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Pharm N895 > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

1
Q

Allergic Rhinitis: Symptoms / characteristics of inflammatory response

A

IgE inflammatory response

  • Nasal congestion
  • Rhinorrhea- runny nose
  • Sneezing
  • Nasal itching
  • Lacrimation- teary eyes
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2
Q

Types of AR

A

Seasonal Allergic Rhinitis(SAR): seasonal aeroallergens- depends on where you are
Perennial Allergic Rhinitis (PAR): year-round environmental allergens
Intermittent Allergic Rhinitis: determined by frequency of exposure- <4 days per week or <4 weeks per year
Persistent Allergic Rhinitis: persistent sxs- >4 days per week or >4 weeks per year
Episodic Allergic Rhinitis: contact w exposure that is not normally part of pt’s environment

Tx does not differ- these are just ways to categorize

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3
Q

Asthma & AR:

A

similar inflammatory components, increase AR in asthmatic pts, asthma + AR = worse outcomes for pts

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4
Q

Agents for AR

A

Oral Antihistamines

Intranasal antihistamines

Intranasal Corticosteroids

Intranasal Agents

Ophthalmic Agents

Leukotriene Receptor Antagonists (LRAs)

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5
Q

Oral Antihistamines: Agents

A

1st Gen

Diphenhydramine (Benadryl)

2nd Gen

Loratadine (Claritin)-

Desloratadine (clarinex)-

Fexofenadine (Allegra)-

Cetirizine (Zyrtec)-

Levocertirizine (Xyzal)-

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6
Q

Oral Antihistamines: Indications

A

For sneezing and itching

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7
Q

Oral Antihistamines: which agent most sedating and most anticholinergic effects?

A

Diphenhydramine (Benadryl) (1st gen)

25-50mg QID

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8
Q

OAs: which less sedating? 1st or 2nd gen?

A

2nd gen

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9
Q

Least sedating second Gen OA?

A

Fexofenadine (Allegra)

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10
Q

Dosing: 1st vs second gen OAs

A

1st: QID
2nd: QD

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11
Q

Best tolerated oral antihistamine?

A

Cetirizine (Zyrtec)- second gen

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12
Q

Which OAs have a SE of urinary retention?

A

Cetirizine (Zyrtec) and Levocertirizine (Xyzal) - second gens

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13
Q

Which OA is a L-enantiomer of cetirizine (mirror image)?

A

Levocertirizine (Xyzal)- – controversy over whether same response

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14
Q

Intranasal antihistamines: Agents

A

Olapatadine (Patanase)

Azelastine (Astelin)

Azelastine/Fluticasone (Dymista)

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15
Q

Intranasal antihistamines: indications and dosing

A
  • Seasonal, perennial, episodic AR
  • Better against nasal congestion v OAs
  • Indicated when Sx affect QoL
  • Daily or PRN (whereas need PO daily)
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16
Q

Intranasal antihistamines: ADRs

A
  • bitter taste, nose bleeds, HA
  • More $$ than OAs
17
Q

Intranasal Antihistamines: advantages over OAs

A
  • Daily or PRN (need PO daily)
  • Better against nasal congestion v OAs
  • Rapid onset v OA
  • Increased dosing frequency v OA
18
Q

Most effective Tx option for symptom control of AR?

A

Intranasal antihistamines

19
Q

Olapatadine (Patanase): dosing

A

1 spay bid

20
Q

Azelastine (Astelin): dosing

A

1-2 sprays bid

21
Q

Azelastine/Fluticasone (Dymista): dosing

A

1 spray bid

22
Q

Intranasal antihistamine: Most $$

A

Olapatadine (Patanase)

23
Q

ALLERGIC RHINITIS: Intranasal Corticosteroids - agents

A
  • Triamcinolone Acetonide (Nasacort)
  • Budesonide (Rhinocort AQ)
  • Flunisolide (Nasalide)
  • Fluticasone (Flonase or Veramyst)
  • Mometasone furoate (Nasonex)
  • Ciclesonide (Omnaris)
24
Q

Triamcinolone Acetonide (Nasacort): ADRs

A

pharyngitis, epistaxis, cough

25
Q

Budesonide (Rhinocort AQ) : ADRs

A

pharyngitis, epistaxis, cough

26
Q

Flunisolide (Nasalide) : ADRs

A

after taste, nasal burning

27
Q

Fluticasone (Flonase or Veramyst) : ADRs

A

HA, epistaxis

28
Q

Mometasone furoate (Nasonex) : ADRs

A

HA, viral infection, epistaxis, cough

29
Q

Ciclesonide (Omnaris): ADRs

A

HA, epistaxis

30
Q

Oxymetazoline (Afrin): MOA

A

intranasal

Alpha-adrenergic agonist –> nasal arteriole vasoconstriction

31
Q

Oxymetazoline (Afrin): how is it most effective?

A

Most effect in combo w intranasal corticosteroids

32
Q

Oxymetazoline (Afrin):​ Adverse Effects

A

Rhinitis medicamentosa (rebound nasal congestion) w prolonged use (>3 days)- take for no more than 72 hrs

33
Q

Ophthalmic agents: Agents and Indications

A

For ophthalmic Sxs of AR

  • Vasoconstrictor- naphazoline (clear-eyes) OTC
  • Antihistamine- Ketotifen (Zaditor) OTC
  • NSAID- Ketorolac (Acular)
  • Corticosteroid- Loteprednol (Alrex)
34
Q

Ophthalmic agents: ADRs

A

Ophthalmic irritation, mydriasis- dilation of pupil, photophobia

35
Q

Ophthalmic agents: considerations prior to administration

A

Remove contacts prior to use

36
Q

Leukotriene Receptor Antagonists (LRAs): Comparability to other agents

A

Not 1st line- similar/ less effective vs 1st line, higher cost

Pharm N895 (13 decks)

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