Allergic rhinitis

Question 1

What is known as the “atopic triad”? You may have one or all 3 together.

Answer 1

atopic dermatitis (eczema), allergic rhinitis, and asthma

Question 2

___ and ___ are of the same pathology. “One airway, one disease”

Answer 2

AR, asthma

Question 3

Type I hypersensitivity reactions are ___-mediated. Examples include: ___, ___, and ___.

Answer 3

IgE, AR, asthma, anaphylaxis

Question 4

Type II hypersensitivity reactions are ___/___-mediated. Examples include ___ reaction and ___ disease.

Answer 4

IgG/IgM, transfusion, Grave’s

Question 5

Type III hypersensitivity reactions are ___. Examples include ___ sickness and ___.

Answer 5

vascular, serum, lupus

Question 6

Type IV hypersensitivity reactions are ___-mediated and are delayed. Examples include: ___ ___ test.

Answer 6

cell, TB skin

Question 7

Seasonal allergies aka ___. Occurs at ____ times of the year, such as ___ ___ from grasses, weeds, trees.

Answer 7

intermittent, specific, hay fever

Question 8

Perennial allergies aka ___. Occurs ___-___ from ___, ___, ___ in the environment everyday.

Answer 8

persistent, year-round, dust, mold, dander

Question 9

Episodic allergic rhinitis aka ___.

Answer 9

sporadic

Question 10

___ is the last-option for AR treatment.

Answer 10

immunotherapy

Question 11

___ are the most effective tx for ALL symptoms of AR.

Answer 11

intranasal corticosteroids (ICS’s)

Question 12

Anticholinergics, like ___ is only useful for nasal discharge or runny nose.

Answer 12

ipratropium

Question 13

Classic symptoms of seasonal AR:

Answer 13

clear drainage, sneezing, itchy eyes/nose

Question 14

Major signs of AR:

Answer 14

allergic shiners (boggy, puffy, dark eyes), pale mucosa, nasal crease, dennie-morgan lines, eczema

Question 15

How to differentiate between AR and sinusitis in the terbunate:

Answer 15

AR - terbunate is pale, boggy mucosa

sinusitis - red/erythemic, “friable” mucosa

Question 16

How to differentiate between AR and sinusitis:

Answer 16

sinusitis will have facial pain, duration > 10 days, fever, bad breath, dental/maxillary pain. Sinusitis does not usually have sneezing.

Question 17

Intermittent is < ___ days per wk, OR < ___ wks.

Answer 17

4, 4

Question 18

Persistent is > ___ days per wk, AND > ___ wks.

Answer 18

4, 4

Question 19

Mild consists of: ___ sleep, ___ impairment of dly activities, ___ work and school, and ___ troublesome symptoms.

Answer 19

normal, no, normal

Question 20

Moderate-Severe consists of: ___ sleep, ___ of dly activities, ___ of work and school, and ___ symptoms.

Answer 20

abnormal, impairment, impairment, troublesome

Question 21

___ generation oral antihistamines are sedating, whereas ___ and ___ generations are non-sedating.

Answer 21

first, second, third

Question 22

What is the DOC for AR (moderate-severe)? What is the tx for mild AR?

Answer 22

intranasal steroids (ICS) aka "big guns"
oral antihistamines (H1) or LTRA

Question 23

Benadryl and Phenergan are examples of ___ generation antihistamines.

Answer 23

first

Question 24

cetirizine (zyrtec) and loratadine (claritin) are examples of ___ generation antihistamines.

Answer 24

second

Question 25

Clarinex and fexofenadine (allegra) are examples of ___ generation antihistamines.

Answer 25

third

Question 26

azelastine (Astelin) and pantase are examples of ___ ___.

Answer 26

intranasal antihistamines

Question 27

Adverse effects of anticholinergics is ___, so precautions in ___.

Answer 27

urinary retention, BPH

Question 28

Must take first-generation antihistamines every ___-___hrs, whereas second and third generations are taken ___. ___ generation antihistamines also build up a tolerance over time, whereas ___ and ___ do not.

Answer 28

4-6, daily, First, second, third

Question 29

___ ___ are recommended in moderate-severe persistent rhinitis when symptoms persist after first-line therapy of ___ ___.

Answer 29

intranasal antihistamines, intranasal corticosteroids

Question 30

You can begin a ___ ___ a few days prior to allergy season.

Answer 30

intranasal steroids

Question 31

With nasal sprays, you want to aim ___ from nasal septum at ___ eyes. Tilt head ___ nostril being treated. You can use nasal ___ first to clear out nostrils.

Answer 31

away, outer, toward, saline

Question 32

Intranasal corticosteroids include:

Answer 32

fluticasone (flonase), budesonide (rhinocort), triamcinolone (nasacort), mometasone (nasonex)

Question 33

Mast cell stabilizers include:

Answer 33

cromolyn sodium

Question 34

Leukotriene receptor antagonists (LTRA’s) include:

Answer 34

montelukast (singulair)

Question 35

Decongestants run the risk of abuse of ___.

Answer 35

pseudoephedrine

Question 36

Decongestansts are ___ agents and act like adrenaline to ___ HR.

Answer 36

sympathomimetic, increase

Question 37

Antitussives/suppressives include: ___. Avoid in ___.

Answer 37

codeine, hydrocodone, dextromethorphan, benzonatate (tessalon pearls), kids

Question 38

Antitussives/expectorants include: ___. Proper ___ is essential to effective expectorant activity.

Answer 38

guaifenesin (mucinex), iodinated glycerol, hydration

Question 39

As far as immunotherapy goes, ___ ___ is considered the gold standard. ___ must be stopped prior to testing.

Answer 39

skin testing, antihistamines

Question 40

Atopic dermatitis, aka ___. Has a strong heriditary/genetic influence. Is a ___ that can break out all over the body, and is a ___-mediated response.

Answer 40

eczema, rash, cell

Question 41

Tx for atopic dermatitis include moisturizers/lubricants that have a low water content like:

Answer 41

eucerin, aquaphoir, nivea, cetaphil

Question 42

Other tx options for atopic dermatitis include:

Answer 42

short bath, lots of moisturizers, mild detergents for clothing

Question 43

Order for increasing potency for topicals is: ___. You can have the same dosage in each one, but the potency increases w/each.

Answer 43

lotion –> cream –> ointment

Question 44

Use the lowest potency steroids to achieve the tx goal in atopic dermatitis, like ___.

Answer 44

1% hydrocortisone

Question 45

Topical immunomodulators/immunosuppressants for ___-line tx of atopic dermatitis include:

Answer 45

second, tacrolimus, pimecrolimus

Question 46

First line tx for atopic dermatitis FLARES is ___ ___. Second line tx is ___ ___.

Answer 46

topical steroids, topical immunomodulators

Question 47

Mainstay therapy for atopic dermatitis is ___, like aquaphor, cetaphil, eucerin, nyvea.

Answer 47

emollients