Allergic rhinitis (respiratory)

Question 1

Therapeutic use for intranasal glucocorticoids?

Answer 1

Prevention and tx of seasonal and perennial (year round) rhinitis (sneezing, nasal itching, and rhinorrhea)

Question 2

MOA of intranasal glucocorticoids?

Answer 2

acts on inflammatory cells and mediators

Question 3

Adverse effects of intranasal glucocorticoids?

Answer 3

Drying of nasal mucosa, ST, epistaxis, and HA

Question 4

Precautions to take with use of intranasal glucocorticoids?

Answer 4

adrenal suppression, delayed wound healing, and ocular disease

Question 5

MOA of antihistamines?

Answer 5

act on H1 receptors blocking the histamine release in the small vessels, capillaries, and nerves during allergic rxns.

Question 6

T/F. Antihistamines relieve itching, sneezing, rhinorrhea, and congestion.

Answer 6

False; do not relieve congestion

Question 7

Example of a 1st generation H1 antagonist (antihistamine)?

Answer 7

Diphenhydramine (Benadryl)

Question 8

Therapeutic uses of of Benadryl?

Answer 8

• Hypersensitivity rxns (allergic rhinitis, conjunctivitis, dermatitis)
• motion sickness
• insomnia

Question 9

MOA of Benadryl?

Answer 9

Antagonizes the effects on the histamine H1 receptor site

Question 10

Adverse effects of Benadryl?

Answer 10

Drowsiness, dry mouth, anorexia, photosensitivity, paradoxical excitation (increased in children), confusion in older adults, urinary retention, constipation, blurred vision

Question 11

Precautions with Benadryl?

Answer 11

Use caution if you have narrow-angled glaucoma, prostatic hyperplasia, peptic ulcer, and bladder neck obstruction

Question 12

Onset of action and routes given for Benadryl?

Answer 12

onset: 30-60 min.
Route: PO, IV, IM

Question 13

Example of a 2nd generation antihistamine?

Answer 13

Fexofenadine (Allegra)

Question 14

Therapeutic use for Fexofenadine (Allegra)?

Answer 14

Relief of sx of seasonal allergic rhinitis

Question 15

MOA of Fexofenadine?

Answer 15

antagonizes the effects of histamine at peripheral histamine (H1) receptors

Question 16

Adverse effects of FexofenaDine?

Answer 16

sedation/Drowsiness, Fatigue, Dyspepsia, Dysmenorrhea

Question 17

Precautions with Fexofenadine?

Answer 17

impaired renal function

Question 18

Onset of action and route of Fexofenadine?

Answer 18

onset- within 1hr

route- PO

Question 19

Interactions with Fexofenadine?

Answer 19

magnesium and aluminum containing antacids which decrease absorption and may decrease effectiveness

Question 20

Therapeutic use of intranasal cromolyn sodium?

Answer 20

allergic rhinitis prophylaxis

Question 21

MOA of intranasal cromolyn sodium?

Answer 21

suppresses release of histamine and other inflammatory mediators from mast cells

Question 22

Adverse effects of Cromolyn Sodium?

Answer 22

Local irritation, Sneezing, Stinging, HA, and hOarseness

Question 23

Precautions for Cromolyn Sodium?

Answer 23

Do not use to treat Sinus infections, asthma, or URIs

Question 24

T/F. Histamines are not decongestants?

Answer 24

True

Question 25

What class of drugs are decongestants?

Answer 25

Sympathomimetics and alpha adrenergic agonist

Question 26

Example of a decongestant/sympathomimetic drug?

Answer 26

Pseudoephedrine (Sudafed)

Question 27

Therapeutic uses of Pseudoephedrine?

Answer 27

temporary relief of sx associated with acute viral URIs

Question 28

MOA of Pseudoephedrine?

Answer 28

Stimulates alpha and beta adrenergic receptors → Releases NE →Produces vasoconstriction in nasal mucous membranes → reduced inflammation in the nasal membranes.

Question 29

Adverse effects of Pseudoephedrine? | Hint: everything goes up

Answer 29

anxiety, nervousness, palpitations, anorexia, HTN, insomnia, urinary retention, seizures, and cardiovascular collapse

Question 30

Contraindications for Pseudoephedrine?

Answer 30

- hypersensitivity to sympathomimetic amines - severe HTN - severe CAD - narrow angle glaucoma - use of tricyclic or monoamine oxidase inhibitor antidepressants - children <4

Question 31

Precautions with Pseudoephedrine?

Answer 31

cardiac dysrhythmias, hyperthyroidism, DM, glaucoma, and prostatic hyperplasia

Question 32

When should patients see provider if sx have not resolved with Pseudoephedrine use?

Answer 32

If sx last longer than 7 days

Question 33

Example of a nasal spray decongestant?

Answer 33

Oxymetazoline (Afrin)

Question 34

MOA of Oxymetazoline (Afrin)?

Answer 34

acts directly on alpha 2 receptors to produce vasoconstriction

Question 35

Why should Oxymetazoline (Afrin) be limited to 3 days?

Answer 35

rebound congestion aka "rhinitis medicamentosa"

Question 36

Is vasoconstriction and CNS stimulation common with topical decongestants?

Answer 36

No, but still possible