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Phar455 > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

1
Q

cells that are located at all interfaces and tell body to be sensitive to a something foreign

A

mast cell

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2
Q

initial exposure of an allergen leads to_____ and subsequent exposure leads to

A

sensitization, mast cell release of mediators (like histamine)

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3
Q

why do antihistamines only help a little bit?

A

more mediators than this are released so some symptoms will break through

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4
Q

allergic process has a strong link with (5 things)

A

asthma**

-recurrent otitis media, sinusitis, nasal polyps and sleep apnea

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5
Q

why are cat allergies more common?

A

lick themselves a lot, gets aerosolized

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6
Q

to be allergic rhinitis, what must be present?

A

a protein as an allergen. Otherwise, could just be an irritant base causing similar sx (smoke, pollution, chemical, etc) and it is not an allergic reaction

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7
Q

what is vasomotor rhinitis

A

reaction to change in position or temperature ie get runny nose, etc

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8
Q

types of non allergic

A

vasomotor rhinitis, rhinitis medicamentosa, hormonal, geriatric rhinitis, etc

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9
Q

Intermittent

A

less than four days per week, or less than four weeks at a time

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10
Q

persistent

A

greater than 4 days per week, and greater than four weeks at a time

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11
Q

mild

A

normal sleep, normal daily activities/work/school, no troublesome symptoms

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12
Q

moderate-severe

A

one or more times; abnormal sleep, impairment of daily activities/sports/leisure, problems at school/work, troublesome sx

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13
Q

some sx of rhinitis (think head, shoulders, knees and toes)

A
  • sneezing
  • rhinorrhea
  • congestion
  • nasal drip
  • eyes: itchy eyes/conjunctivitis
  • throat: sore/itchy throat
  • ears: ear pain/itch, hearing loss
  • mouth: snoring/mouth breathing
  • head: headache/congestion
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14
Q

seasonal vs perennial nasal congestion

A 
s= common, watery, profuse
p= variable, usually PND
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15
Q

seasonal vs perennial sneezing

A 
s= usually present
p= sometimes
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16
Q

seasonal vs perennial ocular sx

A 
s= common, pruritis, injected, watery discharge
p= watery, redness rare
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17
Q

classic allergy behaviour in kids

A
  • nasal crease (push nose up) to open up passages
  • puffy eyes
  • mouth breathing (due to congestion)
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18
Q

allergy differentiation from colds

A 
allergies
-same time every summer
increased sneezing and itch
runny nose or congestion
last longer
PND
more ocular (itchy eyes way more common)
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19
Q

what bothers young allergy sufferers the most?

A

-congestion!!, runny nose, post nasal drip, watering eyes, headache

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20
Q

are HEPA vacuum filters worth using?

A

helped reduce allergens, but no big effect on actual sx… may help a little with repeated, intensive vacuuming

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21
Q

can covers for beds help with total sx?

A

not really, dust mites can live in the bed

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22
Q

opinion on Nasaleze

A
  • inert, cellulose powder to make a barrier in your nose to catch allergens
  • doubtful…. enough allergens probably still get in in spite of this anyway
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23
Q

allergen block opinion

A
  • similar to Nasaleze where it is supposed to catch allergens, but it is a gel and goes on mucus membranes.
  • doubtful, maybe better than powder though
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24
Q

nasal irrigiation opinion

A

small benefit, but well tolerated
helpful, but not as comfortable and a lot of work for little value with cold, but for allergies more value for the amount of work

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25
Q

nasal saline mists

A

could be of some value! Normal saline is good

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26
Q

nasal gels

A

soothing, helpful for allergies, TLC/ wear and tear because your nose is sensitive; saline based gels give moisture and viscosity agents help soothe

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27
Q

antihistamines- use after sx (prn vs regular)

A

not great- should start before you know you will get sx. Not great at playing catch up. Regular dosing is good if know when sx will start (if don’t, can use 2 weeks on, 2 off)- prn not as good

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28
Q

how soon AHs start working, when is it best to start them, what if you wait too long?

A
  • within one hour get reasonable effect, but a few days for maximum relief/real benefits
  • start before sx hit, if you start after histamine is already released and it will take a little longer to work/catch up and be effective
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29
Q

are early or late phase allergies better for AH use?

A

early; rhinnorhea, sneezing, itching (ocular) vs congestion seen with late phase

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30
Q

what is better for late phase allergies?

A

congestion is main SE, so topical steroids would be better than AHs

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31
Q

is tolerance to AHs over time a problem?

A

No, likely think tolerance and just a higher pollen count this year than others, maybe less adherent, check if patient is taking PRN or regular (better). Body inducing drug over time to increase metabolism and decrease drug levels DOES NOT happen.

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32
Q

what if a patient says their AH is ineffective?

A

switch to a different one (trial and error)

if tried over 2 agents in a month, try a topical steroid or send to doctor (possible rediagnosis)

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33
Q

are first of second generation AHs better?

A

second! 1000x better than first gen. They are more potent and decrease SEs. Both are H2 blockers. Both act on H1 receptors, but first generation are more loosely bound.

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34
Q

what is the metabolite of hydroxyzine (atarax) (a first gen AH)

A

cetirizene- and it is second gen non drowsy/sedating!

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35
Q

examples of first gen AHs

A

chlortriplolon (chlorpheniramine), benedryl (diphenhydramine), atarax (hydroxyzine)

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36
Q

First generation AHs ethanolamines

A
  • diphenhydramine
  • doxylamine
  • clemastine
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37
Q

first generation AHs alkylamines

A
  • chlorpheniramine
  • brompheniramine
  • dexbropheniramine
  • triprolodine
38
Q

which AH is found mostly in cold products, not on own

A

chlorpheniramine

39
Q

what is the most sedating group of AHs

A

first generation promethazine, then ethanolamines, then alkylamines

40
Q

what is the most anticholinergic of the AHs?

A

first generation promethazine and ethanolamines tie, then alkylamines

41
Q

what can happen in kids with first generation AH use?

A

paradoxical rx- a reaction you didn’t expect (usually see sedation, can cause hyperactivity. Still very safe to use! And this is a rare response, but they are still rarely used in kids

42
Q

are first generation AHs safe in asthma?

A

theoretically can dry things up more… only problem in bronchitis maybe. Not a lot of problem for kids. Most asthma patients are on an AH for allergy component already, so probably helps more than hurts. However, monographs say not for use in asthma patients.

43
Q

what is the place for first generation AHs in therapy?

A

pretty common in cough products, rarely used in allergies

44
Q

are second generations dosed OD or BID

A

almost exclusively OD

45
Q

second gen AHs- better for seasonal or chronic?

A

seasonal

46
Q

benefits of 2nd gen AHs

A

-more potent, decreased SEs

47
Q

are first generation AHs faster acting than 2nd gen?

A

literature says no! Same: both within one hour.

48
Q

metabolite of loratidine (claritin)

A

desloratidine- neither are more accurate than the other

49
Q

side effects of 2nd gen AHs

A

none!!!!

50
Q

which second gen AHs can you use in kids?

A

all in two years and up (fexofenadine- allegra- says over twelve, this is just for legal reasons, it can be used)

51
Q

interaction with historic 2nd gen AHs astemizole and terfenidine (hismana and seldane)- erythromycin and ketoconazole

A

inhibitors that reduce metabolism and lead to 2-3 times more parent compound- these can be cardiotoxic (historic 2nd gen AHs) and are therefore banned. Their metabolites came on the market ie tefenadine –> allegra (fexofenadine)

52
Q

fexofenadine (allegra) interaction with grape/orange/apple juice or food

A

tend to increase drug levels- affect pGp leading to decreased abs and F of allegra. Reaction is not clinically significant though, there is a wide window and a lot of drug that you are getting.

53
Q

congestion is a _____ stage response in asthma. Are AHs useful?

A

late
-no, they are only good at early responses…but could potentially get lucky. If really stuffy, likely need a topical corticosteroid

54
Q

patient tips for 2nd gen AHs

A
  • nothing will give complete relief

- trial and error

55
Q

if AHs are working for a patient, how long can they take them?

A

If have sx for 6 months, take for 6 months.
1 year? Okay, but check compliance, maybe time for injectable soon
6 month blasts of AHs should NOT make us nervous

56
Q

which 2nd generation AH has the most potential for sedation?

A

reactine- but still less than 1st gen

57
Q

would you give out claritin allergy and sinus?

A

probably not- it has decongestant in it all the time- better to use AH as a baseline every day and decongestant as needed and separately so that you don’t lose effect or cause rebound congestion (and don’t increase SEs). Adding a decongestant is just increased drug exposure you don’t need- use separately PRN.

58
Q

is there a big difference between loratidine and desloratidine? Would you switch a patient to one from the other?

A

no, not huge. Probably try different compound

59
Q

comment on intranasal antihistamines

A

good, make a lot of sense, but only if rx- all OTC ones suck.

60
Q

combination antihistamine and decongestant nasal spray

A

usually corticosteroid does most, if not all, of the work. Especially OTC, no AH for nasal use of value. By rx, good AHs for nasal use and some combo products can be pretty good ie dymitta spray (fluticasone-90% of work, and azelastine-the AH)

61
Q

pheniramine as an intranasal AH

A

terrible product. Not potent and very irritatin. Oxymetazoline and xylometazoline are way better and you can use them for about 7 days (topical decongestants).

62
Q

are OTC AHs in eye products effective?

A

no- they are irritating. Never come by themselves. Usually have a decongestant with them. All are equally bad, same idea as nasal (pyrilamine, antazoline, pheniramine)

63
Q

are rx OTC AHs in eye products effective?

A

Yes! They are great agents, very well tolerated and safe, should all be OTC
-levocabastine, emedastine, ketotifen (Livostin, Emadine, Zaditor)

64
Q

do decongestants help in allergies?

A

Yes! But only for congestion (late stage response). Remember to convince patients to not use combination products to avoid tachyphalaxis- go for AH on own and use this PRN

65
Q

How long can you use a nasal decongestant in allergies and will it help?

A

-7 days max- definitely safe and will help

66
Q

intranasal steroids rx examples

A

mometasone, fluticasone, ciclesonide. Others aren’t really used or rxed ever

67
Q

avamys vs flonase?

A

same identical product, avamys has better mist delivery, broad spray blast and more pharmaceutically elegant

68
Q

when would you use intranasal steroids?

A

they are good therapy for congestion! Any time you ahve congestion, but try 2nd generation AH first

69
Q

efficacy of nasal steroids

A

very good, local

70
Q

ocular corticosteroids are bad for

A

bad for glaucoma/cataracts; but drainage is better and get ocular SEs decreasing as a byproduct by chance- so we still don’t put in to eyes

71
Q

when will intranasal steroids start working

A

used to say 2-3 days, now say within 1 day for most people (but can be up to a week)

72
Q

would dosing an intranasal steroid three times a week make sense?

A

yep! If only using PRN, are always playing catch up and they are less effective

73
Q

dosing for intranasal steroids

A

OD or BID

74
Q

side effects of intranasal steroids

A

local irritation, spray runs down back of throat, potential mucosal thinning (steroid effect), increased ocular pressure (drug induced-CS SE), cataracts (glaucoma as a CS SE if you blast it in to your eyes, likely won’t do this)

75
Q

if your mucosa becomes thinned from intranasal CSs, what will happen with fungal infection and nose bleeds?

A

nothing, doesn’t increase either

76
Q

safety of intranasal steroids in children

A

old ones had increased F, but all new guys seem safe (rx). Fluticasone seems safest and can be used in 4 and under for flonase, but avamys can be used in 2 and under (better delivery system and more powdery)

77
Q

how long can you use intranasal steroids?

A

as long as you need them; comfort zone- as long as dx is right, and if seeasonal/perrenial allergies, use PRN as long as you need

78
Q

should you sniff hard when inhaling nasal spray?

A

no- don’t want it to go into lungs/back of throat, just breath in slightly

79
Q

how does cromolyn work, and why isn’t it used much

A

prevents mediator release (mast cell stabilizer), dosed 4-6x per day- no one will follow this when there are OD and BID options- you will get a lot of non adherance

80
Q

SEs of cromolyn

A

zero, except irritation from formulation

81
Q

cromolyn like formulations; how work and advantages

A

all mast cell stabilizers (decrease release of mediators), dosed BID or QID

82
Q

immunotherpay for allergies can come in one form currently

A
  • injections; get sensitized eventually: start with low dose of allergens, increase slowly, shots build up and make less reactive. Not a fun regimen
  • sublingual (don’t have yet)
83
Q

montelukast-what is it and what can it be used for, mention SEs

A
  • a leukotriene antagonist used for asthma, allergic rhinitis as an adjunct to therapy
  • very clean with few side effects
  • good to try before jump to getting shots; in therapy wil target leukotrienes and histamine
84
Q

ipratropium- what is it, what’s it good for

A

an anticholinergic therefore its side effects help with allergies. Very good for vasomotor rhinitis

85
Q

omalizumab (xolair)- what is it and what dosage form

A

-blocks IgE antibody to mast cells, injection

86
Q

are AHs okay in pregnancy

A

1st gen most studied and are safe in pregnancy and lactation, 2nd gen are less studied but you can still be reassured of their safety. BUT- they will not be helpful in nasal congestion due to hormone changes

87
Q

about one in five women will get this while pregnant (allergy related)

A

nasal congestion due to hormone changes

88
Q

what age in kids can you not use decongestants

A

less than 6; AHs say less than 6 as well, but that is crazy they are perfectly safe

89
Q

when can oral decongestants be used in pregnancy

A

after first trimester

90
Q

intranasal corticosteroids in pregnancy?

A

yes

91
Q

combine oral AH and topical steroid/

A

steroids work very broadly and likely to most of work, but combining makes a lot of sense due to mechanism of action

Phar455 (6 decks)

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