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Erica Pharm 2 Exam > Allergic Rhinitis > Flashcards

Allergic Rhinitis Flashcards

1
Q

What type of cells are the nasal mucosa lined with and what do they release?

A

Mast cells

release histamine

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2
Q

Describe the Antigen-antibody response in allergic rhinitis

A

allergen interacts w/ IgE bound to mast cells –> histamine released –> immune response

(vasodilation, increased vascular permeability,
& production of nasal secretions)

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3
Q

What role does the ANS play in allergic rhinitis?

A

controls rich vascular tissue

SNS: constricts arterioles, reduces mucosal thickness, widens the airway

PNS: dilates arterioles, increases mucosal thickness, incr. stuffiness and runny nose

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4
Q

____ stimulation produces itching.

Sneezing occurs by ____ stimulation pathways.

A

Sensory nerve

vagal

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5
Q

Mast cell mediator: effect of histamine?

A

stimulates irritant receptors, pruritis, vascular permeability, mucosal permeability, smooth muscle contraction

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6
Q

Mast cell mediator: effect of leukotrienes?

A

smooth muscle contraction, vascular permeability, mucus secretion, chemotaxis, neutrophil chemotaxis

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7
Q

Describe the pathophysiology of allergic rhinitis

A

Late phase reaction: 4-8 hrs after initial exposure caused by cytokines primarily released by mast cells

  • Persistent chronic sxs
  • inflamed mucosa become hyper-responsive
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8
Q

What are the evidence-based Level A Tx recommendations for Allergic Rhinitis?

A

nasal steroids
oral antihistamines
intranasal antihistamines
immunotherapy

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9
Q

What medication class is an excellent choice for perennial rhinitis?

A

intranasal corticosteroids

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10
Q

MOA of histamine (H1)-Receptor antagonists

A
  • competitive antagonist of histamine
  • binds to H1 w/o activation and prevents histamine from binding
  • anticholinergic (PNS) properties cause reversal of sxs

**Prophylactic works best

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11
Q

What is the best 1st/2nd generation H1-Receptor antagonist to give a pregnant patient and why?

A

1st gen – Chlorpheniramine (level B) because it has less sedation and anticholinergic affects

2nd gen – Cetirizine (Zyrtec)

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12
Q

histamine (H1)-Receptor antagonists contraindications and drug interactions?

A

contraindicated w/ Hypersensivity to formulation

Interactions - anticholinergics and CNS depressants (Benzos)

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13
Q

histamine (H1)-Receptor antagonists adverse reactions?

A
  • anticholinergic effects - xerostomia, constipation, urinary retention
  • CNS depression
  • Paradoxical excitement
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14
Q

What are some medications under the histamine (H1)-Receptor antagonists drug class?

A

Intranasal and ophthalmic = Azelastine and Olopatadine

Topical = Diphenhydramine

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15
Q

MOA for decongestants

A

stimulates alpha-adrenergic receptors –> vasoconstriction

pseudoephedrine stimulates beta-adrenergic receptors –> increase HR, contractility, and bronchial relaxation

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16
Q

Although topical decongestants are more effective for treating allergic rhinitis, overuse can cause…

A

Rebound congestion

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17
Q

What are some examples of decongestants?

A

intranasal (sprays) & ophthalmic (drops):
- Phenylephrine, Tetrahydrozoline, Naphazoline, Oxymetazoline

Oral: Pseudoephedrine, phenylephrine

18
Q

Contraindications and drug interactions for decongestants?

A

Contraindicated w/ hypersensitivity, and MAOI use w/in 14 days

Interactions: SNRI’s (tachycardia) and
sympathomimetics (enhance ADE’s)

19
Q

ADE’s and monitoring in Decongestants?

A

Rebound congestion w/nasal formula after 3-5 days of use, tachycardia, & HTN

HR and BP

20
Q

MOA for inhaled corticosteroids

A

Reduce mediator release, formation, activity –> reduce inflammation

reverses dilation –> mild vasoconstriction

inhibit mast cell mediated late phase reaction

21
Q

Inhaled Corticosteroid use will show slight improvement of sxs in ____ & peak responses in ____.

A

few days

2-3 weeks

22
Q

What can inhaled corticosteroids also be useful in treating aside from allergic rhinitis?

A

nasal polyps

23
Q

Give examples of inhaled corticosteroids (nasal & inhaled). What are the adverse drug reactions?

A

Beclomethasone, budesonide, flunisolide, fluticasone, mometasone

HA, pharyngitis, cough, epistaxis (nasal formulation)

24
Q

MOA for Leukotriene receptor antagonist

A

inhibition of cysteinyl leukotriene receptor (mast cells release leukotrienes)

LOX inhibitor - Zileuton

25
Q

What drug class do Leukotriene Receptor antagonists need to be combined w/ in order to be effective?

A

Antihistamines

26
Q

Leukotriene receptor antagonists contraindications and drug interactions?

A

contraindicated w/ hypersensitivity

Interactions w/ CYP3A4 and CYP2C9

27
Q

Leukotriene receptor antagonists adverse reactions and what should you monitor?

A

Adverse rxns: HA, mental status changes, dyspepsia, dizziness, fatigue

Monitor mental status and allergy control

28
Q

Cromyln nasal spray MOA, side effects, and how long until symptomatic relief?

A

MOA: mast cell stabilizer

can cause local irritation

2-4 weeks for sxs relief

29
Q

Ipatropium nasal spray MOA, drug interactions, and how long is it safe to use?

A

MOA: anticholinergic and inhibits secretions

may enhance anticholinergic effects of other agents

safety and efficacy beyond 4 days not est.

30
Q

H-2 Receptor antagonist MOA, examples, and what drug can it be combined w/ in allergic reaction, urticaria?

A

MOA: competitively inhibits H2 receptor, prominent in parietal cells, prevents gastric acid secretion

Cimetidine > Ranitidine, Famotidine, Nizatidine
(Raniti/famotidine - fewer side effects)

Combine w/ H-1 blocker

31
Q

What approach should you take in treating a patient w/ allergic rhinitis?

A

if environmental controls don’t work try single-drug tx based on sxs:

Antihistamines - sneezing, itching, rhinorrhea, ocular sxs
Decongestants (systemic) - nasal congestion
Intranasal steroids - sneezing, itching, rhinorrhea, and nasal congestion

32
Q

Describe the pathophysiology of a cough.

  • Voluntary vs. involuntary
  • acute vs. subacute vs. chronic
A

involuntary - “cough center,” medulla oblongata
voluntary - cerebral cortex

acute (<3 wks) – commonly viral URI
Subacute (3-8wks) – bacterial or asthma
chronic (>8 weeks) – postnasal drip syndrome, GERD, asthma

33
Q

Hydrocodone/Codeine MOA and examples

A

MOA: cough suppression, direct central action in the medulla

Codeine/Guiafenesin (Robitussin AC)
Codeine/Promethazine (Phenergan w/Codeine)
Hydrocodone/Chlorpheniramine (Tussionex)

34
Q

Hydrocodone/Codeine contraindications and adverse reactions

A

contraindicated w/hypersensitivity

interactions: CNS depressants, drug abuse/dependency, nausea

35
Q

Hydrocodone/Codeine drug interactions and what should you monitor?

A

CNS depressants

monitor frequency of use

36
Q

MOA of Benzonatate

A
  • suppresses cough by topical anesthetic action on respirator stretch receptors
  • relative to tetracaine
37
Q

Benzonatate adverse reactions and contraindications?

A

ADE’s mental confusion, visual hallucinations, sedation

contraindicated in children under 10yrs d/t increased risk of death

38
Q

MOA of Dextromethorphan (DXM)

A

Decreases sensitivity of cough receptors

Suppresses medullary cough center

39
Q

What are examples of Dextromethorphan (DMX) and what is it structurally related to?

A 
DXM Poylstirex (Delsym)
DXM Hydrobromide

codeine

40
Q

Contraindications, ADE’s and drug interactions of Dextromethorphan (DXM)?

A

Contraindicated w/ MAOI administration w/in 2 weeks

ADE’s: confusion, potential serotonin syndrome

Interacts w/ SSRIs - enhances the serotonergic effect

41
Q

MOA of Guaifenesin

A

irritating gastric mucosa and stimulating respiratory tract secretions –> increase respiratory fluid volume and decrease mucous viscosity

42
Q

Guaifenesin: What are the adverse reactions, contraindications, and what should you monitor

A

ADE’s: dizziness, drowsiness, HA, N/V

Contraindicated w/ hypersensitivity

Monitor hydration status

Erica Pharm 2 Exam (3 decks)

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