Allergic Rhinitis, Cough & Cold Flashcards
What are symptoms of allergic rhinitis?
- Congestion
- Rhinorrhea
- Sneezing
- Itchy eyes
Difference between colds vs allergies
Colds
* Sneezing
- Runny nose
- Thick, dark mucus
- Sore throat
- Body aches
- Symptoms take about 3 days to appear and usually last about a week
Allergies
* Sneezing
- Runny nose
- Thin, clear mucus
- Wheezing
- Red, watery eyes
- Symptoms can last for days or months after contact with allergens
Non-drug treatment of allergies
- Avoiding exposure to known or suspected allergens
What determines patient-specific allergens?
- IgE-mediated skin prick test
What are common allergens?
- Pollens
- Molds
- Dust mites
- Animal dander
What can reduce allergens?
- Vacuuming carpets, drapes and upholstery with a HEPA vacuum cleaner
- Removing carpets
- Upholsterred furniture
- Encasing pillows, mattresses
- Washing bedding and soft toys in hot water weekly
What rates the local air as good to hazardous?
- The air quality index (AQI)
T/F: When children are raised in an overly-clean environment, they lose the chance to build a healthy immune system
TRUE
What do nasal irrigations and wetting agents do?
- They provide symptom relief by reducing nasal stuffiness, runny nose and sneezing
- These products are considered safe for children and pregnat women
Give examples of wetting agents
- Ocean
- Little Remedies
What kind of saline solution does nasal irrigation, such as NeilMed Sinus Rinse uses? Why is it used?
- Isotonic (0.9%) or hypertonic (2 - 3.5%)
- It is used to rinse out allergens and mucus, improve ciliary function and reduce swelling
A homemade or store-bought saline mixture must be combined with __, __, or previously __ and __ water
Fill in the blanks
- Distilled
- Sterile
- Boiled
- Cooled
T/F: Tap water should not be used with saline mixture as it can cause infections when used for nasal irrigation.
TRUE
How do you administer nasal irrigations?
- Syringe or netipot
How do you use a neti pot?
- Prepared saline solution is placed in the neti pot, then poured into one nostril and drained out of the other nostril while breathing through the mouth
Instranasal steroids are first-line for __, __ symptoms.
Fill in the blanks
- Chronic
- Moderate-severe
Milder, intermittent symptoms can be treated with __.
Fill in the blank
- Oral antihistamines
Antihistamines and decongestants are available in both __ and __ formulations
Fill in the blanks
- Nasal
- Oral
Intranasal steroids work by ____.
Fill in the blank
- Decreasing inflammation
T/F: The same steroids used to treat allergic rhinitis and asthma have different brand names.
TRUE
Intranasal steroids - brand/generic, SEs
- Budesonide (Rhinocort Allergy)
- Fluticasone (Flonase Allergy Relief, Flonase Sensimist, Children’sFlonase)
- Triamcinolone (Nasacort Allergy 24HR, Nasacort Allergy 24HR Children)
Side Effects: Epistaxis (nose bleed)
Budesonide and beclomethasone are the preferred nasal steroids in __.
Fill in the blank
- Pregnancy
Instranasal steroids can take up to __ to get full relief.
Fill in the blank
- 1 week
Oral antihistmaines have little effect on nasal __.
Fill in the blank
- Congestion
Oral antihistamines work by blocking __ receptor site.
Fill in the blank
- Histamine-1 (H1)
Second generation oral antihistamines are more preferred due to less __ and __ impairment than first generation oral antihistamines
Fill in the blanks
- Sedation
- Cognitive
What indications diphenhydramine can be used for?
- Tx of acute allergic reactions (+/- epinephrine, depending on severity)
- Prevention of allergic reactions
- Allergic rhinitis
- Cough
- Sleep
- Motion sickness
- Dystonic reactions
What disease states can diphenhydramine worsen?
- BPH
- Dementia
- Constipation
- Glaucoma
First-generation oral antihistamines - names, warnings, SEs
- Diphenhydramine (Benadryl)
- Chlorpheniramine
- Doxylamine
Warnings:
* Use caution in patients with CV disease, prostate enlargement and glaucoma
Side Effects:
* Somnolence, cognitive impairment, anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention)
Diphenhydramine dosages
- Adult: 25 mg PO Q4-6H or 50 mg Q6-8H
- Patients <6 yrs: do not use OTC
Second-generation oral antihistamines - names
- Cetirizine (Zyrtec, Zyrtec Allergy Childrens) + Pseudophedrine (Zyrtec -D)
- Levocetiricine (Xyzal Allergy 2HR, Xyzal Allergy 24 HR Childrens)
- Fexofenadine (Allegra Allergy, Allegra Allergy Childrens) +Pseudophedrine (Allegra-D)
- Loratadine (Claritin, Claritin Childrens) + Pseudophedrine (Claritin-D)
T/F: Fexofenadine should be taken with only water due to the risk of decreased absorption
TRUE
Which second-generation oral antihistamines preferred in pregnancy?
- Loratadine
- Cetirizine
Which second-generation oral histamines have fast onset?
- Cetirizine
- Levocetirizine
Which second-generation oral antihistamines are more sedating?
- Cetirizine
- Levocetirizine
Which second-generation oral antihistamines are less sedating?
- Fexofenadine
- Loratadine
Azelastine and olopatadine are intranasl antihistamines that can be combined with ___ to help with nasal congestion.
Fill in the blank
- Intranasal steroid
What are decongestants and their MOA?
- Decongestants are alpha-adrenergic agonists (sympathomimetics)
- They cause vasoconstriction, which decreases sinus vessel engorgement and mucosal edema and makes them effective at reducing sinus and nasal congestion
Phenylephrine has __ oral absorption. It comes as __, but lasts for a __ time.
Fill in the blanks
- Poor
- Nasal spray
- Shorter
Pseudophedrine is an effective decongestant and is a precursor to __.
Fill in the blank
- Methamphetamine
Pseudophedrine, __ and __ are easily converted to methamphetamine and kept behind the counter
Fill in the blanks
- Phenylpropanolamine
- Ephedrine
What is the maximun amount allowed for purchase of those three products?
- 3.6 grams/day
- 9 grams/month (30-day period)
Oral decongestants - brand/generic, CIs, warnings, SEs
- Phenylephrine (Sudafed PE)
- Pseudoephedrine (Sudafed, Nexafed, Zephrex-D)
Contraindications:
* Do not use withing 14 days of MAO inhibitors
Warnings:
* Avoid in children < 2 yrs (FDA), <4 yrs (package label)
- Use with caution in patients with CV disease and BPH
Side Effects:
* Tachycardia, palpitations, high BP, insomnia, decreased appetite
Intranasal decongestants - brand/generic, SEs
- Oxymetazoline (Afrin)
Side Effects: Rhinitis medicamentosa (rebound congestion if used longer than 3 days)
Intranasl cromolyn (NasalCrom) is an OTC ___ used regularly (not PRN) to be effective. It is safe to use in children >= __ years old and in __.
Fill in the blanks
- Mast cell stabilizer
- 2
- Pregnancy
T/F: Montelukast (Singulair) is the only leukotriene modifying agent indicated for the tx of both asthma and allergic rhitis and it is commonly used in children.
TRUE
Immunotherapy is a __ treatment for allergies, either through __ injections or __ treatments. They work by __ increasing exposure to the allergen
Fill in the blanks
- Preventative
- SC
- SL
- Slowly
The first dose for SL treatment must be in given in a ___ where the patient can be monitored for at least ___ minutes afterward for signs of an allergic reaction (BW). Subsequent dose can be administered at home, but patient should have an ____ while on SL immunotherapy.
Fill in the blanks
- Medical office
* - 30 min
- Epinephrine-auto injector
What are the natural products used for cold?
- Zinc
- Vitamin C (ascorbic acid): decrease in the duration of the cold
- Echinacea
- Airborne and Emergen-C - combo of the 3
MOA of expectorants and examples
- Expectorants can be used to thin mucus and move secretions up and out of the respiratory tract if productive cough is present
Guaifenesin (Mucinex, Robitussin Mucus + Chest Congetion, Robafen) + dextromethorphan (Robafen DM, Robitussin DM)
T/F: Dextromethorphan is a cough suppressant and it suppresses the cough reflex
TRUE
Dextromethorphan acts as a ___. At high doses, it acts as an ___ leading to __ and __
Fill in the blanks
- Serotonin reuptake inhibitor
- NMDA-receptor blocker
- Euphoria
- Hallucinations
Many states ban the sale of dextromethorphan to minors < __ years of age due to its abuse potential
Fill in the blank
- 18
Dextromethorphan - brand/generic, CIs, warnings
- Dextromethorphan (Delsym, Robafen Cough, Robitussin Cough) + guaifenesin (Robafen DM, Robitussin DM)
Contraindications: Do not use within 14 days of MAO inhibitor
Warnings: seratonin syndrome
Codeine - BW, CIs
C-II (pain)
C-V (combo products used for cough and cold)
BW:
* Respiratory depression and death in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to a CYP450 2D6 polymorphism
- Death in nursing infants
Contraindications:
* Do not use in children < 12 years of age or in children < 18 years of age after tonsillectomy and/or adenoidectomy
The FDA reccomends to avoid codeine-containing cough and cold products for patients <18 years of age
Other cough suppressants - names
- Benzonatate (Tessalon Perles)
- Diphenhydramine (Benadryl)
T/F: Avoid promethazine (FDA) for children <2 years
T/F: Avoid topical menthol and camphor for children < 2 years
- TRUE
- TRUE
T/F: Topical menthol, such as Vicks VapoRub can be applied to chest and neck, but never directly to the nose.
TRUE
