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Phar 153 > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

1
Q

Describe the allergic process

A
  • Allergic response to allergens (proteins)
  • Mast cells exist at body interface (stomach, eyes, skin)
  • Initial exposure –> No rxn however leads to sensitization
  • Subsequent exposure enacts symptoms via mast cells release of mediators 9e.g. histamine)
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2
Q

What is sensitization?

A

Sensitization = your body has seen this before and now stands ready. The mast cell now has receptors ready to pick up the allergen when it next appears (allergy season)

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3
Q

Early Phase vs. Late Phase RXN

A

Early –> Rhinorrhea, itchiness, maybe some sneezing

late –> oedema and congestion

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4
Q

What is the link between asthma and allergies?

A

Some component of allergic rhinitis . If can’t control one, other gets worse. Need to have control of both.

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5
Q

Is anti-histamine effective for all mediators?

A

No
can control histamine; however, other receptors activated and mediators released

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6
Q

Perennial Allergies

A
  • Year round; all the time
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7
Q

Acute Allergies

A
  • Can be long; but after 2 months stops –> Seasonal
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8
Q

What are some differentials?

A

Vasomotor rhinitis (temp)
Rhinitis Medicamentosa (decongestants-rebound)
Hormonal (birth control)
geriatric Rhinitis

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9
Q

How is allergic rhinitis classified (new)?

A

Intermittment - Less than 4 days per week, or less than 4 weeks at a time

Persistent - Greater than 4 days per week and greater than 4 weeks at a time

Mild –. Normal sleep, normal activities

Moderate-severe –> Abnormal sleep, impairement of daily activities

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10
Q

Common symptoms of allergies

A

Sneezing, rhinorrhea, congestion, itchy eyes, nasal drip

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11
Q

Facial cues of allergic rhinitis

A
  • Puffy eyes, mouth breathing
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12
Q

Allergies vs a cold

A
  • same time every summer
    Increase sneezing and itchiness
    Runny nose and congestion
    Last longer
    PND
    More ocular
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13
Q

Avoidance of Alergens

A
  • Very hard to do
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14
Q

Nasal irrigation

A

Well tolerated
Small benefit
- helps flush out allergens

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15
Q

Nasal Sprays

A
  • not the same as irrigation
  • tortured by irritation; lubrication can provide relief
  • can use long term
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16
Q

Anti-histamines MOA

A

H1 –> Mast Cells –> prevent histamine release

H2 –. Stomach

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17
Q

How should anti-histamines be used for optimal effectiveness?

A
  • Best used prior to allergen exposure
    Regular dosing is bttter than prn use
18
Q

When would a topical steroid be more useful?

A
  • Topical steroid better for congestion phase than antihistamine
19
Q

First genration ANti-histamines

A

Promethazine

ETHANOLAMINES:
diphenyhydramine
doxylamine
clemastine

ALKYLAMINES
chlorpheniramine
brompheniramine
debroxmpheniramine
tripolidine

20
Q

1st gen sedation

A

promethazine > ethanoamines > alkylamines

21
Q

What are some symptoms of anti-histamines?

A
  • Block H1 receptors alows blockage of cholinergic receptors
  • Anticholinergic symptoms –> dry mouth, drowsiness, constipation
22
Q

1st Gen in Kids and Older People

A

Kids –> Avoid –> use 2nd gen –> Does not cause paradoxical excitation

Avoid in elederly

23
Q

Second Genration ANti-histamines and age of use

A

Loratidine - 2
Desloratidine - 2
cetrizine - 2
Fexofenadine - 12

24
Q

Interactions 2nd gen

A
  • Fexofenadine + grapefruit/orang/apple juice and when taken with food
25
Q

Why are 2nd gen better than first gen?

A
  • Higher affinity for receptor
  • Less s/e
  • Not sedating
26
Q

Patient Dynamics

A
  • Little chance for complete relief
  • Expect trial and error
27
Q

Intranasal Antihistamines

A
  • Dristan - phenylephrine and pheniramine

Dymista - flucatisone (topical steroid) and azelastine

28
Q

Ocular Anti-histamines

A

OTC
pyrillamine, antazoline, pheniramine

RX
Emedastine, ketotifen

29
Q

Decongestant and Anti-histamine

A
  • Want them seperate
30
Q

Intransal Steroid Examples, safety and Use

A

Mometasone
Flucatisone
Ciclesonide

  • Safe –> Will not get rebopund congestion
    When we put the in the nose, do not see common steroidal effects as on the skin –> unheard of –> no mucosal thinning
  • Useful for congestion
  • Budesonide
    -Beclomethasone
  • Flunisolide
31
Q

Efficacy and Onset of ACtion of Intransal Steroid

A
  • More effective than 2nd gens
  • Gonna need 2 weeks to get onset of action (will get some relief in first few days)
32
Q

Intransal Steroids Dosing, S/e and duration of therapy

A
  • OD or BID
  • regular use is better
  • S/e –> Local irritation, nose bleeds (epitaxis), spray runs down back of throat
  • Can use for 2 years; take drug holidays
33
Q

Ages for Intransal Steroids

A
  • Go with what label says
34
Q

Directions for Intransal Steroid Use

A
  • Shake and Prime (makes sure you get ful dose)
  • Blow nose
  • Look down
  • Use right hand for left nostril and vice versa
  • Spray to outside of nose wall
  • Do not sniff hard
35
Q

Cromolyn

A
  • Mast cell stabilizer –> prevents mediator reease
  • Cromolyn, Nalcrom, Opticrom

Dose frequently

36
Q

Opthalmic Allergies

A
  • Therapeutics for eye often underdosed
  • Mast cell stabilizers:
    Cromolyn
    Alocri
    Patanol
    Alomide
37
Q

Immunotherapy

A
  • Allergy shots
  • Really bad allergies
38
Q

Montelukast

A

Lukotriene antagonist
- Asthma, allergic rhinitits

  • Add on therapy
39
Q

Ipratropium

A
  • anti-cholinergic mechanims
    Used in vasmotor rhinitis therapy
40
Q

Allergies Pregnancy

A

Nasal Congestion Common
- MD realm

1st gen and 2nd gen appear to be safe

41
Q

Anti-histamines and Intranasal steroids in Asthma

A

Avoid 1st gen, 2nd gen of choice

Patient is on inhaled steroid, adding an intranasal steroid is reasonable

42
Q

Children ANti-histamines

A
  • 1st gen safe; however use second gens
  • newer topical steroids are safe –> no negative growth effects

Phar 153 (7 decks)

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