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pamela - naplex 2023 > Chapter 37 - Allergic rhinitis, cough & cold > Flashcards

Chapter 37 - Allergic rhinitis, cough & cold Flashcards

1
Q

Allergic Rhinitis Sx

A

Cold-like symptoms
- Congestion
- Rhinorrhea (runny nose)
- Sneezing
- Sinus pressure
- Itchy eyes
- Thin, clear mucus

Can be intermittent or chronic
Inflammatory reaction

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2
Q

Non Drug Treatment

A
  • Avoid Exposure when possible
  • IgE skin test or blood test to determine allergen
  • Ventilation systems with high efficiency particulate air (HEPA) (expensive)
  • Vacuuming with HEPA vacuum cleaner
  • Air quality index (AQI)
  • Pollen counts
  • Nasal irrigation or wetting agents
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3
Q

Common Allergens

A
  • Pollen
  • Mold
  • Dust mites
  • Animal Dander
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4
Q

Budesonide
brand
dose

A

Rhinocort Allergy
1 spray in each nostril daily
adult: max 4 sprays
>= 6 yo: max 2 sprays

(the nude one/ original one to aktar brand khassa bl ttmt w condition)

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5
Q

Fluticasone
brand
dose

A
  • Flonase Allergy Relief
  • Flonase Sensimist
  • Children flonase
  • Xhance (X got a chance mn baaed ma il fluuutt (harab)

Adult and children 2 - 12 yrs: 1-2 sprays per nostril daily
Age 2 - 11yrs: 1 spray per nostril daily

otc or rx

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6
Q

Fluticasone + Azelastine brand

A

Dymista
(Intranasal steroids + Antihistamine)

il fluuuttt (byehrub) la2an Eze Last sooo Dieee mistaaa

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7
Q

Triamcinolone

A
  • Nasacort Allergy 24HR
  • Nasacort Allergy 24HR Children
  • Nasal Allergy 24HR

at 3 am alone (olone) bl nasa –> nasacort

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8
Q

Beclomethasone

A
  • Beconase AQ
    Adult: 1-2 sprays daily
  • Qnasl
  • Qnasl children
    Adult: 2 sprays per nostril daily
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9
Q

Ciclesonide
brand

A
  • Omnaris (om nar 7emle 2 fires b idaya so 2 sprays)
    Adult: 2 sprays per nostril daily
  • Zetonna (b zet 7alo la 7alo so 1 spray)
    Adult: 1 spray per nostril daily
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10
Q

Flunisolide

A

Adult: 2 sprays per nostril BID or TID

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11
Q

Mometasone

A

Nasonex
Nasal implant: Sinuva

Adult: 2 sprays per nostril daily

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12
Q

preferred intranasal steroid in pregnancy?

A

budesonide (nude)
beclomethasone (beclo)

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13
Q

Side effects, warnings and monitoring of intranasal steroids

A

SE:
- Epistaxis (nose bleeds)
- headache
- dry nose
- unpleasant taste
- localized infection

Warnings:
Avoid use
- recent nasal septal ulcers,
- nasal surgery,
- recent nasal trauma
due to delayed wound healing

High doses for prolonged periods can cause:
- adrenal suppression,
- dec growth velocity (pediatrics)
- immunosuppression

Use in caution:
- pt with cataract
- inc intraocular pressure
- open angle glaucoma

Monitor:
- Growth (pediatrics),
- vision changes,
- eye exams in long-term use,
- signs/symptoms of oral thrush
- Sx of adrenal suppression
- If using regularly for several months, recommend periodic nasal exams to evaluate for nasal septal perforation or ulcers

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14
Q

Side effects, warnings and monitoring of intranasal steroids

A

SE:
- Epistaxis (nose bleeds)
- headache
- dry nose
- unpleasant taste
- localized infection

Warnings:
Avoid use
- recent nasal septal ulcers,
- nasal surgery,
- recent nasal trauma
due to delayed wound healing

High doses for prolonged periods can cause:
- adrenal suppression,
- dec growth velocity (pediatrics)
- immunosuppression

Use in caution:
- pt with cataract
- inc intraocular pressure
- open angle glaucoma

Monitor:
- Growth (pediatrics),
- vision changes,
- eye exams in long-term use,
- signs/symptoms of oral thrush
- Sx of adrenal suppression
- If using regularly for several months, recommend periodic nasal exams to evaluate for nasal septal perforation or ulcers

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15
Q

antihistamines indication

A

mild - mod
intermittent se
has little effect on congestion
mainly for itching, sneezing rhinorrhea

blocks H1 receptors

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16
Q

Diphenhydramine
indication?
dose?

A
  • Benadryl
  • Dose:
    Adult:
  • 25 mg PO Q4-6H or
  • 50 mg PO Q6-8H
  • max 300 mg/day
    Age 6-11 yrs:
  • 12.5 - 25 mg PO Q4-6H
  • max 150 mg/day
    Age < 6 yrs:
  • Do not use OTC unless directed by dr
  • 1st G antihistamine
  • Indications:
    ■ Treatment of acute allergic reactions (+/- epinephrine, depending on severity)
    ■ Prevention of allergic reactions (included in most premedication regimens for high-risk drugs)
    ■ Allergic rhinitis
    ■ Cough (hasantitussive properties)
    ■ Sleep (sedating)
    ■ Dystonic reactions (anticholinergic properties)
    ■ Motion sickness

Because of its wide range of effects, it can worsen some disease states (e.g.,BPH, constipation, dementia, glaucoma)

17
Q

Chlorpheniramine brand, dose

A

1st g antihistamine
- Aller-Chlor
- Chlor-Trimeton

IR (adult): 4 mg PO Q4-6H (max 24 mg/ day)
ER(adult): 12 mg PO Q12H (max 24 mg/ day)

18
Q

Doxylamine

A

Unisom Sleep Tabs- for sleep (dodo)

Adult: 12.5-25 mg PO Q4-6H (max 75 mg/day)

19
Q

Clemastine

A

Dayhist Allergy 12 HR Relief
Adult: 1.34-2.68 mg PO Q8-12H (max 8.04 mg/day)

20
Q

Carbinoxamine

A
  • Karbinal ER
  • RyVent

IR (adult): 4-8 mg PO Q6-8H
ER (adult): 6-16 mg PO Q12H

21
Q

1st G antihist CI

A
  • Neonates or premature infants,
  • Breastfeeding
22
Q

Warnings for 1st G antihistamine

A
  • Avoid in the elderly (due to strong anticholinergic effects; Beers criteria) and in children < 2 years
  • Can cause CNS depression/sedation
  • Use with caution in patients with cardiovascular disease, prostate enlargement, glaucoma, asthma, pyloroduodenal obstruction and thyroid disease
  • Do not use with MAO inhibitors (especially clemastine or carbinoxamine)
  • Age restrictions vary for OTC use, check the product labeling (e.g., do not use diphenhydramine in children < 6 years or doxylamine in children < 12 years) (NO DODO BEFORE 12 AM)
23
Q

SE of 1st g antihist

A
  • Somnolence,
  • cognitive impairment,
  • strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation) and
  • seizures/arrhythmias at higher doses
24
Q

1) First-generation antihistamines should not be taken by:

2) Should be discontinued ~ — prior to allergy skin testing

3) do you need to use sunscreen with it?

4) whats the fda safety alert?

A

1) lactating women; second-generation agents preferred

2) ~ 72 hours

3) Can cause photosensitivity; use sunscreens and wear protective clothing while taking

4) FDA issued a Safety Alert regarding reports of abuse/misuse of diphenhydramine by teenagers leading to serious heart problems, seizures, coma or death

pamela - naplex 2023 (32 decks)

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