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Naplex > Allergic Rhinitis, Cough & Cold > Flashcards

Allergic Rhinitis, Cough & Cold Flashcards

1
Q

What are symptoms of allergic rhinitis?

A
  • Congestion
  • Rhinorrhea
  • Sneezing
  • Itchy eyes
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2
Q

Difference between colds vs allergies

A

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
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3
Q

Non-drug treatment of allergies

A
  • Avoiding exposure to known or suspected allergens
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4
Q

What determines patient-specific allergens?

A
  • IgE-mediated skin prick test
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5
Q

What are common allergens?

A
  • Pollens
  • Molds
  • Dust mites
  • Animal dander
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6
Q

What can reduce allergens?

A
  • 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
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7
Q

What rates the local air as good to hazardous?

A
  • The air quality index (AQI)
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8
Q

T/F: When children are raised in an overly-clean environment, they lose the chance to build a healthy immune system

A

TRUE

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9
Q

What do nasal irrigations and wetting agents do?

A
  • They provide symptom relief by reducing nasal stuffiness, runny nose and sneezing
  • These products are considered safe for children and pregnat women
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10
Q

Give examples of wetting agents

A
  • Ocean
  • Little Remedies
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11
Q

What kind of saline solution does nasal irrigation, such as NeilMed Sinus Rinse uses? Why is it used?

A
  • Isotonic (0.9%) or hypertonic (2 - 3.5%)
  • It is used to rinse out allergens and mucus, improve ciliary function and reduce swelling
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12
Q

A homemade or store-bought saline mixture must be combined with __, __, or previously __ and __ water

Fill in the blanks

A
  • Distilled
  • Sterile
  • Boiled
  • Cooled
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13
Q

T/F: Tap water should not be used with saline mixture as it can cause infections when used for nasal irrigation.

A

TRUE

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14
Q

How do you administer nasal irrigations?

A
  • Syringe or netipot
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15
Q

How do you use a neti pot?

A
  • 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
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16
Q

Instranasal steroids are first-line for __, __ symptoms.

Fill in the blanks

A
  • Chronic
  • Moderate-severe
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17
Q

Milder, intermittent symptoms can be treated with __.

Fill in the blank

A
  • Oral antihistamines
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18
Q

Antihistamines and decongestants are available in both __ and __ formulations

Fill in the blanks

A
  • Nasal
  • Oral
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19
Q

Intranasal steroids work by ____.

Fill in the blank

A
  • Decreasing inflammation
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20
Q

T/F: The same steroids used to treat allergic rhinitis and asthma have different brand names.

A

TRUE

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21
Q

Intranasal steroids - brand/generic, SEs

A
  1. Budesonide (Rhinocort Allergy)
  2. Fluticasone (Flonase Allergy Relief, Flonase Sensimist, Children’sFlonase)
  3. Triamcinolone (Nasacort Allergy 24HR, Nasacort Allergy 24HR Children)

Side Effects: Epistaxis (nose bleed)

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22
Q

Budesonide and beclomethasone are the preferred nasal steroids in __.

Fill in the blank

A
  • Pregnancy
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23
Q

Instranasal steroids can take up to __ to get full relief.

Fill in the blank

A
  • 1 week
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24
Q

Oral antihistmaines have little effect on nasal __.

Fill in the blank

A
  • Congestion
25
Q

Oral antihistamines work by blocking __ receptor site.

Fill in the blank

A
  • Histamine-1 (H1)
26
Q

Second generation oral antihistamines are more preferred due to less __ and __ impairment than first generation oral antihistamines

Fill in the blanks

A
  • Sedation
  • Cognitive
27
Q

What indications diphenhydramine can be used for?

A
  • Tx of acute allergic reactions (+/- epinephrine, depending on severity)
  • Prevention of allergic reactions
  • Allergic rhinitis
  • Cough
  • Sleep
  • Motion sickness
  • Dystonic reactions
28
Q

What disease states can diphenhydramine worsen?

A
  • BPH
  • Dementia
  • Constipation
  • Glaucoma
29
Q

First-generation oral antihistamines - names, warnings, SEs

A
  1. Diphenhydramine (Benadryl)
  2. Chlorpheniramine
  3. 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)

30
Q

Diphenhydramine dosages

A
  • Adult: 25 mg PO Q4-6H or 50 mg Q6-8H
  • Patients <6 yrs: do not use OTC
31
Q

Second-generation oral antihistamines - names

A
  1. Cetirizine (Zyrtec, Zyrtec Allergy Childrens) + Pseudophedrine (Zyrtec -D)
  2. Levocetiricine (Xyzal Allergy 2HR, Xyzal Allergy 24 HR Childrens)
  3. Fexofenadine (Allegra Allergy, Allegra Allergy Childrens) +Pseudophedrine (Allegra-D)
  4. Loratadine (Claritin, Claritin Childrens) + Pseudophedrine (Claritin-D)
32
Q

T/F: Fexofenadine should be taken with only water due to the risk of decreased absorption

A

TRUE

33
Q

Which second-generation oral antihistamines preferred in pregnancy?

A
  • Loratadine
  • Cetirizine
34
Q

Which second-generation oral histamines have fast onset?

A
  • Cetirizine
  • Levocetirizine
35
Q

Which second-generation oral antihistamines are more sedating?

A
  • Cetirizine
  • Levocetirizine
36
Q

Which second-generation oral antihistamines are less sedating?

A
  • Fexofenadine
  • Loratadine
37
Q

Azelastine and olopatadine are intranasl antihistamines that can be combined with ___ to help with nasal congestion.

Fill in the blank

A
  • Intranasal steroid
38
Q

What are decongestants and their MOA?

A
  • 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
39
Q

Phenylephrine has __ oral absorption. It comes as __, but lasts for a __ time.

Fill in the blanks

A
  • Poor
  • Nasal spray
  • Shorter
40
Q

Pseudophedrine is an effective decongestant and is a precursor to __.

Fill in the blank

A
  • Methamphetamine
41
Q

Pseudophedrine, __ and __ are easily converted to methamphetamine and kept behind the counter

Fill in the blanks

A
  • Phenylpropanolamine
  • Ephedrine
42
Q

What is the maximun amount allowed for purchase of those three products?

A
  • 3.6 grams/day
  • 9 grams/month (30-day period)
43
Q

Oral decongestants - brand/generic, CIs, warnings, SEs

A
  1. Phenylephrine (Sudafed PE)
  2. 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

44
Q

Intranasal decongestants - brand/generic, SEs

A
  • Oxymetazoline (Afrin)

Side Effects: Rhinitis medicamentosa (rebound congestion if used longer than 3 days)

45
Q

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

A
  • Mast cell stabilizer
  • 2
  • Pregnancy
46
Q

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.

A

TRUE

47
Q

Immunotherapy is a __ treatment for allergies, either through __ injections or __ treatments. They work by __ increasing exposure to the allergen

Fill in the blanks

A
  • Preventative
  • SC
  • SL
  • Slowly
48
Q

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

A
  • Medical office
    *
  • 30 min
  • Epinephrine-auto injector
49
Q

What are the natural products used for cold?

A
  • Zinc
  • Vitamin C (ascorbic acid): decrease in the duration of the cold
  • Echinacea
  • Airborne and Emergen-C - combo of the 3
50
Q

MOA of expectorants and examples

A
  • 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)

51
Q

T/F: Dextromethorphan is a cough suppressant and it suppresses the cough reflex

A

TRUE

52
Q

Dextromethorphan acts as a ___. At high doses, it acts as an ___ leading to __ and __

Fill in the blanks

A
  • Serotonin reuptake inhibitor
  • NMDA-receptor blocker
  • Euphoria
  • Hallucinations
53
Q

Many states ban the sale of dextromethorphan to minors < __ years of age due to its abuse potential

Fill in the blank

A
  • 18
54
Q

Dextromethorphan - brand/generic, CIs, warnings

A
  • Dextromethorphan (Delsym, Robafen Cough, Robitussin Cough) + guaifenesin (Robafen DM, Robitussin DM)

Contraindications: Do not use within 14 days of MAO inhibitor

Warnings: seratonin syndrome

55
Q

Codeine - BW, CIs

A

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

56
Q

Other cough suppressants - names

A
  • Benzonatate (Tessalon Perles)
  • Diphenhydramine (Benadryl)
57
Q

T/F: Avoid promethazine (FDA) for children <2 years

T/F: Avoid topical menthol and camphor for children < 2 years

A
  • TRUE
  • TRUE
58
Q

T/F: Topical menthol, such as Vicks VapoRub can be applied to chest and neck, but never directly to the nose.

A

TRUE

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