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Pharmacotherapy II > Allergic Rhinitis Scott Exam 4 > Flashcards

Allergic Rhinitis Scott Exam 4 Flashcards

1
Q

What is the most common chronic disease in children?

A

Allergic rhinitis

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2
Q

What are the most common symptoms of allergic rhinitis?

A

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

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3
Q

What disease states comprise the allergic triad?

A

Allergic rhinitis, asthma, atopic dermatitis (eczema)

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4
Q

What is the most common allergen in episodic AR?

A

Pet dander

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5
Q

What are the most common triggers of perennial AR?

A

Molds and house dust

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6
Q

What are the most common triggers of seasonal AR?

A

Grasses, trees, weeds, some molds

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7
Q

How do common cold symptoms differ from allergic rhinitis?

A

Cold – no itching, less often rhinorrhea, more HA

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8
Q

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

A

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

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9
Q

How long should you wait until you evaluate treatment efficacy?

A

2-4 weeks of continuous use

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10
Q

What should always be considered to help treat allergic rhinitis?

A

Environmental controls (avoidance, AC, masks)

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11
Q

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

A

Intranasal corticosteroids and oral decongestants

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12
Q

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

A

Oral or intranasal antihistamines

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13
Q

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

A

PO 2nd generation antihistamine

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14
Q

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

A

Intranasal corticosteroids and intranasal antihistamine

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15
Q

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

A

False – no additional benefit. Just switch!

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16
Q

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

A

Skin testing and aggressive avoidance

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17
Q

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

A

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

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18
Q

What are the treatment options for pregnant patients with AR?

A

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

19
Q

What symptom is not well controlled by oral antihistamines?

A

Nasal congestion

20
Q

What medication is most effective in episodic allergic rhinitis?

A

Intranasal antihistamines

21
Q

How long before allergen exposure must an antihistamine be taken?

A

1-2 hours prior to exposure

22
Q

What second generation antihistamine has some mild sedation?

A

Cetirizine (Zyrtec)

23
Q

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

A

Elderly patients

24
Q

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

A

Loratadine (Claritin)

25
Q

What AR treatment has the fastest onset of action?

A

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

26
Q

What is an important counseling point for intranasal decongestants?

A

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

27
Q

What are side effects for topical decongestants? Systemic decongestants?

A

Topical – burning, stinging, dryness, rebound congestion

Systemic – tachycardia, tremor, insomnia (SR dosage forms)

28
Q

What patients should use decongestants with caution?

A

HTN, ischemic heart disease, DM, hyperthyroid

Minimal change HR/BP at doses

29
Q

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

A

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

30
Q

What nasal decongestant is worthless?

A

Phenylephrine

31
Q

What are two available brands of intranasal decongestants?

A

Oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine)

32
Q

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

A

Confusion with names and ingredients – same name different combinations

33
Q

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

A

Corticosteroid nasal sprays (also ocular Sx)

34
Q

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

A

1-2 weeks

35
Q

What are the two OTC corticosteroid nasal sprays?

A

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

36
Q

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

A

Dymista (fluticasone + azelastine)

37
Q

What are side effects of intranasal corticosteroids?

A

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

38
Q

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

A

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

39
Q

What situations may cromolyn be better for?

A

Seasonal rhinitis, pregnancy.

Dosed 3-4 times daily, slow onset, not very effective severe

40
Q

What are uses for ipratropium IN?

A

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

41
Q

What patients may especially benefit from montelukast?

A

Patients with asthma, similar effect to antihistamines.

42
Q

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

A

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.

43
Q

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

A

Grass allergies

Pharmacotherapy II (15 decks)

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