Cough, Cold, Allergy

Question 1

What would you prescribe for cough?

Answer 1

Antitussives or expectorants

Question 2

Antitussives MOA

Answer 2

block cough production via CNS, PNS, or both

Question 3

Contraindications for antitussives

Answer 3

concurrent MAOI use

Question 4

Types of Antitussives

Answer 4

OTC and opiates

Question 5

Antitussives - Central Agents Examples

Answer 5

codeine, dextromethorphan (DM), hydrocodone

Question 6

Antitussives - Central Agents MOA

Answer 6

block cough center in the medulla by elevating threshold for cough

Question 7

Antitussives - Central Agents S/E

Answer 7

1. opiates: sedation, constipation

2. DM: drowsiness, nausea, dizziness, high doses can cause HTN, respiratory depression, tachycardia

Question 8

Antitussives - Peripheral Agents Examples

Answer 8

Camphor, eucalyptus, menthol (Vicks), benzonatate (tessalon perles)

Question 9

Antitussives - Peripheral Agents MOA

Answer 9

anesthetize local peripheral nerve endings, soothe (demulcents)

Question 10

Expectorants MOA

Answer 10

increase amount of fluid in respiratory tract, loosen mucus, clear irritants

Question 11

Expectorants Contraindications

Answer 11

none

Question 12

Expectorants Examples

Answer 12

Guiafenesin/Robitussin

Question 13

Expectorants S/E

Answer 13

well tolerated

may have N/V, drowsiness at high doses

Question 14

What can you give for colds?

Answer 14

Decongestants, others?

Question 15

Decongestants MOA

Answer 15

pre-capillary blood vessel constriction

Question 16

Decongestants Contraindications

Answer 16

concurrent MAOI use

–> HTN crisis

Question 17

Decongestants S/E

Answer 17

1. rebound nasal congestion = rhinitis medicamentosa

2. CNS stimulation - agitation, anxiety, insomnia, increase BP, urinary retention, dry mouth, sweating

Question 18

Examples of Decongestants

Answer 18

1. Direct agonists: phenylephrine/Sudafed PE, Dimetapp

2. Indirect Agonists: pseudoephedrine/sudafed

Question 19

What can you give for allergies?

Answer 19

H1 antagonists, mast cell stabilizers, leukotriene receptor antagonists, intranasal steroids

Question 20

Indications of H1 Antagonists

Answer 20

urticaria, allergic rhinitis, nasal sx from common cold, first generation for nausea

Question 21

H1 Antagonists MOA

Answer 21

block histamine-mediated allergic response cascade, 1st gen have anti-cholinergic capabilities

Question 22

H1 Antagonists Contraindications

Answer 22

none but do not use for acute anaphylactic reaction

Question 23

H1 Antagonists S/E

Answer 23

Drowsy (can be given as off label insomnia medication), 2nd gen not as sedating

Question 24

H1 Antagonists First Generation Examples

Answer 24

Benedryl, Atarax, Chlortrimeton, Periactin

Question 25

H1 Antagonists Second Generation Examples

Answer 25

Loratidine/Claritin, Cetirizine/Zyrtec, Fexofenadine/Allegra

Question 26

Mast Cell Stabilizers MOA

Answer 26

prevent degranulation of mast cells; inhibit release of proinflammatory factors

Question 27

Mast Cell Stabilizers Contraindications

Answer 27

none

Question 28

Route of administation

Answer 28

topical

Question 29

Mast Cell Stabilizers indication

Answer 29

conditions w/ allergy component - asthma, rhinitis, conjunctivitis systemic mastocytosis

Question 30

What are Mast Cell Stabilizers not used for?

Answer 30

acute therapy, acute anaphylactic reaction

Question 31

Mast Cell Stabilizers Examples

Answer 31

Cromolyn sodium (Nasal crom)

Question 32

Mast Cell Stabilizers S/E

Answer 32

generally well tolerated, cough from throat irritation, nasal irritation

Question 33

Indications for leukotriene receptor antagonists

Answer 33

allergic rhinitis, prevention of persistent asthma (not first line), exercise-induced bronchospasm

Question 34

LTRAs MOA

Answer 34

prevent release of leukotrienes, prevent bronchoconstriction, reduce inflammation

Question 35

LTRAs Contraindications

Answer 35

liver disease of any kind, not for acute asthma, only preventatively

Question 36

Examples of LTRAs

Answer 36

Montelukast (Singulair)

Question 37

Indications of intranasal steroids

Answer 37

allergic rhinitis, nasal congestion/sneezing/itching/rhinorrhea

Question 38

intranasal steroids MOA

Answer 38

inhibit pro-inflammatory cells, including basophils, mast cells, eosinophils, lymphocytes, macrophages

Question 39

Contraindications for intranasal steroids

Answer 39

hypersensitivity to any part of the medication

Question 40

Examples of intranasal steroids

Answer 40

Fluticasone/Flonase | Mometasone/Nasonex

Question 41

When is a good time to give intranasal steroids?

Answer 41

if patient cannot take decongestant because BP/HR side effects

Question 42

S/E of intranasal steroids

Answer 42

nosebleeds

Question 43

What should you definitely include in your patient education about intranasal steroids?

Answer 43

They will require continuous dosing to see response, slower response than antihistamines

Question 44

What could you prescribe a 2 year old with allergic rhinitis/nasal congestion?

Answer 44

Mometasone