Antihistamines

Question 1

When a patient presents with rhinitis, what do you need to figure out before prescribing treatment? Why?

Answer 1

whether its allergic rhinitis or a cold
Allergy - just need antihistamine
Cold - need anticholinergic effects

Question 2

Sedating effect of antihistamine depend on the _______ and ________.

Answer 2

Lipophilicity - cross BBB

Anticholinergic properties

Question 3

What are the general cautions for anticholinergic drugs?

Answer 3

pupil dilation (acute angle-closure glaucoma)
urinary retention (BPH)
dry mouth
tachycardia
constipation
sedation

Question 4

Hydroxyzine is sedating or non-sedating?

Answer 4

Sedating - anticholinergic

Question 5

5 indications for hydroxyzine

Answer 5

Anxiety
post-op sedation
antipuritic 
antiemetic
alcohol withdrawal symptoms

Question 6

Which antihistamine is indicated for alcohol withdrawal syndrome?

Answer 6

hydroxyzine

Question 7

which antihistamine is indicated for emergency pruritis?

Answer 7

hydroxyzine

Question 8

which antihistamine is indicated for anxiety?

Answer 8

hydroxyzine

Question 9

Which antihistamine is not well tolerated by the elderly?

Answer 9

hydroxyzine

Question 10

Why shouldn’t a patient with a cold be prescribed hydroxyzine while on vacation and drinking daily?

Answer 10

Alcohol + hydroxyzine = increase CNS toxicity

Question 11

What is the brand name for diphenhydramine?

Answer 11

Benadryl

Question 12

Which antihistamine is indicated for mild-night time sedation?

Answer 12

Diphenhydramine

Question 13

Which antihistamine is indicated for prevention of motion sickness?

Answer 13

Diphenhydramine

Question 14

Which antihistamine is indicated for coughing?

Answer 14

Diphenhydramine

Question 15

Which antihistamine is indicated for treatment of acute phenothiazine-induced dystonic reactions?

Answer 15

Diphenhydramine

Question 16

What patient population should not be prescribed diphenhydramine?

Answer 16

children

Question 17

Doxylamine is another sedating antihistamine. What is one of its brand names?

Answer 17

Nyquil

Question 18

Promethazine is another sedating antihistamine. What is its brand name and indication?

Answer 18

Phenergan - nausea/antiemetic

Question 19

Citirizine is a sedating or non sedating agent? Why?

Answer 19

Non-sedating, BUT, its the most sedating agent of its group

Its a metabolite of hydroxyzine.

Question 20

If a patient is allergic to hydroxyzine, what other antihistamine should you not give them?

Answer 20

cetirizine

Question 21

What is the brand name for Cetirizine?

Answer 21

Zyrtec

Question 22

Loratadine is sedating/nonsedating and is available coformulated with what other drug?

Answer 22

nonsedating

pseudoephedrine

Question 23

What is the brand name for Loratadine?

Answer 23

Claritin

Question 24

What does the D stand for in Claritin-D?

Answer 24

Decongestant - psuedoephedrine

Question 25

What is the active metabolite of loratadine?

Answer 25

Desloratadine - Clarinex

Question 26

Fexofenadine is a sedating/nonsedating antihistamine. Its an active metabolite of ____________ (Seldane) that had what fatal side effect?

Answer 26

Nonsedating. | Terfenadine - QT interval prolongation > Torsades

Question 27

Pseudoephedrine is what sort of drug? What does this mean for rhinitis patients?

Answer 27

alpha-1 agonist | it is a decongestant - vasoconstricts capillaries in nose, decreasing inflammation

Question 28

Patient has a cough that you suspect is from post-nasal drip. What is the treatment?

Answer 28

Pseudoephedrine

Question 29

patient has table-grade orthostatic hypotension. what is the treatment?

Answer 29

pseudoephedrine

Question 30

why is ephedrine no longer available?

Answer 30

it caused hemorrhagic stroke

Question 31

If patient is severely congested and you prescribe sudafed, how long is that patient able to use the nasal products?

Answer 31

3-5 days.

Question 32

Why is sudafed behind the counter?

Answer 32

Its an ingredient in meth.

Question 33

What are the ingredients to meth?

Answer 33

pseudoephedrine, ammonia, HCL, red phosphorus (flares)