Brainscape's Knowledge GenomeTM

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


See full index

130: Professional Practice 2 > Allergic Rhinitis: patient assessment > Flashcards

Allergic Rhinitis: patient assessment Flashcards

1
Q

what are the 3 types of rhinitis

A

allergic

infectious

nonallergic non infectious

can also gen a combo (mixed rhinitis)

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

what causes non allergic non infectious rhinitis

A

reactive rhinitis (rhinopathy) - hyper responsiveness to non allergic, physical or chemical stimuli

  • gustatory rhinitis

drug indued rhinitis

endocrine disorders

hormonal rhinitis

non allergic rhinitis with eosinophilia syndrome

atrophic rhinitis

rhinitis of elderly

idopathic rhinitis

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

distingusihing between allergic rhinitis and non allergic

symptom presentation

sneezing

rhinorrhea

pruritus of eyes/nose and/or palate

nasal obstruction

conjunctivities

A
  • symptom presentation
    • AR: Bilateral, worst upon waking, subtile during day, worse at night
    • NARunilateral symptoms common but can be bilateral. constant day and night
  • sneezing
    • AR: frequest, paroxysmal
    • NAR little to none
  • rhinorrhea
    • AR: anterior watery
    • NAR posterior, wateror/thick or mucopurulent (often ass w/ ifnection)
  • pruritus of eyes/nose and/or palate
    • AR: Frequest
    • NAR: not present
  • nasal obstruction
    • AR variable
    • NAR: usually present and often severe
  • conjunctivities
    • AR frequent
    • NAR: not present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

distingusihing between allergic rhinitis and non allergic

Pain

anosmia

Epistaxis

facial,nasal or throat featues

age/onset of smp

pattern of symptoms

A
  • Pain
    • AR: Sinus pain due to congestion
    • NAR: Variable depending on cause
  • anosmia
    • AR: Rate
    • NAR: Frequest
  • Epistaxis
    • AR: Rare
    • NAR: recurrent
  • facial,nasal or throat features
    • AR: allergic shinners, facies, salute
    • NAR: nasal polyps, spetal deviation, enlarged tonsils and/or adenoids
  • age/onset of smp
    • AR: Earlier
    • NAR: Later
  • pattern of symptoms
    • AR: seasonal or perennial
    • NAR: almost always perennial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how can you distingish AR from structural/mechanical Abnormalities

A

look for

Deviated septum

Enlarged adenoids

Hypertrophic turbinates

Foreign bodies/nasal trauma

Choanal atresia

Nasal polyps

Nasal tumors (benign or malignant)

Nasal valve problems

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

how can you distingish AR from Autoimmune disorders

A

Sjogren’s syndrome

Systemic lupus erythematous (SLE)

Relapsing polychondritis

Eosinophilic Granulomatosis with polyangiitis (formerly Churg-Straus syndrome)

Granulomatous diseases (sarcodosis, granulomatosis with polyanglitis)

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

what else could be mistaken for AR

A

Cystic fibrosis

Cilia dyskinesia syndromes (e.g., primary ciliary dyskinesia)

Immunodeficiency

Amyloidosis

Chronic fatigue syndrome

Disorders of acid reflux: GERD or Laryngopharyndeal erflux (LPR)

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

nasal symptoms that are red flags for AR

A

Unilateral nasal symptoms

Recurrent epistaxis

Mucopurulent nasal discharge

Post-nasal drip with thick mucous

Anterior rhinorrhea with pain

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

ocular red flags for AR

A

Unilateral eye symptoms

Eye pain (infection? Iritis?)

Photophobia

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

other red flags for AR

A

Fever

Muscle pain

Persistent cough

Loss of taste or smell

Symptoms suggestive of anaphylaxis

Wheezing, shortness of breath (asthma?)

Persistent headache, facial pain (sinusitis?)

Other symptoms consistent with uncontrolled asthma, COPD, recurrent sinusitis, otitis media, or thyroid disorder

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

populations that should be referred for AR

A
  • patients who have severe symptms or if trigger for symptom cant be identified
  • pregnant atients -> could be hormonal rhinitis
  • children wtih moderate/severe AR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ar Assessment questionaire

A

symptoms in section 1 are NOT found in AR

  • presence of ANY ONE of the suggests an alternative diagnoses shoudl be investiagted -> consider referral to specialist

(Purulent discharge, postnasal drip, facial pain, and loss of smell are common symptoms of sinusitis - sinusitis usually comes with rhinitisso still evualtue with possibilty of AR

* if have watery/runny nose + one or more symptoms in section 2 it suggests AR

* if have has sneezing, nasal itching, and/or conjunctivitis, but NOT watery runny nose, consider alternative diagnoses and/or referral to a specialist.

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

what are the goals of therapy for treatment of AR

A
  • prevent symptoms by avoiding expsoure to alelrgens
  • alleviate signs and symptoms produced by allergic response
  • minimize adverse effects of treatment
  • improve QOL (swool/work performance, sllep, social functioning)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the non pharmacologic adjunct therapies for AR

A

prevention

saline ansal irrigation

libricant eye drops

cold compress

sunglasses

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

describe prevention as a non pharmacologic adjunct therapy for AR

A
  • avoidance of allergens is first step in management and will reduce medication use
  • Pollen:
    • change clothes and bathe/shower after going outdoors
    • do not dry clothes outdoors, stay indoors
  • Moulds
    • remove houseplants
    • keep indoor humidity between 40-45+
    • use fungicide on sinks, showers, garbage pails
  • Dust mites:
    • wash bedding once/week with hot water
    • encase mattresses, pillows
    • repelace carppet with hardwood flooring
  • Animal Dander
    • keep pets outside of bedroom and main living areas
    • brush pets outside, wash cats weekly and dogs biweekly
    • install HEPA filter
  • Tobacco smoke
    • avoid smoking in car or inside home
    • use of air conditioning may be helpful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Saline Nasal Irrigation (SNI) as a non pharmacologic adjunct therapy for AR

A
  • rinse nasal cavity with salt water solution

safe and cheap alternative or adjuct to pharm therapy

  • shown to improva nasal symptoms, reduce patietn-reported disease severity, decrease use of medicines and impove QOL
  • likley works by moisturizing dty nasal passages, thinning mucus (snot) and flushign out some irritating allergens from nose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

first line option for AR in pregnancy

A

saline nasal irigation

18
Q

what other non pharm treatments for AR exist

A
  • Lubricant eye drops
    • help dilute and flush out allergens and inflammatory cells from tear film
    • can treat comorbid dry eye
  • cold compress
    • can alleviate occular itching by causing conjunctival vasoconstriction
    • reduced hyperemia and edema
  • Sunglasses
    • large wraparound sunglasses may be useful to reduce contact with aeroallergens and improve photophobia
19
Q

how to assess for control in untreated symptopatic patient

A
20
Q

assess for control in treated symptomatic patients

A
21
Q

describe the step up approach for treating AR

A
  1. For mild symptoms, use non sedating H1 antihistamines (oral, intranasal or ocualr)
  2. For moderate-to-severe symptoms and/or persistent AR, use INCS
  3. For patients with uncontrolled symptoms at step 2, use combo of INCS and INAH (intranasal corticosteroids and intranasal antihistamines)
  4. Additional short course of oral sterioids may help establish and continue control yb step 3
    • Intraocular cromones or H1-antihistamines can be added to improve the control of ocular symptoms.

* step down approach can be used in patietns with prev treatment failure or resistance to monotherapy -> step 3 as the frist option, then after few days of imporve conider treatemnt reduction

22
Q

first line therapy for mild, intermitted AR

Rx and Non Rx

A

second generation oral anti histamines

  • only procue modest imporvement in nasal congestion but 1st gen no longer recommneded bc of adverse effects

Non Rx: Cetirizine, Desloratadine, Fexofenadine, Loratadine

Rx: Cetirizine (20mg), Bilastine, Rupatadine

23
Q

first lien therapy for treatment for mild persistent AR

A

regularly administered intranasal corticosteroids

Non Rx: Triamcinolone acetonide, Fluticasone propionate

Rx: Beclomethasone dipropionate, Budesonide, Ciclesonide, flunisolide, fluticasone furonate, mometasone furoate

24
Q

first line treatment for moderate severe AR

A

regularly administered intranasal corticosteroids

Non Rx: Triamcinolone acetonide, Fluticasone propionate

Rx: Beclomethasone dipropionate, Budesonide, Ciclesonide, flunisolide, fluticasone furonate, mometasone furoate

25
Q

why not use first gen antihistamines for AR

give exmaples of them

A

diphenhydramine, chlorpheniramine

  • not selective for H1 reecptor, also have antimuscarinic, anti-alpha, adrenergic and anti-serotonin effect
  • easily cross BBB
  • associated with sedation, psychomotor retardation, reduced academic performact
26
Q

use fo 2nd generation antihistamines for treatmetn of AR

A

ex: fexofenadine, bilastine

more specific for peripheral H1 receptors, limited penetration in BBB (reduced sedation)

  • effectively reduce sneezing, itching and rhinorrhea when taken regularly at the time of maximal symptoms or prior to allergen exposure
  • best results when obtained w/ chronic dosing rather than intermitent
27
Q

what antihisatmine would you not use in children

A

Bilastine (Blexten)

fexogenadine (allegra) not indicated in children under 6

28
Q

drawbacks of antihistamines

A
  • less potent then INCS, but many patients prefer oral drugs
  • intranasal AH less effective than INCS, but work in minutes
  • second gen OAH generally well tolerated but can cause occasiaonal sedation, dry mouth and headache
  • first generation OAH are no logner recommended for AR bc of high risk of significant AE
29
Q

treatment of AR with INCS

A
  • mainstay therapy for moderate-severe AR or mild persistent AR
  • combo of OAH and INCS not found more effective than monotherapy with INCS*
  • can experience benefit in first day of therapy, but most comes 2-4 weeks in
  • potential side effects are nasal irritation and nose bleeds, but less common in newer formulations
30
Q

Rx INCS

A
  • Beclomethasone dipropionate (Beconase Aq®) 50mcg
  • Budesonide (Rhinocort Aqua®)
  • Ciclesonide (Omnaris®)
  • Fluticasone furoate (Avamys®)
  • Fluticasone propionate (Flonase®)
  • Mometasone (Nasonex®)
  • Triamcinolone acetonide (Nasacort Aq®)
31
Q

Non Rx INCS

A

Triamcinolone acetonide (Nasacort Allergy 24HR®)

Fluticasone propionate (Flonase® Allergy Relief) 50mcg

32
Q

frist line therapy for mild, persistent AR or moderate-to-severe AR in patients over 12 years of age

A

Intranasal Corticosteroids (INCS) + Intranasal Antihistamine (INAH)

  • Fluticasone/azelastine (Dymista®) 50mcg/137mcg
  • also reduced ocular symptoms
  • works in min but peak in several days/weeks
  • shoudl be used regularly
  • consider in patients who dont respond to INCS alone
33
Q

Leukotriene Receptor Antagonists (LTRA) for AR treatment

A

ex: montelukast and zafirlukast
- mostest effiacy similar to OAH, not as effective as INCS
- can be used as monotherapy or in combo with INCS or OAH in patients with concomitant asthma
- can use if patients dont improve or cant tolerate first line

34
Q

Intranasal anticholinergics for treatment of AR

A
  • Intranasal ipratropium
  • considered in AR when rhinorrhea is the primary symptom or is refractory to INCS and/or antihistamines
  • effective in cases of vasomotor rhinitis, like “skier’s nose”
35
Q

Intranasal Mast cell stabilizers for treatment fo AR

A

sodium cromoglycate

less effective than INCS but have excellent safety profiles

-

36
Q

decongestants for AR

A
  • may be used temporarily to relieve nasal obstruction symptoms.
    ex: pseudoephedrine, phenylephrine (efficacy for phenyl not well establihed)
  • stimulatrory side effects
37
Q

immunotherapy for AR treatment

A
  • used to desensitize patients with IgE-dependent sensitivities to specific antigens when they cannot effectively avoid the allergen
  • Clinical benefits associated with immunotherapy have been shown to persist for at least three years following administration.
38
Q

duration of treatment for intermitent vvs persistent AR

A

intermmittent: treatment should be contrinued daily for 2 weeks or dor duration of pollen season or other allergen exposure

Persistent; longer course treatment needed

39
Q

the combination of OAH with INCS was found to be ____ than INCS alone

A

the combination of OAH with INCS was not found to be more effective than INCS alone

40
Q

The combination of INAH with INCS was found to be ___ than INCS alone

A

The combination of INAH with INCS was found to be more effective than INCS alone

41
Q

INAH-containing medications are effective within ___

A

minutes

130: Professional Practice 2 (30 decks)

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