Cough, Cold, Allergic Rhinitis

Question 1

Dextromethorphan: contraindications

Answer 1

(antitussive)

• MAOIs
• CNS depressants (alcohol, benzos)

Question 2

Benzonatate: MOA

Answer 2

(antitussive)

reduces cough by anesthetizing respiratory passages (eliminates “tickling” sensation which precipitates cough)

Question 3

Guaifenesin: MOA

Answer 3

(expectorant)

increases hydration of respiratory tract> increases volume and decreases viscosity of secretions

Question 4

camphor: MOA

Answer 4

(local anesthetic)

• reduces sensitivity to cough receptors in periphery
• anesthetizes throat/local air passageways

note: lethal if ingested

Question 5

menthol: MOA

Answer 5

(local anesthetic)

• reduces sensitivity to cough receptors in periphery
• anesthetizes throat/local air passageways

Question 6

benzocaine: MOA

Answer 6

(local anesthetic)

• reduces sensitivity to cough receptors in periphery
• anesthetizes throat/local air passageways

Question 7

Oral decongestants: contraindications

Answer 7

• uncontrolled HTN
• BPH or urinary retention
• glaucoma
• cardiac disease
• hyperthyroidism

Question 8

NSAIDS: contraindications

Answer 8

• increased risk GI bleed
• renal dysfunction
• CV disease
• aspirin allergy

Question 9

Aspirin: contraindications

Answer 9

• Children <19 (Reye’s Syndrome)
• increased risk GI bleed
• gout
• NSAID allergy

Question 10

Acetaminophen: contraindications

Answer 10

liver dysfunction/damage

Question 11

Echinachea: contraindications

Answer 11

asthma, allergy to ragweed/chrysanthemum, immunodeficiency, TB, autoimmune disorders

Question 12

How long do you need to hold antihistamines for before allergen testing?

Answer 12

1st gen: 3-5 days

2nd gen: 10 days

Question 13

Antihistamines: MOA

Answer 13

• H1 receptor antagonists: inhibit H1 receptor-mediated effects of histamine
• anti-inflammatory effects

Question 14

1st gen antihistamines: contraindications

Answer 14

use w/ other CNS depressants, elderly pts (anticholinergic effects)

Question 15

Which 2nd gen antihistamines are most potent and most sedating?

Answer 15

cetirizine & levocetirizine

Question 16

Oral 2nd gen antihistamines: USPSTF recommendations

Answer 16

• AR w/ primary complains of sneezing/itching

- mild AR, intermittent symptoms

Question 17

What are key differences between 1st and 2nd generation antihistamines?

Answer 17

-1st gen= more lipophilic» more crossing BBB, more sedating, more anticholinergic, dose more often

Question 18

Intranasal Steroids: USPSTF recommendation

Answer 18

moderate, severe SAR or PAR; symptoms affecting QOL

Question 19

Intranasal steroids: MOA

Answer 19

• anti-inflammatory: reduce release of inflammatory cells within nasal mucosa
• reduce hyperresponsiveness of nasal mucosa to subsequent exposures to allergen

Question 20

Intranasal Steroids: concerning ADR

Answer 20

• growth suppression in children
• ^ IOP
• HPA axis disruption

Question 21

AR: Pathophysiology

Answer 21

Exposure to allergen:
-Type I hypersensitivity
-IgE antibody production
Subsequent exposure:
-IgE antibodies attach to mast cells
-Release histamines/leukotrienes
-Early phase rxn
Late-phase rxn:
-Histamines & leukotrienes call more inflammatory cells to area
-Nasal congestion and postnasal drip 48hrs

Question 22

Describe best use of decongestants for AR.

Answer 22

short-term adjunctive/secondary therapy for severe congestion while an intranasal steroid is onboarded
-no effect on sneezing/itching/ocular symptoms

Question 23

Describe best use of leukotriene receptor antagonists for AR.

Answer 23

• adjunctive/secondary therapy
• asthma + allergic rhinitis*
• decongestion

Question 24

Mast cell stabilizers: MOA

Answer 24

• bind to mast cells and prevent release of inflammatory mediators
• effect w/ early & late phase AR

Question 25

Describe best use of antimuscarinic or anticholinergic agents for AR.

Answer 25

second line therapy for rhinorrhea uncontrolled by antihistamines or INS