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Immunology > Allergy Pharmacology > Flashcards

Allergy Pharmacology Flashcards

1
Q

What are the three major categories of treatment options for allergies?

A

avoidance of triggers, medications, allergy injections

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2
Q

What are the different ways to avoid allergy triggers?

A

no carpeting or upholstered furniture, bed encasement, no furry or feathered pets, perform maintenance chores, maintain heating/cooling systems, no smoking

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3
Q

What is the goal mechanism of action for allergy meds?

A

decrease the release or inhibiting the effect of histamine release and other mediators

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4
Q

What are the different categories of medicines that can be used for allergies?

A

antihistamines, decongestants, cromolyn sodium, intranasal glucocorticoids, ipratropium, montelukast

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5
Q

What features should the ideal drug for allergic rhinities have?

A

inhibit both early and late phases, be an H1 blocker, counter effects of other mediators, fast-acting, dosing once at night, no SE, manage all symptoms, intranasal admin

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6
Q

What are the first generation antihistamines?

A

diphenhydramine (benadryl), hydroxyzine (atarax), chlorpheniramine (chlor-trimeton)

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7
Q

What is the MOA of first generation antihistamines?

A

block the actions of histamine at H1 receptor sites. Don’t block histamine release

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8
Q

What symptoms do first generation antihistamines reduce?

A

reduce sneezing, itching and rhinorrhea

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9
Q

What are the SE of first generation antihistamines?

A

sedation, anticholinergic effects

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10
Q

What are the CI of first generation antihistamines?

A

lactating mothers, glaucoma, BPH, elderly

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11
Q

What the second generation antihistamines?

A

loratadine (claritan), fexofenadine (allegra), cetirizine (zyrtec)

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12
Q

What is the MOA of second generation antihistamines?

A

inhibit H1 receptors

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13
Q

What is the benefit of second generation antihistamines compared to first generation?

A

less sedating and long acting

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14
Q

What are SE of second generation antihistamines?

A

anticholinergic effects but less than 1st gen. ok for BPH, elderly

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15
Q

What is azelastine (Astelin)?

A

antihistamine nasal spray with some nasal decongestion effect and acts fast

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16
Q

What are the decongestant medications?

A

pseudoephedrine (Sudafed) ora and pseudoephedrine (Afrin) intranasal

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17
Q

What is the MOA of decongestants?

A

alpha-adrenergic agonist

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18
Q

What is the effect of decongestants?

A

vasocontriction restricts blood flow to nasal mucosa that has been dilated by histamine

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19
Q

What are the SE of decongestants?

A

HA, nervousness, irritability, tachycardia, palpitations insomnia

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20
Q

What are CI of decongestants?

A

HTN, cardiovascular disease, hyperthyroidism, glaucoma, co-use with MAOIs

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21
Q

What is rhinitis medicamentosa?

A

prolonged use of topical decongestant may induce rebound congestion upon withdrawal. leads to inflammatory hypertrophy of nasal mucosa

22
Q

What causes rhinitis medicamentosa?

A

down regulation of alpha-adrenoreceptors—>less sensitive to endogenously released NE and exogenously applied vasoconstrictors

23
Q

What are some combos of antihistamine-decongestants?

A

fexofenadine/pseudoephedrin (allegra-D), loratadine/pseudoephedrine (claritan-D), cetirizine/pseudoephedrine (zyrtec-D)

24
Q

What is the MOA of cromolyn sodium (nasalcrom)?

A

mast cell stabilizing agent—>reduces release of histamine and other mediators

25
Q

What are the effects of cromolyn sodium?

A

reduces nasal pruritis, sneezing, rhinorrhea and congestion

26
Q

What are SE of cromolyn sodium?

A

no serious effects

27
Q

What is the prophylactic us of cromolyn sodium?

A

start before pollinosis sx or unavoidable/predicatable exposures

28
Q

What are the benefits of non-steroid nasal sprays (ie cromolyn)?

A

non-Rx, safe, good for prevention, for kids, and for ppl who have known but unavoidable allergen exposure

29
Q

What are the different intranasal glucocorticoids?

A

fluticasone proprionate (flonase), mometasone (nasonex), beclomethasone diproprionate aqueous (beconase), budesonide (rhinocort), flunisolide (nasarel), triamcinolone acetonide (nasacort)

30
Q

What are the MOAs for intranasal glucocorticoids?

A

disabling cells that present antigen to antibody, reduce stimulus for mast cell degranulation, reduce inflammation by limiting late phase response, suppress neutrophil chemotaxis, mildly vasoconstrictive, reduce intracellular edema

31
Q

What are the effects of intranasal glucocorticoids?

A

reduce nasal blockage, pruritis, sneezing and rhinorrhea

32
Q

What are SE of intranasal glucocorticoids?

A

nasal irritation, bleeding (nasal septum perforation)

33
Q

What is an anticholinergic nasal spray?

A

ipratropium bromide (atrovent)

34
Q

What is ipratropium bromide (atrovent) use for and how does it work?

A

good for runny nose, reduces release of substance P

35
Q

What is a leukotriene inhibitor med?

A

montelukast (singulair)

36
Q

What is montelukast (singulair) used for?

A

runny nose/congestion. not first line therapy.

37
Q

What are the different saline intranasal sprays?

A

NaSal, SeaMist, Ocean, Ayr

38
Q

What are the effects of saline intranasal sprays?

A

relief from crusting and can be soothing

39
Q

What meds are used for eye allergies?

A

normal saline, azelastine (optivar), olopatadine (Patanol), naphazoline/pheniramine (Opcon-A)

40
Q

What does azelastine (optivar) do?

A

inhibits histamine release from mast cells, approved for use as early as 3 yrs

41
Q

What does olopatadine (patanol) do?

A

inhibits histamine release from mast cells, is approved for as early as 3 yrs

42
Q

What does naphazoline/pheniramine (opcon-A) do?

A

sympathomimetic which decreases congestion. pheniramine is an antihistamine. approved for use as early as 6 yr

43
Q

When should immunotherapy be considered?

A

meds insufficiently controls sx or produce undesirable SE, avoidance measures fail, H/O AR for at least 2 seasons, positive skin tests

44
Q

What should be used to treat mild intermittent symptoms of AR?

A

non-sedating antihistamines or decongestants

45
Q

What should be used to treat persistent mild to moderate symptoms of AR?

A

intranasal steroid starting 1-2 prior to season, non-sedating antihistamine or decongestant prn, topical ocular antihistamine

46
Q

What should be used to treat severe symptoms of AR?

A

topical nasal corticosteroids, non-sedating antihistamines or decongestant, short term oral corticosteriods, if no response consider immunotherapy

47
Q

What is anaphylaxis?

A

acute systemic allergic rxn that is the result of re-exposure to an antigen that elicits IgE. Type I hypersensitivity

48
Q

How does cardiovascular collapse occur due to histamine and other substances?

A

decreased BP (vasodilation), increased HR, edema (separation of endothelial cells and increased permeability)

49
Q

What are effects of histamine and other substances on respiratory system?

A

bronchospasm and airway edema

50
Q

What are the effects of histamine and other substances on GI system?

A

smooth muscle contraction and diarrhea

51
Q

What are the effects of histamine and other substances on skin?

A

urticaria (hives), flushed appearance

52
Q

What is the treatment for anaphylaxis?

A

epi, antihistamines (benadryl, maybe an H2 blocker), corticosteroids (decadron), treat HTN with IV fluids, bronchodilators (albuterol), observe for 24 hrs, repeat epi/antihistamines if rebound

Immunology (8 decks)

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