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NAPLEX 2024 > 37. Allergic Rhinitis, Cough + Cold > Flashcards

37. Allergic Rhinitis, Cough + Cold Flashcards

1
Q

How to tell difference between cold vs allergic rhinitis

A

Cold: sneezing, runny nose, thick+dark mucus, sore throat, body aches // symptoms take about 3 days to appear, and usually last about a week

Allergy: sneezing, runny nose, thin+clear mucus, wheezing, red/watery eyes // symptoms can last for days or months

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2
Q

____ are first line for chronic, moderate-to-severe symptoms of allergic rhinitis

A

Intranasal steroids

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3
Q

____ can be used for milder, intermittent symptoms of allergic rhinitis

A

Oral antihistamines

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4
Q

MOA of intranasal steroids

A

Decrease inflammation

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5
Q

Common side effect of intranasal steroids

A

Epistaxis (nose bleeds)

Others: HA, dry nose, unpleasant taste, localized infection

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6
Q

It can take up to ____ to get full relief with intranasal steroid use

A

One week

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7
Q

___ and ___ are preferred nasal steroid in pregnancy

A

Budesonide and beclomethasone

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8
Q

Common intranasal steroid examples

A

Budesonide (Rhinocort)
Fluticasone (Flonase)
Trimacinolone (Nasacort)

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9
Q

Oral antihistamines are effective in reducing symptoms of itching, sneezing, rhinorrhea, and other types of immediate hypersensitivity reactions but have little effect on ____

A

nasal congestion

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10
Q

Antihistamines MOA

A

Block H1 receptor site

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11
Q

1st gen Antihistamines examples

A

Diphenhydramine (Benadryl)
Chlorpheniramine (Aller-Chlor)
Doxylamine (Unisom)

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12
Q

Diphenhydramine (Benadryl) adult dosing

A

25mg PO Q4-6H or 50mg PO Q6-8H (max 300mg/day)

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13
Q

Diphenhydramine (Benadryl) age <6yo dosing

A

Do NOT use OTC unless directed by HCP

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14
Q

Warnings for 1st gen oral antihistamines

A

Avoid in elderly - strong anticholinergic effects, Beer’s criteria
Use caution in CVD, prostate enlargement, glaucoma, asthma, pyloduodenal obstruction and thyroid disease
Do NOT use with MAOi (especially celmastine or carbinoxamine)

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15
Q

Side effects for 1st gen oral antihistamines

A

Somnolence, cognitive impairment, strong anticholingeric effects (dry mouth, blurred vision, urinary retention, constipation) and seizures/arrhythmias at higher doses

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16
Q

2nd gen oral antihistamine examples

A

Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
Fexofenadine (Allegra)
Loratadine (Claritin)

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17
Q

More sedating vs less sedating 2nd gen oral antihistamines

A

More = cetirizine, levocetirizine
Less = fexofenadine, loratadine

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18
Q

If using in pregnancy, which 2nd gen oral antihistamines are preferred?

A

Loratadine and cetirizine

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19
Q

Which 2nd gen oral antihistamine should pts take with water (not fruit juice d/t less absorption)

A

Fexofenadine

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20
Q

Which 2nd gen oral antihistamines have fast onset and may work best for some patients?

A

Cetirizine and levocetirizine

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21
Q

Some allergy products come as a combination product with _____, indicated with “-D” in the name

A

Pseudoephedrine or phenylephrine

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22
Q

What are some examples of intranasal antihistamines?

A

Azelastine (Astepro)
Olopatadine (Patanase)

Note: can be combined with intranasal steroid (increases cost and risk for side effects)

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23
Q
A
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24
Q

T/F: intranasal antihistamines should not use with intranasal steroids

A

False - can be combined with intranasal steroid (but increases cost and risk for side effects)

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25
Q

MOA decongestants

A

Alpha-adrenergic agonists (sympathomimetics), cause vasoconstriction reducing sinus and nasal congestion

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26
Q

Under federal law, max amount allowed to purchase pseudoephedrine, phenylpropanolamine and ephedrine is ____ per day and ____ in a 30-day period

A

3.6g per day
9g in 30 day period

27
Q

To combat the methamphetamine epidemic, there are restricted sales of OCT products containing _____ since these can all be converted easily to methamphetamine

A

Pseudoephedrine, phenylpropanolamine, ephedrine

28
Q

Which decongestants should not be used within 14 days of MAOi?

A

Phenylephrine (Sudafed PE) and pseudoephedrine (Sudafed, Nexafed, Zephrex-D)

29
Q

Phenylephrine and pseudoephedrine should be avoided in children ___ (FDA) and ___ (package labeling)

A

<2 yo (FDA), <4 yo (package labeling)

30
Q

Warnings with phenylephrine and pseudoephedrine

A

Use with caution in pts with CV disease and uncontrolled HTN (can increase BP), BPH (can cause urinary retention, DM (can increase BG)

Others: hyperthyroidism (can worsen), bowel obstruction, glaucoma (can increase IOP), renal impairment, seizure disorder, the elderly

31
Q

Side effects with phenylephrine and pseudoephedrine

A

CV stimulation (tachycardia, palpitations, increased BP), CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations), decreased appetite, dizziness, HA

32
Q

Oral decongestants should be avoided in ___ trimester of pregnancy

A

first

33
Q

Intranasal decongestant examples

A

Oxymetazoline (Afrin), phenylephrine (has more side effects than Afrin)

34
Q

Warnings for intranasal decongestants

A

Use caution in pts with BPH, CVD, uncontrolled HTN, thyroid disease, DM

35
Q

Side effects of Intranasal decongestants

A

Rhinitis medicamentosa (rebound congestion if used longer than 3 days)
Others: nasal stinging, burning, and dryness, sneezing, trauma from tip of the device

36
Q

If Afrin (oxymetazoline) is used longer than 3 days, what may occur?

A

Rebound congestion

37
Q

____ is an OTC mast cell stabilizer sued for treatment and ppx of allergic rhinitis. How is it used to be effective?

A

Intranasl cromolyn (NasalCrom)
Must be started at the onset of allergy season and used regularly (not PRN) to be effective

38
Q

NasalCrom is not as effective as other agents but it is safe in which patient populations?

A

Children ≥2yo and pregnancy

39
Q

___ is the only leukotriene modifying agent indicated for the treatment of both allergic rhinitis and asthma. It is commonly used in children

A

Montelukast (Singulair)

40
Q

SL Immunotherapy Oralair contains ____

A

5 different grass pollen extracts

41
Q

SL Immunotherapy Grastek contains ____

A

Timothy grass pollen extract

42
Q

SL Immunotherapy Ragwitek contains ____

A

Ragweed pollen extract

43
Q

SL Immunotherapy Odactra contains ____

A

House dust mite allergen extract

44
Q

Natural products sued for colds

A

Zinc - “possibly effective”
Vitamin C (ascorbic acid) - may decrease duration of cold by 1-1.5 days at doses of 1-3 g/day
Echinacea - “possibly effective”

45
Q

If productive cough is present, ___ can be used to thin mucus and move secretions up and out of respiratory tract

A

Expectorants

46
Q

Expectorants examples

A

Guaifenesin (Mucinex, Robitussin, Robafen)

47
Q

Cough suppressant examples

A

Dextromethorphan (Delsym, Robafen, Robitussin)
Codeine
Benzonatate (Tessalon Perles)
Diphenhydramine (Benadryl)

48
Q

How do dextromethorphan and opioids such as codeine and hydrocodone work as cough suppressants?

A

They have high affinity for several regions of the brain, including the medullary cough center, suppressing the cough reflex

49
Q

___ acts as a serotonin reuptake inhibitor. At usual antitussive doses, it does not have addictive properties. At high doses, it acts as an NMDA-receptor blocker leading to euphoria and hallucinations similar to the illicit substance PCP

A

Dextromethorphan

50
Q

D/t its abuse potential, many states ban the sale of dextromethorphan to people < ___yo

A

18

51
Q

Which cough suppressants should not be used within 14 days of MAOi

A

Dextromethorphan

52
Q

Warnings with dextromethorphan

A

Serotonin syndrome (if co-admin with other serotonergic drugs), use caution in pts who are CYP2D6 poor metabolizers or with CYP2D6i

53
Q

If the product name has DM at the end, such as Robitussin DM, it contains ___

A

dextromethorphan

54
Q

Boxed warning for codeine

A

Respiratory depression + death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers d/t CYP4D6 polymorphism
Deaths have also occurred in nursing infants after being exposed to high conc of morphine from mothers who were ultra-rapid metabolizers

55
Q

Codeine age restriction

A

Do NOT use in children <12yo or <18yo after tonsillectomy and/or adenoidectomy

56
Q

If the product name has AC at the end, such as G Tussin AC, it contains ___

A

Codeine

57
Q

Codeine combination products are C-___

A

C-V

58
Q

Chlorpheniramine/hydrocodone (TussiCaps) is considered C-___

A

C-II

59
Q

In children <18yo, what cough+cold products should be avoided?

A

Codeine and hydrocodone-containing cough and products

60
Q

In children <4yo, what cough+cold products should be avoided?

A

OTC cough and cold products (package labeling)

61
Q

In children <2yo, what cough+cold products should be avoided?

A

OTC cough and cold products (FDA)
Promethazine (FDA)
Avoid topical menthol (Vicks VaporRub) and camphor (package labeling)

62
Q

T/F: Topical products containing menthol (e.g. Vicks VapoRub) work best when applied under the nose to clear the airways

A

False - apply to chest and neck (never directly to the nose)

63
Q

Which drugs are contraindicated within 14 days of MAOi

A

Phenylephrine, pseudoephedrine, and extromethorphan

NAPLEX 2024 (74 decks)

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