus

Question 36

Common bacterial pathogens of sinusitis:

Answer 36

S pneumoniae H influenza M catarrhalis S aureus

Question 37

First-line antibiotics in sinusitis:

Answer 37

Amoxicillin Augmentin * Beta-lactamase cephalosporin

Question 38

Second line antibiotics for sinusitis:

Answer 38

High-dose amoxicillin | Respiratory fluoroquinolone- moxifloxacin or levofloxacin

Question 39

Antibiotics for sinusitis with PCN allergy:

Answer 39

Kids- macrolides or cefurozime | Adults: doxy or respiratory fluoroquinolone- Moxi/levo

Question 40

How long before you switch antibiotics with sinusitis:

Answer 40

Worsening after 72 hours on antibiotic | Can take 3-4 days for relief

Question 41

What is azelastine (astelin, patanase)?

Answer 41

Topical antihistamine used in allergic rhinitis

Question 42

Side effects of azelastine?

Answer 42

Bitter taste, somnolence, ha, nasal burning

Question 43

What is Atrovent?

Answer 43

Anticholinergic that is good for a runny nose.

Question 44

Atrovent is pregnancy category?

Answer 44

C

Question 45

Indications for Atrovent?

Answer 45

Allergic and non allergic rhinitis

Question 46

Is intranasal cromolyn safe in pregnancy?

Answer 46

Yes

Question 47

How long for intranasal cromolyn to work?

Answer 47

Up to 2 weeks

Question 48

What is an ocular antihistamine?

Answer 48

Patanol, pataday

Question 49

Are ocular antihistamines safe in pregnancy?

Answer 49

No category c