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PT I Exam I > Allergic Rhinitis & Common Cold > Flashcards

Allergic Rhinitis & Common Cold Flashcards

1
Q

Atopy Triad (Rule of 3)

A

Atopic Dermatitis
Allergic Rhinitis
Asthma

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2
Q

NSAID Caution (Rule of 3)

A

Aspirin Allergy
Nasal Polyps
Asthma

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3
Q

Zinc and the common cold

A

Helps with tissue repair

SE: Causes a decrease in appetite due to change in taste + anosmia (inability to smell)

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4
Q

Vitamin C and the common cold

A

Prophylaxis has only been show to be semi-efficacious

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5
Q

Nasal Steroids and the common cold

A

Not as effective against a virus versus allergic rhinitis

- Cause mild vasoconstriction and anti-inflammatory effects

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6
Q

Decongestants and the common cold

A

Nasal: Use for 3 days then throw away (Virus = transmittable)

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7
Q

Antihistamines and the common cold

A

More helpful for sleep induction than symptoms relief from the rhinovirus

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8
Q

Nasal Irrigation Considerations for Patients

A

USE CLEAN WATER
Do NOT use in kids < 4 y.o.
- Can use a nasal aspirator

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9
Q

SACAOS: What is this?

A 
Step Approach to Sinus Issues
S = Sinus Rinse
A = Antihistamines/Decongestants
C = Corticosteroid sprays
A = Antibiotics
O = Oral corticosteroids
S = Surgery
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10
Q

Define Sinusitis and Rhinitis

A

Sinusitis: Inflammation of the lining of the sinuses
- PAINFUL for patients
Rhinitis: Inflammation of the lining of the nasal passages

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11
Q

When should you refer a patient with rhinosinusitis to a SPECIALIST?

A

1) Recurrent episodes: 2 to 4 episodes with at least 8 weeks between the episodes
2) Symptoms after 2 courses of antibiotics
3) Comorbid immunodeficiency

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12
Q

What is allergic rhinitis?

A

Exposure to an allergen elicits nasal symptoms and inflammation of the lining of the nasal passages

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13
Q

Who is at risk for developing allergic rhinitis?

A

Family history
Atopy
Clean-freaks

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14
Q

Patient comes to your pharmacy and asks what she can do to get rid of her runny nose and watery eyes that continually bother her at least 4 times a week for months at a time. It has been affecting her sleeping habits and she has been falling asleep at work randomly.

Classify her allergic rhinitis severity.

A

Moderate-Severe: Pt may have impairment of sleep, daily life or troublesome symptoms
- Occur > 4 days per week AND > 4 weeks

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15
Q

Jack’s mom brings him into the clinic and asks for a recommendation to help her son’s runny nose and itchy eyes. She reveals that he is 12 years old and that the family recently visited a horseback riding ranch for vacation 5 days ago.

Classify his allergic rhinitis severity.

A

Mild: Symptoms do not impair sleep or daily life
- Occur ≤ 4 days per week OR ≤ 4 weeks

  • Probably due to allergen exposure at the ranch
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16
Q

What happens in the early phase of the allergic response?

A

IgE binds to mast cells = rapid release of allergic mediates

Then Leukocytes and eosinophils migrate to the nasal mucosa

17
Q

What happens in the last phase of the allergic response?

A

Cytokines have caused huge infiltration and inflammation + mucus hypersecretion

18
Q

List the symptoms of Allergic Rhinitis

A

Sneezing
Watery runny nose
Itching eyes, nose, palate - “Allergic salute” Congestion: Varies, usually not severe, can lead to mouth breathing
Conjunctivitis
Allergic shiners = “black eyes”
Allergic crease = on nose from rubbing upward

19
Q

How do you treat allergic rhinitis?

A 
#1 Avoid the Allergen
#2 Prophylax whenever possible
#3 Daily therapy - must be started 10 to 14 days b4 allergy season
#3 Incidental - Take drug 1 to 2 hrs before exposure
20
Q

What is the #1 choice for allergic rhinitis?

A

Nasal steroids; No product has been proven superior to the others

21
Q

Nasal Steroids Benefits (4)

A

1) Vasoconstriction - mild
2) Reduced edema and infiltrates
3) Mast cell stabilization - mild
4) Reduced inflammation

22
Q

Concerns with Nasal Steroid Use

A
  1. Growth suppression in children
  2. Epistaxis (Nose bleeds)
  3. Drug interactions
    - Fluticasone inhibits CYP3A4
  4. Takes 3 to 4 days for improvement to appear!
23
Q

What is the role of antihistamines in allergic rhinitis treatment?

A

2nd line therapy
Benefits: Bind at H1 receptor to block histamine
- 2nd gens may have anti-inflammatory effects

24
Q

Which antihistamines is recommended for skin allergies?

A

Tavist (clemastine)

25
Q

List the 1st generation antihistamines from this lecture

A

chlorpheniramine
clemastine
diphenhydramine
doxylamine

26
Q

List the 2nd generation antihistamines from this lecture

A 
Piperzine = Ceterizine, levocetirizine
Piperidine = loratadine, fexofenadine, desloratadine
27
Q

What are the concerns with antihistamine use?

A

1st Generations:
May cause sedation (or stimulation in young kiddos)
Anticholinergic
Photosensitizing

Do not use:
Newborns/Infants, Lactation, BPH, MAOI use, Urinary retention issues, Asthma attack or Narrow Angle glaucoma

28
Q

How do you over come tolerance of antihistamines?

A

Switch classes: Piperzine to Piperidine and vice versa

29
Q

List DDIs with antihistamines

A

Fexofenadine = avoid fruit juices due to compete for CYP receptors for uptake

Loratadine = ketoconazole, cimetidine, erthromycin

Chlorpheniramine = phenytoi

30
Q

What are azelastine and olapatdine?

A

Nasal antihistamines

31
Q

What are the benefits of decongestant use?

A

Constriction of blood vessels
Decreased mucosal edema
- Airways open up!

32
Q

What are concerns with decongestant use?

A

MAOI use because these drugs require MAO for metabolism
Elevated BP due to vasoconstriction
Tachycardia
Stimulant use = anxiety, tremor, insomnia, restlessness and nausea

33
Q

What is rebound congestion?

A

Problem that occurs with longer term use of decongestants

- Avoid this by using for 3 days then stopping use for 3 days before continuing the same cycle

34
Q

Cromolyn nasal Spray

A

Mast cell stabilization
- May cause nasal irritation

Not widely recommended

35
Q

Ipratropium nasal spray

A

Antisecretory but NOT a vasconstrictor

PT I Exam I (9 decks)

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