allergic rhinits, cough & cold Flashcards
budesonide
Rhinocort Allergy
OTC
age>=6
budesonide and beclometasone are preferred nasal steroids in prego
- intranasal steroid
Fluticasone
flonase
Rx and OTC
>=12 years 1-2 sprays per nostril
2-11 years 1 spray per nostril
fluticasone + azelastine
Dymista
triamcinolone
Nasacort
>=6years 1-2 sprays
2-5 years 1 spray
beclometasone
beconase
1-2 sprays BID
Diphenhydramine (it’s everywhere)
- acute allergic reacting (+/- epi depends on severity)
- prevent of allergic reactions
- allergic rhinitis
- cough (has antitussive properties)
- sleep (sedating)
- dystonic reactions (anticholinergic properties)
- motion sickness
cause of wide range it can worsen disease states (BPH, constipation, dementia, glaucoma)
diphenhydramine
Benadryl
Rx and OTC
<6 years do not use OTC and major contra <2 years and elderly adults!
adults: max 300mg/day
6-11: max 150mg/day
- first-gen oral antihistamines
anticholinergic effects
dry mouth
blurred vision
urinary retention
constipation
seizures/arrhythmias at high doses
mad as a hatter, hot as hell, red as a beat, dry as a bone, and blind as a bat
chlorpheniramine
aller-chlor, chlor-trimeton
OTC
- first-gen oral antihistamines
doxylamine
unisome- for sleep
>12
OTC
- first-gen oral antihistamines
Safety/SE/ monitoring of
- first-gen oral antihistamines
- warning in elderly and <2
- can cause prostate enlargement, glaucoma, thyroid,
- do not use w/ MOA, especially clemastine or carbinoxamine
- somnolence, strong cognitive impairment, and strong anticholinergics effects
cetirizine
Zyrtec
OTC and Rx
- second-gen oral antihistamines
cetirizine + pseudoephedrine
Zyrtec-D
OTC
- second-gen oral antihistamines
levocetirizine
Xyzal
OTC
contra: end-stage renal disease CrCl<10, hemodialysis, 6-11 years w/ renal impairment
- second-gen oral antihistamines
fexofenadine
fexofenadine + pseudoephedrine
Allegra, Allegra-D
take w/ water (not fruit juice- decrease absorption)
avid amin w/ aluminum or mag containing products
OTC
- second-gen oral antihistamines
loratadine
loratadine + pseudoephedrine
Claritin, Claritin-D
OTC
Azelastine
Astepro
OTC and RX
+ flutcasone (dymista)
- intranasal antihistamiin
safety/SE/monitoring of
- second-gen oral antihistamines
- in prego loratadine and cetirizine are preferred
- cetirizine and levocetirizine have a fast onset
- more sedating: cetirizine and levocetirizine
- less sedating: fexofenadine and loratadine
pseudoephedrine, phenylpropanolamine and ephedrine
phenylephrine
max 3.6 g per day and 9 g per month
decongestants
alpha-adrenergic agonist
vasoconstriction
phenylephrine
Sudafed PE
low bioavailability, most times nasal spray version used by more SE so nasal spray oxymetazoline is preferred for nasal spra
- systemic decongestants
pseudoephedrine
Sudafed, Nexafed, Zephrex-D
Rx and behind the counter
- systemic decongestants
safety/SE/monitoring of
- systemic decongestants
for phenylephrine and pseudoephedrine
- DO NOT USE within 14 days of MOA
- avid in children <2 (FDA), package label <4 years
- cardio SE- tachy, palpitation increased BP
- SE- BPH, urinary retention, glaucoma risk, insomnia, hallucinations… decreased appetite
oxymetazoline
Afrin
>6
OTC
do not use more than 3 days, or rebound congestion will occur (rhinitis medicamentosa)
warning do not use w/ MOA, BPH risk…
- intranasal topical decongetant
montelukast
singular
tx of both allergic rhinits and ashtma
but remember neuropsychiatric side effects
intranasal ipratropium
decreasing rhinorrhea by causing nasal dryness not effect for other symptoms
oralair
grastek
ragwitek
Odactra
5 different grass pollens extract
timothy grass pollen extract
ragweed pollen extract
house dust mite allergen extract
natural products for colds
zinc
vitamin c
echinacea
AirBone and Emergen-C- include vitamin C, vitamin E, zinc and echinacea
Guaifenesin
Guaifenesin + dextromethorphan
Mucinex, Robitussin, Rabafan
Rabafen DM, Robitussin DM
do not use ER tabs in pt <12 years
expectorant- for productive cough, think mucus
cough suppressants
dextromethorphan and opioids (codeine and hydrocodone) have high affinity for several regions of the brain including medullary cough center, suppressing cough.
Bezonatate suppresses cough by topical anesthetic action on the respiratory stretch receptor. do not use in <10 years
abuse potential: Dextromethorphan acts as…
SRI- it does not have addictive properties, but at high doses, it acts as an NMDA- receptor blocker leading to euphoria and hallucinations similar to PCP- “robo-tripping”
abuse potential: codeine
codeine products contain one or more non-codeine active ingredients (guaifenesin) and no more than 200 mg/ 100ml are scheduled as C-V drugs.
abused w/ promethazine a lot street name- “purple drank” and “lean”
dextromethorphan
dextromethorphan + guaifenesin
Delsym, rabafen, robitussim
DM in name indicates dextromethorphan
contra: do not use 14 days of MOA inhibitors
risk: Serotonin syndrome, CNS depression
OTC do not use <4 years
- cough suppressants
Codeine
C-II (for pain)
C-V (combo products for cough and cold)
risk of respiratory depression!
keep in mind CYP450 2D6! rapid metabolizers
contra: <12 years or 18years of age after tonsillectomy and/or adenoidectomy
FDA contra <18 yrs
- cough suppressants
Benzonatate
tessalon perles
do not use in children <10yrs
tussiCaps
CII
chlorpheniramine/hydrocodone
cap: 8/10mg Q12h PRN
suspension 8/10mg ER per 5ml (10 ml/day max)Q12hrs PRN
promethazine/codeine
C-V
6.25/10mg per 5ml (max60ml/day) q4hrs
Bromfed DM
brompheniramine/ pseudoephedrine/ dextromethorphan
2/30/10mg per 5ml max 60ml/day
dextromethorphan/ promethazine
15mg/ 6.5mg per 5 ml
max 30 ml
cough and cold comb names
D
decongestant
cough and cold comb names
PE
phenylephrine
cough and cold comb names
DM
dextromethorphan
cough and cold comb names
AC
contains codeine
cough and cold comb names
Guaifenesin
mucolytic
thins out mucus
cough and cold comb names
analgesic
combo w/ cough and cold usually is acetaminophen
cough and cold comb names
antihistamines
diphenhydramine, chlopheniramine, brompheniarmine
common and cause sedation; night time products
children
< 18years
< 4
< 2
<18 yrs: avoid codeine and hydrocodone containing cough and cold products (FDA)
<4: avoid OTC cough and cold products (package label)
<2: avoid OTC cough and cold products (FDA), avoid promethazine (FDA), avoid topical methol and camphor (package label)
