Allergic Rhinitis Flashcards
Allergic rhinitis affects patients either
1.
2.
Seasonally
Perennially
Moderate-severe allergic rhinitis is classified as
1.
2.
3.sleep disturbance
4. troublesome symptoms
- impaired school/work
- impaired ADL
Red flags for referral in allergic rhinitis:
1. Children < __ yo
2.
3.
4. Unilateral symptoms
5. AOM
6. uncontrolled asthma
- 2 yo
- mod-severe
- treatment failure/persistent symptoms (tried OTC 2 weeks)
The following classes of OTC medications can help with allergic rhinitis
1.
2.
3.
- oral antihistamines
- decongestants
- intranasal corticosteroids
______________ help relieve most symptoms of acute allergic rhinitis such as sneezing, rhinorrhea, nasal itch and conjunctivitis
Antihistamines
Antihistamines are most effective if used _______________
prophylactically
Of the less-sedating antihistamines, ____________ is more likely to cause some sedation, especially at higher doses.
Cetirizine
Patients whose occupations require vigilance or concentration should receive only less-sedating antihistamines, as they do not affect performance and have no anticholinergic effects. ___________ and ____________ were shown to have no effect on driving performance.
Bilastine and rupatadine
First generation antihistamines are not recommended due to?
Side effects: CNS sedation fatigue impaired cognitive function
anticholinergic urinary retention dry eyes, mouth constipation
What is the onset of second-generation antihistamines?
1 hour
Second generation antihistamines require dose adjustment in?
Renal impairment
Oral decongestants (_____________, _______________) relieve nasal obstruction
Pseudoephedrine, phenylephrine
Avoid oral decongestants in those receiving _____
MAOi (Serotonin syndrome risk)
Avoid use of oral decongestants in
1.
2.
3.
Uncontrolled HTN
Hyperthyroidism
pregnancy / BF
Oral decongestants can lead to side effects like:
1.
2.
3.
- restlessness
- tachycardia
- increased BP
Dysglycemia (caution in DM patients)
The two long acting topical nasal decongestants available in Canada include:
1.
2.
Oxymetazoline
Xylometazoline
Fast onset, 5-10 minutes
The use of intranasal decongestants for more than 3–7 days may result in ____________
Rebound congestion
Decongestants are typically contraindicated in < __ yo
12
Consider _____________ as monotherapy or add-on therapy with INCS or oral antihistamines in patients with concomitant asthma or nasal polyps, or in patients who have failed to respond to adequate trials of first-line therapies (INCS or oral or intranasal antihistamines).
Montelukast
____________ _______________ are the mainstay of therapy for moderate to severe rhinitis symptoms
Intranasal corticosteroids (INCS, e.g., beclomethasone, budesonide, ciclesonide, fluticasone furoate, fluticasone propionate, mometasone and triamcinolone)
INCS peak effect may take __ - __ weeks
1-2
If allergic rhinitis is not adequately controlled with intranasal corticosteroid monotherapy, the addition of an _____________ may be considered but should be discontinued if no benefit is observed within 2–4 weeks.
antihistamine
Azelastine/fluticasone combination intranasal spray is available for treatment of allergic rhinitis and ocular symptoms in patients over 12 years of age. Studies found that the combination is superior to fluticasone propionate or azelastine alone for nasal congestion, rhinorrhea, sneezing, nasal itch and eye symptoms. Consider using the combination product for patients who continue to have symptoms despite an adequate trial of INCS
Patients primary allergic rhinitis symptom is rhinorrhea, what could you consider?
Intranasal anticholinergic
Ipratropium bromide (Atrovent)
Rare side effect associated with Montelukast therapy?
Psychiatric Symptoms
When oral antihistamines, INCS or leukotriene receptor antagonists provide insufficient relief, topical ophthalmic antihistamines _________, _________ can be used to provide ocular symptom relief
Ketotifen
Olopatadine
Onset Few minutes
Duration 12 hours
______________ is indicated only when there is evidence of IgE-dependent sensitivity to a specific antigen the patient cannot effectively avoid and when frequency and severity of symptoms are difficult to control with conventional drug therapy.
Immunotherapy or allergy shots
costly
Children with allergic rhinitis can use:
1.
2.
2nd gen antihistamines
Intranasal corticosteroids
Preferred initial therapy for nasal symptoms during pregnancy is ________
Saline Drops/Spray
Options for managing allergic rhinitis in pregnancy
1.
2.
3.
4.
- Antihistamines
- Corticosteroids
- Monteklukast
- Intranasal decongestant
Which intranasal corticosteroid should be avoided in pregnancy ?
Triamcinolone in 1st trimester
Desloratadine, loratadine and rupatadine are available as ________. _______ is available as a chewable tablet, an oral solution and a fast-dissolve tablet.
Syrups, Cetirizine (Reactive)
Which of the 2nd gen oral antihistamines is dosed BID?
Fexofenadine (Allegra)
