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PHAR153 > Allergic Rhinits > Flashcards

Allergic Rhinits Flashcards

1
Q

Where would you find mast cells?

A

stomach
eyes
skin

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2
Q

Describe sensitization.

A

your body has seen an allergen before and is now ready for a future exposure. the mast cells now have receptors for allergens and are ready to degranulate upon exposure to cause the symptoms of allergic rhintis

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3
Q

Differentiate between early phase and late phase reactions.

A

early phase:
-upon first exposure to an allergen
-lasts minutes to hours
-rhinorrhea, sneezing, itch

late phase:
-continuous exposure to allergen
-leads to inflammation
-nasal congestion

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4
Q

Why do we say that asthma and allergic rhinitis go hand-in-hand?

A

if your asthma is uncontrolled, then your allergies are probably uncontrolled (and vice versa)

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5
Q

What are the perennial causes of allergic rhinitis?

A

house dust mite
animal danders
indoor moulds

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6
Q

What is the difference between an irritant and an allergen?

A

allergens are protein based, irritants tend to be chemicals

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7
Q

Differentiate between acute allergic rhinitis and perennial allergic rhinitis?

A

acute:
-contained
-seasonally based

perennial:
-year round
-continuous exposure (danders, moulds, dust)

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8
Q

Explain why each of the following is non-allergic: vasomotor rhinitis, rhinitis medicamentosa, hormonal, geriatric rhinitis

A

vasomotor: runny nose due to temp change
medicamentosa: drug induced congestion (topical decongestants)
hormonal: stopping/starting birth control can cause congestion
geriatric: as you age, you get runny nose easier

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9
Q

Differentiate between intermittent and persistent.

A

intermittent:
-less than 4 days per week OR
-less than 4 weeks at a time

persistent:
-more than 4 days per week OR
-more than 4 weeks at a time

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10
Q

Differentiate between mild and moderate-severe.

A

mild:
-normal sleep
-normal daily activities
-no troublesome symptoms

moderate-severe:
-abnormal sleep
-impairment of daily activities
-troublesome symptoms

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11
Q

What are the main symptoms of allergic rhinitis?

A

sneezing
rhinorrhea
congestion
nasal drip
ocular symptoms (conjunctivitis)

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12
Q

What are some good symptoms as starting points for differentiating between acute and perennial?

A

acute: hit hard by runny nose, itch
perennial: congestion

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13
Q

What are some facial clues for allergic rhinitis?

A

puffy eyes
mouth breathing

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14
Q

What are the characteristics of allergies that help us say “okay, I think this is allergic rhinitis, NOT a cold” ?

A

same time every summer
increased sneezing and itch
back and forth btwn runny nose and congestion
PND
more ocular symptoms
lasts longer

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15
Q

What are the approaches to therapy of allergic rhinitis?

A

avoidance of allergens/triggers (tough to do)
nasal irrigation (trying to flush out allergens)
antihistamines

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16
Q

True or false: Rhinaris nasal mist or gel is for nasal irrigation

A

false
it is for irritated nasal tissue

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17
Q

Explain the MOA of antihistamines.

A

in the case of allergies, the antihistamine binds to the H1 receptor to prevent histamine binding, thus preventing the symptoms of allergic rhinitis

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18
Q

Which symptoms of allergic rhinitis are antihistamines best for?

A

rhinorrhea
sneezing
itch
NOT GREAT FOR CONGESTION

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19
Q

Do we develop a tolerance to antihistamines?

A

likely not

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20
Q

True or false: 1st gen antihistamines have 1000x greater affinity for H1 receptor than 2nd gen

A

false
2nd gen has 1000x greater affinity

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21
Q

How are antihistamines best taken for allergic rhinitis?

A

prior to exposure (catch up dont work)
regular dosing

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22
Q

Name the family classes of 1st gen antihistamines and the drugs in those classes.

A

promethazine
ethanolamines: dph, doxylamine, clemastine
alkylamines: chlorpheniramine, brompheniramine, dexbrompheniramine, triprolidine

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23
Q

Which antihistamine are sedative? Why?

A

1st gen
they cross BBB, anti-cholinergic effect greater than 2nd gen

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24
Q

Rank the family classes of 1st gen antihistamines from greatest anti-cholinergic effect to smallest.

A

promethazine/ethanolamines>alkylamines

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25
Q

Which gen of antihistamines are paradoxical?

A

1st gen
makes kids hyper rather than tired (RARE RXN)

26
Q

True or false: 1st gen antihistamines are not safe in asthmatics, and are highly encouraged in kids

A

false
safe for asthma
discouraged for kids

27
Q

What is the place in therapy for 1st gen antihistamines?

A

insect bites
itchy rashes

28
Q

Describe the efficacy of 2nd gen antihistamines.

A

higher affinity for H1 than 1st gen
better for seasonal allergies

29
Q

What is the dosing of 2nd gen antihistamines?

A

OD
except Allegra which is BID

30
Q

When should we expect an onset from 2nd gen antihistamines?

A

roughly an hour however it make take a day or two for the effects to ramp up

31
Q

True or false: 1st gen antihistamines have a faster rate of onset than 2nd gen antihistamines

A

false

32
Q

Why would someone take a rapid dissolve version of Reactine?

A

convenience (ex: child wont take other forms/flavours)

33
Q

Is there a massive difference between Reactine 5mg, 10mg, or 20mg?

A

most likely not
20mg is Rx strength and is probably for insurance purposes

34
Q

What is the starting age for the following: loratadine, desloratadine, cetirizine, fexofenadine

A

loratadine: 2y
desloratadine: 2y
cetirizine: 2y
fexofenadine: 12y

35
Q

What are the side effects of 2nd gen antihistamines?

A

almost none
safest agents in therapeutic realm

36
Q

What can reduce the efficacy of fexofenadine?

A

grapefruit/orange/apple juice
food

37
Q

What do we make of the following claim for Aerius: “helps with congestion and stuffiness” (essentially saying it has anti-inflammatory properties) ?

A

probably not true, antihistamines are not great for congestion
this is lots to expect of an antihistamine

38
Q

What are some patient dynamics surrounding antihistamines?

A

little chance for complete relief
trial and error
how quick will relief occur? couple hours, maybe days
when to start? if seasonal, get ahead of the curve
will tolerance develop? highly unlikely
if helpful, how long? perennial=all the time, seasonal=drug holiday

39
Q

What makes Dristan a poor choice as an intranasal antihistamine? What makes Dymista a good choice?

A

Dristan contains a decongestant (dont want to use long term cause reb cong) and a 1st gen antihistamine
Dymista contains a topical steroid (fluticasone) and a 2nd gen antihistamine (azelastine)

40
Q

Which symptom of allergic rhinitis tends to go under-treated?

A

ocular symptoms

41
Q

What is the issue with most OTC intraocular antihistamines?

A

they contain a decongestant (long term use can cause reb cong in the eyes) and 1st gen antihistamine

42
Q

Why are Rx intraocular antihistamines better than the OTC ones? Examples?

A

they contain a 2nd gen AH and no decongestant
zaditor, emadine

43
Q

A patient comes in and presents symptoms of allergies and also congestion. They are holding a box that has cetirizine and pse as the active ingredients, what is your suggestion?

A

I would recommend she takes cetirizine as a stand alone product and takes the pse separate as well on an as needed basis
we don’t want people using decongestants on a long term basis
ALWAYS GO WITH SEPERATE PRODUCT

44
Q

Why are intranasal steroids so great for congestion? What are some examples of intranasal steroids?

A

they do not cause rebound congestion
mometasone, fluticasone, ciclesonide

45
Q

What is the place in therapy of intranasal steroids for allergic rhinitis?

A

1A-1B with 2nd gen AH
if patient comes back in a few weeks after trying 2nd gen AH, then recommend an intranasal steroid

46
Q

True or false: an intranasal steroid is superior to a 2nd gen AH for nasal symptoms

A

true

47
Q

What is the dosing for intranasal steroids?

A

OD or BID
regular use is better

48
Q

What are the side effects of intranasal steroids?

A

local irritation
spray runs down back of throat

49
Q

What is the bioavailability of intranasal steroids such as mometasone, fluticasone, and ciclesonide? What about the older ones like budesonide and triamcinolone?

A

less than 1% for the newer ones
greater than 30% for the older ones

50
Q

What is the aging for the following: fluticasone (Flonase and Avamys), mometasone, ciclesonide, beclomethasone, budesonide, flunisolide, triamcinolone?

A

fluticasone: 4y Flonase, 2y Avamys
mometasone: 3y
ciclesonide: 12y
beclomethasone: 6y
budesonide: 6y
triamcinolone: 4y

51
Q

What is something you should mention to a patient regarding the usage of intranasal steroids?

A

pump priming needed at the start

52
Q

Where should you aim when using an intranasal steroid? What is a good technique to hit this area?

A

the outside wall of the nose
use right hand for left nostril and vice versa

53
Q

What is Cromolyn?

A

a mast cell stabilizer
not very commonly used due to inconvenient dosing of up to 6x per day
oral, ophthalmic, or intranasal

54
Q

What are some Cromolyn (ophthalmic) like products?

A

Alocril (nedrocomil): mast cell stabilizer, BID
Patanol (olopatadine): mast cell stabilizer + AH, BID, Pataday=OD
Alomide (lodoxamide): mast cell stabilizer, QID

55
Q

What is Montelukast?

A

leukotriene antagonist
for asthma and allergic rhinitis
it is an add-on therapy

56
Q

What is Atrovent nasal spray (ipratropium)?

A

used for people that have chronic vasomotor rhinitis
anti-cholinergic MOA: drying up secretions

57
Q

True or false: nasal congestion is common for pregnant women and treatment is the realm of the MD

A

true

58
Q

What are the general guidelines on drugs and pregnancy? Are antihistamines safe during pregnancy?

A

avoid any medicine during 1st trimester
1st gen: large body of data, safe
2nd gen: less evidence, appear to be safe

59
Q

True or false: in spite of safety, the use of antihistamines during pregnancy is the doctors choice

A

true

60
Q

What are the Rx ocular antihistamines? What about OTC ocular antihistamines?

A

Rx: emedastine, ketotifen (2nd gen antihistamines)
OTC: pyrilamine, antazoline, pheniramine (1st gen agents)

PHAR153 (20 decks)

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