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Finals > Allergic Rhinitis, cough and cold > Flashcards

Allergic Rhinitis, cough and cold Flashcards

1
Q

Should you take Antibiotics if you have viral common cold symptoms?

A

No, It does not help, it increases antibiotic resistance instead.

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1
Q

Explain the process of allergic rhinitis re: pollen

A

1) Exposure to pollen
2) plasma cells release IgE.
3) IgE antibodies binds to mast cells
4) Pollen binds to IgE antibodies and release histamine
5) histamine cause allergy symptoms

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2
Q

Why is the first generation of antihistamines eg. promethazine not an ideal choice ?

A

drugs such as promethazine, diphenhydramine and chlorpheniramine are more sedating and have more ANS block

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3
Q

Why is the second generation better than the first generation antihistamine?

A

It has improved selectivity for H1 histamine receptors.
Reduced lipophilicity and greater p-glycoprotein efflux pump affinity and so reduced CNS effect.

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4
Q

Which drug should you take if you are working In jobs where wakefulness is critical?

A

Fexofenadine and loratidine

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5
Q

how to administer antihistamines?

A

oral, max serum levels at 1-2 hours

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6
Q

excretion forms of antihistamines

A

1st : urine
2nd: urine- cetirizine
feces- fexofenadine

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7
Q

where are antihistamines metabolised?

A

1st: liver ( hydroxylation)
2nd: Liver (p450) with active metabolites.

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8
Q

List examples of decongestants

A

Pseudoephedrine
Oxymetazoline
Phenylephrine

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9
Q

How to administer decongestants?

A

oral or intranasal

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10
Q

MOA of decongestants

A

Vasoconstriction of nasal blood vessels
Reduce inflammation and secretion of mucus

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11
Q

Which drug is an alpha 1 selective agonist? which is non selective? Which drug cause release of adrenaline to increase?

A

sympathomimetic agents:
Direct alpha adrenergic agonist:
alpha 1 selective: phenylephrine
Non selective: oxymetazoline

Indirect increase in release of adrenaline: pseudoephedrine

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12
Q

List examples of nasal glucocorticoid and their administration route

A

fluticasone, momethasone

intranasal

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13
Q

MOA of nasal glucocorticoid

A

Anti- inflammatory
Reduce inflammation- reduce congestion and mucus secretion

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14
Q

Adverse effects of sympathomimetic agents

A

1) Rebound congestion with prolonged use of topical nasal decongestant

2) CNS stimulant
- oral decongestant
- restlessness, tremors, anxiety, insomnia, irritability

3) Cardiovascular
- Tachycardia, especially with indirect sympathomimetic agents:
pseudoephedrine
- HTN due to vasoconstriction
- oral

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15
Q

Adverse effects of nasal glucocorticoid

A

Local mucosa dryness and irritation

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16
Q

Which sympathomimetic agent is an OTC?

A

Pseudoephedrine

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17
Q

MOA of nasal glucocorticoid

A

Anti inflammatory:
reduce inflammation, reduce nasal congestion and mucus secretion.

18
Q

What should you prescribe for rhinorrhoea?

A

Antihistamines:
promethazine, cetirizine, fexofenadine, Loratidine.

Decongestants:
Pseudoephedrine, phenylephrine , oxymetazoline.

Mucoregulators:
Ipatropium, Cromoglicic acid.

19
Q

What should you prescribe for non productive cough that is affecting the patient’s sleep.

A

Antitussive:
codeine
Diphenhydramine
Dextromethorphan

20
Q

What should you prescribe for productive cough that affect’s the patient’s sleep?

A

Expectorant:
Guaifenesin

Mucoactive:
Acetylcysteine
Ambroxol

21
Q

Pharmacological class of codeine and its MOA

A

opiod, acts in CNS to suppress cough

22
Q

Adverse reaction of codeine (opiod)

A

1) CNS sedation
2) weak opiod but has potential for abuse
3) Respiratory depression
- risk of overdose
- should not occur at normal clinic doses
- risk on patients with severe respiratory insufficiency.

4) Do not combine with CNS depressants eg. XCYP2D6 ultra rapid metabolism

DO NOT USE IN CHILDREN, more sensitive to opiod induced respiratory depression, respiratory centre and liver not fully mature.

NOT RECOMMENDED for those below 18 years old.

23
Q

Adverse effects of Diphenhydramine ( non opiod)

A

sedative, anticholinergic

Limited effects for cold

24
Q

Adverse effects for Dextromethophan
(non opioid)

A

1) CNS: drowsiness, dizziness, confusion, excitement, insomnia, nervousness

2) Gastrointestinal
Nausea, vomiting, stomach pain

3) Abuse potential at high dose
- dissociative anaesthetic like effect.

25
Q

Name an example of an expectorant and explain its moa

A

Guaifenesin

It increases production of respiratory tract fluid to liquefy and increase viscosity of tenacious secretions.

26
Q

Adverse effect of guaifenesin?

A

GI disturbances and nausea

27
Q

What should you take note of when prescribing guaifenesin to children

A

Caution for those < 6 years old

Do not give to those <2 years old.

28
Q

What advice should you give to patients who are taking expectorants?

A

Do not take it for cough associated with smoking or asthma.

To drink more fluid to make the secretions less viscous to protect renal function ( nephrolithiasis)

29
Q

Give an example of mucolytics

A

Acetylcysteine

30
Q

MOA of acetylcysteine

A

Free sulfhydryl groups and open disulphide bonds in mucoproteins
lower mucus viscosity

31
Q

Adverse reaction of Acetylcysteine

A

bronchospasm
Anaphylactoid reaction: rash hypotension dyspnea wheezing

GI disturbances: carbocisteine contraindicated for those with peptic ulcer.

32
Q

Who should you be more cautious of when prescribing mucolytics?

A

Elderly or debilitating patients with severe respiratory insufficiency

asthma

33
Q

List an example of mucokinetics

A

Bromhexine with its active metabolite Ambroxol

34
Q

MOA of ambroxol:

A

it promotes mucus clearance:
increase ciliary beat frequency, reduce adherence of mucus to cilia.

stimulate surfactant production: an anti flu factor to prevent mucus from sticking to alveolar and bronchial walls

antioxidant as free radical scavenger

Anti inflammatory by decreasing cytokines
Suppress influenza virus multiplication

Local anaesthetic by blocking sodium channel.

35
Q

Side effects of ambroxol?

A

Allergic reactions
cutaneous adverse effects
avoid pts with hx of asthma and peptic ulcer disease
caution <6 years old
don’t give those < 2 years old.

36
Q

is promethazine safe for geriatric use?

A

elderly more prone to sedation and confusion. anticholinergic effects can precipitate dementia.
Contraindicated for narrow angle glaucoma

37
Q

is decongestant safe for geriatric use?

A

increased risk of htn and cardiovascular adverse events

38
Q

is codeine safe for geriatric use?

A

No, more susceptible for sedation and confusion

39
Q

is dextromethorphan safe for geriatric use?

A

No, more susceptible for sedation and confusion

40
Q

is Diphenhydramine safe for geriatric use?

A

elderly more prone to sedation and confusion. anticholinergic effects can precipitate dementia.
Contraindicated for narrow angle glaucoma

41
Q

what is the best way to ensure recovery from a cough and a cold?

A

wait 3-7 days

42
Q

Agonists activate receptors. Antagonists block agonists from binding but on their own have no effect on receptor activity. What does antihistamine do on their own in the absence of histamine?

A

Produce the opposite effects to histamine

Finals (10 decks)

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