COPD & Allergy Flashcards
pathophys of COPD
not fully reversible airflow limitation; chronic lung and airway inflammation w mucus hypersecretion and gas exchange abnormalities
Treatment strategies for COPD
B2-R agonist anti-ACh inhalers bronchodilators long-acting inhaled bronchodilators Combined therapy of bronchodilators
ADR of inhaled corticosteroids in COPD
increased risk of osteoporosis with extended use
roflumilast
oral PDE4 inhibitor
used in pts with severe COPD with bronchitis and history of exacerbation to dec exacerbations
ADR roflumilast
nausea, diarrhea, insomnia, weight loss
interaction with CYP 3A4 inhibitors and inducers
Meds to use for COPD exacerbations
inhaled bronchodilators (B2-ag or anti-ACh), theophylline, systemic corticosteroids, +/- roflumilast antibiotics if infection present
Tx of COPD
stop smoking, bronchodilators, steroids (?), antibacterials (frequent infection)
etiology of allergic rhinitis
Seasonal (SAR) - repetitive predictable symptoms in spring/fall, acute and triggered by allergens
perennial (PAR) - chronic, triggered by non-seasonal allergens
*Can have both
Sx of allergic rhinitis
ocular: venous congestion -> “allergic shiners”, pruritus, watery red eyes or SAR conjunctivitis
Nasal: clear rhinorrhea, sneezing, congestion, pruritus, post-nasal drip
systemic: fatigue, irritability, cognitive impairment
Drug categories for allergic rhinitis
Anti-histamines/ H1-R antagonist
decongestants
corticosteroids
MOA of antihistamines
antagonize capillary permeability, wheal and flare formation, pruritus
anti-ACh properties reduced nasal, salivary, lacrimal gland secretions
Brompheniramine
1st gen oral antihistamine
chlorpheniramine
1st gen oral antihistamine
clemastine
1st gen oral antihistamine
diphenhydramine
1st gen oral antihistamine
1st vs. 2nd gen oral antihistamines
1st gen penetrates CNS -> sedation/ cognitive impairment; OTC
2nd gen Rx and OTC; peripherally selective = “non-sedating”
cetirizine
2nd gen oral antihistamine
levocetirizine
2nd gen oral antihistamine
fexofenedine
2nd gen oral antihistamine
*really low CNS penetration
loratadine
2nd gen oral antihistamine
desloratadine
2nd gen oral antihistamine
ADR of oral antihistamines
1st gen: anti-ahc effects = dry mouth/nose/eyes, blurred vision, urinary retention, constipation, tachycardia
CNS depression = sedation, impaired performance
azelastine
fast-acting intranasal antihistamine, peaks at 3 hours
relieves sneezing, pruritus, rhinorrhea, reduces nasal congestion
ADR intranasal antihistamine
bitter taste, sedation, local irritation
oral decongestant MOA
A-adrenergic agonist -> vasoconstriction of vessels in mucosa = temporary relief of nasal congestion
phenylephrine
direct-acting oral decongestant
also short-acting intranasal decongestant
pseudoephedrine
indirect-acting/mixed oral decongestant
slower onset, longer duration, more effective than direct acting phenylephrine
ADR of oral decongestants
more likely in young/old: cardiac stimulation -> increased BP and HR, arrhythmia, palpitations; CNS stimulation -> insomnia, anxiety, tremors; if taken with MAOI increases BP further
Precautions with oral decongestants
hypersensitivity, idiosyncratic reactions, MAOI use
may exacerbate hyperthyroidism, glaucoma, HTN, BPH
naphazoline
intermediate acting intranasal decongestant
tetrahydrozoline
intermediate acting intranasal decongestant
oxymetazoline
long-acting intranasal decongestant
Rhinitis medicamentosa & tx
rebound nasal congestion with more than 3 days use of decongestant
Tx: withdraw decongestant 1 nostril at a time, use intranasal corticosteroid, normalizes in 1-2 weeks
MOA of intranasal corticosteroid
anti-inflammatory action on cells and mediators involved with inflammation
DOC for allergic rhinitis & effects
intranasal corticosteroid (most effective)
relieves sneezing, rhinorrhea, pruritus, nasal congestion
max benefit in 7 days
ADR of intranasal corticosteroid
sneezing, stinging with administration
headache
epistaxis
beclomethasone
intranasal corticosteroid
budesonide
intranasal corticosteroid
flunisolide
intranasal corticosteroid
fluticasone
intranasal corticosteroid
mometasone
intranasal corticosteroid
triamcinolone
intranasal corticosteroid
Use of inhaled corticosteroids in COPD
patients with FEV1 less than 50% expected and exacerbations for 3 years
categories of intranasal decongestants
short-acting (less than 4 hr) intermediate acting (4-6 hr) long-acting (up to 12 hr)
