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NAPLEX 2023 > Chapter 37: Allergic Rhinitis, Cough & Cold > Flashcards

Chapter 37: Allergic Rhinitis, Cough & Cold Flashcards

1
Q

____ can determine patient-specific allergens

A

IgE-mediated skin prick test

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2
Q

Examples of wetting agents that are commercially available for allergic rhinitis

A

Ocean, Little Remedies

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3
Q

Nasal irrigation uses ___ or ___ saline solution to rinse out allergens and mucus, improve ciliary function and reduce swelling

A

Isotonic (0.9%) or hypertonic

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4
Q

What is first line for chronic, moderate-severe symptoms of allergic rhinitis

A

Intranasal steroids

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5
Q

Mild, intermittent symptoms of allergic rhinitis can be treated with

A

oral antihistamines

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6
Q

Budesonide brand name for allergic rhinitis

A

Rhinocort Allergy

My bud is a rhino

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7
Q

Fluticasone brand name for allergic rhinitis

A

Flonase Allergy Relief, Flonase Sensimist, Children’s Flonase

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8
Q

Triamcinolone brand name for allergic rhinitis

A

Nasacort Allergy 24H, Nasacort Allergy 24H Children

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9
Q

How long can it take for full relief of symptoms if using an intranasal steroid for allergic rhinitis

A

up to 1 week

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10
Q

What are the preferred nasal steroids in pregnancy for allergic rhinitis

A

Budesonide and beclomethasone

remember B for baby

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11
Q

T/F: Antihistamines work well for nasal congestion

A

Fasle

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12
Q

Antihistamines MOA

A

block histamine at H1 receptor site

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13
Q

First generation antihistamines should be avoided in which patient population

A

Elderly (due to sedation and cognitive impairment)

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14
Q

First generation antihistamines should be used with caution in which disease states

A

Prostate enlargement and glaucoma

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15
Q

Cetirizine brand name

A

Zyrtec

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16
Q

Levocetirizine brand name

A

Xyzal

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17
Q

Fexofenadine brand name

A

Allegra

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18
Q

Loratadine brand name

A

Claritin

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19
Q

Which second generation antihistamine should be taken with water only and NOT juice due to decreased absorption

A

Fexofenadine

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20
Q

Which second generation antihistamines should be used in pregnancy

A

Loratadine or cetirizine (Claritin or Zyrtec)

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21
Q

Which second generation antihistamines have a fast onset and may work best for some patients

A

Cetirizine and levocetirizine (Zyrtec and Xyzal)

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22
Q

Which two second generation antihistamines are more sedating

A

Cetirizine and levocetirizine

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23
Q

Which two second generation antihistamines are least sedating

A

Fexofenadine and loratidine

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24
Q

Benadryl dosing for adults

A

25 mg PO Q4-6h
50 mg PO Q6-8h

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25
Q

Benadryl dosing for age < 6 years

A

DO NOT USE OTC unless directed by a healthcare provider

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26
Q

Which drug class can be combined with an intranasal steroid to help with congestion

A

Intranasal antihistamines (Azelastine and Olopatadine)

Increased cost and risk for side effects

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27
Q

Decongestant MOA

A

Alpha-adrenergic agonists that cause vasoconstriction, which decreases sinus vessel engorgement and mucosal edema

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28
Q

Which decongestant has poor oral absorption

A

Phenylephrine (comes as a nasal inhaler, but lasts for a shorter time & causes more SE than oxymetazoline inhalers)

29
Q

Pseudoephedrine is a precursor to which drug

A

methamphetamine

30
Q

Under federal law, the max amount of PSE products allowed for purchase in a day & in a 30-day period is

A

3.6 g per day
9 grams in a 30-day period

(remember: 3-6-9)

31
Q

Phenylephrine brand name

A

Sudafed PE

32
Q

Pseudoephedrine brand names

A

Sudafed, Nexafed, Zephrex-D

33
Q

Oxymetazoline brand name

A

Afrin (nasal spray)

34
Q

Systemic decongestants CI

A

Do not use within 14 days of MAOi

35
Q

Systemic decongestants should be avoided in children < __ years (FDA) and < __ years (package labeling)

A

2

4

36
Q

Systemic decongestants should be used with caution in patients with

A

CV disease, BPH (can cause urinary retention)

37
Q

Systemic decongestant SE

A

Tachycardia, palpitations, increased BP, insomnia, decreased appetite

38
Q

Oxymetazoline can cause rhinitis medicamentosa (rebound congestion) if used longer than

A

3 days

39
Q

Intranasal cromolyn (NasalCrom) MOA

A

OTC mast cell stabilizer for tx and ppx of allergic rhinitis

40
Q

In order for intranasal cromolyn to be effective, it must be started at the onset of allergy season and:

A

used regularly (not PRN)

41
Q

Which patient groups can benefit from intranasal cromolyn

A

Children >/= 2 years old and pregnancy

42
Q

Montelukast brand name

A

Singulair

43
Q

Montelukast is the only leukotriene modifying agent indicated for both

A

allergic rhinitis and asthma

44
Q

Montelukast is commonly used in which patient population

A

children

45
Q

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:

A

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)

Should always have epipen on SL immunotherapy

46
Q

How is the common cold transmitted

A

Mucus secretions or by air

47
Q

T/F: the common cold is a bacterial infection

A

False - viral

48
Q

Which natural products can be used for cold symptoms

A
  • Zinc for cold prevention and treatment
  • Vitamin C (ascorbic acid) decreases duration of cold
  • Echinacea is possibly effective for treatment
49
Q

What can be used if a productive cough is present

A

Expectorants to thin mucus

50
Q

Which drugs are expectorants

A

Gauifenesin (Mucinex, Robitussin Mucus + Chest Congestion, Robafen)
+ dextromethorphan (Robafen DM, Robitussin DM)

51
Q

Which drugs are cough suppressants

A
  • Dextromethorphan (Delsym, Robafen Cough, Robitussin Cough)
  • Codeine
  • Benzonatate (Tessalon Perles)
  • Diphenhydramine
52
Q

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

A

II

V

53
Q

Dextromethorphan CI

A

Do not use within 14 days of MAOi

54
Q

Dextromethorphan Warnings

A

serotonin syndrome

55
Q

Codeine BW

A

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)

56
Q

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

A

12

18

57
Q

Dextromethorphan at high doses acts as a(n)

A

NMDA-receptor blocker leading to euphoria and hallucinations

58
Q

Promethazine/codeine drug schedule

A

C-V

59
Q

Chlorpheniramie/hydrocodone (TussiCaps, Tussionex) drug class

A

C-II

60
Q

Children < __ years should avoid OTC cough and cold products per package labeling

A

4

61
Q

Children < __ years should avoid OTC cough and cold products (per FDA), promethazine (per FDA), and topical menthol and camphor (per package labeling)

A

2

62
Q

What are what are the 1st generation antihistamines?

A

Hydroxyzine, meclizine, promethazine
Oral: diphenhydramine (Benadryl), chlorpheniramine, doxylamine

63
Q

Dextromethorphan brand name

A

Delsym

64
Q

Dextromethorphan + guaifenesin brand name

A

Robasen DM, Robitussin DM

65
Q

Benzonatate brand name

A

Tessalon Perles

66
Q

Study tip for OTC’s
D =
PE =
DM =
AC =

A

D = decongestant (phenylephrine or pseudoephedrine)
PE = phenylephrine
DM = dextromethorphan
AC = contains codeine

67
Q

Avoid menthol is age < ____

A

<2 - can cause cardiac and CNS toxicity if ingested

68
Q

Promethazine/phenylephrine/codeine
Guaifenesin/codeine
Guaifenesin/codeine/pseudoephedrine
Controlled status

A

C-V

NAPLEX 2023 (88 decks)

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