Allergic rhinitis: product selection, implement/follow uo

Question 1

what is the treatment of choice for AR in children

Answer 1

2nd gen OAH, INCS, Intranasal sodium cromoglycate

oral antihistamines *mainstay

• if willing to use nasal preps, cromoglycate and some INCS are safe and effective
• Mometasone and fluticasone propionate are typically recommended due to low oral bioavailability and absence of growth suppression with long-term use
• fluticasome smells bas tho

***give memetasone if doing INCS

Question 2

what is treatment of choice for older adults with AR

Answer 2

INCS< 2nd gen OAH, Montelukast, Intranasal ipratropium

• lower initial doses may be recommended due to decreased metabolism
• avoid 1st generation bc of anticholinergic effects
• avoid decongestants bc of potantial stimulant effects (esp if heart disease or hypertension)

* INCS = mainstay treatment (Triamcinolone acetonide, Fluticasone propionate, Mometasone furoate, Fluticasone furoate, Flunisolide, Ciclesonide, Budesonide, Beclomethasone dipropionate)

Montelukast (leukotriene receptor antagonist) and intranasal ipratropium (anticholinergic) are also generally well-tolerated by this population

• second generation OAH

Question 3

AR treatment in pregnant women

Answer 3

• first line = Intranasal sodium cromoglycate
• antihistamines may be considered
• do not initiate or increase immunotherapy during preg at risk of anaphylaxis to fetus but maintenance doses are safe

Question 4

how to counsel on appropriate use of INCS

Answer 4

• ideally started prior to exposure to relevant allergens and used regualrly
• educate on common side effects of nasal irritation and stinging
• can reduce side effects by aiming spray away from nasal septum

Question 5

how to properly administer nasal product

Answer 5

1. Prime
   
   • remove cap, shake bottle, hold upright and point spray away from you and spray it
2. Use
   
   • bloe nose to clear nostils
   • remove cap, shake bottle, close off one nostril
   • aim nozzle toward back of nose DO NOT spray twds nasal septum
   • spray while sniffing

Question 6

monitoring/follow up for effecacy and safety

Answer 6

• efficacy: monitoring allergic symptoms
  
  • desired outcome = improvement in allergic symptoms
  • time frame 2 weeks
  • patient to monitor daily, RPh to follow up in 3-7 dys
• Safetey, minimal/no aderse effects
  
  • no daytime drowsiness w/ antihistamine, no insomnia w/ decongestant
  • no inc in BP with patients with hypertension is taking decongestant
  • patient to monitor daily, RPh to follow up in 3-7 days

Question 7

Answer 7