Allergic rhinitis, cough & cold Flashcards
Allergic rhinitis treatment
Intranasal steroids
Antihistamines
Decongestants
Intranasal steroids
most effective in reducing nasal symptoms of AR (sneezing, itching, rhinorrhea, congestion)
- Budesonide (Rhinocort)
- Fluticasone (Flonase)
- Triamcinolone (Nasacort)
Rhinocort Allergy
Intranasal steroid
Budesonide
OTC
6yo and older
Flonase
Intranasal steroid
Fluticasone
Rx & OTC
2yo and older
(+ azelastine -> Dymista)
Nasacort
Intranasal steroid
Triamcinolone
OTC
2yo and older
Intranasal steroid safety warnings
- avoid use if recent trauma to nasal passages
- high doses for prolonged periods adrenal suppression & immunosuppression
- increased intraocular pressure -> caution in cataracts & glaucoma
Intranasal steroids ADE
- nose bleed
- HA
- dry nose
- unpleasant taste
- localized infection
Preferred nasal steroids in pregnancy
- budesonide
- beclomethasone
Antihistamines
commonly used for mild-moderate allergic rhinitis
effective in reducing symptoms of itching, sneezing, rhinorrhea
little effect on congestion
First gen antihistamines
- diphenhydramine (benadryl)
- chlorpheniramine (Aller-Chlor)
- Doxylamine
first gen antihistamines: safety / side effects / monitoring
CI: neonates, premature infants, breastfeeding
Warnings:
- avoid in elderly and children < 2
- caution in pts with BPH and glaucoma
ADE:
- somnolence
- cognitive impairment
- anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation
second gen antihistamines
- Cetirizine (Zyrtec)
- Levocetirizine (Xyzal)
- Fexofenadine (Allegra)
- Loratadine (Claritin)
2nd gen antihistamines safety / ADE / monitoring
CI:
- levocetirizine CI in ESRD
ADE:
- somnolence (less than 1st gen)
- HA
Zyrtec
2nd gen antihistamine
Cetirizine
Xyzal
2nd gen antihistamine
Levocetirizine
Allegra
2nd gen antihistamine
Fexofenadine
Notes: take with water only & avoid admin with aluminum or magnesium
Claritin
2nd gen antihistamine
Loratadine
preferred 2nd gen antihistamines in pregnancy
loratadine
cetirizine
fastest onset 2nd gen antihistamines
cetirizine
levocetirizine
more sedating 2nd gen antihistamines
cetirizine
levocetirizine
less sedating 2nd gen antihistamines
fexofenadine
loratadine
Decongestants moa
alpha-adrenergic agonists (sympathomimetics) -> vasoconstriction
Decongestants: agents
- Phenylephrine (Sudafed PE)
- Pseudoephedrine (Sudafed, Nexafed, Zephrex-D)
Decongestant safety / ADE/ monitoring
- do not use within 14 days of MAOi
- avoid in children < 2 (FDA), < 4 (labeling)
- avoid in first trimester of pregnancy
- ADE: tachycardia, palpitations, inc BP, insomnia, dec appetite
Afrin
topical decongestant
Oxymetazoline
Notes:
- do not use for more than 3 days
- caution in patients with BPH
- can cause rebound congestion with prolonged use
- fast onset (5-10 min)
Expectorants
used to thin mucus in productive cough
Agent:
- Guaifenasin (Mucinex)
ADE:
- N/V/D, dizziness, HA, rash
Do not use ER caps in children < 12
Cough suppressants: when to use
used for nonproductive cough, or to suppress productive cough at night
Cough suppressants: agents
- Dextromethorphan (Delsym, Robafen, Robitussin)
- Codeine
- Benzonatate (Tessalon Perles)
- Diphenhydramine (Benadryl)
Delsym, Robafen, Robitussin
cough suppressant
Dextromethorphan
do not use within 14 days of MAOi
ADE: N/V, drowsiness, serotonin syndrome
OTC: do not use in children < 4 years
Tessalon Perles
Cough suppressant
Benzonatate
do not use in children < 10 years old
ADE: somnolence, confusion, hallucinations
