Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology > Antihistamines, Allergen Immunotherapy And Allergic Emergencies > Flashcards

Antihistamines, Allergen Immunotherapy And Allergic Emergencies Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

All ________________ are of potential value in the treatment of nasal allergies, particularly seasonal allergic rhinitis (hayfever), and they may be of some value in vasomotor rhinitis

A

antihistamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

All antihistamines are of potential value in the treatment of nasal ______________, particularly ______________ rhinitis, and they may be of some value in ______________ rhinitis

A

nasal allergies

seasonal allergic (hayfever)

vasomotor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Antihistamines reduce ______________ and ________________ but are usually less effective for ________________

A

rhinorrhoea

sneezing

nasal congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Antihistamines are used ________________ in the eye, in the nose, and on the skin

A

topically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Oral antihistamines are also of some value in preventing ____________ and are used to treat ______________ rashes, ____________, and __________; they are also used in drug allergies

A

urticaria

urticarial

pruritus

insect bites and stings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Antihistamines may also be given in ______________ following initial stabilisation of the patient, especially in patients with persistent cutaneous symptoms

A

anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Antihistamines may also be given in anaphylaxis following initial stabilisation of the patient, especially in patients with persistent _____________ symptoms

A

cutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Antihistamines (including cinnarizine, cyclizine, and promethazine teoclate) may also have a role in ________________ and _______________

A

nausea

vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Buclizine is included as an anti-emetic in a preparation for _____________

A

migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Buclizine is included as an ________________ in a preparation for migraine

A

anti-emetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Antihistamines may also have a role in occasional _____________

A

insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

All older antihistamines cause sedation but ________________ and ________________ may be more sedating whereas chlorphenamine maleate and cyclizine may be less so

A

alimemazine tartrate

promethazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

All older antihistamines cause sedation but alimemazine tartrate and promethazine may be more sedating whereas _______________ and _________________ may be less so

A

chlorphenamine

cyclizine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Non-sedating antihistamines such as acrivastine, bilastine, cetirizine hydrochloride, desloratadine (an active metabolite of loratadine), fexofenadine hydrochloride (an active metabolite of terfenadine), levocetirizine hydrochloride (an isomer of cetirizine hydrochloride), loratadine and mizolastine cause less sedation and psychomotor impairment than the older antihistamines because they ___________________

A

penetrate the blood brain barrier only to a slight extent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The use of first-generation antihistamines in _____________ patients is potentially inappropriate (STOPP criteria) as safer, less toxic antihistamines are widely available

A

elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The use of ________________ antihistamines in elderly patients is potentially inappropriate (STOPP criteria) as safer, less toxic antihistamines are widely available

A

first-generation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the second generation antihistamines? (3)

A
  1. Cetirizine
  2. Fexofenadine
  3. Loratadine
  • the fox, the satyr, and the rat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the main first generation antihistamines? (5)

A
  1. Diphenhydramine
  2. Carbinoxamine
  3. Clemastine
  4. Chlorpheniramine
  5. Brompheniramine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Immunotherapy using ____________________ containing house dust mite, animal dander (cat or dog), or grass pollen extract and tree pollen extract can reduce symptoms of asthma and allergic rhinoconjunctivitis

A

allergen vaccines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Immunotherapy using allergen vaccines containing house dust mite, animal dander (cat or dog), or grass pollen extract and tree pollen extract can reduce symptoms of ______________ and allergic __________________

A

asthma

rhinoconjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Vaccines containing wasp venom extract or bee venom extract may be used to reduce the risk of severe ______________ and systemic reactions in individuals with hypersensitivity to wasp and bee stings.

A

anaphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

An ____________ preparation of grass pollen extract is licensed for disease-modifying treatment of grass pollen-induced rhinitis and conjunctivitis, and an ____________ preparation of house dust mite extract is licensed for disease-modifying treatment of house dust mite allergic rhinitis or asthma in certain patients

A

oral

oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

______________ is a monoclonal antibody that binds to immunoglobulin E (IgE). It is used as additional therapy in individuals with proven IgE-mediated sensitivity to inhaled allergens, whose severe persistent allergic asthma cannot be controlled adequately with high dose inhaled corticosteroid together with a long-acting beta2 agonist

A

Omalizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is anaphylaxis?

A

a severe, life-threatening, generalised or systemic hypersensitivity reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Anaphylaxis is characterised by rapidly developing _____________ and/or ______________ and/or ______________ problems, and is usually associated with skin and mucosal changes; prompt treatment is required.

A

airway

breathing

circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the most common allergens that cause anaphylaxis? (4)

A
  1. Food (e.g. peanuts, sesame, tree nuts, soy, shellfish, and cow’s milk)
  2. Drugs (e.g. antibacterials, aspirin and other NSAIDs, neuromuscular blocking drugs, chlorhexidine, contrast media, and vaccines)
  3. Venom (e.g. insect stings)
  4. Latex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In the case of drugs, anaphylaxis is more likely after _____________ administration

A

parenteral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Anaphylactic reactions may also be associated with ____________ and ____________ in foods and medicines

A

additives

excipients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Is refined arachis (peanut) oil present in some medical products likely to cause an allergic reaction?

A

Unlikely — nevertheless it is wise to check the full formula of preparations which may contain allergens

30
Q

Certain patients may be at higher risk of anaphylaxis, either because of ________________ or because of _________________

A

an existing comorbidity (such as asthma)

an increased likelihood of repeated exposure to the same allergen (such as those with venom or food allergies)

31
Q

_________________ may follow an anaphylactic reaction

A

Cardiopulmonary arrest; start cardiopulmonary resuscitation (CPR) immediately

32
Q

What is the immediate management of anaphylaxis? (10)

A
  1. Immediately call for an ambulance or the resuscitation team
  2. Remove the trigger if possible (eg drug or insect stinger)
  3. Place patient in a comfortable (eg flat to aid in the restoration of blood pressure OR semi-recumbent if airway or breathing problems and no evidence of CV instability OR in the recovery position for unconscious patients who are breathing normally)
  4. IM adrenaline
  5. Assess response to treatment by monitoring vitals and auscultate for wheeze
  6. Repeat dose of IM adrenaline given after 5-min if there is no improvement in the patient’s condition
  7. Nebulized adrenaline may be added as an adjunct to treat upper airway obstruction (but only after treatment with IM adrenaline and NOT as an alternative)
  8. High flow O2 given as soon as it is available
  9. IV fluids for patients with which or if there is poor response to initial dose of adrenaline
  10. Inhaled bronchodilator therapy may also be considered for patients with persistent respiratory problems but should NOT be used as an alternative to further treatment with adrenaline

*antihistamines are NOT part of the initial emergency treatment of anaphylaxis but may be used following stabilization in patients with persistent cutaneous symptoms (same with oral steroids)

33
Q

What is the dose of adrenaline used to treat anaphylaxis in adults?

A

IM 500 micrograms of adrenaline 1 in 1000

*same for children 12-17 yo

34
Q

What is the dose of adrenaline used to treat anaphylaxis in children under 12 yo?

A

6-11 yo: 300 micrograms adrenaline 1 in 1000
6 mo-5 yo: 150 micrograms adrenaline 1 in 1000
Up to 6 mo: 100-150

35
Q

What is the dilution of adrenaline used in CPR vs anaphylaxis?

A

CPR: 1 in 10,000 or 100 micrograms/mL
(1 mg for adults)

Anaphylaxis: 1 in 1,000 or 1 mg/mL
(500 micrograms for adults)

36
Q

Patients who have no improvement in respiratory and/or cardiovascular problems despite _______ appropriate doses of intramuscular adrenaline/epinephrine, should have their care escalated quickly and managed as having refractory anaphylaxis

A

2

37
Q

Nebulised adrenaline/epinephrine may be effective as an adjunct to treat upper airways obstruction caused by laryngeal oedema, but only after treatment with _______________ and not as an alternative

A

intramuscular adrenaline/epinephrine

38
Q

Antihistamines _________ (are/are not) recommended as part of the initial emergency treatment of anaphylaxis

A

Are not; may be used following stabilization, especially in patients with persistent cutaneous symptoms

39
Q

The routine use of corticosteroids for the emergency treatment of anaphylaxis ______ (is/is not) recommended

A

Is not; may be used after initial resuscitation for refractory reactions or ongoing asthma/shock

40
Q

Can corticosteroids be given instead of adrenaline in the initial treatment of anaphylaxis?

A

Nooope; only after initial resuscitation with adrenaline for refractory reactions or ongoing asthma/shock

Oral route where possible

41
Q

Refractory anaphylaxis is defined as anaphylaxis that requires ongoing treatment due to persisting respiratory and/or cardiovascular problems despite ____ appropriate doses of intramuscular adrenaline/epinephrine

A

2

42
Q

Adrenaline/epinephrine therapy should be supported with ____________ therapy

A

intravenous fluid

43
Q

Patients should be treated with an intravenous adrenaline/epinephrine infusion. Intravenous adrenaline/epinephrine should only be given by experienced specialists and in a setting where patients can be carefully monitored. If an intravenous infusion cannot be administered safely (e.g. due to a patient being outside a hospital setting), __________________

A

continue to give intramuscular adrenaline/epinephrine at 5-minute intervals while life-threatening cardiovascular and/or respiratory features persist

44
Q

If pregnant, what position should patients be put in during an episode of anaphylaxis?

A

Lie on left side to prevent aortic compression

45
Q

Where should IM adrenaline be given?

A

Anterolateral aspect — middle third of thigh

46
Q

What are the signs of life-threatening airway problems? (2)

A
  1. Hoarse voice

2. Stridor

47
Q

What are the signs of life-threatening breathing problems? (5)

A
  1. Increased work of breathing
  2. Wheeze
  3. Fatigue
  4. Cyanosis
  5. SpO2<94%
48
Q

What are the signs of life-threatening circulation problems? (4)

A
  1. Low BP
  2. Signs of shock
  3. Confusion
  4. Reduced consciousness
49
Q

What volume of fluids should be given to adults in the treatment of anaphylaxis following IM adrenaline administration?

A

IV fluid challenge with crystalloid — 500-1000 mL

(10 mL/kg in children)

https://www.resus.org.uk/sites/default/files/2021-04/Anaphylaxis%20algorithm%202021.pdf

50
Q

How should patients be managed prior to discharge following an episode of anaphylaxis? (3)

A
  1. Provided with 2 adrenaline auto-injectors
  2. Trained on their correct use
  3. Advised to carry them at all times
51
Q

The provision of adrenaline/epinephrine auto-injectors are appropriate for all patients who have had anaphylaxis, with the exception of those with a _____________

A

drug-induced reaction (unless future exposure to the trigger drug will be difficult to avoid)

52
Q

______________ can be caused by an allergic reaction. It involves the swelling of deeper tissues, most commonly in the eyelids and lips, and sometimes the tongue and throat

A

Angioedema

53
Q

Allergic angioedema that occurs with life-threatening airway and/or breathing and/or circulatory problems should be managed as _______________

A

anaphylaxis

54
Q

Unlike allergic angioedema, adrenaline/epinephrine, corticosteroids, and antihistamines should not be used for the treatment of acute attacks of ______________________

A

Hereditary angioedema

(including attacks involving laryngeal oedema) as they are ineffective and may delay appropriate treatment—intubation may be necessary
*C1-esterase inhibitors should be used instead

55
Q

What is the treatment of choice for acute hereditary angioedema?

A

C1-esterase inhibitors, an endogenous complement blocker derived from human plasma

56
Q

Which drugs can be used for short-term prophylaxis of hereditary angioedema? (2)

A
  1. Tranexamic acid
  2. Danazol (unlicensed)

*started several days before planned procedures (eg dental work) and continued for 2-5 days afterwards

57
Q

Non-sedating antihistamines such as certirizine hydrochloride cause less ____________ and ______________ impairment than the older antihistamines, but can still occur; sedation is generally minimal

A

sedation

psychomotor

58
Q

Children under _______ years should not be given over-the-counter cough and cold medicines containing chlorphenamine

A

6

59
Q

Children under 6 years should not be given over-the-counter cough and cold medicines containing ____________

A

chlorphenamine (a 1st gen antihistamine)

60
Q

Older antihistamines should be prescribed with caution in patients with which conditions? (5)

A
  1. Epilepsy
  2. Prostatic hypertrophy
  3. Pyloroduodenal obstruction
  4. Susceptibility to angle-closure glaucoma
  5. Urinary retention

(Due to anti-cholinergic effects)

61
Q

What are the common side effects of first generation antihistamines? (8)

A
  1. Impaired concentration
  2. Abnormal coordination
  3. Dizziness
  4. Dry mouth
  5. Fatigue
  6. Headache
  7. Nausea
  8. Blurred vision

(Due to anti-cholinergic effects)

62
Q

What advice should be given to patients and carers regarding antihistamines?

A

Drowsiness may affect performance of skilled tasks eg cycling or driving

Sedating effects are enhanced by alcohol

63
Q

Sedating effects of antihistamines are enhanced by consumption of ___________

A

Alcohol

64
Q

Adrenaline is not licensed for the treatment of CPR in ____________ and infants with body-weight under ____________

A

Infants

5 kg

(But still used in this group)

65
Q

Adrenaline should be prescribed with caution in which patients? (20)

A
  1. Arteriosclerosis
  2. Arrhythmias
  3. Cerebrovascular disease
  4. Cor pulmonale
  5. DM
  6. Elderly
  7. Hypercalcemia
  8. Hyperreflexia
  9. HTN
  10. Hyperthyroidism
  11. Hypokalemia
  12. IHD
  13. Obstructive cardiomyopathy
  14. Occlusive vascular disease
  15. Organic brain damage
  16. Pheochromocytoma
  17. Prostate disorders
  18. Psychoneurosis
  19. Severe angina
  20. Susceptibility to angle closure glaucoma

**cautions are only for non-life-threatening situations

66
Q

What is the main side effect of adrenaline?

A

Cardiomyopathy and MI

but also may cause injection site necrosis, CNS hemorrhage, hepatic/renal/ intestinal necrosis, pulmonary edema

67
Q

IM use of adrenaline in pregnancy may reduce ___________ and cause ___________, ___________, and ___________ in fetus.

Can delay second stage of labor

A

placental perfusion

tachycardia

cardiac irregularities

extrasystoles

**only use if benefits outweigh risk

68
Q

Is adrenaline safe to administer while breastfeeding?

A

Yes; present in milk but poor oral bioavailability so unlikely to cause harm

69
Q

What monitoring is required when administering adrenaline?

A

Monitor BP and ECG

70
Q

Which antihistamines are used in the management of nausea and vomiting? (4)

A
  1. Cyclizine
  2. Cinnarizine
  3. Promethazine
  4. Buclizine

Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions