Allergic Rhinitis

Question 1

Allergies are the ___ most common chronic disease in the U.S.

Answer 1

Fifth

Question 2

Allergic rhinitis is mediated by what inflammatory response?

Answer 2

Production of IgE

Question 3

What exposures agitate allergic rhinitis and produce its inflammatory response?

Answer 3

Inhaled allergens

Question 4

Allergic rhinitis with symptoms occurring < 4 days/week or < 4 weeks/yr is classified as
a. Mild
b. Severe
c. Intermittent
d. Persistent

Answer 4

c. Intermittent

Question 5

Allergic rhinitis with symptoms that interfere with quality of life is classified as
a. Mild
b. Severe
c. Intermittent
d. Persistent

Answer 5

b. Severe

Question 6

Allergic rhinitis with symptoms that do not interfere with quality of life is classified as
a. Mild
b. Severe
c. Intermittent
d. Persistent

Answer 6

a. Mild

Question 7

Allergic rhinitis with symptoms occurring > 4 days/week or > 4 weeks/yr is classified as
a. Mild
b. Severe
c. Intermittent
d. Persistent

Answer 7

d. Persistent

Question 8

A woman comes into your pharmacy with her 8 year old daughter. She complains of nasal congestion, rhinorrhea, sneezing and nasal itching. Do you choose to treat or refer this patient?

Answer 8

Refer. < 12 years old is an exclusion for self care

Question 9

Self care exclusions for allergic rhinitis

Answer 9

. <12 yrs old
. Pregnant/lactating
. Symptoms of non-allergic rhinitis
. Symptoms of otitis media, sinusitis, bronchitis, other infection
. Symptoms of undiagnosed asthma, COPD, lower respiratory tract infections
. Severe side effects of treatment

Question 10

Pharmacological therapies include

Answer 10

. Intranasal corticosteroids
. Second gen antihistamines (sometimes first gen)
. Intranasal antihistamines
. Decongestants
. Leukotriene receptor antagonists
. Immunotherapy

Question 11

Budesonide drug classification and MOA

Answer 11

Intranasal corticosteroid
Anti-inflammatory, antipruritic and vasoconstriction

Question 12

Which of the following is a first generation antihistamine?
a. Loratidine
b. Fexofenadine
c. Diphenhydramine
d. Cetirizine

Answer 12

c. Diphenhydramine

Question 13

Second gen antihistamines MOA

Answer 13

Long acting tricyclic antihistamines with SELECTIVE peripheral histamine H1 receptor antagonistic properties

Question 14

Adverse effects of intranasal corticosteroids

Answer 14

. Local irritation
. Headache
. Pharyngitis
. Cough

Question 15

Adverse reactions of second gen antihistamines

Answer 15

. Constipation/diarrhea

Question 16

Adverse effects of first gen antihistamines

Answer 16

. Sedating
. Dry mouth
. Dizziness

Question 17

Intranasal antihistamines examples and MOA

Answer 17

. Azelastine and olopatadine
. Selective H1 receptor antagonist and inhibits release from mast cells

Question 18

Adverse reactions of intranasal antihistamines

Answer 18

. Epistaxis
. Sneezing
. Postnasal drip
. Abnormal taste
. Headache

Question 19

How often should intranasal antihistamines be dosed?

Answer 19

Twice daily

Question 20

What is the difference between decongestants labeled D vs PE?

Answer 20

D- decongestant, mostly pseudoephedrine
PE- phenylephrine

Question 21

Oral pseudoephedrine MOA and adverse reactions

Answer 21

Directly stimulates alpha adrenergic receptors of respiratory mucosa causing vasoconstriction
. Can cause headache, insomnia, tachycardia/arrhythmia and increase BP

Question 22

Nasal pseudoephedrine should not be used for more than __ days
a. 3
b. 5
c. 7
d. 14

Answer 22

a. 3

Question 23

Nasal pseudoephedrine can have what adverse reaction if overused?

Answer 23

Rebound congestion; worsening of the congestion

Question 24

Which leukotriene receptor antagonist is FDA approved for allergic rhinitis?

Answer 24

Montelukast (Singulair)

Question 25

What is the black box warning associated with montelukast?

Answer 25

Serious neuropsychiatric events including agitation, aggression, depression, suicidal thoughts and behavior