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NAPLEX Review > Allergic Rhinitis, Cough & Cold > Flashcards

Allergic Rhinitis, Cough & Cold Flashcards

1
Q

What is first line therapy for chronic, moderate-to-severe symptoms of allergies

A

Intranasal steroids

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2
Q

What is first line therapy for mild, intermittent symptoms of allergies

A

Oral antihistamines

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3
Q

Intranasal steroid MOA

A

decreases inflammation

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4
Q

Intranasal steroids Warnings and SE

A

Warnings: avoid use if recent nasal trauma, high doses for prolonged periods can cause adrenal suppression, decreased growth velocity, and immunosuppression; can increase intraocular pressure
SE: epistaxis (nose bleeds), HA, dry nose, unpleasant taste

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5
Q

What are OTC and Rx intranasal steroids

A

OTC: Budesonide, fluticasone, Triamcinolone
Rx: beclomethasone, ciclesonide, flunisolide, mometasone

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6
Q

What are the preferred intranasal steroids in pregnancy?

A

Budesonide and beclomethasone

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7
Q

Antihistamine effect on allergies

A

reduce itching, sneezing, rhinorrhea, and other types of immediate hypersensitivity reactions

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8
Q

Antihistamine MOA

A

block histamine at histamine-1 (H1) receptor site

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9
Q

What are first generation oral antihistamines?

A

Diphenhydramine, chlorpheniramine, doxylamine, clemastine, carbinoxamine

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10
Q

Which have more sedating side effects, first or second generation antihistamines?

A

First

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11
Q

First generation oral antihistamine CI, Warnings, SE

A

CI: newborn or premature infants, lactating women, acute asthma, use with MAOi
Warnings: avoid in elderly and children <2
SE: somnolence, cognitive impairment, strong anticholinergic effects and seizures/arrhythmias at high doses

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12
Q

What are second generation oral antihistamines?

A

Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
Fexofenadine (Allegra)
Loratadine (Claritin)

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13
Q

What are the intranasal antihistamines

A

Azelastine

Olopatadine

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14
Q

Second generation oral antihistamine CI, warnings, SE

A

CI: levocetirizine ESRD, hemodialysis, infants and children 6 months-11 years with renal impairment
Warnings: CNS depression/sedation
SE: somnolence can be seen, HA

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15
Q

Which second generation oral antihistamines are preferred in pregnancy?

A

Cetirizine and loratadine

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16
Q

Which are the least sedating second generation oral antihistamines?

A

fexofenadine and loratadine

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17
Q

Decongestant MOA

A

alpha-adrenergic agonist that cause vasoconstriction which decreases sinus and nasal congestion

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18
Q

What is the maximum amount of pseudoephedrine allowed for purchace according to federal law?

A

3.6g/day
9g/30 days

States can make a more strict law

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19
Q

Phenylephrine vs oxymetazoline
Which has longer half life?
Which has more side effects?

A

Oxymetazoline - shorter half-life

Phenylephrine - more side effects

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20
Q

What 3 OTC medications are restricted and can be converted to methamphetamine?

A

pseudoephedrine, phenylpropanolamine, and ephedrine

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21
Q

What are systemic decongestants?

A

Phenylephrine (Sudafed PE)

Pseudoephedrine (Sudafed, Nexafed, Zephrex-D)

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22
Q

Oral decongestant (phenylephrine, pseudoephedrine) CI, warnings, SE

A

CI: Do not use within 14 days of MAOi
Warnings: Avoid in children <2 (FDA), and <4 (package labeling), use with caution in patients with CV disease and uncontrolled HTN, hyperthyroidism, diabetes, bowel obstruction, glaucoma, BPH
SE: cardiovascular stimulation, CNS stimulation, decreased appetite, dizziness, HA

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23
Q

Which has a higher availability and is a more effective decongestant?
Phenylephrine or pseudoephedrine

A

Pseudoephedrine

24
Q

What are topical decongestants and how are they administered?

A

Oxymetazoline (Afrin) and Phenylephrine (Neo-Snephrine)

Administered nasally

25
Intranasal decongestant CI, Warnings, and SE
CI: Oxymetazoline (do not use for more than 3 days?) Warnings: do not use with MAOi or if closed-angle glaucoma, use with caution in patients with CV disease and uncontrolled HTN, thyroid disease, diabetes, and BPH SE: rhinitis, medicamentosa (rebound congestion if used >3 days)
26
Which has faster onset, intranasal or oral decongestants?
intranasal
27
Intranasal cromolyn MOA and indication
Mast cell stabilizer | Treatment and prophylaxis of allergic rhinitis
28
Intranasal cromolyn administration, when to see max effect, who is it safe to use in?
Administer daily (not PRN) Improvement in 3-7 days Max effect in 2-4 weeks Safe in children >2 and pregnancy
29
Montelukast MOA and indication
Leukotriene modifying agent | Allergic rhinitis and asthma
30
Montelukast BBW
Serious neuropsychiatric side effects including suicidal thoughts and actions
31
What symptoms is intranasal ipratropium used for?
Decreasing rhinorrhea by causing nasal dryness
32
How is immunotherapy used to help with allergies?
Used as a way to prevent allergies through subcutaneous injections or sublingual treatments SLOWLY increase exposure to allergen making immune system less sensitive to allergen
33
How long should immunotherapy be done to treat allergies?
At least 3 years
34
What are the four different sublingual treatments for allergic rhinitis and what do they target?
Oralair - 5 types of grass pollen Grastek - timothy grass pollen Ragwitek - ragweed pollen Odactra - house dust mite allergen
35
How is the common cold spread?
Mucus secretions (via patient's hand) or coughing/sneezing (via air)
36
How is a cold treated?
You don't treat the cold - you treat the symptoms | Colds are caused by viruses
37
What natural products are used for colds? Are they effective?
Zinc and Echinacea - "possibly effective" | Vitamin C - effectively decrease cold duration
38
What can high doses (4 g/d) of vitamin C cause?
Diarrhea and kidney stones
39
What OTC medications are expectorants? When should they be used?
Guaifenesin | Use if cough is productive to thin and move secretions up and out of the lungs
40
Guaifenesin SE
Nausea, vomiting, dizziness, HA, rash, diarrhea, stomach pain
41
What medications are cough suppressants? Which are OTC vs Rx?
Dextromethorphan - OTC Codeine - Rx (CII if for pain, CV if for cough/cold) Benzonatate - Rx Diphenhydramine - OTC/Rx
42
What schedule is codeine?
CII if used for pain | CV if in combo product for cough and cold and has <200mg codeine/100mL
43
When are cough suppressants used?
For dry, nonproductive cough or to suppress cough to allow for sleep at night
44
How is dextromethorphan abused?
At high doses, it acts as an NMDA-receptor blocker which causes euphoria and hallucinations
45
How does dextromethorphan work at therapeutic doses?
Acts as a serotonin reuptake inhibitor
46
Dextromethorphan CI, SE
CI: use within 14 days of an MAOi SE: serotonin syndrome (if co-administered with other serotonerigic drugs), N/V, drowsiness
47
Codeine BBW, CI
BBW: respiratory depression and death (children) following tonsillectomy and/or adenoidectomy with CYP2D6 polymorphism and nursing infants with mothers who have CYP2D6 polymorphism CI: children <12 (any indication) and <18 after tonsillectomy and/or adenoidectomy
48
Benzonatate warnings and SE
Warnings: Children <10 SE: somnolence, confusion, hallucinations
49
What is included in a cough and cold combo product if the name contains D
decongestant (phenylephrine or pseudoephedrine)
50
What is included in a cough and cold combo product if the name contains PE
Phenylephrine
51
What is included in a cough and cold combo product if the name contains DM
dextromethorphan
52
What is included in a cough and cold combo product if the name contains AC
codeine
53
What analgesia is most commonly contained in OTC cough/cold combo products?
Acetaminophen
54
What cough and cold agents are safe to use in children?
hydration, nasal bulbs, saline drops/sprays (ocean), vaporizers/humidifiers Ibuprofen/APAP for pain or fever
55
What cough and cold medications should be avoided in children <18, 4, and 2?
<18: codeine and hydrocodone-containing products (FDA) <4: Avoid OTC cough and cold products (package labeling) <2: Avoid OTC cough and cold products and promethazine (FDA) and topical menthol and camphor (package labeling)
56
Why should promethazine not be used in children <2 years old?
Risk of fatal respiratory depression
57
Why should menthol an camphor not be used in children <2?
Menthol can cause cardiac and CNS toxicity if ingested | Camphor lacks data

NAPLEX Review (79 decks)

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