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OTC > Allergies > Flashcards

Allergies Flashcards

1
Q

Annual direct costs of allergic rhinitis:

A

$3.4 billion

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2
Q

Indirect costs of allergic rhinitis:

A

$11 billion

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3
Q

Allergies are triggered by…

A

indoor and outdoor environmental allergens

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4
Q

Common outdoor allergens:

A
  • pollen
  • mold spores
  • pollutants (highly populated areas)
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5
Q

Common indoor allergens:

A
  • house dust-mites
  • cockroaches
  • mold spores
  • pet dander
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6
Q

Occupational areoallergens:

A
  • wool dust
  • latex
  • resins
  • biologic enzymes
  • organic dusts
  • various chemicals
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7
Q

4 phases of pathogenesis:

A
  1. sensitization phase
  2. early phase
  3. cellular recruitment phase
  4. late phase
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8
Q

Phase one of pathogenesis: sensitization phase

A
  • occurs on initial allergen exposure

- allergen stimulates beta-lymphocyte mediated IgE production

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9
Q

Phase two of pathogenesis: early phase

A
  • occurs w/in minutes of subsequent allergen exposure
  • rapid release of pre-formed mast cells mediators (histamine and proteases)
  • includes production of additional mediators: prostaglandins, kinis, leukotrienes, neuropeptides
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10
Q

Phase three of pathogenesis: cellular recruitment phase

A

circulating leukocytes are attracted to nasal mucosa and release more inflammatory mediators

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11
Q

Phase four of pathogenesis: late phase

A
  • begins 2-4 hours after allergen exposure
  • symptoms include mucus hypersecretion secondary to submucosal gland hypertrophy and congestion
  • continued persistent inflammation “primes” tissue, results in lower threshold for allergic/nonallergic medicated triggers
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12
Q

Bilateral symptoms are the….

A

worst in the morning, subside during the day, and then worsen at night

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13
Q

Common symptoms:

A
  • frequent, paroxysmal sneezing
  • anterior, watery rhinorrhea
  • frequent itching and conjunctivitis
  • sinus pain
  • throat pain
  • allergic shiners
  • dennie’s lines
  • allergic salute
  • allergic crease
  • allergic gape
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14
Q

Sinus pain is caused by…

A

congestion

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15
Q

Throat pain is caused by…

A

postnasal drip irritation

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16
Q

Allergic shiners are…

A

darkening around eyes due to venous congestion

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17
Q

Dennie’s lines are…

A

wrinkles beneath lower eyelids

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18
Q

Allergic salute is…

A

patient is rubbing tip of the nose upward w/ the palm of their hand

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19
Q

Allergic crease is…

A

the horizontal crease above bulbar portion of nose secondary to “salute”

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20
Q

Allergic gape:

A

open-mouth breathing due to nasal obstruction

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21
Q

T/F: allergic rhinitis can be cured

A

F, can only reduce symptoms and improve patient’s functional status

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22
Q

Treatment should be _______ to provide optimal symptomatic relief and/or control

A

individualized

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23
Q

Three steps for treatment:

A
  1. allergen avoidance
  2. pharmacotherapy
  3. immunotherapy
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24
Q

T/F: immunotherapy is only provided by PCP

A

T

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25
Q

T/F: Allergy avoidance is typically not sufficient for complete relief

A

T

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26
Q

Avoidance of allergens:

A
  • primary nonpharmacologic measure

- depends on specific allergens

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27
Q

House dust mites:

A
  • found in all but driest regions of US

- thrives in warm and humid environments

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28
Q

How to reduce # of house dust mites:

A
  • lower household humidity to less than 40%
  • apply acaricides
  • reduce mite-harboring dust by removing items such as: carpet, upholstered furniture, stuffed animals, bookshelves
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29
Q

Outdoor mold spores:

A
  • prevalent in late summer and fall (especially on calm, clear, dry days)
  • avoid activities that disturb decaying plant material
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30
Q

Indoor mold spores:

A
  • lower household humidity
  • remove houseplants
  • venting food preparation areas and bathrooms
  • repairing basements or crawlspaces
  • frequently applying fungicide to moldy areas
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31
Q

Cat derived allergens:

A

get allergen free cats :)

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32
Q

How to reduce # of cockroaches:

A
  • keep kitchen areas clean
  • keep food sealed
  • treat infested areas w/ baits or pesticides
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33
Q

If patients are triggered by pollutants, they need to be aware of…

A

air quality index (AQI)

- plan for activities when AQI is low

34
Q

Nasal wetting agents are used to relieve…

A
  • nasal mucosal irritation and dryness
35
Q

Nasal wetting agents help decrease…

A
  • nasal stuffiness
  • rhinorrhea
  • sneezing
36
Q

Nasal wetting agents aids in the removal of ____ from nose

A
  • dried
  • encrusted
  • thick mucus
37
Q

Nasal wetting agents include:

A
  • saline
  • propylene
  • polyethylene glycol sprays
  • gels
38
Q

Nasal irrigation should only be used with…

A

distilled, sterile, or boiled water

39
Q

Intranasal corticosteroids are good for…

A

intermittent/occasional

40
Q

Intranasal corticosteroids are also known as…

A

glucocorticords

- considered primary line therapy

41
Q

Intranasal corticosteroids are effective for treatment of nasal symptoms such as…

A
  • itching
  • congestion
  • rhinitis
  • sneezing
42
Q

Intranasal corticosteroids inhibit…

A

multiple cell types and mediators

- stops allergic cascade

43
Q

Intranasal corticosteroids have low systemic ____

A

absorption

44
Q

Adverse effects of Intranasal corticosteroids:

A
  • usually minor
  • nasal discomfort
  • bleeding
  • sneezing
  • cough
  • pharyngitis
45
Q

Longterm use of Intranasal corticosteroids has been linked to changes in…

A
  • vision
  • glaucoma
  • cataracts
  • increased risk of infection
  • growth inhibition in children
46
Q

Drug interactions of Intranasal corticosteroids w/…

A
  • protease inhibitors (ritonavir, tipranavir, telaprevir)
  • increases serum [ ] of steroids
  • avoids combination
47
Q

Antihistamines are used to relieve…

A

symptoms of allergic rhinitis

  • itching
  • sneezing
  • rhinorrhea
48
Q

Mechanism of action of antihistamines:

A
  • compete at central and peripheral histamine-1 receptor sites
  • prevents histamine receptor interaction and subsequent mediator release
  • 2nd generation antihistamines inhibit release of mast cell mediators as well
  • may decrease cellular recruitment
49
Q

Two classes of antihistamines:

A
  • 1st gen

- 2nd gen

50
Q

1st generation of antihistamines:

A
  • crosses blood brain barrier
  • sedating
  • nonselective for H1 receptors
  • lipophilic
51
Q

2nd generation of antihistamines:

A
  • doesn’t cross blood brain barrier
  • nonsedating
  • peripherally selective for H1 receptors
  • lipophobic
52
Q

Overdose of antihistamines have two effects:

A
  • sedating

- nonsedating

53
Q

Sedation effects of antihistamines are…

A
  • cardiac symptoms: tachycardia, conduction abnormalities

- CNS signs and symptoms: psychosis, hallucinations, agitation, lethargy, insomnia

54
Q

Nonsedation effects of antihistamines are…

A
  • drowsiness
  • restless/hyperactivity
  • tachycardia
55
Q

Adverse effects of antihistamines:

A
  • primary effects are CNS effects and anticholinergic effects
  • mainly seen with 1st gen, rarely with 2nd gen
  • anxiety
  • hallucinations
  • appetite stimulation
56
Q

Anticholinergic adverse effects:

A
  • dryness of eyes and mucous membranes
  • blurred vision
  • urinary hesitancy and retention
  • constipation
  • reflex tachycardia
57
Q

Drug interactions w/ antihistamines:

A
  • amiodarone
  • antacids
  • CNS depressants
  • metoprolol
  • phenytoin
  • potassium chloride
58
Q

Effect of amiodarone and antihistamines:

A

increased risk of QT prolongation

59
Q

Effect of antacids and antihistamines:

A

decrease efficacy

60
Q

Effect of CNS depressants and antihistamines:

A

increased sedation

61
Q

Effect of metoprolol and antihistamines:

A

increased metoprolol serum [ ]

- risk of hypotension

62
Q

Effect of phenytoin and antihistamines:

A

decreased phenytoin elimination

63
Q

Effect of potassium chloride and antihistamines:

A

increased risk of ulcers

64
Q

Contraindicatoins for antihistamines:

A
  • newborns/premature infants
  • lactating women
  • narrow-angle glaucoma
  • stenosing peptic ulcer
  • symptomatic prostatic hypertrophy
  • bladder neck and pyloroduodenal obstruction
65
Q

Combination products of antihistamines:

A
  • marketed w/ decongestants and analgesics

- use w/ caution because of increased risk of adverse effects

66
Q

Indication for decongestants:

A
  • temporary relief of nasal and eustachian tube congestion and for cough associated w/ postnasal drip
  • OTC of this are not approved by FDA
67
Q

Mechanism of action for decongestants:

A
  • stimulation of alpha adrenergic receptors results in constriction of blood vessels
  • decreases sinusoid vessel engorgement and mucosal edema
68
Q

Three types of decongestants:

A
  • direct-acting: bind directly to adrenergic receptors
  • indirect-acting: displace norepinephrine from storage vesicles in prejunctional nerve terminals
  • mixed: have both direct and indirect activity
69
Q

Special populations include:

A
  • pregnant women
  • lactating women
  • children < 12
  • elderly patients
70
Q

First line medication for pregnant women:

A

intranasal cromolyn

71
Q

Medications w/ no risk for pregnant women:

A
  • diphenhydramine

- chlorpheniramine

72
Q

Medications that have low risk of adverse fetal effects:

A
  • levocetirizine
  • loratadine
  • cetirizine
73
Q

Medication that has moderate risk of adverse fetal effets:

A

fexofenadine

74
Q

T/F: INCS are considered compatible

A

T

75
Q

Budenoside and triamcinolone have been linked to…

A
  • cleft lip and palate

- low birth weight

76
Q

Medications for lactating women:

A
  • intranasal cromolyn
  • short acting chlorpheniramine, fexofenadine, or loratadine (best option)
  • take dose at bedtime after last feeding of the day
77
Q

Children < 12 should be referred to PCP for possible…

A

undiagnosed asthma

78
Q

Elderly patients should avoid…

A

sedating histamines

79
Q

Why should elderly patients avoid sedating histamines?

A
  • increased risk of CNS depressive adverse effects (confusion/hypertension)
  • more likely to be taking meds w/ anticholinergic properties
80
Q

Drugs of choice for elderly patients:

A
  • loratadine

- intranasal cromolyn

81
Q

Many patients achieve symptomatic relief w/in…

A

3-4 days of therapy

- complete relief: 2-4 weeks

OTC (23 decks)

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