Allergic Rhinitis Scott Exam 4

Question 1

What is the most common chronic disease in children?

Answer 1

Allergic rhinitis

Question 2

What are the most common symptoms of allergic rhinitis?

Answer 2

Nasal congestion, rhinorrhea, sneezing, itching, postnasal drip (which may cause cough), conjunctivitis, fatigue, irritability, nasal crease (children)

Question 3

What disease states comprise the allergic triad?

Answer 3

Allergic rhinitis, asthma, atopic dermatitis (eczema)

Question 4

What is the most common allergen in episodic AR?

Answer 4

Pet dander

Question 5

What are the most common triggers of perennial AR?

Answer 5

Molds and house dust

Question 6

What are the most common triggers of seasonal AR?

Answer 6

Grasses, trees, weeds, some molds

Question 7

How do common cold symptoms differ from allergic rhinitis?

Answer 7

Cold – no itching, less often rhinorrhea, more HA

Question 8

What symptoms would point you towards sinus infection instead of allergic rhinitis?

Answer 8

Colored nasal discharge, fever, chills, cough, length of time

Question 9

How long should you wait until you evaluate treatment efficacy?

Answer 9

2-4 weeks of continuous use

Question 10

What should always be considered to help treat allergic rhinitis?

Answer 10

Environmental controls (avoidance, AC, masks)

Question 11

What is the two general treatments for nasal congestion in AR?

Answer 11

Intranasal corticosteroids and oral decongestants

Question 12

What are the two general treatments for rhinorrhea, nasal itching, and intermittent sneezing?

Answer 12

Oral or intranasal antihistamines

Question 13

What is the mainstay for mild chronic (minimal impact QOL) AR symptoms?

Answer 13

PO 2nd generation antihistamine

Question 14

What are the two general treatments for moderate to severe chronic symptoms?

Answer 14

Intranasal corticosteroids and intranasal antihistamine

Question 15

True or false: Adding an intranasal corticosteroid to an oral antihistamine may help control AR symptoms.

Answer 15

False – no additional benefit. Just switch!

Question 16

After step 2 treatments fail for AR, what might be an option if a patient still has moderate to severe symptoms?

Answer 16

Skin testing and aggressive avoidance

Question 17

If AR treatment is controlling symptoms but has significant side effects, should you try to decrease the dose or switch to a different agent?

Answer 17

Switch to a different agent – lower dose likely not efficaceous.

Question 18

What are the treatment options for pregnant patients with AR?

Answer 18

Avoidance, intranasal saline, oral antihistamines, nasal cromolyn, intranasal corticosteroids, montelukast. AVOID oral decongestants.

Question 19

What symptom is not well controlled by oral antihistamines?

Answer 19

Nasal congestion

Question 20

What medication is most effective in episodic allergic rhinitis?

Answer 20

Intranasal antihistamines

Question 21

How long before allergen exposure must an antihistamine be taken?

Answer 21

1-2 hours prior to exposure

Question 22

What second generation antihistamine has some mild sedation?

Answer 22

Cetirizine (Zyrtec)

Question 23

What patient population is especially affected by anticholinergic effects of antihistamines (dry mouth, urinary retention, constipation)?

Answer 23

Elderly patients

Question 24

What second generation antihistamine is usually dosed lower than what might be needed?

Answer 24

Loratadine (Claritin)

Question 25

What AR treatment has the fastest onset of action?

Answer 25

Intranasal antihistamines--helps with ocular symptoms too although some drowsiness, expensive, and BID

Question 26

What is an important counseling point for intranasal decongestants?

Answer 26

Do not take for longer than 3 days (may use longer if just at night).

Question 27

What are side effects for topical decongestants? Systemic decongestants?

Answer 27

Topical -- burning, stinging, dryness, rebound congestion | Systemic -- tachycardia, tremor, insomnia (SR dosage forms)

Question 28

What patients should use decongestants with caution?

Answer 28

HTN, ischemic heart disease, DM, hyperthyroid | Minimal change HR/BP at doses

Question 29

What is the maximum amount of sudafed that can be bought per day? Per 30 days?

Answer 29

Daily: 3.6g MAX 30 days: 7.2g MAX No restrictions when dispensed by prescription

Question 30

What nasal decongestant is worthless?

Answer 30

Phenylephrine

Question 31

What are two available brands of intranasal decongestants?

Answer 31

Oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine)

Question 32

What is one thing to watch out for when dealing with OTC decongestants?

Answer 32

Confusion with names and ingredients -- same name different combinations

Question 33

What is the most effective treatment for nasal symptoms when used consistently?

Answer 33

Corticosteroid nasal sprays (also ocular Sx)

Question 34

How long must intranasal cortocosteroids be used to reach maximum benefit?

Answer 34

1-2 weeks

Question 35

What are the two OTC corticosteroid nasal sprays?

Answer 35

Nasacort Allergy 24 (triamcinolone) once daily, not for children

Question 36

What is the name for the combination intranasal corticosteroid and antihistamine?

Answer 36

Dymista (fluticasone + azelastine)

Question 37

What are side effects of intranasal corticosteroids?

Answer 37

Nasal irritation/stinging, dryness, sneezing, sore throat, epistaxis, some systemic absorption

Question 38

What steps should you tell a patient to follow when using an intranasal mist?

Answer 38

Blow nose, remove cap, shake container, prime, squirt mid-inhalation while blocking other nostril, point away from septum, clean nose piece.

Question 39

What situations may cromolyn be better for?

Answer 39

Seasonal rhinitis, pregnancy. | Dosed 3-4 times daily, slow onset, not very effective severe

Question 40

What are uses for ipratropium IN?

Answer 40

Decreases rhinorrhea and best for vasomotor (non-allergic) rhinitis. Used 4 times daily.

Question 41

What patients may especially benefit from montelukast?

Answer 41

Patients with asthma, similar effect to antihistamines.

Question 42

For children taking montelukast, what counseling points should you give?

Answer 42

The oral granules can be taken PO directly or mixed with a spoonfull of soft food (not liquids or large amnt). Ingest within 15 mins of mixing.

Question 43

What allergies may make a patient eligible to receive sublingual immunotherapy?

Answer 43

Grass allergies