Allergy Drugs

Question 1

Skin or blood allergy tests are mediated by:

Answer 1

IgE

Question 2

Purpose of nasal irrigation and types

Answer 2

Nasal irrigation rinses out allergens and mucus, increases ciliary function and reduces swelling. Nasal wetting agents (saline, propylene and polyethylene glycol sprays) or nasal irrigation with warm saline (isotonic or hypertonic) may reduce symptoms.

Saline solutions are either isotonic (0.9%) or hypertonic (2-3.5%).

Question 3

Mechanism of immunotherapy

Answer 3

turning the Th2 IgE-based response into a Th1 response and providing relief to some allergy sufferers

Question 4

First line treatment for mild to moderate allergies

Answer 4

Oral antihistamines

Question 5

Effects of antihistamines

Answer 5

They are effective in reducing symptoms of itching, sneezing, and rhinorrhea, but have little effect on nasal congestion.

Question 6

First gen antihistamines examples

Answer 6

Diphenhydramine, Doxylamine, Hydroxazine, Promethazine, Meclizine

Question 7

Antihistamines MOA

Answer 7

The H1 antihistamines resemble the side chain of histamine and permit binding to the H1 receptor as a competitive receptor antagonist. H1 antihistamines can block most of the effects of histamine on vascular smooth muscle and nerves, thus preventing or counteracting allergic reactions. Antihistamines administered orally or rapidly absorbed and widely distributed to tissues. Many are extensively metabolized by cP450 and can interact with other drugs that are metabolized by those enzymes

Question 8

Oral antihistamines warning

Answer 8

first-generation oral antihistamines have strong anticholinergic effects, “anticholinergic toxidrome” includes: sinus tachycardia, dry skin, dry mucous membranes, dilated pupils, constipation, ileus, urinary retention, and agitated delirium. Avoid use in the elderly particularly if already on anticholinergic meds, caution with cardiovascular disease, prostate enlargement (increases difficulty urinating), glaucoma, GI obstruction, and caution for excessive sedation.

Question 9

Side effects of antihistamines

Answer 9

All anticholinergic: somnolence/sedation, cognitive impairment, dry mouth, blurred vision, urinary retention, constipation

Second gen preferred for pregnancy

Question 10

Uses of Diphenhydramine (Benadryl®), Promethazine (Phenergan), Meclizine

Answer 10

Diphenhydramine (Benadryl®)- allergies if sedation is not a concern, and is ubiquitous as an over-the-counter sleeping aid, as in combination with acetaminophen, Tylenol PM sleep aid type products.

Promethazine (Phenergan®)- used widely for nausea and vomiting, with prominent sedation

Meclizine (Motion-Time®, Antivert®)- this first-generation antihistamine is indicated for motion sickness, and treatment of vertigo.

Question 11

Difference in second gen antihistamines

Answer 11

Second-generation agents are preferred for daily treatment of allergies, since they cause less sedation and cognitive impairment due to their design which provides much less penetration through the blood-brain barrier.

Question 12

Intranasal. antihistamines benefit and example

Answer 12

By treating the nasal mucosa directly with a topical preparation, systemic side effects are lessened (but not eliminated) while still providing control over nasal allergies.

Aselastine (Astelin ®)

Question 13

First line treatment for moderate to severe rhinitis

Answer 13

Intranasal corticosteroids

They are the most effective medication class in controlling symptoms of chronic allergy rhinitis

Question 14

MOA of intranasal corticosteroids

Answer 14

Intranasal corticosteroids work like any other steroids, by blocking arachidonic acid cleavage from the cell membrane and thus decreasing the synthesis of downstream inflammatory mediators.

Question 15

Suffix for all intranasal corticosteroids

Answer 15

-side or -one

Question 16

Difference in side effects between inhaled corticosteroids. and systemic

Answer 16

Side effects are much more likely with systemically administered corticosteroids, which used to be our only option before these drugs were developed as inhaled or sprayed topical agents.

Question 17

Corticosteroids side effects

Answer 17

Delayed wound healing ; can cause nasal septal performation if patients do not aim away from nasal septum when giving, avoid use with recent nasal septal ulcers, nasal surgery, or nasal trauma until healing has occurred.

Question 18

Inhaled corticosteroids examples

Answer 18

Beclomethasone (Beconase AQ®)

Budesonide (Rhinocort Aqua®)

Fluticasone (Flonase®)

Question 19

Decongestant MOA

Answer 19

Decongestants are all alpha adrenergic agonists (sympathomimetic) and they work by causing vasoconstriction. Typically if a product has a D after it, it also contains the sympathomimetic decongestant. (i.e. Mucinex D®)

Question 20

Examples of systemically active decongestants

Answer 20

Phenylephrine (Sudafed PE®)

Pseudoephedrine (Sudafed®)

Question 21

Contraindications for systemic decongestants

Answer 21

caution in patients with cardiovascular disease, uncontrolled hypertension (can raise BP), hyperthyroidism (can worsen symptoms), diabetes (can increase blood glucose), glaucoma (can increase intraocular pressure), BPH (can cause urinary retention), and in the elderly. These drugs are also contraindicated in pregnancy as they cause systemic vasoconstriction–bad for the fetus to have their placental vessels vasoconstrict! Since nasal congestion (and systemic venous congestion) is universal in pregnancy, this is a clinical tip you need to know.

Question 22

Side effects of systemic decongestants

Answer 22

Side Effects: all sympathomimetic: cardiovascular stimulation, CNS stimulation (anxiety, tremors, insomnia, nervousness, restlessness), dizziness, headache, anorexia.

Question 23

Important. usage directions for intranasal decongestants

Answer 23

important to limit used to less than three days to prevent rebound congestion or “rhinitis medicamentosa” with discontinued use. This problem leaves the patient dependent on these agents to have a normal, non-swollen nasal mucosa if used longer than three days, an patients should be warned about this.

Question 24

Use of expectorants (mucolytics)

Answer 24

These products are used to decrease mucus secretion viscosity (thin out mucus), to help with clearing mucous secretions out of the airway.

Question 25

Example of expectorant

Answer 25

Guaifenesin (Mucinex®): is used to decrease mucus secretion viscosity (thin out mucus), to help with clearing mucous secretions out of the airway.

Question 26

Examples of cough suppresants

Answer 26

Dextromethorphan (DM) and Codeine

Question 27

MOA of cough suppresants

Answer 27

high affinity for several regions of the brain, including the medullary cough center, suppressing the cough reflex. DM also acts as a serotonin reuptake inhibitor, and an NMDA receptor blocker at high doses, which can cause a euphoric and hallucinogenic effects similar to PCP. Some states have thus banned the sale of DM to minors.

Question 28

Danger of codeine dosing

Answer 28

Codeine’s metabolism is very unpredictable due to genetic polymorphisms and can cause respiratory suppression and death at standard doses. It should not be used for this purpose,