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Pharm Spring 2023 > Allergic Rhinits > Flashcards

Allergic Rhinits Flashcards

1
Q

What is the first line treatment for allergic rhinitis

A

INCS

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2
Q

What is the second line treatment for allergic rhinitis

A

Oral anti-histamine (2nd gen)

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3
Q

When should someone consider medication after treating AR non-pharmacolgically

A

After 2-4 weeks of self-treatment

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4
Q

What do all antihistamines block?

A

Block H1 receptors
*which is the main target for early phase allergic response

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5
Q

Why are 1st generation oral antihistamines not preferred in the treatment of AR

A
  1. They are sedating
    *anticholinergic (ANTI-DUMBBELLS)
  2. Added effects are not useful in treating AR and contribute to more SE
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6
Q

Why are 2nd generation oral antihistamines preferred in the treatment of AR

A
  1. Inhibit release of mast cell mediators, minimal to no effect on cholinergic receptors (less sedating)
  2. Fewer SE
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7
Q

When should you take a 2nd gen oral antihistamine for AR

A

At least 1 week prior to expected allergy exposure

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8
Q

What are the SE of oral antihistamines

A

CNS depression
1. Impaired driving
2. In coordination
3. Impaired information processing
4. Sedation
ANTI-DUMBBELLS
*common with 1st generation AH

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9
Q

What is the least sedating 1st gen AH

A

Chlorpheniramine
*but still more sedating than 2nd gen AH

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10
Q

What 2nd gen AH may cause mild sedation

A
  1. Cetirizine
  2. Levocetirizine
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11
Q

What are the CI of 1 gen Antihistamines

A
  1. New born
  2. Breastfeeding
  3. Narrow angle / angle closure glaucoma
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12
Q

What are the warnings of 1st gen and 2nd gen oral antihistamines

A
  1. Combination with other sedating medication or tranquilizers
  2. Elderly (fall risk with sedation)
  3. Prostate enlargement (BPH)
  4. Fexofenadine with fruit juice
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13
Q

Which drugs can cause paradoxical excitiation

A

Oral antihistamine
*in children and elderly

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14
Q

What is the indication for Azelastine

A

Intranasal antihistamine
1. Temporary relief of nasal congestion, runny nose, sneezing and itchy nose

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15
Q

How many sprays to use of Azelastine (Intranasal antihistamine)

A

12 and + = 2 sprays in each nostril or 1 to 2 sprays in each nostril every 12 hours
6 to 11 = 1 spray each nostril every 12 hours

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16
Q

What are the SE of Azelastine

A
  1. Bitter tastes, headache, sedation
  2. Avoid taking with alcohol or other sedatives
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17
Q

What is the role of Azelastine in the treatment of AR

A
  1. Fewer side effects compared to oral AH
  2. Fast acting
  3. May be used if oral AH are ineffective or in combination with INCS
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18
Q

What is the indication of Intranasal corticosteroids (INCS)

A
  1. Treatment of nasal allergy symptoms
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19
Q

What is the MOA of INCS

A
  1. Suppress the immune system by reducing activity and volume of the lymphatic system
    *inhibits early phase and late phase process of the immune response, decreasing inflammation
20
Q

When should INCS be started

A

At least 1 week prior to known allergen exposure

21
Q

What are the different types of INCS

A
  1. Triamcinolone 55mcg/ACT
  2. Fluticasone
  3. Budesonide
22
Q

What is the adults and pediatric dosing of INCS

A

Adult
*2 sprays
Peds
*1 spray bc of the risk of growth stunting

23
Q

What are the SE of INCS

A
  1. Nasal discomfort
  2. Bleeding
  3. Sneezing
24
Q

What are the CI of INCS

A
  1. Nose surgery not fully healed
25
Q

What are the warnings of INCS

A
  1. Possible growth inhibition in children
  2. Cataracts
  3. Glaucoma
26
Q

When is montelukast used?

A

Last line treatment of AR if antihistamines and INCS didn’t work
1. Prescription only
2. For perennial and season rhinitis

27
Q

Why is montelukast not used anymore

A

Users can experience
1. Anxiety
2. Depression

28
Q

What is chromolyn sodium used for/MOA? (Mast cell stabilizer)

A
  1. Treatment of allergic rhinitis
    *protects mast cells from activation in early phase preventing and treating symptoms of allergic rhinitis
    *start 1-2 weeks prior (takes 2-4 weeks to work)
29
Q

What are the SE and role in therapy of cromolyn sodium

A

SE
1. Sneezing
2. Nasal stinging
3. Burning
Role in therapy
1. Last line
2. for patients with CI to AH or INCS

30
Q

What should be used in Peds population dealing with AR

A
  1. 2nd gen oral AH
    *1st gen oral AH are no preffered
  2. INCS
    *safe (1 spray)
  3. Mast cell stabilizer
    *safe (2 and up)
31
Q

What should be used during pregnancy when dealing with AR

A

Preferred AH
1. Pregnant
*loratadine
*cetirizine
*levocetirizine
*chlorpheniramine
2. Breastfeeding
*2nd generation AH

32
Q

Are INCS and cromolyn sodium CI during pregnancy and lactation

33
Q

What ages can used nasal saline spray / irrigation?

A
  1. Any age
    *nasal sprays are preferred for infants and toddlers due to nasal irrigation being difficult for them to tolerate
34
Q

What type of water should you use for nasal saline irrigation

A
  1. Use distilled, sterile, filtered or boiled water
    *tap water increases the risk of infection
35
Q

What is the indication of decongestants (PO)

A
  1. Provide temporary relief of nasal and Eustachian tube congestion and cough associated with PND
36
Q

What is the MOA of decongestants

A
  1. Alpha receptors agonist that causes contraction of blood vessels in nose / sinuses which will decrease inflammation and muscosal edema
37
Q

What is the difference between pseudoephedrine and phenylephrine

A

Pseudo
*more effective than PE, but has higher incidence of ADRS
*longer acting
*available behind the counter
Phenyl
*less effective than PSE, but has lower potential for ADRS
*short acting
*OTC

38
Q

What are the different types of topical decongestants

A
  1. Sprays / drops
    *phenylephrine
    *oxymatzoline
  2. Nasal inhalers
    *propylhezedrine
    *levmetamfetamine
39
Q

Why should you not use topical decongestants for more than 3 to 7 days

A
  1. Can cause rhinitis meticamentosa
    *rebound congestion
    *nasal congestion w/o runny nose or sneezing following several days of nasal decongestant use
40
Q

What are the SE of decongestants (Cardiovascular)

A

Oral > topical
1. Cardiovascular stimulation
*increase BP/HR/palpitations
*precipitation of underlying arrhythmia

41
Q

What are the SE of decongestants (CNS stimulation)

A
  1. CNS stimulation
    *restlessness
    *anxiety
    *irritability
    *tremor
42
Q

What are the SE of decongestants (rebound congestion)

A

only with topical

43
Q

What are the CI of decongestants

A
  1. Use of MAOI within 14 days
44
Q

What are the warnings of decongestants

A
  1. Cardiovascular disease
    *May worsen HTN, arrhythmias, ischemic heart disease
  2. Prostate enlargement
  3. Angle closure glaucoma
  4. Pregnancy
45
Q

Dosage of oral decongestant (pseudo and phenyl)

A

Phenyl
*adult 10mg
*children (6 to 12) 5mg
*children (4 to 6) 2.5mg
Pseudo
*adult 60mg
*children (6 to 12) 30mg
*children (4 to 6) 15mg

46
Q

Which of the these decongestants has the lowest potential to increase blood pressure?
Neo-Synephrine Nasal Spray (phenylephrine)
Sudafed PE Tablets (phenylephrine)
Sudafed Tablets (pseudoephedrine)
Nexafed Tablets (pseudoephedrine)

A

Neo-Synephrine Nasal Spray (phenylephrine)

Pharm Spring 2023 (27 decks)

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