Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 130 > Allergic Rhinitis e-Module > Flashcards

Allergic Rhinitis e-Module Flashcards

1
Q

Rhinitis definition

A

inflammation of nasal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how much of the population does rhinitis affect

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Rhinitis is the presence of one or more of what symptoms

A

sneezing
rhinorrhea
nasal congestion
nasal itching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the most common form of chronic rhinitis

A

allergic rhinitis AKA hay fever
25% of CAN pop
+prevalence is increasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is AR

A

systemic
IgE antibody-mediated
inflammatory disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what characterizes AR

A

inflammation (swelling and or irritation of inside of nose (nasal mucosa) following allergen inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

classifications of allergens

A

indoor and outdoor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

outdoor allergens

A

grass or tree pollen

mould

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

indoor allergens

A

dust mites and insects

animal dander

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

impacts of AR

A

negative impacts on social life, sleep, concentration ability, school performane, wrk productivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

where is prevalence hgihest

A

school aged children

-may be more common in children with history of asthma and atopic dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

atopic triad

A

AR, asthma, atopic dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How get AR

A

genetic predisoposition

  • 1 parent affected, children 30% chance dev
  • 2 parents –> 50%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

AR localization

A

historically
-nose and nasal passages

Current evidence
-component of systemic airway disease involving entire respiratory tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

allergy/sinus relief is in top 10 OTC cat in CAN (T/F)

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How RPh optimize care for AR patients

A

need to ID patient cohorts who self-select and are at high risk of mismanagement
—> opportunity for RPh to enegage pateints and encourage discussion abt AR mngmnt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pathophysiology and Etiology

A

multifactorial disease induced by gene-environment interactions

characteristic symptoms are result of an antigen-antibody mediated reaction
-3 phases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the 3 phases of the antigen-antibody mediated reaction

A

sensitization
immediate response
late phase reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Sensitization

A
  • allergen enters nose –> sensitizes mucosal mast cells
  • sensitization occurs via t-cell release of cytokines
  • cytokines promote allergen-specificIgE antibody production by plasma cells
  • IgE binds to mast cells and basophils

THIS FIRST PHASE OCCURS ON 1ST CONTACT WITH ALLERGEN
-second and third phase are on re-exposure to allergen in sensitized individual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Immediate response

A

early phase reaction occurs within minutes of exposure
-lasts 30-90 minutes

allergen bound to allergen specific IgE and the sensitized mast cells release preformed mediators
+histamine
+prostaglandin D2
+kinins

inflammatory mediators
-attract, recruit and activate additional inflammatory mediators into nasal mucosa —> late-phase response
+eosinophils, neutrophils and T lymphocytes

21
Q

Late reaction

A

associated with chronic inflammation charcterized by migration of inflammatory cells
+eosinophils, monocytes, macrophages, basophils

begin 4-8 hours after allergen exposure and peak 12-24 hours

release of cytokines chemokines and growth factors
-further perpetuate inflammatory response

results in recurrent symptoms that often persist
-usually nasal congestion

22
Q

Signs and symptonms

A 
Nasal obsturction (congestion)
sneezing
nasal itching
rhinorrhea
Postnasal drainage (postnasal drip)
irritability
fatigue
23
Q

Common symptoms patients rarely report directly

A 
subset of patients:
concomitant allergic conjunctivitis
\+bilateral ocular itching
\+redness
\+tearing
\+burning

Other symptoms

  • facial P (over cheeks and forehead
  • itchy throat/palate
  • ear fullness and popping
24
Q

Clinical presentation of AR depending on phase of allergic reaction

A

Sensitization phase
- asymptomatic

Early response (cts to late response)

  • sneezing,
  • rhinorrhea,
  • nasal and palatal pruritis,
  • congestion

Late Response

  • nasal congestion is particularly common
  • fatigue
  • malaise
  • irritability
  • neurocognitive deficits (possible)
  • allergic shiners
  • morgan’s lines
  • transverse nasal creases
25
Q

Physical exam: Face

A 
Allergic facies
-highly arched palate
-open mouth (chronic mouth breathing)
-dental malocclusion
TYPICALLY SEEN IN CHILDREN WITH EARLY ONSET AR

OTHER:

  • frequent gimacing
  • twitching face and nose (itchy mucus membs)

younger children typically dont blow nose

  • frequently rub, snort, sniff, cough, clear throats
  • scratch their itchy palates with their tongues, producing a clicking sound
26
Q

Physical signs: eyes

A

Dennie-morgan lines
-accentuated lines or folds below lower eyelids that may become more noticeable with age —> suggest concomitant allergic conjunctivitis

Allergic conjunctivitis
-ocular itching, burning, tearing, conjunctival injection (redness faiding twd edges)

Allergiv shiners

  • infraorbital edema and darkening due to subcutaneous venodilation
  • more severe disease more pronounced discoloration under eyes
27
Q

Physical exam: nose

A 
allergic salute
-transverse nasal crease casued byrepeated rubbing and pushing/wiping tip
-upward motion
-try and relieve itching and open airway
\+more common in children

Nasal mucosal swelling, bleeding

bluish or pale, thin secretions

nasal polyps or other structural abnormalities visible by internal endoscopy

28
Q

physical signs: posterior oropharynx

A

postnasal drip

  • nasal passages obstructed, rhinorrhea may be visible dripping down posterior pharynx
  • leads to cough/ frequent throat clearing
  • constant swallowing or halitosis

lymphoid hyperplasia
-hyperplastic lymphoid tissue lining posterior pharynx (resembles cobblestones)

tonsillar hypertrophy
-persistently enlarged tonsils

29
Q

physical exam: ears

A

-generally normal

  • tympanic membranes may retract
  • serous fluid may accumulate behind TMs of patients with seig nasal mucosal swelling
  • eustacian tube dysfunction

pneumatic otoscopy –> asses eustachian tube dysfunction
valsalva’s maneuver –> asses for fluid behind ear drum

30
Q

physical exam:sinuses

A

palpitation of sinuses for sensitivity

maxillary tooth sensitivity

31
Q

physical exam: chest and skin

A

Wheezing (sign of concurrent asthma

atopic disease

32
Q

what is one of most important sequalae of untreated AR

A

sleep disturbed breathing

33
Q

Cognitive and psychiatric issues: children/adolescents

A
  • ADHD
  • lower exam scores during peak pollen seasons
  • poor conc
  • impaired athletic performance
  • low self esteem
34
Q

Cognitive and psychiatric issues: in adults

A
  • anxiety
  • depression
  • reduced academic performane
  • reduced work productivity (lower than that of patients with asthma)
  • impaired sexual performance
  • lower quality of life scores
35
Q

Classification: traditional

A

perennial (throughout year)

seasonal (specific season)

FALLEN OUT OF FACOUR
-seasonal allergies may exp symptoms year-round and perennial may experioence symptoms intermittently

36
Q

modern classification of AR

A

based on symptom duration AND severity

  • intermittent or persistent
  • mild, moderate, severe
37
Q

Intermittent AR

A

<4 days/wk OR <4 consecutive weeks

38
Q

persistent AR

A

> 4days/wk AND >4 consecutive weeks

39
Q

mild symptoms

A

normal sleep
symptoms not bothersome
no impairment of daily activities, sports, leisure
normal work/school

40
Q

moderate/severe

A

abnormal sleep OR
symptoms are bothersome OR
impairment of daily activities, sports, leisure OR
problems at work/school

41
Q

how subjectively quantify patient symp severity

A

VAS - visual analogue scale

For AR, usually asked over past 24 hours how troublesome are allergy symptoms (0-10)

10cm horizontal line
-not bothersome ———————–very bothersome

42
Q

VAS score less than 2

A

well-controlled AR

43
Q

VAS score [2,5)

A

partly controlled disease

44
Q

VAS score 5 or more

A

uncontrolled AR

45
Q

MASK-air

A

reliable valid highly engaging tool
treatment scroll list
VAS to assess AR control and school/work productivity

46
Q

MASK-air VAS questions

A 
VAS 1 (overall symptoms): “Overall, how much are your allergic symptoms bothering you today?”
    VAS 2 (Rhinitis): “How much are your nose symptoms bothering you today?”
    VAS 3 (Conjunctivitis): “How much are your eye symptoms bothering you today?”
    VAS 4 (asthma): “How much are your asthma symptoms bothering you today?”
47
Q

Protective and risk factors

A

falmily history = one of strongist predictors of dev of AR

Others:

  • male gender
  • birth during pollen season
  • firstborn status
  • overweight
  • maternal exposure to indoor allergens sa dust mite allergen
  • serum IgE >100IU/mL before age 6
  • presence of allergen-specific IgE
48
Q

SCHOLAR

A

S: main & associated symptoms: nasal pruritus, congestion, rhinorrhea, sneezing, eye involvement

C: characteristics of allergic symptoms: frequency, severity: VAS score, QoL impact

H: history of AR

O: onset/timing/pattern/seasonality of symptoms (e.g., intermittent, persistent)

Note: It’s not uncommon for patients to attribute persistent nasal symptoms to a “constant cold” and so it remains imperative to document both the duration and frequency of these “colds”.10

L: location of symptoms (e.g., nose, eyes, palate)

A: aggravating factors (e.g., triggers, irritants)

R: remitting factors (including therapies tried, regimens followed, and subsequent responses)

Pharm 130 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions