48. Allergic Rhinitis, Cough & Cold

Question 1

Which antihistamines are available as an intranasal spray?

A. Diphenhydramine, loratidine
B. Azelastine, olopatadine
C. Loratidine, olopatadine
D. Azelastine, fexofenadine
E. Fexofenadine, diphenhydramine

Answer 1

B. Azelastine and olopatadine are formulated as intranasal sprays.

Question 2

Second-generation antihistamines such as fexofenadine have the following properties:

A. They cause more histamine release than the first-generation agents.
B. They cause considerable dry mouth.
C. They cause more constipation.
D. They cause significant cognitive dysfunction.
E. They have less CNS side effects such as sedation than first-generation agents.

Answer 2

E. Second-generation antihistamines are less sedating and cause less CNS effects.

Question 3

Which of the following medications are approved for allergic rhinitis and may provide mild benefit? (Select ALL that apply.)

A. Nasalcrom
B. Natesto
C. Singulair
D. Timoptic eye drops
E. Atrovent nasal spray

Answer 3

A, C, E. Singulair, Nasalcrom, and Atrovent nasal spray are all approved for mild allergic rhinitis.

Question 4

The first step in treating allergies is to control allergens. Reducing allergens will reduce allergy symptoms. Which of the following are ways to reduce allergen exposure? (Select ALL that apply.)

A. Keeping windows closed as much as possible; use air conditioning, if available.
B. Vacuum once monthly.
C. Cover pillows and mattresses with allergy-free covers to reduce dust mite contamination.
D. Remove or wash stuffed animals.
E. Use a clothes dryer rather than hanging clothes outside.

Answer 4

A, C, D, E. Bedding should be washed in hot water. Pets should be kept outdoors, or at least out of the bedroom of the allergy-sufferer. Mold is a major allergen; control mold growth as much as possible.

Question 5

Mike is a 12 year old boy who has been prescribed fluticasone nasal spray for allergic rhinitis. Counseling points should include which of the following? (Select ALL that apply.)

A. Gently blow your nose to clear it of mucus before using the medicine.
B. You do not need to forcefully blow your nose.
C. Tilt your head backward slightly. Breathe out slowly.
D. Hold the pump bottle with your thumb at the bottom and your index and middle fingers on top. Use a finger on your other hand to close your nostril on the side not receiving the medicine.
E. Squeeze the pump as you begin to breathe in slowly through your nose. Repeat these steps for the other nostril. If you are using more than one spray in each nostril, follow repeat the beginning step.

Answer 5

A, B, D, E. Tilt your head forward slightly before using the mist. Try not to sneeze or blow your nose just after using the spray.

Question 6

What is the safest recommendation for providing benefit for allergy nasal symptoms in a twelve month old child?

A. Beconase
B. Saline nasal spray, such as Ocean
C. Diphenhydramine
D. Pseudoephedrine
E. Nasonex

Answer 6

B. Topical saline sprays or drops have benefit in both children and adults, without harmful side effects. Using regular saline nasal irrigation with a device such as a Neti pot can reduce allergy symptoms and decrease reliance on medications.

Question 7

A mother comes to the pharmacy and asks for something to relieve her 4 year old son’s itchy eyes, runny nose and occasional sneezing. The pharmacist should recommend:

A. Diphenhydramine 12.5 mg Q4-6H
B. Diphenhydramine 25 mg Q4-6H
C. Diphenhydramine 12.5 mg Q6-8H
D. Diphenhydramine 25 mg Q6-8H
E. Do not recommend diphenhydramine

Answer 7

E. Diphenhydramine is not recommended in children under the age of 6 years old.

Question 8

What is the active ingredient in Sudafed-PE?

A. Diphenhydramine
B. Phenylephrine
C. Pseudoephedrine
D. Loratadine
E. Cetirizine

Answer 8

B. Sudafed contains the decongestant pseudoephedrine, and Sudafed-PE contains phenylephrine, which was used as a replacement for pseudoephedrine.

Question 9

A 9 year old female patient weighing 65 pounds presents to the pharmacy with fever and chills. The mother would like to give her daughter ibuprofen and asks what dose she should give. What would be an appropriate dose in milligrams?

A. 200 mg Q4-6H
B. 200 mg Q6-8H
C. .300 mg Q4-6H
D. 400 mg Q4-6H
E. 400 mg Q6-8H

Answer 9

B. In patients < 12 years of age, the recommended weight-based dosing is 5 to 10 mg/kg/dose every 6 to 8 hours as needed with a maximum of 40 mg/kg/day.

Question 10

A mother would like to pick up something from the pharmacy for her 9 year old daughter’s fever and needs help selecting a medication. What are appropriate choices? (Select ALL that apply.)

A. Aspirin
B. Ibuprofen
C. Acetaminophen
D. Chlorpheniramine
E. Diphenhydramine

Answer 10

B, C. Ibuprofen and acetaminophen are appropriate anti-pyretic medications for this patient. Aspirin is avoided in children due to risk of Reye’s syndrome. Naproxen is not indicated for fever in patients < 12 years old. Diphenhydramine does not reduce fever.

Question 11

First-generation antihistamines such as diphenhydramine and chlorpheniramine can cause or aggravate the following conditions: (Select ALL that apply.)

A. Sedation
B. Dry mouth
C. Confusion
D. Urinary retention
E. Blurry vision

Answer 11

A, B, C, D, E. They will also worsen the ability to urinate if a patient has prostate enlargement, and there is some caution with the use in patients with glaucoma.

Question 12

Choose the correct brand-generic match:

A. Cetirizine-Clarinex
B. Desloratadine-Zyrtec
C. Fexofenadine-Allegra
D. Levocetirizine-Claritin
E. Loratadine-Xyzal

Answer 12

C.

Question 13

Cory asks the pharmacist to show him where the guaifenesin is located. What is guaifenesin?

A. A cough suppressant
B. A decongestant
C. An antihistamine
D. An expectorant
E. An analgesic

Answer 13

D. Expectorants contain guaifenesin which is supposed to help loosen mucus. The efficacy is unclear; drinking warm tea may provide similar benefit. It is not particularly harmful, either.

Question 14

Antihistamines that are used for allergic rhinitis come in these formulations: (Select ALL that apply.)

A. Oral tablets
B. Suppositories
C. Eye drops
D. Oral solution
E. Transdermal patches

Answer 14

A, C, D. They also come as nasal spray. Oral solutions are available for pediatrics. Nasal antihistamine sprays are useful for itchy noses and ophthalmics are useful for itchy eyes.

Question 15

A patient has bad congestion and has purchased pseudoephedrine. What side effect can be expected with the use of pseudoephedrine?

A. Racing heart rate
B. Sedation
C. Increased appetite
D. Decreased blood pressure
E. Peripheral edema

Answer 15

A. Pseudoephedrine causes tachycardia, insomnia, decreased appetite and blood pressure elevation and should be used with caution in certain conditions.

Question 16

Which of the following are cough suppressants?

A. Dextromethorphan, codeine, Tessalon Perles, promethazine
B. Delsym, codeine, brompheniramine, hydrocodone
C. Dextromethorphan, chlorpheniramine, benzonatate, Benadryl
D. Delsym, codeine, Zonatuss
E. Dextromethorphan, codeine, benzonatate, TussiCaps

Answer 16

D. Dextromethorphan (Delsym), codeine and benzonatate (Zonatuss, Tessalon Perles), are cough suppressants.

Question 17

What are common side effects of the zinc lozenge? (Select ALL that apply.)

A. Mouth irritation
B. Loss of smell
C. Metallic taste
D. Nausea
E. Diarrhea

Answer 17

A, C, D. Zinc lozenges can cause mouth irritation, metallic taste, and nausea. Loss of smell is a side effect of using nasal swabs or sprays.

Question 18

A mother has brought in a prescription for fluticasone for her 6 year-old son. His mother finally took him to the doctor and asked for something that might work better for his constant stuffy nose and sneezing. What is the preferred treatment for daily, moderate-severe, chronic allergic rhinitis treatment?

A. Loratadine or another second-generation antihistamine
B. Diphenhydramine or another first-generation antihistamine
C. Intranasal corticosteroids
D. Neti pots
E. Saline irrigation

Answer 18

C. The most effective medication class for controlling symptoms of allergic rhinitis are intranasal steroids. These are considered first-line treatment for moderate-severe rhinitis.

Question 19

Any product containing pseudoephedrine must be sold under certain restrictions. These include the following: (Select ALLthat apply.)

A. Stores must keep a logbook of sales (exception is the single dose package that contains a maximum of 60 mg or 2 of the 30 mg tablets).
B. The customer must show photo identification issued by the state (driver’s license, identication card) or federal government (passport).
C. The store must verify that the name matches the photo identification and that the date and time are correct. Record the home address.
D. The store staff must record the amount of pseudophendrine person received [maximum of 3.6 grams or 120 of the 30 mg tablets, and 9 grams (300 tablets) in a 30-day period].
E. The patient must be at least 12 years of age.

Answer 19

A, B, C, D. Pseudoephedrine is located behind pharmacy counters as part of the “Combat Meth Act” under the Patriot Act to crack down on the methamphetamine epidemic.

Question 20

The FDA recommends against the use of cough and cold products in children under this age:

A. 16 years
B. 2 years
C. 10 years
D. 7 years
E. 4 years

Answer 20

B. The FDA recommends against the use of these products in children under 2 years of age. The American Academy of Pediatrics recommends against them in children under 6 years.

Question 21

Which of the following statements concerning prescription cough syrups are correct? (Select ALL that apply.)

A. The ones that are controlled by the DEA are mostly C-V.
B. Promethazine is a common ingredient in prescription cough syrups because it is safe for use in very young children (less than 2 years of age).
C. The brand name of promethazine is Phenergan.
D. Codeine is safe to use as a tablet or syrup in children post-tonsillectomy.
E. In Cheratussin AC the C stands for codeine (guaifenesin+codeine) and Cheratussin DAC the D stands for dextromethorphan (guaifenesin+codeine+dextromethorphan)

Answer 21

A, C. Promethazine is contraindicated in children less than 2 years of age due to the risk of fatal respiratory depression. The FDA warning specifically cautions against use of codeine in children post-tonsillectomy or post-adenoidectomy. The D in DAC stands for decongestant.

Question 22

A patient has been prescribed beclomethasone for allergic rhinitis. What are brand name/s of beclomethasone when used for allergies? (Select ALL that apply.)

A. Flonase
B. Qnasl
C. QVAR
D. Asmanex
E. Beconase AQ

Answer 22

B, E. Beclomethasone for asthma is QVAR and beclomethasone for allergies is Beconase AQ or Qnasl.

Question 23

A patient has been prescribed triamcinolone for allergic rhinitis. What is the brand name of triamcinolone when used for allergies?

A. Beconase
B. Qnasl
C. Nasacort AQ
D. Azmacort
E. Nasonex

Answer 23

C. Triamcinolone for allergies is Nasacort AQ.

Question 24

A patient would like to purchase pseudoephedrine to relieve her stuffy nose but is confused about all the different brand names available. She would like to know which brand medications are pseudoephedrine:

A. Sudafed PE, Zephrex-D, Sudafed
B. Afrin, Zephrex-D, Sudafed PE
C. Nexafed, Zephrex-D, Sudafed
D. Nexafed, Zephrex-D, Sudafed PE
E. Afrin, Zephrex-D, Sudafed

Answer 24

C. Sudafed, Nexafed, and Zephrex-D are all brand names for pseudoephedrine. Sudafed PE is the brand name for phenylephrine and Afrin is the brand name for oxymetazoline.

Question 25

A mother would like to use the neti pot to clear her son’s nasal congestion since she heard it is relatively safe. She asks what kind of water should she use in the pot. The pharmacist can safely recommend the following types of water: (SelectALL that apply):

A. Boiled water
B. Tap water
C. Bottled water
D. Distilled water
E. Non-potable water

Answer 25

A, C, D. Tap water can contain amoebas, which can thrive in the nasal passages and cause serious infections.

Question 26

Oral antihistamines are used for occasional, mild allergy symptoms. They provide benefit for the following symptoms: (Select ALL that apply.)

A. Itchy eyes
B. Chest congestion
C. Nasal congestion
D. Itchy nose
E. Watery eyes

Answer 26

A, D, E. The antihistamines have little effect on nasal congestion and are often given in combination with a decongestant to help with congestion.

Question 27

Why are promethazine with codeine syrups not recommend in young children < 6 years of age?

A. Risk of Reye’s syndrome, cardiac arrest, and neurological problems
B. Risk of respiratory depression, severe skin reactions, and ototoxicity
C. Risk of respiratory depression, cardiac arrest, and nephrotoxic problems
D. Risk of respiratory depression, cardiac arrest, and neurological problems
E. Risk of Reye’s syndrome, severe skin reactions, and ototoxicity

Answer 27

D. Promethazine with codeine syrups are not recommend in young children < 6 years of age due to the risk of respiratory depression, cardiac arrest, and neurological problems.

Question 28

A 7 year old male patient weighing 52 pounds presents to the pharmacy with fever and chills. The mother would like to give her son acetaminophen and asks what dose she should give. If the liquid suspension comes in 160 mg/5 mL, what is an appropriate dose in milliliters?

A. 5 mL Q4-6H
B. 5 mL Q6-8H
C. 10 mL Q4-6H
D. 10 mL Q6-8H
E. 15 mL Q4-6H

Answer 28

C. In patients < 12 years of age, the recommended weight-based dosing is 10 to 15 mg/kg/dose every 4 to 6 hours as needed with a maximum of 5 doses in 24 hours.

Question 29

A 30 year old male comes to the pharmacy complaining of itchy eyes, a runny nose and occasional sneezing. He wants to know what can help with his symptoms that always seem to happen around springtime. The pharmacist should recommend:

A. Diphenhydramine 12.5 mg Q4-6H
B. Diphenhydramine 25 mg Q4-6H
C. Diphenhydramine 12.5 mg Q6-8H
D. Diphenhydramine 25 mg Q6-8H
E. Do not recommend diphenhydramine

Answer 29

B. The adult dose for diphenhydramine is 25-50 mg PO Q4-6H.

Question 30

A pharmacist has recommended oxymetazoline (Afrin) to a patient. The pharmacist should include the following instructions in the proper use of this agent:

A. Breathe the medicine in through your mouth.
B. Do not exceed 3 days use.
C. Do not exceed more than 10 days of continuous use.
D. This is useful for improving sleep.
E. Do not use if you have nasal congestion.

Answer 30

B. Decongestant nasal sprays are not used longer than three days due to the risk of rebound nasal congestion, or rhinitis medicamentosa, which is difficult to treat.

Question 31

What is the mechanism of action of pseudoephedrine?

A. Blocks beta 1 receptors, resulting in nasal vessel constriction
B. Activates alpha adrenergic receptors, resulting in epinephrine release
C. Inhibits norepinephrine reuptake
D. Blocks dopamine receptors in the final pathway of epinephrine release
E. Agonizes serotonin receptors, constricting nasal vessels to reduce blood flow

Answer 31

B. The increase in epinephrine causes vasoconstriction.

Question 32

A patient comes into the pharmacy asking for recommendations on natural products to treat her common cold. She is particularly interested in using zinc. Which counseling point should the pharmacist recommend?

A. Avoid using nasal swabs or sprays due to the risk of loss of taste.
B. Avoid using lozenges due to the risk of loss of smell.
C. Avoid using nasal swabs or sprays due to the risk of loss of smell.
D. Avoid using lozenges or sprays due to the risk of loss of taste.
E. Avoid using nasal swabs or sprays due to the risk of loss of hearing.

Answer 32

C. Avoid using nasal swabs or sprays due to the risk of loss of smell (anosmia).

Question 33

A patient has been prescribed fluticasone for allergic rhinitis. What are brand name/s of fluticasone when used for allergies? (Select ALL that apply.)

A. Flonase
B. Veramyst
C. Flovent
D. Beconase AQ
E. Rhinocort Aqua

Answer 33

A, B. Be very careful with the steroids used for asthma and those used for allergic rhinitis-they are often the SAME drug but in a different delivery device.

Question 34

A patient has been prescribed mometasone for allergic rhinitis. What is the brand name of mometasone when used for allergies?

A. Beconase
B. Qnasl
C. Asmanex
D. QVAR
E. Nasonex

Answer 34

E. Mometasone for asthma is Asmanex and for allergies is Nasonex.

Question 35

Which of the following statements is true regarding the common cold?

A. The common cold is a viral infection of the upper respiratory tract transmitted primarily by mucous secretion and best prevented by coughing into the hands.
B. The common cold is a bacterial infection of the upper respiratory tract transmitted primarily by mucous secretion and best prevented by coughing into the hands.
C. The common cold is a fungal infection of the lower respiratory tract transmitted primarily by mucous secretion and best prevented by frequent hand washing.
D. The common cold is a bacterial infection of the lower respiratory tract transmitted primarily by mucous secretion and best prevented by frequent hand washing.
E. The common cold is a viral infection of the upper respiratory tract transmitted primarily by mucous secretion and best prevented by frequent hand washing.

Answer 35

E. The common cold is a viral infection of the upper respiratory tract transmitted primarily by mucous secretion and best prevented by frequent hand washing.

Question 36

In 2014 the FDA approved 3 new sublingual treatments for allergic rhinitis due to specific types of grass pollen. They are alternatives to allergy shots, which must be given in a physician office. Which statement is true regarding these sublingual medications?

A. All sublingual doses of these medications must be given in the physician’s office.
B. Patients receiving these medications for the first time must be monitored for at least 30 minutes after the first dose for signs of an allergic reaction.
C. Patients receiving these medications are at risk of an allergic reaction only after the first dose.
D. Patients receiving these medications should be prescribed corticosteroids prior to therapy.
E. These sublingual tablets are taken once weekly and the patient must not eat or drink anything 30 minutes prior or 30 minutes after taking a dose.

Answer 36

B. Only the first dose needs be given in the physician’s office to monitor for an allergic reaction. The sublingual tablets are taken daily, before and throughout pollen season.

Question 37

Larry asks the pharmacist to show him where the dextromethorphan is located. What is dextromethorphan?

A. A cough suppressant
B. A decongestant
C. An antihistamine
D. An expectorant
E. A mucolytic

Answer 37

A. Dextromethorphan comes alone and in many combination cough and cold products. It is an antitussive, or cough suppressant.