Chapter 37 - Allergic rhinitis, cough & cold Flashcards
Allergic Rhinitis Sx
Cold-like symptoms
- Congestion
- Rhinorrhea (runny nose)
- Sneezing
- Sinus pressure
- Itchy eyes
- Thin, clear mucus
Can be intermittent or chronic
Inflammatory reaction
Non Drug Treatment
- 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
Common Allergens
- Pollen
- Mold
- Dust mites
- Animal Dander
Budesonide
brand
dose
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)
Fluticasone
brand
dose
- 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
Fluticasone + Azelastine brand
Dymista
(Intranasal steroids + Antihistamine)
il fluuuttt (byehrub) la2an Eze Last sooo Dieee mistaaa
Triamcinolone
- Nasacort Allergy 24HR
- Nasacort Allergy 24HR Children
- Nasal Allergy 24HR
at 3 am alone (olone) bl nasa –> nasacort
Beclomethasone
- Beconase AQ
Adult: 1-2 sprays daily - Qnasl
- Qnasl children
Adult: 2 sprays per nostril daily
Ciclesonide
brand
- 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
Flunisolide
Adult: 2 sprays per nostril BID or TID
Mometasone
Nasonex
Nasal implant: Sinuva
Adult: 2 sprays per nostril daily
preferred intranasal steroid in pregnancy?
budesonide (nude)
beclomethasone (beclo)
Side effects, warnings and monitoring of intranasal steroids
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
Side effects, warnings and monitoring of intranasal steroids
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
antihistamines indication
mild - mod
intermittent se
has little effect on congestion
mainly for itching, sneezing rhinorrhea
blocks H1 receptors
Diphenhydramine
indication?
dose?
- 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)
Chlorpheniramine brand, dose
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)
Doxylamine
Unisom Sleep Tabs- for sleep (dodo)
Adult: 12.5-25 mg PO Q4-6H (max 75 mg/day)
Clemastine
Dayhist Allergy 12 HR Relief
Adult: 1.34-2.68 mg PO Q8-12H (max 8.04 mg/day)
Carbinoxamine
- Karbinal ER
- RyVent
IR (adult): 4-8 mg PO Q6-8H
ER (adult): 6-16 mg PO Q12H
1st G antihist CI
- Neonates or premature infants,
- Breastfeeding
Warnings for 1st G antihistamine
- 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)
SE of 1st g antihist
- Somnolence,
- cognitive impairment,
- strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation) and
- seizures/arrhythmias at higher doses
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?
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
