Chapter 37: Allergic Rhinitis, Cough & Cold Flashcards by Emily Jansen

____ can determine patient-specific allergens

IgE-mediated skin prick test

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Examples of wetting agents that are commercially available for allergic rhinitis

Ocean, Little Remedies

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

Isotonic (0.9%) or hypertonic

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

Intranasal steroids

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Mild, intermittent symptoms of allergic rhinitis can be treated with

oral antihistamines

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Budesonide brand name for allergic rhinitis

Rhinocort Allergy

My bud is a rhino

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Fluticasone brand name for allergic rhinitis

Flonase Allergy Relief, Flonase Sensimist, Children’s Flonase

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Triamcinolone brand name for allergic rhinitis

Nasacort Allergy 24H, Nasacort Allergy 24H Children

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

up to 1 week

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What are the preferred nasal steroids in pregnancy for allergic rhinitis

Budesonide and beclomethasone

remember B for baby

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T/F: Antihistamines work well for nasal congestion

Fasle

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Antihistamines MOA

block histamine at H1 receptor site

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First generation antihistamines should be avoided in which patient population

Elderly (due to sedation and cognitive impairment)

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

Prostate enlargement and glaucoma

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Cetirizine brand name

Zyrtec

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Levocetirizine brand name

Xyzal

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Fexofenadine brand name

Allegra

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Loratadine brand name

Claritin

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

Fexofenadine

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Which second generation antihistamines should be used in pregnancy

Loratadine or cetirizine (Claritin or Zyrtec)

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

Cetirizine and levocetirizine (Zyrtec and Xyzal)

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Which two second generation antihistamines are more sedating

Cetirizine and levocetirizine

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Which two second generation antihistamines are least sedating

Fexofenadine and loratidine

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Benadryl dosing for adults

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

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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) Increased cost and risk for side effects

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) Should always have epipen on SL immunotherapy

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 Warnings

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

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

What are what are the 1st generation antihistamines?

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

Dextromethorphan brand name

Delsym

Dextromethorphan + guaifenesin brand name

Robasen DM, Robitussin DM

Benzonatate brand name

Tessalon Perles

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

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

Avoid menthol is age < ____

<2 - can cause cardiac and CNS toxicity if ingested

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

C-V