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Pharm II: Exam 1 > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

1
Q

What is Rhinitis? What are common causes to consider?

A

Inflammation of the nose and upper respiratory tract

  • Allergic
  • Non-allergic (Vasomotor, Infectious)
  • Occupational (Irritants)
  • Hormonally-related (Pregnancy)
  • Drug-related
  • Inflammatory/Immunologic Diseases
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2
Q

What are common complications associated with Allergic Rhinitis?

A
  • Asthma
  • Sinusitis
  • Obstructive sleep apnea
  • Otitis media
  • Nasal polyposis
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3
Q

Describe the etiology and pathophysiology of the early-phase allergic rhinitis?

A

[occurs within minutes]

  • Trigger allergen becomes bound to IgE fixed to mast cells in nasal mucosa

¦

  • Mast cells degranulate (release of histamine, macophages, WBCs, cysteine leukotrienes, and prostaglandins)

¦

  • Vasodilation, mucosa edema, hypertrophy (resulting nasal congestion)
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4
Q

T or F: Rhinorrhea, sneezing, itching are all sumptoms associated with the early response.

A

T

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5
Q

Describe etiology and pathphysiology of the late-phase allergic rhinitis?

A

Affects up to 50% of patients (begins as early as 2 hours lasting up to 12 hours)

  • Release of mediators
  • Characterized by inflammation and severe long lasting nasal congestion (main symptom)
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6
Q

What is the priming response associated with allergic rhinitis?

A

Patients usuall prolonged/repeasted exposure to allergic rhinitis

Streamlines process (lower threshold) resulting in mediator release

Late phase inflammation thought to contribute

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7
Q

What are the different types of Allergic Rhinitis?

A
  • Seasonal (only during certain times of the year)
  • Perennial (presents throughout the year)
  • Episodic (triggered by intermittent exposure)
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8
Q

What are available medications for treatment of allergic rhinitis? What is a 1st LINE TX for mild and servere allergic rhinitis?

A
  • Corticosteriods (Internasal) [1st LINE TX, severe]
  • Antihistamines (Oral) [1st LINE TX, mild]
  • Antihistamines (Intranasal)
  • Decongestants
  • Mast Cell Stabilizers
  • Leukotrienes receptor anatagonists
  • Antimuscarinic agents
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9
Q

What intranasal corticosteriods are available for treatment of allergic rhinitis?

A
  • Beclomethasone dipropionate
  • Budesonide
  • Ciclesonide
  • Flunisolide
  • Fluticasone furoate
  • Fluticasone propionate
  • Mometasone
  • Triamcinolone acetonide
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10
Q

T or F: When administering intranasal medications, remember to clear nose shake to prime and tip head backwards.

A

F; DO NOT TIP HEAD BACKWARDS

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11
Q

What oral antihistamines are available for treatment of allergic rhinitis?

A
  • Desloratadine
  • Loratadine
  • Fexofenadine
  • Cetririzine
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12
Q

What intranasal antihistamines are available for treatment of allergic rhinitis?

A
  • Azalastine
  • Olopatadine
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13
Q

Why are intranasal antihistamines a useful treating allergic rhinitis? Pitfalls?

A
  • Helpful with congestion
  • Less effective with ocular symptoms
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14
Q

What decongestants are available for treatment of allergic rhinitis? Are these oral or intranasal medications?

A
  • Pseudophedrine (oral)
  • Phenylephrine (oral, intranasal)
  • Oxymetazoline (intranasal)
  • Naphazoline (intranasal)
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15
Q

Why are decongestants useful in treatment of allergic rhinitis? Pitfalls?

A

Helpful with nasal congestion; No benefit for sneezing, itching, rinorrhea, ocular symptoms

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16
Q

T or F: Intranasal decongestants can not be used more than 3 days due to possible rhinitis medicamentosa.

A

T; considered paradoxial rebound congestion

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17
Q

What are ADRs associated with intranasal decongestants?

A
  • Stinging
  • Burning
  • Dryness
  • Sneezing

Generally mild (not often any systemic effects)

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18
Q

What are ADRs associated with oral decongestants?

A

Generally well-tolerated; Caution with cardiac disease, cerebrovascular disease, glaucoma, hyperthyroidism, diabetes

19
Q

What mast cell stabilizers are available for treatment of allergic rhinitis? What forms are available?

A

Cromolyn sodium (OTC interanasal prep)

20
Q

What is the MOA of Cromolyn sodium? Duration of treatment?

A

Stabilize mast cells preventing release of inflammatory mediators; May take up to 2 weeks (moderately effective but not as good as intranasal steriod/antihistamines)

21
Q

What are indications for using Cromolyn sodium?

A

Patients with mild/intermittent symptoms (esp. pedatrics and pregnancy)

22
Q

What are ADRs of Cromolyn sodium?

A
  • Generally well-tolerated
  • Mild local stinging
  • Sneezing
  • Unpleasant taste
  • Epistaxis
23
Q

What leukotriene receptor antagonists are available for treatment of allergic rhinitis?

A

Montelukast (Singulair)

24
Q

What is the MOA of Montelukast?

A

Competitively anatgonizes leukotriene receptors

25
Q

T or F: Combination treatment of montelukast with antihistamines provides better coverage than either alone, however not better than intranasal steriods.

A

T

26
Q

What are ADRs of Montelukast?

A

Well-tolerated

FDA WARNING: suicidal ideation

27
Q

What general demographics are treated with Montelukast?

A
  • Children over 6 months of age
  • Pregnancy
28
Q

What antimuscarinic agents are available for treatment of allergic rhinitis? What delivery systems are available?

A

Ipatroprium (intranasal spray)

29
Q

What dose-related changes in treatment with Ipatroprium?

A
  • 0.03%: children 6+ Y/O
  • 0.06%: Rinorrhea associated with colds in children 5+ Y/O
30
Q

When is Ipatroprium indicated for a patient with allergic rhinitis?

A

Limited use for patients with uncontrolled rhinorrhea (antihistamines/intranasal steroids uneffective)

31
Q

What ADRs are associated with Ipatroprium?

A
  • Mild epistaxis
  • Nasal dryness
32
Q

What immunomodulators are available for treatment of allergic rhinitis?

A

Omalizumab (Xolair)

33
Q

T or F: Omalizumab is approved for asthma (not allergies) with displayed benefit for allergic rhinitis treatment.

A

T

34
Q

What is the BLACK BOX warning for Omalizumab?

A

Anaphylaxis

35
Q

Why is Saline indicated for allergic rhinitis?

A

Helpful with sneezing and congestion but less effective than intranasal steriods?

36
Q

What ADRs are associated with Saline treatment?

A
  • Some nausea
  • Mild irritation
37
Q

Why are intraocular preparation useful for treatment of allergic rhinitis?

A

Good for treatment of patients with predominantly eye-related symptoms

38
Q

What intraocular preparations are available for treatment of allergic rhinitis? What type of drug is the intraocular prep?

A
  • Naphazoline (Decongestant/Vasoconstrictor)
  • Naphazoline/Pheniramine (Decongestant/Antihistamine)
  • Emedastine (Antihistamine)
  • Alcaftadine (Antihistamine)
  • Cromolyn (Mast cell stabilizer)
  • Nedocromil (Mast cell stabilizer)
  • Lodoxamide (Mast cell stabilizer)
  • Acelastine (Mast cell stabilizer/antihistamine)
  • Epinastine (Mast cell stabilizer/antihistamine)
  • Olopatadine (Mast cell stabilizer/antihistamine)
  • Ketorlac (NSAID)
  • Loteprednol (Corticosteroid)
39
Q

How do you treat/prevent allergic rhinitis? (Silly question)

A

Avoidance!!

40
Q

What medications may be used as adjunct TX for mild allergic rhinitis?

A
  • Decongestants (OTC)
  • Intranasal decongestants (OTC, short-term)
  • Saline (intranasal)
  • Intraocular preps (as needed)
41
Q

What medications may beused as 1st LINE TX for mild allergic rhinitis?

A
  • Antihistamines (Oral)
42
Q

What medications may be used as 1st LINE TX for moderate to severe (persistent) allergic rhinitis?

A
  • Steriods (intranasal)
    • Add oral antihistamine
43
Q

What medications may be used as adjunctive TX for moderate to severe (persistent) allergic rhinitis?

A
  • Decongestant (intranasal, short-term)
  • Saline (intranasal)
  • Ipratroprium (esp. for uncontrolled rhinorrhea

[should consider replace 1 1st LINE TX with montelukast]

Pharm II: Exam 1 (7 decks)

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