antihistamines Flashcards
Which is the primary site of ocular allergies?
a. conjunctiva
b. lids
c. cornea
conjunctiva
Includes the coagulation-kinin sequence and non-classical complement cascade
a. innate immune response
b. adaptive immune response
innate immune response
The innate immune response is a first-line response that is _______, acute, ______ memory, and involves both humoral and cell-mediated responses.
a. specific, has memory
b. nonspecific, has memory
c. nonspecific, lacks memory
nonspecific, lacks memory
T/F: The classical complement cascade (Ag-Ab) is part of the specific adaptive immune response.
True!
All of the following describe the adaptive immune response, except:
a. requires prior exposure of the antigen
b. features both specificity and memory.
c. found exclusively in jawed vertebrates
d. involves memory B and T cells
e. all of the above describes adaptive immune response
all of the above
Which is aka “acquired immunity” and is the basis for vaccinations?
a. innate immune response
b. adaptive immune response
adaptive immune response
All of the following are involved in the innate immune response, except:
a. Natural killer T cells
b. macrophages
c. B cells
d. monocytes and granulocytes
B cells are NOT part of the innate immune response.
The response time for an innate immune response is _____, and _____ for an adaptive immune response.
a. less than 12 hours, 1 day
b. less than 12 hours, 1-2weeks
c. less than 24 hours, 1 day
d. less than 24 hours, 1-2 weeks
less than 12 hours, 1-2 weeks
A foreign substance having the capacity to evoke an immunological response.
antigen
which is not one of the 3 categories of antigens that can cause an allergic response?
a. environmental
b. biological
c. chemical
d. physical
physical
An exaggerated immune response specifically involving an innate or foreign innocuous antigen classified as an “allergen”
hypersensitivity
Atopy, asthma, and anaphylaxis are examples of what type of hypersensitivity response?
a. type I
b. type II
c. type III
d. type IV
type I
Which types are most commonly associated with ocular reactions?
a. Types I & III
b. Types I & IV
c. Types III & IV
d. Types I and II
Types I and IV
I = allergy IV = Delayed CD4 and/or Cell-mediated CD8
Which type of hypersensitivity reaction is IgE based?
a. Type I only
b. Type II only
c. Types I and II
d. Types I and IV
Type I only (allergy)
Which type of hypersensitivity reaction is "IgM or IgG based"? a. Type I only b. Type II only c. Types II and III Types III and IV
Types II and III
Atopy, asthma, and anaphylaxis are what type of hypersensitivity response?
Type I, II, III or IV?
Type I
Antibody mediated or cytotoxic such as Graves, MG or autoimmune diseases are what type of hypersensitivity response?
Type II
Arthritis, nephritis, vasculitis, SLE (lupus) are what type of hypersensitivity response?
Type III
Transplant rejection, IDDM (Diabetes), MS, and RA are what type of hypersensitivity response?
Type IV
Which type of hypersensitivity is T cell based, antibody independent, and not responsive to antihistamines?
Type IV
Itch is an essential symptom of what?
ocular allergy
What is the dosing frequency for ocular allergies?
every 2 hours to once daily
q2h to Qd
Decongestants, antihistamines, ____ ____ stabilizers, NSAIDS, s_____, allergen avoidance, and cold compresses are all allergy therapies.
Mast Cell stabilizers, steroids
Avoid ______ the eyes is the most important piece of advice that an optometrist can give when it comes to allergies.
AVOID RUBBING THE EYES!!!
Decongestants are ________ agonists that are imidazole derivatives lacking a saturated ______ ring.
adrenergic (alpha), benzene ring.
Why is phenylephrine NOT commonly used to treat allergies? (2 adverse effects)
because it causes “rebound congestion” and chronic use can cause “conjunctiva medicamentosa”
What is the general dosing condition for decongestants?
BID to QID
2 to 4 times per day
Do NOT give decongestants to which patients?
Do NOT give to pts with “angle closure glaucoma” or narrow angles, and be cautious with cardiovascular, hyperthyroidism, and diabetes.
T/F: vasoconstriction reduces hyperemia and edema.
True
Phenylephrine, naphazoline, oxymetazoline, and tetrahydrozoline are all _______ ______ (aka decongestants).
a. cholinergic agonists
b. adrenergic agonists
c. cholinergic antagonists
d. adrenergic antagonists
adrenergic agonists!!
Which decongestant causes elevated IOP and mydriasis?
a. phenyleprhine
b. naphazoline
c. tetrahydrozoline
d. oxymetazoline
naphazoline
Which decongestant causes reduced IOP?
a. phenylephrine
b. naphazoline
c. tetrahydrozoline
d. oxymetazoline
tetrahydrozoline (longer word)
how many histamine receptor types are there?
4 types (H1,2,3,4)
which histamine receptor type promotes gastric acid production and immune cell activation?
H2
the eye, stomach, heart, lungs and immune cells have a substantial distribution of which type of histamine receptors?
H2
immuno-modulation, inflammation, and nociception occur in what histamine receptor type?
H4
Which histamine receptor type is involved in pre-synaptic feedback inhibition?
H3
which histamine receptor type is involved in immediate hypersensitivity reactions?
H1
_______ promotes vascular permeability, which causes runny nose, watery eyes, swollen lids, and papillae.
Histamine!! (this is what makes you sneeze… the thing you are allergic to)
Topical histamine in the eyes used in experimental animals has additional effects such as _______ IOP, mild miosis, and ________ blood aqueous barrier permeability.
increased IOP, increased BAB permeability.
histamine induces vaso________, smooth muscle ________, broncho_______, and stimulates sensory nerves causing pain, itching and sneezing.
vasoDILATION, smooth muscle CONTRACTION, and bronchoCONSTRICTION. (VD, BC)
It was long perceived that H1 and H2 anti-histamines were “histamine receptor antagonists”, but it has been found that they are actually “________ agonists”
INVERSE agonists
______ agonists bind to the same receptor site as agonists but cause the opposite effect. They cause the reversal of ________ receptor activity.
INVERSE agonists, constitutive
H2 anti-histamine therapy is also used to treat ___________.
GERD and peptic ulcers
If a patient presents with a deeper ocular condition, such as moderate to severe eyelid edema, what kind of therapy would be most effective?
Oral therapy
Antihistamines are usually either once a day, every 2 hours, or every 4 hours.
True! (QD, BID, QID)
Which of the following is NOT an indication for anti-histamine use?
a. itchy and watery eyes
b. mild to mod. allergic conjunctivitis
c. myokymia
d. intra-operative anti-mydriatic
e. allergic rhinitis
intra-operative anti-mydriatic. it should be miotic!!!!
OTC and prescription anti-histamines often cause drowsiness because they are _______ and _____ enter the CNS.
a. cholinergic, readily
b. cholinergic, do not
c. anticholinergic, readily
d. anticholinergic, do not
anticholinergic, readily (easily)
if your patient comes in with a red eye, what should you always ask to rule out systemic cause?
ask if the patient has any upper respiratory problems or rhinitis, to rule out systemic causes.
What are the 2 common antihistamine-decongestion drugs called?
Naphcon-A (visine) and Vasocon-A.
“con” refers to the decongestant and “A” refers to antihistamine. Both of these are 1st generation antihistamines
T/F? Vasocon-A = antazoline phosphate + Naphazoline HCl; Naphcon-A= Pheniramine maleate + Naphazoline HCl.
True!!!
Mnemonic: “VA hospitals have a lot of NPs (Nurse Practitioners)”
the suffix “-zoline” is indicative of what type of drug?
a. antihistamine
b. decongestant
c. antibiotic
b. decongestant!!!
Which of the following are adverse effects of topical antihistaminics/decongestants?
a. mydriasis
b. anisocoria
c. reactive hyperemia
d. vasoconstriction
e. all of the above
all of the above!
Why are MAOI and EtOH considered contraindications for topical antihistaminics?
MAOI blocks degradation and metabolism of catecholamines, which can dangerously elevate catecholamine levels; EtOH is a CNS depressant, which causes sedation. Therefore, it can have an additive effect if the patient is taking EtOH.
Mast cell stabilizers are useful against type I hypersensitivity reactions, but are NOT USEFUL for which type?
a. type 1
b. type 2
c. type 3
d. type 4
useless for type 4 hypersensitivity rxns. WHY??? Recall that type 4 includes medicamentosa, which does NOT involve degranulation. The whole point of using a Mast Cell Stabilizer is to inhibit degranulation.
How do “mast cell stabilizers” function as a type of allergy treatment?
Mast cell stabilizers are oral agents that block Ca2+ influx, which inhibits degranulation.
If a patient presents with Vernal Keratoconjunctivitis or Giant Papillary Conjunctivitis (GPC), which would be the best treatment?
a. Antihistamine
b. Decongestant
c. Mast Cell Stabilizer
d. NSAID
e. Steroid
Mast Cell Stabilizer would be BEST!!
Which topical mast cell stabilizer is the FASTEST acting in its class (15-30 min) and the ONLY one that is BID dosing?
a. permirolast (alamast)
b. nedocromil (alocril)
c. lodoxamide (alomide)
d. cromolyn (crolom)
nedocromil (alocril)
T/F: Mast Cell Stabilizers (MCS) are better suited than Decongestants for use in younger children.
true!!!
MCS’s can be used in 2,3,4 year olds. while decongestants can only be used in 6yr and older.
Which Topical Mast Cell Stabilizer can be used in a 2 yr old child?
a. permirolast
b. nedocromil
c. lodoxamide
d. cromolyn
lodoxamide (alomide)
T/F: A typical treatment course using Mast Cell Stabilizers is 7-days QID followed by BID maintenance.
True!!
Out of the four topical mast cell stabilizers: ________ has the most adverse effects, while ________ has the least.
a. nedocromil, lodoxamide
b. lodoxamide, cromolyn
c. lodoxamide, nedocromil
d. nedocromil, permirolast
c. lodoxamide, nedocromil
Which topical Antihistaminic/Mast cell stabilizer combo drug is available OTC?
a. Ketotifen (ALAWAY)
b. Epinastine (ELESTAT)
c. Alcaftadine (LASTACAFT)
d. Olopatadine (PATADAY)
Ketotifen (ALAWAY) is the ONLY Antihistaminic/MCS combo drug that is available OTC. (Claritin Eye, Refresh, Zatidor).
It is given BID.
Which topical Antihistaminic/ Mast cell stabilizer combo drug has anti-H2 receptor properties and can cause upset stomach?
a. Ketotifen (ALAWAY)
b. Epinastine (ELESTAT)
c. Alcaftadine (LASTACAFT)
d. Olopatadine (PATADAY)
Epinastine (ELESTAT)
Which TWO antihistaminic/Mast cell stabilizer combo drugs are taken QID (every 4 hours)?
a. Ketotifen (ALAWAY)
b. Epinastine (ELESTAT)
c. Alcaftadine (LASTACAFT)
d. Olopatadine (PATADAY)
Alcaftadine (LASTACAFT)
Olopatadine (PATADAY)
NSAID’s work as an _____________ agent, not as an antihistamine or Mast cell stabilizer.
anti-inflammatory agent
Ketorolac tromethamine (Acular) is a __________ approved to treat Seasonal Allergic Conjunctivitis (SAC)
a. antihistaminic
b. decongestant
c. mast cell stabilizer
d. NSAID
e. steroid
NSAID
T/F: Loteprednol etabonate (lotemax) is safe for long term therapy of SAC and VKC.
True!!!
T/F: If a patient has a cold or an upper respiratory infection, it is better to use an oral drug rather than a topical.
True!!
T/F: Topical antihistaminics required dosing may be _____ frequent than oral therapy.
a. more
b. less
Topical = more frequent
First generation oral antihistaminics (classic) cause drowsiness, while second generation ones are non-drowsy.
True!
Second generation oral antihistaminics are non-drowsy because they have poor _________ character and thus do NOT enter the CNS.
a. lipophobic
b. lipophilic
poor lipophilic character
cimetidine, famotidine, nizatidine, and ranitidine are all examples of ________?
oral anti-H2 antihistamines
Diphenhydramine, aka ________ OTC, is a first generation oral antihistaminic that causes drowsiness and can sometimes be used specifically as a sedative.
BENADRYL!!!
Fexofenadine (Allegra) is a second generation oral anti-histaminic that has the least CNS effects (least drowsy)
True!
Which is the MOST POTENT second generation oral anti-histaminic, but is the most sedating one as well?
a. fexofenadine (ALLEGRA)
b. claritin (loratadine)
c. clarinex (desloratadine)
d. zyrtec (cetirizine)
Zyrtec (cetirizine)
