Allergic Rhinitis, Cough and cold Flashcards
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Allergic rhinitis:
Background: when patient has an allergy to an _________
Symptoms include:
allergen (pollen, dust, pet dander)
- sneezing
- itchy nose
-itchy eyes - itchy throat
- thin, clear mucus
- wheezing
- red watery eyes
- nasal congestion
- rhinorrhea “ runny nose”
-postnasal grip (when laying down, nasal thin mucus is dripping down the back of throat, which can cause itchy throat or throat irritation) - symptoms can last for days or months after contact with allergens
- as long as allergen is present you are going to have those symptoms
Allergic rhinitis is sometimes also called _________
hay fever or simply “allergies”
The symptoms of allergic rhinitis are very similar to the symptoms of a cold. So it is very important to be able to differentiate between the to.
Symptoms of a Cold: include
-
-
With a Cold we see
- a more thick dark mucus
- going to sound like they are very congested plugged
- have a harder time breathing
- have more of a sore throat
- have body aches
- with a cold, it is a virus, you catch it and then it goes away after about a week
Allergic rhinitis can be
intermittent-
chronic-
intermittent- (exposure to animal dander when visiting a friends home)
chronic- (symptoms that last for months whenever the pollen count is elevated)
Non-drug Treatment for Allergic rhinitis includes:
-
-
- recognize allergens and avoid exposure
- High-efficiency particular air (HEPA) filters may help
- Weekly vacuuming of carpets, drapes, upholstery with a HEPA vacuum cleaner
— For Dust mites: remove carpets and upholstered furniture, encase mattresses, pillows, box springs in allergen-impermeable covers, wash bedding and soft toys in hot water every 1-2 weeks
What can be used to determine patient specific allergens?:
an IgE-mediated skin prick test or blood test:
common allergens include:
- pollens from trees, grasses and weeds
- molds, both indoor and outdoor
- dust mites that live in bedding, carpeting and other items that hold moisture
- animal dander from furred animals such as cats and dogs, horses and rabbits
Other things we can do for allergic rhinitis include:
Nasal Irrigation: just cleaning out the nasal passages
Wetting agents: helps keep nasal passages wet
Both provide symptom relief by reducing nasal stuffiness, runny nose and sneezing.
Nasal gels with petrolatum can be applied around the nostrils to physically block pollens and allergens from entering the nose.
These products are considered safe for most populations, including children and pregnant women.
Wetting agents are commercially available and contain saline, propylene or polyethylene glycol, which provide moisture and reduce irritation to the nasal passages.
examples:
Ocean
Little remedies
Simply Saline
Nasal Irrigation uses an isotonic (0.9%) or hypertonic (2-3.5%) saline solution, made with salt and water, to rinse out allergens and mucus, improve ciliary function and reduce swelling.
examples:
Neil Med Sinus Rinse
-Nasal irrigations can be administered using a syringe or Netipot (the prepared saline solution is then poured into one nostril and drained out of the other nostril)
the water used for nasal irrigation should be boiled and cooled OR used with distilled water to prevent passage of infection.
Drug Treatment for Allergic rhinitis:
- depends on severity of illness and symptoms (Mild Moderate Severe, if acute or chronic)
- is it more of an eye symptom vs. nose symptom
-
-
-
- intranasal steroids (1st line for moderate to severe symptoms, chronic)
- 1st generation antihistamines (milder symptoms)
- 2nd generation antihistamines (milder symptoms)
- decongestants (can be used if congestion is present)
- mast cell stabilizer
- leukotriene receptor antagonist (reserved for last time patients who can use other options)
- immunotherapy (severe allergies)
Intranasal steroids work by __________.
They are effective __________
We use in ___________
-decreasing inflammation.
- in reducing the nasal symptoms for allergic rhinitis ( sneezing, itching, rhinorrhea, congestion).
- they don’t work right away, will have some affect, but take a little bit of time to build up.
- chronic allergic rhinitis
** Note the same steroids used to treat allergic rhinitis and asthma have different Brand Names AND Delivery systems**
Allergic rhinitis - Steroids - Intranasal
ex. fluticasone for allergic rhinitis comes as intranasal inhaler as Flonase.
Asthma - Steroids - oral Inhaler
ex. fluticasone for asthma comes as oral inhaler as Flovent.
Antihistamines 1st generation
work by __________.
They are effective __________
We use in ___________
Examples:
“pretty sedating”
use more for intermittent symptoms. They work right away.
Benadryl
Antihistamines 2nd generation
work by __________.
They are effective __________
We use in ___________
Examples:
usually preferred since less sedation
use more for intermittent symptoms. They work right away.
Rhinocort Allergy -rhin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
-preferred in pregnancy!
budesonide
class: corticosteroid
Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis
MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.
Dosage forms: intranasal steroid
Dosing:
Max dose:
Contraindications:
Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use
Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation
Monitoring:
Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?
- effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)
Drug-Drug/Food interactions:
What oral inhaler form of budesonide is indicated for Asthma Treatment?
Flonase Allergy Relief -nas
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
fluticasone
class: corticosteroid
Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis
MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.
Dosage forms: intranasal steroid
Dosing:
Max dose:
Contraindications:
Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use
Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation
Monitoring:
Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?
- effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)
Drug-Drug/Food interactions:
what oral inhaler form of fluticasone is used for Asthma Treatment?
Flovent
Nasacort Allergy 24HR -nas
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
triamcinolone
class: corticosteroid
Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis
MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.
Dosage forms: intranasal steroid
Dosing:
Max dose:
Contraindications:
Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use
Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation
Monitoring:
Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?
- effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)
Drug-Drug/Food interactions:
what oral inhaler form of triamcinolone is used for Asthma Treatment?
Beconase AQ -nas
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
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Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
beclomethasone
class: corticosteroid
Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis
MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.
Dosage forms: intranasal steroid
Dosing:
Max dose:
Contraindications:
Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use
Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation
Monitoring:
Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?
- effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)
Drug-Drug/Food interactions:
Qnasl -nas
beclomethasone
what oral inhaler form of beclomethasone is used for Asthma Treatment?
Zetonna
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
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Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
ciclesonide
class: corticosteroid
Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis
MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.
Dosage forms: intranasal steroid
Dosing:
Max dose:
Contraindications:
Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use
Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation
Monitoring:
Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?
- effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)
Drug-Drug/Food interactions:
Omnaris
ciclesonide
what oral inhaler form of ciclesonide is used for Asthma Treatment?
Nasonex -nas
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
mometasone
class: corticosteroid
Indications: First line for Moderate-Severe, chronic symptoms, of Allergic Rhinitis
MOA: a glucocorticoid that depresses the activity of endogenous chemical mediators of inflammation, so it works by decreasing inflammation.
Dosage forms: intranasal steroid
Dosing:
Max dose:
Contraindications:
Warnings:
- Avoid if recent nasal septal ulcers, nasal surgery, or recent nasal trauma due to delayed wound healing
- High doses for prolonged periods can cause: adrenal suppression, decrease growth velocity (pediatrics) and immunosuppression.
- Use caution in patients with cataracts and or glaucoma; increases IOP, open-angle glaucoma and cataracts have occurred with prolonged use
Side Effects: *Epistaxis (nose bleeds), headache, dry nose, pharyngitis, unpleasant taste, localized infection, nasal septal perforation
Monitoring:
Pearls/Notes: OTC
- can take up to one week to get full effect.
- Shake bottle well before each use.
- prime device before first use?
- effective in reducing nasal symptoms for allergic rhinitis (sneezing, itching, rhinorrhea, congestion)
Drug-Drug/Food interactions:
what oral inhaler form of mometasone is used for Asthma Treatment?
What are the preferred nasal steroids in pregnancy?
budesonide & beclomethasone
Benadryl
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
diphenhydramine
class: 1st- generation antihistamines
Indications: Mild-Moderate symptoms, Intermittent, of Allergic Rhinitis
MOA: works by blocking histamine at the histamine-1 (H1) receptor site. Reduces symptoms of itching, sneezing, runny nose BUT NOT congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications: neonates or premature infants, breastfeeding
Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation
Side Effects:
Monitoring:
Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death
Drug-Drug/Food interactions:
Chlor-Trimeton
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
chloropheniramine
class: 1st- generation antihistamines
Indications: Mild-Moderate symptoms, Intermittent of Allergic Rhinitis
MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications: neonates or premature infants, breastfeeding
Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation
Side Effects:
Monitoring:
Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death
Drug-Drug/Food interactions:
Aller-Chlor
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
chloropheniramine
class: 1st- generation antihistamines
Indications: Mild-Moderate symptoms of Allergic Rhinitis
MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications: neonates or premature infants, breastfeeding
Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation
Side Effects:
Monitoring:
Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death
Drug-Drug/Food interactions:
Unisom (for sleep)
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
doxylamine
class: 1st- generation antihistamines
Indications: Mild-Moderate symptoms of Allergic Rhinitis
MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications: neonates or premature infants, breastfeeding
Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation
Side Effects:
Monitoring:
Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death
Drug-Drug/Food interactions:
Dayhist Allergy 12 HR relief
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
clemastine
class: 1st- generation antihistamines
Indications: Mild-Moderate symptoms of Allergic Rhinitis
MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications: neonates or premature infants, breastfeeding
Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation
Side Effects:
Monitoring:
Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death
Drug-Drug/Food interactions:
Karbinal ER
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
carbinoxamine
class: 1st- generation antihistamines
Indications: Mild-Moderate symptoms of Allergic Rhinitis
MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications: neonates or premature infants, breastfeeding
Warnings:
- Caution in elderly patients with Prostate Enlargement, Glaucoma, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation
Side Effects:
Monitoring:
Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death
Drug-Drug/Food interactions:
Ryvent
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
carbinoxamine
class: 1st- generation antihistamines
Indications: Mild-Moderate symptoms, Intermittent of Allergic Rhinitis
MOA: work by blocking histamine at the histamine-1 (H1) receptor site. Reduce symptoms of itching, sneezing, runny nose BUT NOT congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications: neonates or premature infants, breastfeeding
Warnings:
- Caution in elderly patients with Prostate Enlargement (BPH), Glaucoma, Sjogren’s Syndrome, CV disease, thyroid disease, others.
- Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years old
- Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
- Can cause CNS depression/sedation
Side Effects:
Monitoring:
Pearls/Notes:
- more sedation and cognitive impairment
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
- seizures/arrhythmias at higher doses
- Avoid in children < 2 years old due to risk of serious side effects
- 1st generation Should Not be taken by lactating women; second generation are preferred
- Can cause photosensitivity; use sunscreens and wear protective clothing while taking
- FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures. coma or death
Drug-Drug/Food interactions:
also a 1st generation antihistamine
hydroxyzine
also a 1st generation antihistamine
meclizine
also a 1st generation antihisamine
promethazine
diphenhydramine in pharmacy is everywhere!
It has many indications which include:
-
-
-
Zyrtec
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
class: 2nd-generation antihistamine (preferred over 1st generation due too less sedation)
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- response is patient specific
Drug-Drug/Food interactions:
All Day Allergy
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
certirizine
Xyzal Allergy 24HR
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
levocertirizine
Allegra Allergy
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- take with water (NOT fruit juice due to decreased absorption), Avoid administration with aluminum or magnesium containing products
Drug-Drug/Food interactions:
- Avoid use with erythromycin and ketoconazole
fexofenadine
Claritin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
loratadine
Alavert
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
loratadine
Clarinex
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
desloratadine
Astepro
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
azelastine
Astelin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
azelastine
Dymista
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
azelastine + fluticasone
Patanase
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
olopatadine
-
-
What age cut off can individuals use these?
Astelin
Astepro
5 years and older
Which 2nd generation antihistamines are preferred in pregnancy?
cetirizine and levocetirizine
Which 2nd generation antihistamines have formulation which can have phenylalanine AND that we would want to avoid in patients with PKU?
fexofenadine, loratadine, desloratadine
Within the class of 2nd generation antihistamines, which are more sedating compared to the others?
cetirizine & levocetirizine
Oral Decongestants include:
- (PE) phenylephrine
- (PSE) pseudoephedrine
Sudafed PE
class:
Indications:
MOA:
Dosage forms:
**Dosing:
**Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
- has low bioavailability (< or = 38%)
Drug-Drug/Food interactions:
phenylephrine
class: decongestant, alpha-adrenergic agonist (sympathomimetic)
Indications: For Nasal Congestion in allergic rhinitis or due to cold
MOA: works by causing vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications:
**DO NOT USE within 14 days of MAO inhibitors.
Warnings:
** Avoid in children < 2 years old (FDA), < 4 years (according to package labeling)
** Use with caution in patients with *CV disease and uncontrolled hypertension (can increase BP), hyperthyroidism (can worsen), diabetes (can increase BG), bowel obstruction, glaucoma (can increase IOP) *BPH (can cause urinary retention), the elderly
Side Effects:
- cardiovascular stimulation *(tachycardia, palpitations, increase blood pressure),
- CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations)
*- decrease appetite,
Monitoring:
Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
-pseudoephedrine is more effective
- Onset of 15-60 minutes
Drug-Drug/Food interactions:
Zephrex-D
class:
Indications:
MOA:
Dosage forms:
**Dosing:
**Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
pseudoephedrine
class: decongestant, alpha-adrenergic agonist (sympathomimetic)
Indications: For Nasal Congestion in allergic rhinitis or due to cold
MOA: works by causing vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications:
**DO NOT USE within 14 days of MAO inhibitors.
Warnings:
** Avoid in children < 2 years old (FDA), < 4 years (according to package labeling)
** Use with caution in patients with *CV disease and uncontrolled hypertension (can increase BP), hyperthyroidism (can worsen), diabetes (can increase BG), bowel obstruction, glaucoma (can increase IOP) *BPH (can cause urinary retention), the elderly
Side Effects:
- cardiovascular stimulation *(tachycardia, palpitations, increase blood pressure),
- CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations)
*- decrease appetite,
Monitoring:
Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
-pseudoephedrine is more effective
- Onset of 15-60 minutes
Drug-Drug/Food interactions:
Nexafed
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
pseudoephedrine
class: decongestant, alpha-adrenergic agonist (sympathomimetic)
Indications: For Nasal Congestion in allergic rhinitis or due to cold
MOA: works by causing vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications:
**DO NOT USE within 14 days of MAO inhibitors.
Warnings:
** Avoid in children < 2 years old (FDA), < 4 years (according to package labeling)
** Use with caution in patients with *CV disease and uncontrolled hypertension (can increase BP), hyperthyroidism (can worsen), diabetes (can increase BG), bowel obstruction, glaucoma (can increase IOP) *BPH (can cause urinary retention), the elderly
Side Effects:
- cardiovascular stimulation *(tachycardia, palpitations, increase blood pressure),
- CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations)
*- decrease appetite,
Monitoring:
Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
-pseudoephedrine is more effective
- Onset of 15-60 minutes
Drug-Drug/Food interactions:
Sudafed
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
pseudoephedrine
class: decongestant, alpha-adrenergic agonist (sympathomimetic)
Indications: For Nasal Congestion in allergic rhinitis or due to cold
MOA: works by causing vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion.
Dosage forms:
Dosing:
Max dose:
Contraindications:
**DO NOT USE within 14 days of MAO inhibitors.
Warnings:
** Avoid in children < 2 years old (FDA), < 4 years (according to package labeling)
** Use with caution in patients with *CV disease and uncontrolled hypertension (can increase BP), hyperthyroidism (can worsen), diabetes (can increase BG), bowel obstruction, glaucoma (can increase IOP) *BPH (can cause urinary retention), the elderly
Side Effects:
- cardiovascular stimulation *(tachycardia, palpitations, increase blood pressure),
- CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness, fear, hallucinations)
*- decrease appetite,
Monitoring:
Pearls/Notes:
- Has Poor oral absorption. It comes as a nasal spray but lasts for a short time and causes more side effects than the popular oxymetazoline spray.
-pseudoephedrine is more effective
- Onset of 15-60 minutes
Drug-Drug/Food interactions:
Afrin
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
oxymetazoline
class: topical nasal decongestant
Indications: For Nasal Congestion in allergic rhinitis or due to cold
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
- DO NOT USE FOR MORE THAN 3 DAYS! (Can cause Rhinitis medicamentosa “rebound congestion”. It will make the original congestion even worse.
Warnings:
- Do NOT use with MAO inhibitors or if patients have closed angle glaucoma
Side Effects:
Monitoring:
Pearls/Notes:
Fast onset = (5-10 minutes)
Drug-Drug/Food interactions:
Combat Methamphetamine Epidemic Act 2005:
- Limits sales of PSE to 3.6 grams/ day (120 tablets of 30mg tabs) and 9 grams per 30-day period (EXCEPTION: 60mg single pack)
- Behind the counter or in a locked cabinet, requires ID and signature
To combat the methamphetamine epidemic, there are restricted sales of non-prescription products containing: ________
- pseudoephedrine
- phenylpropanolamine
- ephedrine
“since these can all be easily converted to methamphetamine”
NasalCrom
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
cromolyn
class: Intranasal mast cell stabilizer
Indications: For Tx and Prophylaxis of allergic rhinitis
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
OTC
- start using at onset of allergy season
- dosed every 6-8 hours regularly (not as needed)
- symptom improvement can be seen within 4-7 days but maximal effect in 2-4 weeks
- good safety profile: can be used in children > or = 2 years old and in pregnancy
Drug-Drug/Food interactions:
Singulair
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
montelukast
class: leukotriene receptor antagonist
Indications: For both Allergic rhinitis & Asthma
- For Allergic rhinitis, it should be reserved for those who are unable to be treated effectively with other medications.
MOA:
Dosage forms: oral tablet
Dosing: Is dosed once daily
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- commonly used in children
- is the only leukotriene modifying agent
Drug-Drug/Food interactions:
Atrovent
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
ipratropium bromide
class:
Indications:
MOA:
Dosage forms: intranasal
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- useful to decrease rhinorrhea but not effective for other nasal symptoms
Drug-Drug/Food interactions:
For very severe allergies patients can receive ______
immunotherapy: is a preventative treatment for allergies either SC or SL. They work by slowly increasing exposure to the allergen, making the immune system less sensitive to the substance.
recommended treatment is minimum for 3 years.
what are the 4 FDA approved SL treatments for allergic rhinitis that are tailored to specific allergens?
Oralair
Grastek
Ragwitek
Odactra
*very first dose must be given in a doctors medical office
Cough and Cold is commonly caused by __________
viruses (rhinovirus, coronavirus, influenza)
The common cold, a viral infection of the upper respiratory tract, is transmitted by _________.
Transmission is best prevented by _________
mucus secretions (via patients’ hand) or by the air (from coughing or sneezing)
frequent hand washing
Cold
- No fever, some body aches
- cough, if present, is due to post-nasal drip
- More nasal symptoms (runny or clogged nose)
coughs that are associated with colds are usually ____________
nonproductive, dry coughs
Drug treatment: with natural products- “ that are “possibly effective” for Colds include:
-
-
-Zinc: For treatment -
start within 48 hours and use as directed (every 2 hours while awake)
Do Not Use > for longer than 5-7 days (can cause copper deficiency)
Do Not Use zinc nasal swabs or sprays (can cause loss of smell)
- vitamin C (ascorbic acid): For treatment- (1-3 grams/day)
may reduce duration of cold - Echinacea: For treatment
may reduce duration of cold - Airborne & Emergen-C - vitamin C, E, zinc, echinacea - No known benefit
Zinc lozenges can cause
mouth irritation, a metallic taste and nausea
Zinc nasal formulations were removed from market due to causing loss of smell
vitamin C doses of 4 grams or more can cause
diarrhea and possibly kidney stones
Drug treatment for Colds includes classes of
-
expectorants
cough suppressants
decongestants
analgesics/antipyretics
Mucinex
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
guaifenesin
class: expectorant/mucolytic
Indications: used to treat a productive, Wet cough
MOA: thins out mucus and makes it easier to cough phlegm out of airway tract
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
Robitussin Mucus + Chest Congestion
Robafen
Robafen DM
dextromethorphan (DM) + guaifenesin
Robitussin DM
dextromethorphan (DM) + guaifenesin
Delsym
class:
Indications:
MOA:
Dosage forms:
Dosing:
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Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
dextromethorphan (DM)
class: cough suppressant
Indications: Indicated for dry, nonproductive cough
MOA: it blocks the cough reflex center in the brain. “has a high affinity for the medullary cough center”
- also acts as a serotonin reuptake inhibitor –> risk of serotonin syndrome
-High doses then it also acts as a NMDA-receptor blocker –> euphoric & hallucinogenic properties
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
- product has been abused for euphoric properties
- 2012 - CA banned sales to minor (must be > or = 18 years old to purchase)
Max dose is 120mg/day
Drug-Drug/Food interactions:
Codeine
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
C-II, when given by itself
class: cough suppressant
Indications: For dry, non-productive cough
MOA: acts centrally on respiratory center in the medulla to increase the cough threshold
Dosage forms:
Dosing:
Adult - 7.5-120mg PO as a single dose or divided doses
Max dose:
Contraindications:
- *DO NOT USE in children < 12 years of age (any indication) or in children < 18 years of age after tonsillectomy and/or adenoidectomy
Warnings:
- *Respiratory depression and death have occurred in children who receive codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to CYP2D6 polymorphism
- *deaths have also occurred in nursing infants after being exposed to high concentrations of morphine from mothers who were ultra rapid metabolizers
Side Effects:
Monitoring:
Pearls/Notes:
- ** The FDA recommends to AVOID codeine-containing cough and cold products for patients < 18 years of age
Drug-Drug/Food interactions:
what schedule is codeine as a single entity?
Schedule C-II
what schedule is codeine as a combination product?
Schedule C-V
Codeine products containing one or more non-codeine active ingredients and no more than 200mg of codeine per 100mL are scheduled ____
C-V drugs
Tessalon Perles
class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
benzonatate
class: cough suppressant/topical anesthetic
Indications:
MOA: suppresses cough by a topical anesthetic action on the respiratory stretch receptors
Dosage forms:
Dosing: 100-200mg PO TID PRN
Max dose: 600mg/day
Contraindications:
Warnings: DO NOT USE in children < 10 years if age; accidental and fatal overdose has been reported
Side Effects: somnolence, confusion, hallucinations
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:
the abbreviation DM means the product has
dextromethorphan
Cough Suppressants are used for ____________
dry, nonproductive cough or to suppress cough at night to allow for restful sleep.
the abbreviation D means the product has a
decongestant
the abbreviation AC means the product has
codeine
the abbreviation PE, means the product has
phenylephrine
Pediatric Cough and Cold treatment:
For Children < 2 years old,
AVOID OTC cough and cold products (FDA)
AVOID promethazine (FDA)
AVOID topical menthol and camphor (package labeling)
Pediatric Cough and Cold treatment:
For children < 4 years old,
AVOID OTC cough and cold products (package labeling)
Pediatric Cough and Cold treatment:
For children < 18 years old
AVOID codeine and hydrocodone-containing cough and cold products (FDA)
Pediatric Cough and Cold treatment:
For children < 12 years of age
AVOID codeine-containing products (FDA)
Dosing of Tylenol in pediatric patients
- 10-15mg/kg every 4-6 hours
- Do NOT EXCEED 5 doses in 24 hours
- infant drops/children’s liquid = 160mg/5mL
- use measuring device that comes with the medication
Dosing of Ibuprofen in pediatric patients
- 5-10 mg/kg every 6-8 hours
- DO NOT EXCEED 40mg/kg/day
- infant drops = 50mg/1.25mL
- children’s liquid = 100mg/5 mL
- use measuring device that comes with the medication
We do NOT want to use aspirin in pediatric patients/children because of the risk of inducing __________
Reyes Syndrome
Never Aspirin in less than 16 years old
