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NAPLEx > allergic rhinits, cough & cold > Flashcards

allergic rhinits, cough & cold Flashcards

1
Q

budesonide

A

Rhinocort Allergy
OTC
age>=6
budesonide and beclometasone are preferred nasal steroids in prego
- intranasal steroid

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2
Q

Fluticasone

A

flonase
Rx and OTC
>=12 years 1-2 sprays per nostril
2-11 years 1 spray per nostril

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3
Q

fluticasone + azelastine

A

Dymista

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4
Q

triamcinolone

A

Nasacort
>=6years 1-2 sprays
2-5 years 1 spray

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5
Q

beclometasone

A

beconase
1-2 sprays BID

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6
Q

Diphenhydramine (it’s everywhere)

A
  • 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)

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7
Q

diphenhydramine

A

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

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8
Q

anticholinergic effects

A

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

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9
Q

chlorpheniramine

A

aller-chlor, chlor-trimeton
OTC
- first-gen oral antihistamines

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10
Q

doxylamine

A

unisome- for sleep
>12
OTC
- first-gen oral antihistamines

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11
Q

Safety/SE/ monitoring of
- first-gen oral antihistamines

A
  • 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
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12
Q

cetirizine

A

Zyrtec
OTC and Rx
- second-gen oral antihistamines

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13
Q

cetirizine + pseudoephedrine

A

Zyrtec-D
OTC
- second-gen oral antihistamines

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14
Q

levocetirizine

A

Xyzal
OTC
contra: end-stage renal disease CrCl<10, hemodialysis, 6-11 years w/ renal impairment
- second-gen oral antihistamines

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15
Q

fexofenadine
fexofenadine + pseudoephedrine

A

Allegra, Allegra-D
take w/ water (not fruit juice- decrease absorption)
avid amin w/ aluminum or mag containing products
OTC
- second-gen oral antihistamines

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16
Q

loratadine
loratadine + pseudoephedrine

A

Claritin, Claritin-D
OTC

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17
Q

Azelastine

A

Astepro
OTC and RX
+ flutcasone (dymista)
- intranasal antihistamiin

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18
Q

safety/SE/monitoring of
- second-gen oral antihistamines

A
  • in prego loratadine and cetirizine are preferred
  • cetirizine and levocetirizine have a fast onset
  • more sedating: cetirizine and levocetirizine
  • less sedating: fexofenadine and loratadine
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19
Q

pseudoephedrine, phenylpropanolamine and ephedrine
phenylephrine

A

max 3.6 g per day and 9 g per month

20
Q

decongestants

A

alpha-adrenergic agonist
vasoconstriction

21
Q

phenylephrine

A

Sudafed PE
low bioavailability, most times nasal spray version used by more SE so nasal spray oxymetazoline is preferred for nasal spra
- systemic decongestants

22
Q

pseudoephedrine

A

Sudafed, Nexafed, Zephrex-D
Rx and behind the counter
- systemic decongestants

23
Q

safety/SE/monitoring of
- systemic decongestants

A

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

24
Q

oxymetazoline

A

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

25
Q

montelukast

A

singular
tx of both allergic rhinits and ashtma
but remember neuropsychiatric side effects

26
Q

intranasal ipratropium

A

decreasing rhinorrhea by causing nasal dryness not effect for other symptoms

27
Q

oralair
grastek
ragwitek
Odactra

A

5 different grass pollens extract
timothy grass pollen extract
ragweed pollen extract
house dust mite allergen extract

28
Q

natural products for colds

A

zinc
vitamin c
echinacea

AirBone and Emergen-C- include vitamin C, vitamin E, zinc and echinacea

29
Q

Guaifenesin
Guaifenesin + dextromethorphan

A

Mucinex, Robitussin, Rabafan
Rabafen DM, Robitussin DM

do not use ER tabs in pt <12 years
expectorant- for productive cough, think mucus

30
Q

cough suppressants

A

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

31
Q

abuse potential: Dextromethorphan acts as…

A

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”

32
Q

abuse potential: codeine

A

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”

33
Q

dextromethorphan
dextromethorphan + guaifenesin

A

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

34
Q

Codeine

A

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
35
Q

Benzonatate

A

tessalon perles
do not use in children <10yrs

36
Q

tussiCaps

A

CII
chlorpheniramine/hydrocodone
cap: 8/10mg Q12h PRN
suspension 8/10mg ER per 5ml (10 ml/day max)Q12hrs PRN

37
Q

promethazine/codeine

A

C-V
6.25/10mg per 5ml (max60ml/day) q4hrs

38
Q

Bromfed DM

A

brompheniramine/ pseudoephedrine/ dextromethorphan
2/30/10mg per 5ml max 60ml/day

39
Q

dextromethorphan/ promethazine

A

15mg/ 6.5mg per 5 ml
max 30 ml

40
Q

cough and cold comb names
D

A

decongestant

41
Q

cough and cold comb names
PE

A

phenylephrine

42
Q

cough and cold comb names
DM

A

dextromethorphan

43
Q

cough and cold comb names
AC

A

contains codeine

44
Q

cough and cold comb names
Guaifenesin

A

mucolytic
thins out mucus

45
Q

cough and cold comb names
analgesic

A

combo w/ cough and cold usually is acetaminophen

46
Q

cough and cold comb names
antihistamines

A

diphenhydramine, chlopheniramine, brompheniarmine
common and cause sedation; night time products

47
Q

children
< 18years
< 4
< 2

A

<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)

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