Chapter 37: Allergic Rhinitis, Cough & Cold Flashcards
____ can determine patient-specific allergens
IgE-mediated skin prick test
Examples of wetting agents that are commercially available for allergic rhinitis
Ocean, Little Remedies
Nasal irrigation uses ___ or ___ saline solution to rinse out allergens and mucus, improve ciliary function and reduce swelling
Isotonic (0.9%) or hypertonic
What is first line for chronic, moderate-severe symptoms of allergic rhinitis
Intranasal steroids
Mild, intermittent symptoms of allergic rhinitis can be treated with
oral antihistamines
Budesonide brand name for allergic rhinitis
Rhinocort Allergy
Fluticasone brand name for allergic rhinitis
Flonase Allergy Relief, Flonase Sensimist, Children’s Flonase
Triamcinolone brand name for allergic rhinitis
Nasacort Allergy 24H, Nasacort Allergy 24H Children
How long can it take for full relief of symptoms if using an intranasal steroid for allergic rhinitis
up to 1 week
What are the preferred nasal steroids in pregnancy for allergic rhinitis
Budesonide and beclomethasone
remember B for baby
T/F: Antihistamines work well for nasal congestion
Fasle
Antihistamines MOA
block histamine at H1 receptor site
Which group of antihistamines cause more sedation
first-generation
second generation are preferred
Which drugs are first generation oral antihistamines
Benadryl, chlorpheniramine, doxylamine
First generation antihistamines should be avoided in which patient population
Elderly (due to sedation and cognitive impairment)
First generation antihistamines should be used with caution in which disease states
Prostate enlargement and glaucoma
Cetirizine brand name
Zyrtec
Levocetirizine brand name
Xyzal
Fexofenadine brand name
Allegra
Loratadine brand name
Claritin
Which second generation antihistamine should be taken with water only and NOT juice due to decreased absorption
Fexofenadine
Which second generation antihistamines should be used in pregnancy
Loratadine or cetirizine (Claritin or Zyrtec)
Which second generation antihistamines have a fast onset and may work best for some patients
Cetirizine and levocetirizine (Zyrtec and Xyzal)
Which two second generation antihistamines are more sedating
Cetirizine and levocetirizine
Which two second generation antihistamines are least sedating
Fexofenadine and loratidine
Benadryl dosing for adults
25-50 mg PO Q4-6H
Benadryl dosing for age < 6 years
DO NOT USE OTC unless directed by a healthcare provider
Which drug class can be combined with an intranasal steroid to help with congestion
Intranasal antihistamines (Azelastine and Olopatadine)
Decongestant MOA
Alpha-adrenergic agonists that cause vasoconstriction, which decreases sinus vessel engorgement and mucosal edema
Which decongestant has poor oral absorption
Phenylephrine (comes as a nasal inhaler, but lasts for a shorter time & causes more SE than oxymetazoline inhalers)
Pseudoephedrine is a precursor to which drug
methamphetamine
Under federal law, the max amount of PSE products allowed for purchase in a day & in a 30-day period is
3.6 g per day
9 grams in a 30-day period
(remember: 3-6-9)
Phenylephrine brand name
Sudafed PE
Pseudoephedrine brand names
Sudafed, Nexafed, Zephrex-D
Oxymetazoline brand name
Afrin (nasal spray)
Systemic decongestants CI
Do not use within 14 days of MAOi
Systemic decongestants should be avoided in children < __ years (FDA) and < __ years (package labeling)
2
4
Systemic decongestants should be used with caution in patients with
CV disease, BPH (can cause urinary retention)
Systemic decongestant SE
Tachycardia, palpitations, increased BP, insomnia, decreased appetite
Oxymetazoline can cause rhinitis medicamentosa (rebound congestion) if used longer than
3 days
Intranasal cromolyn (NasalCrom) MOA
OTC mast cell stabilizer for tx and ppx of allergic rhinitis
In order for intranasal cromolyn to be effective, it must be started at the onset of allergy season and:
used regularly (not PRN)
Which patient groups can benefit from intranasal cromolyn
Children >/= 2 years old and pregnancy
Montelukast brand name
Singulair
Montelukast is the only leukotriene modifying agent indicated for both
allergic rhinitis and asthma
Montelukast is commonly used in which patient population
children
An alternative to immunotherapy (allergy shots), SL treatment can be given. The 4 FDA-approved SL treatments for allergic rhinitis are tailored to specific allergens & the first dose must:
be given in a medical office where the patient can be monitored for at least 30 min after for signs of an allergic reaction (boxed warning)
How is the common cold transmitted
Mucus secretions or by air
T/F: the common cold is a bacterial infection
False - viral
Which natural products can be used for cold symptoms
- Zinc for cold prevention and treatment
- Vitamin C (ascorbic acid) decreases duration of cold
- Echinacea is possibly effective for treatment
What can be used if a productive cough is present
Expectorants to thin mucus
Which drugs are expectorants
Gauifenesin (Mucinex, Robitussin Mucus + Chest Congestion, Robafen)
+ dextromethorphan (Robafen DM, Robitussin DM)
Which drugs are cough suppressants
- Dextromethorphan (Delsym, Robafen Cough, Robitussin Cough)
- Codeine
- Benzonatate (Tessalon Perles)
- Diphenhydramine
Codeine if used for pain as a single entity is a schedule __ drug & if used in combination products for cough and cold is a schedule ___ drug
II
V
Dextromethorphan CI
Do not use within 14 days of MAOi
Dextromethorphan SE
serotonin syndrome
Codeine BW
respiratory depression and death in children who received codeine following tonsillectomy and/or adenoidectomy and have evidence of being ultra-rapid metabolizers of codeine d/t a 2D6 polymorphism
(also in nursing infants)
Codeine should not be used in children < __ years for any indication. The FDA recommends to avoid codeine-containing cough and cold products for patients < __ years
12
18
Dextromethorphan at high doses acts as a(n)
NMDA-receptor blocker leading to euphoria and hallucinations
Promethazine/codeine drug schedule
C-V
Chlorpheniramie/hydrocodone (TussiCaps, Tussionex) drug class
C-II
Children < __ years should avoid OTC cough and cold products per package labeling
4
Children < __ years should avoid OTC cough and cold products (per FDA), promethazine (per FDA), and topical menthol and camphor (per package labeling)
2
