Allergic Rhinitis/Cough/Colds

Question 1

Can prevent or suppress the major symptoms of allergic rhinitis

• Budesonide, fluticasone propionate, triamcinolone
• Adverse effects: drying of the nasal mucosa and a burning or itching sensation, sore throat, epistaxis, and headache
• Systemic effects are possible but are rare at recommended doses. The major concerns are adrenal suppression and slowing of linear growth in children (whether final adult height is reduced is unknown)

Answer 1

Intranasal glucocorticoids

Question 2

• These drugs can relieve sneezing, rhinorrhea, and nasal itching; however, they do not reduce nasal congestion
• Less effective than glucocorticoids
• The most common complaint is sedation, which occurs frequently with the first-generation antihistamines (e.g., diphenhydramine) and much less often with the second-generation agents (e.g., fexofenadine)
• Anticholinergic effects also common with first-generation

Answer 2

Oral Antihistamines

Question 3

• Azelastine, olopatadine
• The usual dosage is two sprays in each nostril twice daily
• Systemic absorption can cause somnolence
• Some patients experience nosebleeds and headaches, can also cause unpleasant taste

Answer 3

Intranasal antihistamines

Question 4

• Reduces symptoms by suppressing the release of histamine and other inflammatory mediators from mast cells
• Best suited for prophylaxis and hence should be given before symptoms start
• Responses may take a week or two to develop
• Adverse reactions are minimal

Answer 4

Intranasal cromolyn sodium

Question 5

• Reduce nasal congestion by activating α1-adrenergic receptors on nasal blood vessels
• This causes vasoconstriction, which, in turn, causes shrinkage of swollen membranes followed by nasal drainage
• Only relieve congestion
• Phenylephrine, Pseudoephedrine (associated with abuse), Oxymetazoline
• Adverse effects: Rebound congestion (limit 3-5 days), CNS stimulation, widespread vasoconstriction

Answer 5

Decongestants (Sympathomimetics)

Question 6

Indicated for allergic rhinitis, asthma, and the common cold

• Administered as a nasal spray (0.03% and 0.06%)
• Blockade of cholinergic receptors inhibits secretions from the serous and seromucous glands lining the nasal mucosa and decreases rhinorrhea
• Does not decrease sneezing, nasal congestion, or postnasal drip
• Systemic effects are absent

Answer 6

Ipratropium (Anticholinergic Agent)

Question 7

Benefits derive from blocking binding of leukotrienes to their receptors

• In people with allergic rhinitis, leukotrienes act primarily to cause nasal congestion (by promoting vasodilation and by increasing vascular permeability)
• By blocking leukotriene receptors, montelukast relieves nasal congestion, although it has little effect on sneezing or itching
• Can cause rare but serious neuropsychiatric effects including agitation, aggression, hallucinations, depression, insomnia, restlessness, and suicidal thinking and behavior

Answer 7

Montelukast (Leukotriene Antagonist)

Question 8

• Monoclonal antibody directed against IgE, an immunoglobulin (antibody) that plays a central role in the allergic release of inflammatory mediators from mast cells and basophils
• Several studies have demonstrated significant improvement of allergic symptoms

Answer 8

Omalizumab (Monoclonal Antibody)

Question 9

Codeine, Hydrocodone

• Both drugs act in the CNS to elevate cough threshold
• Hydrocodone is somewhat more potent than codeine and carries a greater liability for abuse
• Codeine is the most effective cough suppressant available. The drug is active orally and can decrease both the frequency and intensity of cough
• Adverse effects: suppression of respiration

Answer 9

Opioid Antitussives

Question 10

• Most effective over-the-counter (OTC) nonopioid cough medicine and the most widely used of all cough medicines
• Derivative of the opioids; however, it does not produce typical opioid-like euphoria or physical dependence (except when taken in high doses)
• Can also reduce pain due to blockade of receptors for N-methyl-D-aspartate (NMDA) in the brain and spinal cord

Answer 10

Dextromethorphan

Question 11

• Structural analog of two local anesthetics: tetracaine and procaine
• Suppresses cough by decreasing the sensitivity of respiratory tract stretch receptors (components of the cough-reflex pathway)
• Adverse effects are usually mild (e.g., sedation, dizziness, and constipation
• Should be swallowed intact
• Not safe for children under 10 years of age

Answer 11

Benzonatate

Question 12

Ex. Guaifenesin

Drug that renders cough more productive by stimulating the flow of respiratory tract secretions

Answer 12

Expectorant

Question 13

Ex. hypertonic saline and acetylcysteine

Drug that reacts directly with mucus to make it more watery

Answer 13

Mucolytic