Allergic Rhinitis/Cold Flashcards
1
Q
Intranasal Steroids
A
- 1st line; used for chronic, moderate-severe sxs
- Budesonide (Rhinocort)
- Fluticasone (Flonase)
- Triamcinolone (Nasacort)
- SE: Epitaxis (nose bleeds)
- Can take up to one week to get full relief
- Budesonide and beclomethasone = preferred for pregnancy
2
Q
Benadryl
A
- Diphenhydramine
- First-generation oral antihistamine
- Adult: 25 mg PO Q4-6H or 50 mg PO Q6-8H
- DON’T use OTC in kids <6yo
3
Q
Other First-Generation Antihistamines
A
- Chlorpheniramine (Aller-Chor)
- Doxylamine (Unisom)
4
Q
First-Gen Antihistamines Information
A
- Warning: Avoid in elderly (antichol. SE), can cause prostate enlargement and glaucoma
- SE: Somnolence, cog. impairment, anticholinergic effect
- Avoid in kids <2 yo
- ALL antihistamines are for mild-moderate sxs
5
Q
Zyrtec
A
- Cetirizine
- pseudoephedrine option (-D)
- 2nd Gen Antihistamine
6
Q
Xyzal
A
Levocetirizine
- 2nd Gen Antihistamine
- Okay to use in 6 mo+
7
Q
Allegra
A
- Fexofenadine
- pseudoephedrine option (-D)
- 2nd Gen Antihistamine
- Separate from fruit juice and antacids (decreased absorption)
8
Q
Claritin
A
- Loratidine
- pseudoephedrine option (-D)
- 2nd Gen Antihistamine
9
Q
2nd Gen Antihistamine Information
A
- AVOID fruit juice with fexofenadine (decreased absorption)
- Loratadine and cetirizine preferred in preggo
- Cetirizine and Levocetirizine have the fastest onsets (work best for some people); therefore are also more sedating than the other two
- Generally preferred over 1st gen due to less somnolence
- Most okay in 2 yo+ unless otherwise mentioned
10
Q
Intranasal Antihistamines
A
- Azelastine (Astelin)
- Olopatadine (Patanase)
- Helps with nasal congestion, can combine with INS
- Not recommended as often
11
Q
Systemic Decongestants
A
- Phenylephrine (Sudafed PE) - OTC, poor oral absorption
- Pseudoephedrine (Sudafed, Nexafed) - Rx and OTC (BEHIND COUNTER), abuse potential!
12
Q
Topical Decongestants
A
- AKA Intranasal
- Oxymetazoline (Afrin)
13
Q
Systemic Decongestant Information
A
- CI: use within 14 days of MAOI
- Avoid in children <2yo (FDA) or <4 yo (packaging)
- Caution in patients with CV disease/BPH (increases BP and can cause urinary retention)
- SE: tachycardia, palpitations, increased BP, insomnia, decreased appetite
14
Q
Topical Decongestant Information
A
- Caution in use with BPH patients
- SE: Rhinitis medicamentosa (rebound congestion when used >3 days)
15
Q
NasalCrom
A
- Cromolyn
- OTC mast cell stabilizer
- Used regularly, not PRN
- Start at onset of allergy season and throughout
- Safe in children =<2 yo and pregnancy
- Dosed QD multiple times a day
16
Q
Singulair
A
- Montelukast
- Leukotriene modifying agent
- Used for allergic rhinitis and asthma
- Box Warning: Serious neuropsychiatric SE
17
Q
Immunotherapies
A
- Preventative treatment for allergies, either SQ or SL
- Work by slowly increasing exposure to allergen
- SQ shots must be given in medical office, SL must be given in medical office FIRST time then continue at home
- Must have an EpiPen at home if using immunotherapy SL option
18
Q
Oralair
A
- 1 of 4 approved FDA SL treatments for allergic rhinitis
- Five different grass pollen extracts
19
Q
Grastek
A
- 1 of 4 approved FDA SL treatments for allergic rhinitis
- Timothy grass pollen extract
20
Q
Ragwitek
A
- 1 of 4 approved FDA SL treatments for allergic rhinitis
- Ragweed pollen extract
21
Q
Odactra
A
- 1 of 4 approved FDA SL treatments for allergic rhinitis
- House dust mite allergen extract
22
Q
Natural Medicines for Cold
A
- Zinc: may decrease duration of cold or be used as a preventative “possibly effective” (start immediately w/ sxs)
- Vitamin C (Ascorbic Acid): decrease duration of cold, “possibly effective”
- Echinacea: “possibly effective”
- Airborne and Emergen-C are popularand contain the above products plus additional vitamins/supplements like vit. E
23
Q
Expectorants
A
- Guaifenesin (Mucinex, Robitussin Mucus + Chest, Robafen)
- Plus Dextromethorphan = DM
- Thins mucus and used when productive coughs are present
24
Q
Cough Suppressant Options
A
- Dextromethorphan (Delsym, Robafen Cough, Robitussin Cough)
- Codeine - CII as single entity for pain, CV in combination products for cough/cold
- Benzonatate (Tessalon Perles)
- Diphenhydramine (Benadryl)
25
Dextromethorphan MOA
- Serotonin reuptake inhibitor that acts as a NMDA-receptor blocker at high doses => euphoria and hallucinations (robo-tripping)
- Banned to sale to minor <18 yo
- For dry, unproductive cough
26
Dextromethorphan Information
- CI: Use within 14 days of a MAOI
- Warning: 5HT syndrome
- DM = dextromethorphan contained in product
27
Codeine Information
- Box Warning: respiratory depression and death in kids receiving tonsillectomy and/or adenoidectomy (ultra-rapid metabolizers); also death in nursing infants
- CI: Use in kids <12 yo, or children < 18 yo receiving tonsillectomy and/or adenoidectomy
- FDA recommends avoiding these cough/cold products in patients < 18 yo
- CII monotherapy, CV when combined
28
Bromfed DM
- Brompheniramine/pseudoephedrine/DM
| - Rx and OTC
29
TussiCaps or Tussionex
- Chlorpheniramine + Hydrocodone
| - CII
30
Avoid in <18 yo...
- Codeine containing cough/cold products (FDA)
| - Hydrocodone containing cough/cold products (FDA)
31
Avoid in <4 yo...
-OTC cough/cold products (per package labeling)
32
Avoid in <2 yo...
- OTC cough/cold products (FDA)
- Promethazine (FDA)
- Topical menthol/camphor (package labeling)
- Decongestants (FDA)
33
APAP/Ibu Child Dosing
- APAP: 10-15 mg/kg Q4-6H; 160 mg/5 mL
- Ibu: 5-10 mg/kg Q6-8H; don't exceed 40 mg/kg/d; dosing varies based on product used
- NEVER ASA: Reyes syndrome risk
