50 - Allergic Rhinitis Flashcards
non-pharms
avoid exposure to triggers, wash bedding, carpets, shower, don’t have pets in the bedroom
Describe topical pharmacological options
- use saline nasal spray to wash out mucus and allergen
- lubricant eye drops or cold compresses can reduce conjunctival symptoms
What symptoms do antihistamines relieve?
relieve most symptoms such as sneezing, rhinorrhea, nasal itch and conjunctivitus
not congestion
Which antihistamine may relieve congestion?
desloratidine - may relieve congestion and is indicated for congestion
fexofenadine - may help but it is not indicated for this symptom
Antihistamines are most effective if used ______
prophylactically
*but onset of action is fast enough so they are still effective when used PRN
Of the less-sedating AH’s, which one is more likely to cause some sedation, esp at higher doses?
cetirizine
Decongestants are _____ _____
alpha agonists
_______ (decongestant) effectiveness has not been well established
phenylephrine
Which decongestant is available as a single entity product or in combo with less-sedating AH’s?
pseudoephedrine
Decongestants have _____ side effects
stimulant
Avoid decongestants if taking ____
MAOi
Who should you caution decongestants in?
in those with HTN, hyperthyroidism or ischemic heart disease, though evidence of risk is weak when used at recommended doses
What are topical decongestants?
- oxymetazoline
- xylometazoline
Use of topical decongestants for more than ____ days may result in rebound congestion
3-7
Concomitant use of an intranasal _____ may mitigate rebound congestion
corticosteroid (ex. fluticasone)
What is the mainstay of treatment for moderate-severe rhinitis symptoms?
intranasal corticosteroids
May need _____ week trial for corticosteroids to benefit
2-4
_____ is an intranasal corticotseroid that comes as DPI for those who don’t like aqueous sprays
budesonide
Advantage of intranasal corticosteroids over oral corticosteroids?
does not cause adrenal suppression @ therapeutic doses
What is Levocabastine?
An antihistamine nasal spray
-less potent than INCS and is not effective for treatment of congestion
Intranasal ipratropium is only good for ______
rhinorrhea
What is a LTRA that has a modest effect on allergic rhinitis?
montelukast
points about ophthalmic mast cell stabilizers?
- require several days for onset of effect
- QID dosing
why is regular use of topical vasoconstrictors for the eyes not recommended?
bc of the development of rebound vasodilation
Immunotherapy is useful when symptoms caused by what?
pollen or dust mites
Immunotherapy is indicated when there is evidence of ____ sensitivity to a specific antigen
IgE
What is drug of choice in kids?
oral antihistamines
can also use intranasal corticosteroids
Choices in pregnancy?
- second gen AHs more safe than 1st gens
- montelukast safe
- INCS are also safe
- can use pseudoephedrine but avoid in 1st trimester
