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PDAT4 > 39 - Allergic Rhinitis > Flashcards

39 - Allergic Rhinitis Flashcards

1
Q

Etiology of
PERENNIAL ALLERGIES

WHAT TREATMENT FOR PERENNIAL?

A

Dust Mites / INDOOR Molds / Occupational Allergens

PET dander / Cockroaches

Cetirizine + Levocetirizine

Desloratadine / Azelastine

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2
Q

Etiology of
SEASONAL ALLERGIES

WHAT TREATMENT FOR SEASONAL?

A

FALL + SPRING

Tree / Grass / Pollen / Mold Spores / Ragweed

ALL DRUGS INDICATED FOR SEASONAL

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3
Q

Environmental Controls

for ALLERGIES

A

LOWER HUMIDITY <40%

HEPA FILTERS

Vacuum Often / remove Carpets

ALLERGEN COVERS

Wash Clothes / Clean Mold

Elminiate Cockroaches / Keep pets OUT of bedroom / Remove Plants

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4
Q

Non-Pharmacologic Therapy

Allergies

A

EXERCISE
increases Sympathetic Tone
effective if produces perspiration for 15-30 min daily

Saline Irrigation
Soothes nasal tissues
<6 y/o = 2-3 drops QID
>6 y/o = 2 sprays QID

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5
Q

1st Gen Antihistamines

Uses

A

Prevent & Relieve: Wet Symptoms

does NOT relieve NASAL CONGESTION

  • *SEDATING -** crosses BBB
  • *Ethanolamines > alkylamines** in sedation

AC Symptoms

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6
Q

Alkylamines

A
  • less sedating*
  • *1st Gen Antihistamine**

Bromphe-niramine

Chlorphe-niramine

Dexbromphe-niramine

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7
Q

Ethanolamines

A
  • *MORE SEDATING** > Alkylamine
  • *1st Gen Antihistamine**

Clemastine

Diphenhydramine

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8
Q

Loratadine

Indication / Dose / ADR

A

Seasonal Rhinitis

2y/o +

>6 y/o - 10mg QD

HA / Somnolence / Fatigue / Dry mouth

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9
Q

Cetirizine

Indication / Dose / ADR

A

BOTH
seasonal + perennial rhinitis

2 y/o+

>6yo - 10mg QD

DROWSINESS WARNING

tiredness / dry mouth

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10
Q

Levocetirizine

Indication / Dose / ADR

A

BOTH
seasonal & perennial rhinitis

IN PM & GOOD FOR 6MONTHS+

6-11 y/o = 2.5 mg daily in PM

12+ = 5mg QD in PM

  • SLEEPINESS*
  • *diarrhea / nose bleeds**
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11
Q

Desloratadine

Indication / Dose / ADR

A

RX ONLY

BOTH
seasonal & perennial rhinitis

GOOD FOR 6MO+

12 y/o + = 5mg QD

  • Somnolence*
  • *pharyngitis / dry mouth / fatigue**
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12
Q

Fexofenadine

A

Seasonal Rhinitis Only

2 y/o+

12y/o+ = 60mg BID or 180mg QD

LEAST EFFECTIVE

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13
Q

Which ORAL Allergy Medications are

CATEGORY C - Pregnancy

A

FEXOFENADINE // DES-Loratadine

Brompheniramine

most other drugs are CATEGORY B

Lactation:
Recommend to AVOID

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14
Q

Azelastine = Astepro 0.5%

Type / Indication / ADR

A

INTRANASAL ANTIHISTAMINE

  • *BOTH**
  • *Seasonal + Perennial**

12 y/o +
2 sprays EN QD

Pregnancy CAT C & caution in nursing

ADR:
Bitter Taste / SEDATION / nasal discomfort / epistaxis

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15
Q

Which INTRANASAL Antihistamines

are PREGNANCY CATEGORY C?

A

AZELASTINE

OLOPADINE

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16
Q

Olopatadine = Patanase

Type / Indication / ADR

A

Intranasal ANTIHISTAMINE

Seasonal Only

6+ y/o
12 y/o + = 2S EN BID

Pregnancy CAT C & caution in Nursing

BITTER TASTE & SEDATION

17
Q

Intranasal Decongestants

Drugs / Use / ADR

A

-ZOLINE
Naphazoline / Oxymetazoline / Tetrahydrozoline / Xylometazoline
+ Phenylephrine

REDUCE NASAL CONGESTION

ADR:
Nasal Irritation / dryness / Sneezing
REBOUND CONGESTION = RHINITIS MEDICAMENTOSA
Use only for 3-5 Days MAX
Use b4 Intranasal Corticosteroid

18
Q

Intranasal Decongestants

Drugs & Doses

A
  • *-ZOLINE**
  • *TNPXO** - 4-6-6-8-12

–Tetrahydrozoline: 3 sprays Q4H

–Naphazoline: 2 sprays Q6H

–Phenylephrine: 2 sprays Q6H

–Xylometazoline: 2 sprays Q8H

–Oxymetazoline: 2 sprays Q12H

19
Q

Pseudophedrine

Type / Indication / ADR

A

Oral Decongestant

2+ y/o
>12 y/o
60 mg Q6H

ADR:
CNS / CV Stimulation
↑BP / HR / IOP

Contraindications:
MAO inhibitors / uncontrolled HT / CAD / Glaucoma

20
Q

Phenylephrine

Type / Indication / ADR

A

Oral Decongestant

> 12 y/o
10mg po q4h
max 60mg qd

CI:
MAOi / uncontrolled HTN / HYPERthyroidism / BPH

21
Q

Ipratropium Bromide 0.06% = Atrovent

Type / Indication / ADR

A
  • *ANTICHOLINERGIC**
  • Seasonal Rhinitis Only*

Decreases NASAL MUCUS secretion

Dose: 2S EN QID

ADR: HA + Epistaxis

CI:
Angle closure glaucoma / Prostatic Hypertrophy

22
Q

Cromolyn Sodium = NasalCrom

Type / Indication / ADR

A
  • *Mast Cell Stabilizer**
  • not as effective*

PROPHYLACTIC USE
prevents & relieves : sneezing / rhinirrhea + itching

ADR:
sneezing / nasal STINGING / burning / irritation

23
Q
  • *Intranasal Corticosteroids**
  • *for Allergic Rhinitis**

Uses / MoA / ADR

A

-NIDE / -LIDE or -SONE / -LONE

ALL SYMPTOMS
sneezing / nasal itching / rhinorrhea / congestion

Mild VasoCONSTRICTION / decrease Leukotrienes & prostoglandins

  • *DAILY ADMIN** –> 2week for full response
  • rather than AS NEEDED*

ADR:
local irritation / SNEEZING / mucosal erosion / HA + epistaxis

24
Q

Triamcinolone = Nasacort

Intranasal Corticosteroid

A

2 y/o+
12+ = 2S EN QD –> titrate down to 1S

Scent Free

Alcohol Free

No bitter after taste

25
Q

Fluticasone = Flonase

Intranasal Corticosteroid

A

4 y/o+
4-11 = GROWTH STUNTING

12+ = 2S EN QD –> 1 week 1-2S EN QD PRN

LIGHT FLORAL SCENT

RELIEVES ITCHY & WATERY EYES!

26
Q

Flonase SENSIMIST

Intranasal Corticosteroid

A

2 y/o+

ALCOHOL FREE

SCENT FREE

VIRTUALLY NO DRIP

27
Q

Budesonide = Rhinocort

Intranasal Corticosteroid

A

2 y/o+

Scent Free

Alcohol Free

LOWER VOLUME PER SPRAY
vs Flonase

Indoor & Outdoor
Allergy

28
Q

Which Intranasal Corticosteroid:

LOWEST VOLUME PER SPRAY

A

BUDESONIDE
RHINOCORT

29
Q

Monelukast = Singulair

Type / Uses

A

Leukotriene Modifiers

  • *2+ y/o**
  • *>15 yo** = 10 mg QD

Improves:
Daytime nasal sx / Nasal Congestion / Itching / Sneezing / Runny ose

Helpful if patient has ASTHMA

30
Q

IMMUNOTHERAPY
for Allergic Rhinitis

A
  • *SC Injection**
  • *1-2x / week** –> until MAX tolerated dose

3-5 Years

For:
Severe / Persistent Symptoms
& pts who CANT avoid allergen exposure

31
Q

Oral Immunotherapies
for Allergic Rhinitis

A

GRASTEK
Grass Allergy // 5-65 yo

ORALAIR
Grass Allergy // 10-65 yo

RAGWITEK
RAGWEED allergy // 18-65 yo

32
Q

Recommendation #1 = STRONG

Initial Treatment for SEASONAL AR in 12 y/o+

A

INTRANASAL CORTICOSTEROID Monotherapy

rather than
Intranasal Corticosteroid PLUS Oral AntiHistamine

33
Q

Recommendation #2 - STRONG

For Initial Treatment of SEASONAL AR
in persons 15 y/o +

A

Intranasal Corticosteroid

  • over a*
  • *Leukotriene receptor Antagonist (Singulair**)
34
Q

Recommendation #3 = WEAK

For treatment of:
Moderate - SEVERE Seasonal AR
in those 12 y/o +

A

WEAK RECOMMENDATION

Intranasal Corticosteroid
+
Intranasal Antihistamine

35
Q

What are the
INTRANASAL ANTIHISTAMINES

A

-INE

Azelastine = Astepro
CAT C // BOTH + Perennial / 12yo+

Olopatadine = Patanase
CAT C also // only seasonal // 6 y/o+

PDAT4 (34 decks)

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