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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
Azelastine (Astelin and Astepro) olopatadine (Patanase) for adults and children older than
12 years old
26
adverse effects Azelastine (Astelin and Astepro) olopatadine (Patanase)
somnolence nosebleeds headaches
27
Azelastine (Astelin and Astepro) olopatadine (Patanase) what generation
second generation | intranasal antihistamines
28
Chlorpheniramine | Diphenhydramine (Benadryl)
first generation oral antihistamines | sedating
29
Cromolyn reduces symptoms by
suppressing the release of histamine and other inflammatory mediators from mast cells used for prophylaxis may take a week or 2 to develop
30
If congestion is present ______ should be used before Cromolyn
topical decongestant
31
Sympathomimetics (Decongestants) work by
shrinking swollen membranes followed by nasal drainage
32
topical vs oral Sympathomimetics (Decongestants)
topical - vasoconstriction is rapid and intense | oral - responses are delayed, moderate and prolonged
33
In pt with allergic rhinitis Sympathomimetics (Decongestants) only relieve
congestion They do not reduce rhinorrhea, sneezing or itching
34
Adverse effects of topical Sympathomimetics (Decongestants)
Rebound congestion
35
how to prevent rebound congestion
limit topical administration to 3-5 days
36
how to break rebound congestion
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
37
topical Sympathomimetics (Decongestants) are not appropriate for
chronic rhinitis
38
Adverse effects of oral Sympathomimetics (Decongestants)
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
39
Sympathomimetics (Decongestants) that is associated with abuse
Pseudoephedrine - similar to amphetamine
40
what is the combat methamphetamine epidemic act of 2005
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
41
what Sympathomimetics (Decongestants) is not very effective
phenylephrine
42
how should you administer drops?
with pt in a lateral, head-low position, causes to spread slowly over the nasal mucosa
43
drops are preferred in young children bc
they are particularly susceptible to toxicity
44
Sprays are ____ effective than drops
less
45
Diff in oral and topical agents
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
46
route for phenylephrine that is effective and route that is not
oral - not due to first pass metabolism | topical - fast and effective
47
Pseudoephedrine oral
compared with oral phenylephrine, it is better absorbed, longer half life and much more effective
48
Atrovent for allergic rhinitis treats
decreases rhinorrhea does not decrease sneezing, nasal congestion or postnasal drip
49
most common side effects for Atrovent used for allergic rhinitis
nasal drying and irritation | no systemic effects
50
Montelukast (Singulair) for seasonal and perennial allergic rhinitis works to relieve
nasal congestion little effect on sneezing or itching less effective than intranasal glucocorticoids
51
Montelukast (Singulair) adverse effects
Neurophsychiatric effects including agitation, aggression, hallucinations, depression, insomnia, restlessness, SI
52
Best to reserve Montelukast for
patients who do not respond to or cannot tolerate intranasal glucocorticoids, antihistamines or both
53
Opioid antitussives used most often for cough suppression work by? examples
act in CNS to elevate cough threshold Codeine - most effective Hydrocodone - more potent - greater liability for abuse
54
opioid antagonist
naloxone (narcan)
55
What schedule when codeine is dispensed alone vs with antitussive mixtures
Schedule II | Schedule V
56
most common OTC nonopioid cough medicine
Dextromethorphan
57
At therapeutic doses, dextromethorphan does not
depress respiration
58
antihistamine with the ability to suppress cough
Diphenhydramine
59
Diphenhydramine adverse
sedative | anticholinergic
60
Benzonatate (Tessalon) combo of
tetracaine and procaine
61
Adverse effects of Benzonatate (Tessalon)
sedation dizziness constipation
62
pt ed for Benzonatate (Tessalon)
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
overdose of Benzonatate (Tessalon)
seizures dysrhythmias death
64
smaller doses of Benzonatate (Tessalon) can cause
confusion chest numbness visual hallucinations burning sensation in eyes
65
Benzonatate (Tessalon) for children and adults
10 and older
66
a drug that renders cough more productive by stimulating flow of resp tract secretions
Expectorant (guaifenesin - Mucinex)
67
a drug that reacts directly with mucus to make it more watery
mucolytic (hypertonic saline and acetylcysteine) can trigger bronchospasm
68
drug that smells like rotten egg bc of sulfur content
Mucolytics
69
most URIs are caused by
rhinovirus
70
URI symptoms
``` rhinorrhea nasal congestion cough sneezing sore throat hoarseness headache malaise myalgia fever for children ```
71
Vit c and zinc for colds
no evidence that it will prevent or cure
72
combination cold remedies contain 2 or more of
``` nasal decongestant an antitussive analgesic antihistamine caffeine ```
73
Why are antihistamines used in cold remedies
because of anticholinergic properties, used to suppress mucus secretion but it can worsen URI bc it can thicken secretions -> may lead to sinusitis
74
why is caffeine used in cold remedies
to offset sedative effects of antihistamines may also help with associated headaches
75
OTC combo formulations
it can be reformulated and then sold under the same name
76
Young children and OTC cold remedies
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
managing colds in children
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
LTRA that that does not cause liver injury
Montelukast (Singulair)
79
What LTRA does not have neuropsychiatric side effects
they all do Zileuton (Zyflo) Zafirlukast (Accolate) Montelukast (Singulair)
80
what 2 LTRAs have the risk of Churg Strauss syndrome
Zafirlukast (Accolate) | Montelukast (Singulair)
81
weight loss flulike pulmonary vasculitis
Churg Strauss syndrome usually when glucocorticoids are being withdrawn
82
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!
Cromolyn very safe inconvenient
83
Pt ed for cromolyn
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
Bronchodilators are used in
COPD | asthma
85
SABA kids
2yr and older
86
anticholinergics should not be used in kids younger than
11 years old
87
Methylxanthines kids
children of all ages including neonates
88
Pregnant women and bronchodilators
B2 agonists may cause uterine relaxation. Benefits greater than risk inhaled anticholinergics are among the safer no methylxanthines
89
B2 agonists and breastfeeding
fine use caution
90
anticholinergics
dry up milk
91
older adults bronchodilators
anticholinergics on BEERS B agonists benefit vs risk
92
LABAs and asthma important note
long term control, not first line MUST be combined with a glucocorticoid
93
LAMA that contains lactose
Umeclidinium
94
Ipratropium (Atrovent)
Short Acting Anticholinergic
95
Aclidinium (Tudorza) Tiotropium (Spiriva) Umeclidinium (Incruse Elliptal)
Long Acting Muscarinic Antagonist
96
med for asthma warned to avoid caffeine
Theophylline caffeine can intensify adverse effects while decreasing theophylline breakdown
97
med for asthma that warn against smoking tobacco or marijuana
Theophylline increase clearance of Theophylline
98
signs of theophylline tox
``` nausea vomiting abd discomfort diarrhea insomnia restlessness palpitations ```
99
decreased FEV1 means
obstruction on exhalation
100
FEV1/FVC (pulmonary function test) is used to
distinguish obstructive from restrictive
101
FEV1/FVC decreased
obstructive
102
pulmonary fibrosis | conditions of decreased intercostal or diaphragmatic strength such as myasthenia gravis, obesity, pectus excavatum
restrictive
103
FEV1/FVC increased or normal
restrictive
104
what is used to monitor asthma
PEF (does not diagnose)
105
maximal rate of airflow during expiration using a peak flowmeter
PEF
106
when Use of SABAs increase, physical activity limited what does your pulmonary function test do
FEV1 decreases which means FEV1/FVC number drops
107
Saba goal for control
less than 2 days a week
108
to diagnose COPD requires what
pulmonary function test FEV1/FVC less than 0.7
109
Treatment goal COPD
reduce symptoms improve pt health status increase exercise tolerance reduce risks and mortality
110
COPD few symptoms low risk is what category and what treatment
Cat A | SABA and consider LAMA or LABA
111
COPD increased symptoms, low risk | cat and treatment?
Cat B Symptom control - SABA Add in LAMA or LABA or combo LAMA/LABA
112
antiinflammatory asthma long term
glucocorticoids LTRA Cromolyn
113
Bronchodilators asthma - long term control
LABA inhaled or oral | Theophyline
114
Quick relief Bronchodilator
SABA | Anticholinergics
115
Quick relief Antiinflammatory
Glucocorticoids systemic
116
COPD few symptoms, high risk
Cat C SABA first choice - LAMA persistent symptoms - Combo LAMA/LABA or LABA/IGC
117
COPD increased symptoms, high risk
Cat D SABA first choice - LAMA or LAMA/LABA or IGC/LABA Persistent - Combo LAMA/LABA/IGC still persistent consider Roflumilast Azithromycin
118
what drug class will you avoid in COPD in pt with a tachydysrhythmia or heart issue
LABA
119
taking a glucocorticoid and blood sugar in adrenal suppression - how does it change
Hyperglycemia hypoglycemia
120
glucocorticoid must be combined with what for COPD
LABA
121
FEV1 > = 80 copd
mild COPD
122
FEV1 50-79%copd
Moderate
123
FeV1 30-49%copd
Severe
124
FEV1 <30%copd
Very Severe

Pharm Exam 3 (19 decks)

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