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Pharm Exam 3 > ch 63 > Flashcards

ch 63 Flashcards

1
Q

allergic rhinitis symptoms

A

sneezing
rhinorrhea
pruritis
nasal congestion due to dilation and increased permeability of nasal blood vessels

some have associated
conjunctivitis
sinusitis
asthma

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2
Q

Allergic rhinitis has 2 major forms

A

seasonal

perennial

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3
Q

seasonal rhinitis is AKA
occurs in the ___ and ___
in reaction to

A

Hay fever
spring and fall
outdoor allergens such as fungi and pollens from weeds, grasses and trees

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4
Q

Perennial (nonseasonal rhinitis)is triggered by

A

indoor allergens such as house dust mite and pet dander

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5
Q

drug classes for allergic rhinitis

A

intranasal glucocorticoids
antihistamines (oral and intranasal)
sympathomimetics (oral and intranasal)

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6
Q

the most effective drugs for prevention and treatment of seasonal and perennial rhinitis

A

intranasal glucocorticoids
Budesonide (Rhinocort Aqua)
Fluticasone Propionate (Flonase)
Triamcinolone (Nasocort Allergy 24 hours)

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7
Q

Budesonide (Rhinocort Aqua)
Fluticasone Propionate (Flonase)
Triamcinolone (Nasocort Allergy 24 hours)

A

intranasal glucocorticoids

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8
Q

Adverse effects intranasal glucocorticoids

A 
drying of the nasal mucosa
burning or itching sensation
sore throat 
epistaxis
headache

systemic effects rare at recommended dosing
adrenal suppression
slowing of linear growth in children

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9
Q

Benefits of intranasal glucocorticoids are greatest when

A

dosing is done daily rather than irregularly

After symptoms are controlled, dosage reduced to lowest effective

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10
Q

For patients with seasonal allergic rhinitis max effects of intranasal glucocorticoids may require

For perennial rhinitis max responses may take

A

a week or more to develop

2-3 weeks to develop

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11
Q

If you have congestion and you are administering intranasal glucocorticoids, how can you improve absorption

A

apply a topical decongestant first

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12
Q

first line drugs for mild to moderate allergic rhinitis

A

oral antihistamines

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13
Q

Oral antihistamines are most effective when taking

A

prophylactically and less helpful when taken after symptoms appear

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14
Q

Oral antihistamines relieve

A

sneezing, rhinorrhea, nasal itching but do not reduce nasal congestion

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15
Q

why are glucocorticoids more effective than antihistamines

A

Histamine is only one of several mediators of allergic rhinitis

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16
Q

why are antihistamines not effective with symptom control in the common cold

A

histamine does not contribute to symptoms of infectious rhinitis

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17
Q

Some patients take first generation antihistamines for their drying effect during a common cold but why could this complicate it

A

increasing the viscosity of their secretions

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18
Q

Adverse effects of first gen antihistamines (diphenhydramine)

A 
sedation 
anticholinergic effects such as drying of nasal secretions
dry mouth
constipation
urinary hesitancy
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19
Q

When generation of antihistamines has sedation and anticholinergic adverse effects

A

first gen which are rare in second gen

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20
Q

if nasal congestion is the dominant complaint
what meds?

if that doesnt work?

A

Intranasal glucocorticoids
Oral decongestant

combination therapy
allergy testing
reassess for anatomic nasal obstruction
reassess for nonallergic inflammation
immunotherapy
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21
Q

if intermittent sneezing, nasal itching and rhinorrhea are the main complaints, what meds?

if that doesnt work?

A

oral antihistamine
intranasal antihistamines

allergy testing
avoidance
immunotherapy

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22
Q

If mild rhinitis symptoms

if that doesnt work

A

oral antihistamine

intranasal glucocorticoids
intranasal antihistamine

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23
Q

moderate/severe rhinitis symptoms

if that doesnt work

A

intranasal glucocorticoids
intranasal antihistamine
combination therapy

allergy testing
aggressive environmental control
immunotherapy

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24
Q

2 intranasal histamines used for allergic rhinitis

A

Azelastine (Astelin and Astepro)

olopatadine (Patanase)

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25
Q

Azelastine (Astelin and Astepro)
olopatadine (Patanase)

for adults and children older than

A

12 years old

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26
Q

adverse effects
Azelastine (Astelin and Astepro)
olopatadine (Patanase)

A

somnolence
nosebleeds
headaches

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27
Q

Azelastine (Astelin and Astepro)
olopatadine (Patanase)

what generation

A

second generation

intranasal antihistamines

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28
Q

Chlorpheniramine

Diphenhydramine (Benadryl)

A

first generation oral antihistamines

sedating

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29
Q

Cromolyn reduces symptoms by

A

suppressing the release of histamine and other inflammatory mediators from mast cells

used for prophylaxis
may take a week or 2 to develop

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30
Q

If congestion is present ______ should be used before Cromolyn

A

topical decongestant

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31
Q

Sympathomimetics (Decongestants) work by

A

shrinking swollen membranes followed by nasal drainage

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32
Q

topical vs oral Sympathomimetics (Decongestants)

A

topical - vasoconstriction is rapid and intense

oral - responses are delayed, moderate and prolonged

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33
Q

In pt with allergic rhinitis Sympathomimetics (Decongestants) only relieve

A

congestion

They do not reduce rhinorrhea, sneezing or itching

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34
Q

Adverse effects of topical Sympathomimetics (Decongestants)

A

Rebound congestion

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35
Q

how to prevent rebound congestion

A

limit topical administration to 3-5 days

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36
Q

how to break rebound congestion

A

abrupt discontinuation (very uncomfortable)
stop one nostril at a time
or
use intranasal glucocorticoid (in both nostrils) for 2-6 weeks starting 1 week before d/c decongestant

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37
Q

topical Sympathomimetics (Decongestants) are not appropriate for

A

chronic rhinitis

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38
Q

Adverse effects of oral Sympathomimetics (Decongestants)

A

CNS excitation includes restlessness
irritability
anxiety
insomnia

widespread vasoconstriction - if used in excess this can happen in the topicals as well. This can be dangerous for those with HTN, CAD, Cardiac dysrhythmias, Cerebrovascular disease

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39
Q

Sympathomimetics (Decongestants) that is associated with abuse

A

Pseudoephedrine - similar to amphetamine

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40
Q

what is the combat methamphetamine epidemic act of 2005

A

all products that contain pseudoephedrine be kept behind the counter even though you dont need a prescription. It is tracked and you can purchase no more than 9g per month and 3.6g on any given day

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41
Q

what Sympathomimetics (Decongestants) is not very effective

A

phenylephrine

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42
Q

how should you administer drops?

A

with pt in a lateral, head-low position, causes to spread slowly over the nasal mucosa

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43
Q

drops are preferred in young children bc

A

they are particularly susceptible to toxicity

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44
Q

Sprays are ____ effective than drops

A

less

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45
Q

Diff in oral and topical agents

A

1) topical act faster than oral and are usually more effective
2) oral agents act longer than topical preparations
3) systemic effects (vasoconstriction and CNS stim) occur primarily with oral agents; topical agents usually elicit these responses only when dosage is higher than recommended
4) rebound congestion is common with prolonged use of topicals but its rare in oral

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46
Q

route for phenylephrine that is effective and route that is not

A

oral - not due to first pass metabolism

topical - fast and effective

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47
Q

Pseudoephedrine oral

A

compared with oral phenylephrine, it is better absorbed, longer half life and much more effective

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48
Q

Atrovent for allergic rhinitis treats

A

decreases rhinorrhea

does not decrease sneezing, nasal congestion or postnasal drip

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49
Q

most common side effects for Atrovent used for allergic rhinitis

A

nasal drying and irritation

no systemic effects

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50
Q

Montelukast (Singulair) for seasonal and perennial allergic rhinitis works to relieve

A

nasal congestion

little effect on sneezing or itching

less effective than intranasal glucocorticoids

51
Q

Montelukast (Singulair) adverse effects

A

Neurophsychiatric effects including agitation, aggression, hallucinations, depression, insomnia, restlessness, SI

52
Q

Best to reserve Montelukast for

A

patients who do not respond to or cannot tolerate intranasal glucocorticoids, antihistamines or both

53
Q

Opioid antitussives used most often for cough suppression work by?
examples

A

act in CNS to elevate cough threshold

Codeine - most effective
Hydrocodone - more potent - greater liability for abuse

54
Q

opioid antagonist

A

naloxone (narcan)

55
Q

What schedule when codeine is dispensed alone vs with antitussive mixtures

A

Schedule II

Schedule V

56
Q

most common OTC nonopioid cough medicine

A

Dextromethorphan

57
Q

At therapeutic doses, dextromethorphan does not

A

depress respiration

58
Q

antihistamine with the ability to suppress cough

A

Diphenhydramine

59
Q

Diphenhydramine adverse

A

sedative

anticholinergic

60
Q

Benzonatate (Tessalon) combo of

A

tetracaine and procaine

61
Q

Adverse effects of Benzonatate (Tessalon)

A

sedation
dizziness
constipation

62
Q

pt ed for Benzonatate (Tessalon)

A

in children younger than 2 - ingestion of just 1-2 caps can be fatal

swallow whole. Do not suck or chew
-can cause laryngospasm, bronchospasm, and circulatory collapse

63
Q

overdose of Benzonatate (Tessalon)

A

seizures
dysrhythmias
death

64
Q

smaller doses of Benzonatate (Tessalon) can cause

A

confusion
chest numbness
visual hallucinations
burning sensation in eyes

65
Q

Benzonatate (Tessalon) for children and adults

A

10 and older

66
Q

a drug that renders cough more productive by stimulating flow of resp tract secretions

A

Expectorant (guaifenesin - Mucinex)

67
Q

a drug that reacts directly with mucus to make it more watery

A

mucolytic
(hypertonic saline and acetylcysteine)
can trigger bronchospasm

68
Q

drug that smells like rotten egg bc of sulfur content

A

Mucolytics

69
Q

most URIs are caused by

A

rhinovirus

70
Q

URI symptoms

A 
rhinorrhea
nasal congestion
cough
sneezing
sore throat
hoarseness
headache
malaise
myalgia
fever for children
71
Q

Vit c and zinc for colds

A

no evidence that it will prevent or cure

72
Q

combination cold remedies contain 2 or more of

A 
nasal decongestant
an antitussive
analgesic
antihistamine
caffeine
73
Q

Why are antihistamines used in cold remedies

A

because of anticholinergic properties, used to suppress mucus secretion but it can worsen URI bc it can thicken secretions -> may lead to sinusitis

74
Q

why is caffeine used in cold remedies

A

to offset sedative effects of antihistamines may also help with associated headaches

75
Q

OTC combo formulations

A

it can be reformulated and then sold under the same name

76
Q

Young children and OTC cold remedies

A

no proof of safety but is proof of potential for serious harm

children treated for convulsions, tachycardia, hallucinations, impaired consciousness

FDA says no OTC cold remedies for children younger than 2yrs….reviewing safety for 2-11

American Academy of pediatrics says older than 6 years

only use pediatric approved products

ask a professional first

read all product safety info first

use measuring device provided with product

d/c and seek professional care if condition worsens or fails to improve

avoid using antihistamine containing products to sedate

77
Q

managing colds in children

A

bulb syringe to remove nasal secretions in ages less than 6 mos

saline nose drops to decrease stuffiness

cool mist humidifier to thin secretions

older than 1 yr , honey for cough

older than 2 yrs, mentholated chest rubs

acetaminophen or ibuprofen for discomfort or fever

78
Q

LTRA that that does not cause liver injury

A

Montelukast (Singulair)

79
Q

What LTRA does not have neuropsychiatric side effects

A

they all do
Zileuton (Zyflo)
Zafirlukast (Accolate)
Montelukast (Singulair)

80
Q

what 2 LTRAs have the risk of Churg Strauss syndrome

A

Zafirlukast (Accolate)

Montelukast (Singulair)

81
Q

weight loss
flulike
pulmonary vasculitis

A

Churg Strauss syndrome

usually when glucocorticoids are being withdrawn

82
Q

alternative to inhaled glucocorticoid for prophylactic therapy of asthma, administered on a fixed schedule to reduce frequency and intensity of attacks. Max effects take several weeks to develop

given 4 times per day!

A

Cromolyn

very safe
inconvenient

83
Q

Pt ed for cromolyn

A

instruct pt on proper use and care of nebs

administer 15 min before exercise and exposure to other precipitating factors such as cold and environment

long term - regular schedule

monitor and record peak expiratory flow, symptom frequency, symptom intensity, nighttime awakenings, effect on normal activity, SABA use

84
Q

Bronchodilators are used in

A

COPD

asthma

85
Q

SABA kids

A

2yr and older

86
Q

anticholinergics should not be used in kids younger than

A

11 years old

87
Q

Methylxanthines kids

A

children of all ages including neonates

88
Q

Pregnant women and bronchodilators

A

B2 agonists may cause uterine relaxation.
Benefits greater than risk
inhaled anticholinergics are among the safer

no methylxanthines

89
Q

B2 agonists and breastfeeding

A

fine use caution

90
Q

anticholinergics

A

dry up milk

91
Q

older adults bronchodilators

A

anticholinergics on BEERS

B agonists benefit vs risk

92
Q

LABAs and asthma

important note

A

long term control, not first line

MUST be combined with a glucocorticoid

93
Q

LAMA that contains lactose

A

Umeclidinium

94
Q

Ipratropium (Atrovent)

A

Short Acting Anticholinergic

95
Q

Aclidinium (Tudorza)
Tiotropium (Spiriva)
Umeclidinium (Incruse Elliptal)

A

Long Acting Muscarinic Antagonist

96
Q

med for asthma warned to avoid caffeine

A

Theophylline

caffeine can intensify adverse effects while decreasing theophylline breakdown

97
Q

med for asthma that warn against smoking tobacco or marijuana

A

Theophylline

increase clearance of Theophylline

98
Q

signs of theophylline tox

A 
nausea
vomiting
abd discomfort
diarrhea
insomnia
restlessness
palpitations
99
Q

decreased FEV1 means

A

obstruction on exhalation

100
Q

FEV1/FVC (pulmonary function test) is used to

A

distinguish obstructive from restrictive

101
Q

FEV1/FVC decreased

A

obstructive

102
Q

pulmonary fibrosis

conditions of decreased intercostal or diaphragmatic strength such as myasthenia gravis, obesity, pectus excavatum

A

restrictive

103
Q

FEV1/FVC increased or normal

A

restrictive

104
Q

what is used to monitor asthma

A

PEF (does not diagnose)

105
Q

maximal rate of airflow during expiration using a peak flowmeter

A

PEF

106
Q

when Use of SABAs increase, physical activity limited what does your pulmonary function test do

A

FEV1 decreases which means FEV1/FVC number drops

107
Q

Saba goal for control

A

less than 2 days a week

108
Q

to diagnose COPD requires what

A

pulmonary function test FEV1/FVC less than 0.7

109
Q

Treatment goal COPD

A

reduce symptoms
improve pt health status
increase exercise tolerance
reduce risks and mortality

110
Q

COPD few symptoms low risk is what category and what treatment

A

Cat A

SABA and consider LAMA or LABA

111
Q

COPD increased symptoms, low risk

cat and treatment?

A

Cat B
Symptom control - SABA

Add in LAMA or LABA or combo LAMA/LABA

112
Q

antiinflammatory asthma long term

A

glucocorticoids
LTRA
Cromolyn

113
Q

Bronchodilators asthma - long term control

A

LABA inhaled or oral

Theophyline

114
Q

Quick relief Bronchodilator

A

SABA

Anticholinergics

115
Q

Quick relief Antiinflammatory

A

Glucocorticoids systemic

116
Q

COPD few symptoms, high risk

A

Cat C
SABA

first choice - LAMA

persistent symptoms - Combo LAMA/LABA or LABA/IGC

117
Q

COPD increased symptoms, high risk

A

Cat D
SABA

first choice - LAMA or LAMA/LABA or IGC/LABA

Persistent - Combo LAMA/LABA/IGC

still persistent consider
Roflumilast
Azithromycin

118
Q

what drug class will you avoid in COPD in pt with a tachydysrhythmia or heart issue

A

LABA

119
Q

taking a glucocorticoid and blood sugar

in adrenal suppression - how does it change

A

Hyperglycemia

hypoglycemia

120
Q

glucocorticoid must be combined with what for COPD

A

LABA

121
Q

FEV1 > = 80 copd

A

mild COPD

122
Q

FEV1 50-79%copd

A

Moderate

123
Q

FeV1 30-49%copd

A

Severe

124
Q

FEV1 <30%copd

A

Very Severe

Pharm Exam 3 (19 decks)

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