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Clinical part B > Allergic rhinitis > Flashcards

Allergic rhinitis Flashcards

1
Q

risk factors of allergic rhinitis

A

age - adolescents and young adults
family history
repeated exposure to multiple offending allergen
presence of other allergic conditions (asthma and atopic dermatitis)

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2
Q

pathophysiology

A

IgE produces after first contact and binds to mast cells and basophils
second exposure IgE recognizes allergen causing degranulation and release of preformed mediators, lasts 30-90 min
4-8 hours later get migration of inflammatory mediators, eosinophils etc and congestion predominated

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3
Q

nasal symptoms

A

paroxysmal sneezing
itching
watery rhinorrhea
nasal congestion

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4
Q

what happens after persistant inflammation

A

decrease threshold of allergen needed to produce a response

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5
Q

ocular symptoms

A 
red irritated eyes 
itching or burning 
tearing 
stringy watery discharge 
puff eyelid in the morning
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6
Q

facial symptoms

A

openmouth breathing
allergic salute
darkeningunder eyes due to venous congestion
wrinklens beneath the lower lid

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7
Q

systemic symptoms

A

cognitive impairment
fatigue
irritability
malaise

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8
Q

3 characteristic exposure time to allergens

A

seasonal
perennial (all year)
episodic

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9
Q

2 characterizations of symptom frequency

A

intermittent is = 4 days per week OR = 4 weeks per year

persistent is >4days per week AND >4 weeks per year

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10
Q

mild symptom severity

A

doesnt interfere with quality of life

no troublesome symptoms

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11
Q

moderate to severe symptom severity

A

symptoms interfere with the quality of life

abnormal sleep, impairment of activites, troublesome symptoms

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12
Q

differential diagnosis of allergic rhinitis

A 
infectious rhinitis (cold)
idiopathic or inflammatory non allergic rhinitis 
vasomotor rhinitis (non inflammatory) 
hormonal - pregnancy, mensus
nasal polyps 
drug induced rhinitis
occupational rhinitis
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13
Q

describe vasomotor rhinitis

A

non allergic
occurs later in life
nasal congestion, rhinorrhea, postnasla drip usually in women 40-60
many different triggers

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14
Q

medications that can cause non allergic drug induced rhinitis

A 
antihypertensive agents 
oral contraceptives
NSAIDS
topical decongestants overuse
older antipsychotics
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15
Q

red flags

A 
under 2 (asthma?)
wheezing shortness of breath
tightness in chest
painful ears/sinuses (infection?) 
fever
purulent nasal/ocular discharge
allergen not identifiable 
no response to OTC after 2 weeks
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16
Q

how does normal saline help with allergic rhinitis

A

reduce concentration of inflammatory mediators
flush out mucus and allergens
improve nasal airflow

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17
Q

how might nasal breathing strips help

A

mechanical means to improve nasal airflow

relieve symptoms?

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18
Q

goals of therapy

A

avoid or minimize the exposure to the allergen
alleviate symptoms
minimize adverse effects of the medication

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19
Q

antihistamine mechanism of action

A

reversible antagonist at H1 receptor preventing binding and action at the receptor site

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20
Q

which symptoms do antihistamines help with

A

reduce sneezing, runny nose, and itching but not congestion or stuffiness (except desloratadine, cetirizine, fexofenadine)

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21
Q

2 examples of first generation antihistamines

A

chlorpheniramine

diphenhydramine

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22
Q

examples of second generation AH

A

loratadine
cetirizine
fexofenadine

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23
Q

side effects of first gen

A 
dry mouth and eyes 
constipation 
urinary retention 
sedation 
fatigue 
dizziness
sedation 
mucus secretion thickened
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24
Q

drug interactions with first gen

A

alcohol
hypnotics
sedatives
CNS depressants

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25
Q

average dosing and onset for 2nd gen

A

about an hour

dose once daily

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26
Q

side effects of second gen

A

headache

cetirizine may cause drowsiness

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27
Q

how should AH be taken for chronic allergic rhinitis

A

start 2 weeks before season and continue throughout the season and 2 weeks after
taken on a daily basis

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28
Q

how should AH be taken for infrequent exposure

A

2-4 hours before exposure

29
Q

how to take AH if already experiencing symptoms

A

wont work right away because no effect on the histamine already released can start but will only see the benefit in 2-3 days

30
Q

what may be some causes of ineffectiveness of AH

A 
non adherence 
increased antigen exposure 
worsening of condition 
severe diseae
similar symptoms to unrelated disease 
switch to another class of AH
31
Q

contraindications for 1st gen

A 
glaucoma (increases pressure) 
bladder obstruction 
peptic ulcer
hyperthyroidism (increase cardiac effects) 
cardiac disease 
prostate disease 
chronic lung disease (thickened mucus)
32
Q

oral decongestants

A

phenyephrine

pseudoephedrine

33
Q

intranasal decongestants

A

oxymetazoline
xylometazoline
phenylephrine

34
Q

decongestants mechanism of action and what it treats

A

vasoconstriction on the alpha receptors in nasal mucosa and decreased inflammation only useful in late stage to help with congestion

35
Q

onset of action for oral decongestants

A

15-30 min

36
Q

age for oral decongestants

A

over 6

37
Q

adverse effects of aroal decongestants

A 
dizzy 
headache
tremor 
difficulty sleeping 
peripheral vasoconstriction 
tachycardia 
palpitation 
blood sugar
38
Q

contraindications of oral decongestants

A 
heart disease 
gluacima 
diabetes
hyperthyroidism 
porstate enlargment
severe hypertension
39
Q

onset for intranasal decongestants

A

5-10min

40
Q

side effects of intranasal decongestants side effects

A

nasal burning stinging dryness

nucosal ulceration

41
Q

what is rhinitis medicamentosa in intranasal decongestants

A

rebound congestion that occurs from prolonged use (3-5days) that causes down regulation of alpha receptors
rebound swelling of nasal mucosa

42
Q

what age can use intranasal decongestants

A

over 12

43
Q

which decongestant is best to use

A

topical because less systemic effects

44
Q

what are some alternates to decongestants

A

desloratidine
cetirizine
fexofenadine
normal saline

45
Q

opthalmic decongestant mechanism of action

A

vasoconstriction decreases eye redness

46
Q

contraindications of opthalmic decongestant

A

glaucoma

47
Q

side ffects of opthalmic decongestants

A

burning, stinging

rebound redness and swelling if used more than 10 days

48
Q

example of mast cell stabolizer

A

sodium cromoglycate

49
Q

mast cell stabilizer mechanism of action

A

inhibits degranulation of mast cells to alleviate runny nose itching and sneezing

50
Q

disadvantages to mast cell stabilizers

A

delayed onset
may take 4-7 days for any improvement and full benefit 3-4 weeks
requires 3-4 times a day dosing so lack of adherence
not very effective

51
Q

intranasal corticosteroids mechanism of action

A

decrease influx of inflammatory cells and inhibit release of cytokine which leads to the reduction of inflammation

52
Q

onset of intranasal corticosteroids

A

30 min max effect takes 7-14 days

53
Q

side effects of intranasal corticosteroids

A 
burning
stinging
bosebleeds
headache 
throat irritation 
nos sytemic effects because quickly metabolized
54
Q

age you can use intranasal corticosteroids

A

triamcinolone over 12

fluticasone over 18

55
Q

what can pharmacists prescribe for vasomotor and allergic rhinitis

A

corticosteroid nasal preparations for topical use

56
Q

why is it better to use 2nd gen AH than intranasal AH

A

have similar efficacy but lots of side effects and twice daily dosing

57
Q

what prescription combo is available and when do you use it

A

intranasal corticosteroid and antihistamine

only when no resolution with INS alone

58
Q

example of prescription intranasal anticholinergic and how does it work

A

ipratropium solution prevents secretions of the nasal mucosa

59
Q

when to use IN anticholinergics

A

excessive rhinorrhea

somet ypes of vasomotor rhinitis

60
Q

why is there no drug interactions with IN anticholinergic

A

no systemic absorption and doesnt cross BB

61
Q

when can you use oral steroids

A

for short time in patients with severe symptoms, in combo with INS

62
Q

what do you use for persistant symptoms that affect the quality of life

A

intranasal corticosteroids

63
Q

what do you use for mild intermittent symptoms

A

oral second gen antihistamine

64
Q

what is immunotherapy

A

giving the patient some of the allergen so the immune system would not respond when exposed to the allergen

65
Q

two types of immunotherapy

A

subcutaneous injection - regular intervals at doctors office
sublingual - first at office then at home

66
Q

best option for children?

A

INS can be prescribed for children over 4 but likely use 2nd gen antihistamine because 1st cause hyperactivity
nasal saline before eating and sleeping

67
Q

treatment of allergic rhinitis in pregnant women (if first time experiencing symptoms prob vasomotor not allergic!!)

A

loratidine and cetirizine

68
Q

what reduces effectiveness of fexofenadine

A

juices

69
Q

monitoring of allergic rhinitis

A

symptom relief within 3-4 days
complete relief may take 2 weeks of not refer
pharmacist follow up in a week

Clinical part B (15 decks)

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