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Pharmacy Practice I > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

1
Q

Allergic Rhinitis

A
  • Inflammation of nasal mucosa in response to allergens

- Systemic disease with prominent nasal symptoms

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2
Q

Pathophysiology

A

Immune response to allergens with four phases:

  1. Sensitization: initial allergen exposure, IgE antibodies produced
  2. Early: within minutes of subsequent allergen exposure, inflammatory mediators released and produced
  3. Cellular recruitment: more inflammatory mediators released
  4. Late: 2-4 hours later
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3
Q

Triggers

A
  • Outdoor allergens: pollen, pollutants, mold spores

- Indoor allergens: pet dander, dust mites, cockroaches, mold spores

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4
Q

Risk Factors

A
  • Family history of allergic disorders
  • Elevated IgE (>100IU/mL >6)
  • Eczema
  • Positive rxn to allergy skin tests
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5
Q

Clinical Presentation

A
  • Eyes: itching, watering, conjunctivitis (redness and irritation)
  • Nose: sneezing, rhinorrhea, congestion, itching
  • Mouth: itching of palate
  • Other: fatigue, irritability, malaise, cognitive impairment
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6
Q

Allergic Rhinitis Classification

A

Duration
-Intermittent: occur ≤4 days per week OR ≤4 weeks
-Persistent: occur >4 days per week AND >4 weeks
-Episodic: occur when individual is in contact with exposure that is not normally part of environment
Severity
-Mild: do not impair sleep or daily activities, no troublesome symptoms
-Moderate-Severe: one or more of the following: impairment of sleep / daily activities / troublesome symptoms

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7
Q

Allergic Rhinitis or the Common Cold?

A

Onset:
• Allergic rhinitis = fast onset (within
minutes after allergen exposure)
• Common cold = slower onset (within 1-3 days after contact with virus)
Duration:
• Allergic rhinitis symptom relief = 2-4 weeks
• Common cold = self-limiting, within 7-14 days

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8
Q

Complications of Allergic Rhinitis

A

-Sinusitis: sinus tenderness, headache
-Otitis Media: ear pain, feeling of fullness in ear, drainage or fluid from ear
• Children may also exhibit tugging on ear, irritability, sleeplessness

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9
Q

Exclusions for Self-Treatment

A
  • Children <12 years*
  • Pregnancy or lactation
  • Symptoms of otitis media, sinusitis, bronchitis, or other infection
  • Symptoms of undiagnosed or uncontrolled asthma, chronic obstructive pulmonary disorder (COPD), or other lower respiratory disorder
  • Severe or unacceptable side effects from treatment
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10
Q

Nasal Wetting Agents

A

-Examples: saline, propylene, or polyethylene glycol sprays or gels
-Relieve nasal mucosal irritation and dryness
• Leads to decreased nasal stuffiness, rhinorrhea, and sneezing
• Also aid in removal of dried or thick mucus in nose
-No significant adverse effects

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11
Q

Nasal Irrigation

A
  • Warm saline solutions used to flush nasal passages
  • Examples: Neti pot, NeilMed® Sinus RinseTM
  • Mild stinging or burning may occur
  • Only distilled, sterile, or boiled (then cooled) tap water should be used to prepare nasal irrigation solutions
  • Patient should not share device with others
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12
Q

Nasal Aspirators

A
  • Used to suction out mucus
  • Useful in children and infants
  • Can use saline nasal spray beforehand to loosen mucus
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13
Q

Nasal Dilators

A
  • Open nasal passages to relieve congestion

- Example: Breathe Right® nasal strips

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14
Q

Intranasal Corticosteroids

A

Budesonide, Fluticasone Furoate, Fluticasone Propionate, Triamcinolone Acetonide
-Mech: Stimulate glucocorticoid receptors, resulting in decreased inflammation
-Effective for: Rhinorrhea, sneezing, itchy nose, nasal congestion (fluticasone also itchy/watery eyes)
-Adverse Effects: local (nasal discomfort, epistaxis, nasal irritation, pharyngitis, cough)
-Contra: cataracts, glaucoma, nasal trauma
• Fluticasone propionate: Children <4 yr
• Triamcinolone acetonide: Children <2 yr
-Drug Interactions: fluticasone - avoid use with protease inhibitors / ketoconazole

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15
Q

1st Generation Oral Antihistamines

A

Chlorpheniramine, Diphenhydramine, Doxylamine

  • Mech: Block histamine-1 receptors at central and peripheral sites
  • Effective for: Rhinorrhea, sneezing, itchy nose, itchy/watery eyes
  • Onset: 30-60 minutes
  • Adverse Effects: CNS (sedation, dizziness, PE), anticholinergic (dry eyes/mouth, blurry vision, constipation, etc.), photosensitivity
  • Avoid use with other CNS depressants due to enhanced CNS depressant effects: alcohol, benzodiazepines, opioids
  • Contra: newborns/premies, children <6 yr, breastfeeding, glaucoma, asthma, (BPH), bladder neck, pyloroduodenal obstruction, older adults (dementia)
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16
Q

2nd / 3rd Generation Oral Antihistamines

A

Cetirizine, Fexofenadine, Levocetirizine, Loratadine

  • Mech: Block histamine-1 receptors at peripheral sites
  • Effective for: Rhinorrhea, sneezing, itchy nose, itchy/watery eyes
  • Onset: 1-2 hours
  • Adverse Effects: sedation
  • Avoid use with other CNS depressants due to enhanced CNS depressant effects
  • Cetrizine: kidney / liver
  • Fexofenadine: kidney, erythromycin, ketoconazole, fruit juices/antacids (down)
  • Levocetirizine: end stage kidney disease, hemodialysis
  • Loratadine: kidney / liver
17
Q

Oral Decongestants

A

Pseudoephedrine, phenylephrine

  • Mech: Stimulate alpha-adrenergic receptors in respiratory tract mucosa to produce vasoconstriction
  • Effective for: Nasal congestion
  • Onset: 30-60 minutes
  • Adverse Effects: cardiovascular, insomnia, tachyphylaxis
  • Avoid use within 2 weeks of MAOI
  • Contra: children <2 yr, cardiovascular conditions, diabetes mellitus, hyperthyroidism, pregnancy, breastfeeding, BPH, glaucoma
  • Do not use more than 7 days
18
Q

Topical Decongestants

A

Oxymetazoline, Phenylephrine

  • Mech: Stimulate alpha-adrenergic receptors in the arterioles of the nasal mucosa to produce vasoconstriction
  • Effective for: Nasal congestion
  • Onset: ≤5 minutes
  • Adverse Effects: nasal stinging, burning, dry, sneezing
  • Drug Interactions: minimal
  • Use for >3 days
19
Q

Intranasal Mast Cell Stabilizers

A

Cromolyn Sodium (Nasal-Crom)

  • Mech: Decrease histamine degranulation from mast cells
  • Effective for: Rhinorrhea, sneezing, itchy nose, nasal congestion
  • Onset: 3-7 days for initial response; 2-4 weeks for full benefit
  • Adverse Effects: sneezing, stinging, burning
  • Caution in children <2
  • No known interactions

Pharmacy Practice I (27 decks)

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