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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
Q

Intranasal decongestant CI, Warnings, and SE

A

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
Q

Which has faster onset, intranasal or oral decongestants?

A

intranasal

27
Q

Intranasal cromolyn MOA and indication

A

Mast cell stabilizer

Treatment and prophylaxis of allergic rhinitis

28
Q

Intranasal cromolyn administration, when to see max effect, who is it safe to use in?

A

Administer daily (not PRN)
Improvement in 3-7 days
Max effect in 2-4 weeks
Safe in children >2 and pregnancy

29
Q

Montelukast MOA and indication

A

Leukotriene modifying agent

Allergic rhinitis and asthma

30
Q

Montelukast BBW

A

Serious neuropsychiatric side effects including suicidal thoughts and actions

31
Q

What symptoms is intranasal ipratropium used for?

A

Decreasing rhinorrhea by causing nasal dryness

32
Q

How is immunotherapy used to help with allergies?

A

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
Q

How long should immunotherapy be done to treat allergies?

A

At least 3 years

34
Q

What are the four different sublingual treatments for allergic rhinitis and what do they target?

A

Oralair - 5 types of grass pollen
Grastek - timothy grass pollen
Ragwitek - ragweed pollen
Odactra - house dust mite allergen

35
Q

How is the common cold spread?

A

Mucus secretions (via patient’s hand) or coughing/sneezing (via air)

36
Q

How is a cold treated?

A

You don’t treat the cold - you treat the symptoms

Colds are caused by viruses

37
Q

What natural products are used for colds? Are they effective?

A

Zinc and Echinacea - “possibly effective”

Vitamin C - effectively decrease cold duration

38
Q

What can high doses (4 g/d) of vitamin C cause?

A

Diarrhea and kidney stones

39
Q

What OTC medications are expectorants? When should they be used?

A

Guaifenesin

Use if cough is productive to thin and move secretions up and out of the lungs

40
Q

Guaifenesin SE

A

Nausea, vomiting, dizziness, HA, rash, diarrhea, stomach pain

41
Q

What medications are cough suppressants? Which are OTC vs Rx?

A

Dextromethorphan - OTC
Codeine - Rx (CII if for pain, CV if for cough/cold)
Benzonatate - Rx
Diphenhydramine - OTC/Rx

42
Q

What schedule is codeine?

A

CII if used for pain

CV if in combo product for cough and cold and has <200mg codeine/100mL

43
Q

When are cough suppressants used?

A

For dry, nonproductive cough or to suppress cough to allow for sleep at night

44
Q

How is dextromethorphan abused?

A

At high doses, it acts as an NMDA-receptor blocker which causes euphoria and hallucinations

45
Q

How does dextromethorphan work at therapeutic doses?

A

Acts as a serotonin reuptake inhibitor

46
Q

Dextromethorphan CI, SE

A

CI: use within 14 days of an MAOi
SE: serotonin syndrome (if co-administered with other serotonerigic drugs), N/V, drowsiness

47
Q

Codeine BBW, CI

A

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
Q

Benzonatate warnings and SE

A

Warnings: Children <10
SE: somnolence, confusion, hallucinations

49
Q

What is included in a cough and cold combo product if the name contains D

A

decongestant (phenylephrine or pseudoephedrine)

50
Q

What is included in a cough and cold combo product if the name contains PE

A

Phenylephrine

51
Q

What is included in a cough and cold combo product if the name contains DM

A

dextromethorphan

52
Q

What is included in a cough and cold combo product if the name contains AC

A

codeine

53
Q

What analgesia is most commonly contained in OTC cough/cold combo products?

A

Acetaminophen

54
Q

What cough and cold agents are safe to use in children?

A

hydration, nasal bulbs, saline drops/sprays (ocean), vaporizers/humidifiers
Ibuprofen/APAP for pain or fever

55
Q

What cough and cold medications should be avoided in children <18, 4, and 2?

A

<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
Q

Why should promethazine not be used in children <2 years old?

A

Risk of fatal respiratory depression

57
Q

Why should menthol an camphor not be used in children <2?

A

Menthol can cause cardiac and CNS toxicity if ingested

Camphor lacks data

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