Allergic Rhinitis, Asthma, COPD, Viral Rhinitis Flashcards
Differentiating factors between URTI and allergies
URTI- more episodic, sore throat or fever often, no itch. Allergies nasal obstruction and rhinorrhea common, with itching and eye sx often and sneeze
non drug choices in allergies
saline nose spray, irrigation systems, lubricant eye drops, avoid triggers, use air ocnditioning,
antihistamines help with congestion T or F
F- not usually recommended-desloratidine may be the only one that has some partial benefit. Work for sneeze rhinorrhea, itch, conjuntivitis
when should antihistamines be started for allergies
prophylactically- but can be used prn too
which 2nd gen antihistamine is most likley to cause sedation
cetirizine
treat mild to moderate allergy sx
allergen avoidance and antihistamine with or without prn decongestant. DOesn’t work? try intranasal steroid regularly
treat mod to severe allergy sx
allergen avoidance and intranasal steroid with or without: antihistamine, decongestant prn, eye drops for eye sx
when should decongestants be used with caution
uncontrolled blood pressure, hyperthyroidism, ischemic heart disease and not at all in those receiving MOAIs
how long can topical nasal decongestsants be used
3-7 days to prevent rebound congestion
how long can topical nasal steroids be used
as long as needed- qd or prn for allergy sx is fine, probably best daily
which intransasl steroids are safe for kids
mometasone, fluticasone furoate and propionate die to low oral F and absence of growth suppression long term
first line choice for allergies in kids
2nd gen antihistamines
what can/can’t you use for allergies in preg
can use 2nd gen antihistamines, montelukast, intranasal steroids. Can’t use oral decongestants in first trimester of preg
SE of decongestants
insomnia, tremor, irritable, HA, tachycardia, urinary retention
SE of 1st gen antihistamines
sedation, fatigue, dizzy, impaired cog, antichol.
steps in asthma therapy (adult)? How does it change in kids under 6?
saba prn, add ics, add laba, add leukotriene/increase ics/theophylline. Change in kids? reverse LTRA and laba
name SABAs- SE?
salbutamol, terbutaline- tremor, tachy, nervousness
name LABAs-how often are they used, when are they given in asthma? Which one is only for COPD?
salmetorol, formoterol- use BID. Given only with ICS. Indacterol also one but only for COPD. Vilanterol too.
when are anticholinergics used in asthma. SE?
not routinely- maybe if very susceptible to tremor or tachy from BAs, or for BB indued bronchospasm (ipra only, not tio it doesn’t act fast enough). SE= dry mouth, metallic taste
short term and long term side effects from high dose systemic CS therapy (ie for acute asthma exacerbation, etc)
short; fluid retention, glucose intolerance (hyperglycemia) , HTN, increased appetite, mood alterations, weight gain. Long; adrenal axis suppression, cataracts, dermal thinning, diabetes, glaucoma, HTN, myopathy, OP
asthma and preg
use meds! all safe. Uncontrolled asthma much higher risk (pre term birth, low BW< congenital anomalies, pre eclampsia, etc)
how soon to use a SABA before exercise and how long does it last?
5-10 minutes, lasts 2-4 hours
diagnostic criteria for COPD
FEV1 less than 80% and FEV1/FVC ration less than 0.7
COPD treatment
start with SABA or SAAC (ie a short acting bronchodilator) (combo of the 2 even better, long acting bronchodilator if sx persistent, LABA/LAMA combo, add ICS, add O2
tio vs ipratropium in COPD
tio preferred as it deposits better in airways of patients with low inspiratory flow rates and gives activity 24 hours vs up to 8 with ipra.
name LAAC (LAMAs)
tiotropium, glycopyrronium, aclidinium, umiclinidium
name the only OD LABA available
indacaterol- both rapid acting and long acting
most common infectious agent in COPD exacerbations
virus. however, if increased dyspnea, sputum or increased sputum purulance antibiotics may be indicated. Common step pneumo hameophilis, moraxella. If complicated, klebsiella or pseudomonas may be involved
cephalosporin counselling
GI upset (with or without food), rash
fluoroquinolone counselling
headache, peripheral neuropathy, tendon rupture, QT. Separate from antacids, Ca and iron.
macrolides counselling
GI, QT, clarith bitter taste
tetracycline counselling
GI, photosens, sepearte iron and antacids
sulfonamide counselling
N, rash, SJS rare
amox clav counsel
like other pens (GI,, rash) but more diarrhea
viral rhinitis resolves untreated usually in; what to do in the meantime
7-10 days- fluids, handwash, rest, decon, antihistamines, acet/ibu,
comment on zinc for a cold
may reduce duration 1-1.5 days, but low evidence. Must be initiated within 24 hours onset and has an unpleasant taste (N)
choices for constipation in pregnancy
bulk forming psyllium first line (not absorbed systemically), stimulants short term only, lactulose/PEG is safe
antidiarrheals to avoid or take in preg
can take loperamide, avoid diphenoxylate and bismuth
metronidazole counselling
N, H/A, dry mouth, metallic taste, no alcohol with or for 48 hours after
most common causes of PUD
H pylori and NSAID/ASA use
red flags for heartburn
VBAD- vomitting, bleeding, anemia, dysphagia, unexplained weight loss, age over 50
how long do you treat with PPIs empirically for dyspepsia? then what?
4-8 weeks. Then try stopping or step down to H2antag
what foods should be avoided in dyspepsia
spicy, orange juice, coffee, fatty, large meals
name the 2 triple therapy regimens for h pylori eradication
ppi bid, clarith 500mg BID and amox 1g BID. OR ppi BID, clarith 250 bid, metro 500bid. for 10-14 days
non pharm GERD management
modify diet (caffeine, chocolate, acidic, large fatty meals), decrease body weight, avoid eating 3 hours before bed, avoid lying down after meals, elevate head of bed, stop smoking, avoid tight clothes
can you get tachyphylaxis from H2 receptor antagonists? PPIs?
H2- yes (also no meal associated acid suppression), PPI no
difference between UC and crohns
UC only colon, crohns anywhere
when are live attenuated vaccines CI (antrhax, intranasal influenze, MMR, polio live oral, smallpox, TB BCG, typhoid live oral, yellow fever, varicella)
TNF alpha inhibitors or immunomodulator
what vaccines are recommended even on therapy in IBD
yearly flu shot, pneumococcal q3-5 years, HPV in young females
other names for 5 asa, and how is it given
5 aminosalicylic acid, mesalamine, mesalazine. Given oral or PR, all equally effective and safe
5ASA is formulated for targetted release how
salofalk, mesasal and pentasa release in small bowel (available there and in colon) or sulfasalazine, olsalazine, asacol and mesavant only release in colon
typical treatments for IBD
5ASA (maintenance of remission), corticosteroids (induce remission- not for MOR), immunosuppressors (azathioprine, 6 mercaptopurine- used to reduce steroid doses and to maintain remission if needed)
when might ginger gravol be useful
preg and postoperative N/V
what is in diclectin and what is it approved for, what is max dose
doxylamine and pyridoxine (B6)- NV preg. 2 tabs HS, 1 in AM and 1 in afternoon (ie max 4 tabs daily)
first line agents in N/V pregnancy
diclectin, dimenhydrinate (can be added to diclectin), promethazine
what are domperidone and metoclopromide used for? differences>
both gastropareisis. D has less SE (both have D, cramp, HA, hyperprolactinemia), used for functional dyspepsia as well. M used for drug induced N, migraine N, and has more SE (add drowsy, fatigue, EPS)
