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271- F1 > ENT-3 > Flashcards

ENT-3 Flashcards

1
Q

What are the IN antihistamines?

A

Azelastine (Astelin, Astepro)

Olopatadine (Patanase)

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2
Q

What are the effects of IN antihistamines?

A

More effective for nasal congestion than PO antihistamines
Onset 30min
Have some mast cell stabilizing effects

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3
Q

What are the SE of IN antihistamines?

A

Bitter taste

~10% systemic absorption -> sedation

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4
Q

What are the effects and mechanism of decongestants?

A

Relieve congestion
Stimulate alpha-receptors -> vasoconstriction in nasal mucosa
Do not prevent histamine release
Given as monotherapy or combination either nasal spray (NS) or PO

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5
Q

What are the 2 PO decongestants?

A

Pseudoephedrine (Sudafed)

Phenylephrine (Neo-synephrine®)

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6
Q

What are the nasal spray decongestants?

A 
Phenyephreine
Afrin
Naphazoline (Privine®) 
Tetrahydrozoline (Tyzine®) 
Xylometazolone (Otrivin®)
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7
Q

What are the SE of decongestants?

A 
Due to sympathetic stimulation
Dose related
Cardiovascular
Increase BP
CNS
Insomnia
Nervousness
Irritability
Anxiety
Decrease appetite
Tremors, HA, hallucination
W/ BPH-> urinary retention
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8
Q

What is the hazard of long term use of nasal decongestants?

A

rebound congestion (i.e. Rhinitis Medicamentosa) – use no longer than 3-7 days

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9
Q

What are the DDI of nasal decongestants?

A

+ Selegiline, phenelzine, procarbazine (Monoamines oxidase inhibitor) -> hypertensive crisis (contraindicated)
+ bromocriptine -> HTN, tachy, seizure
Linezolid – reversible MOAI -> increase risk of hypertensive crisis
+ Beta blockers -> antagonize antihypertensive effects
+ Aluminum hydroxide -> decrease renal excretion  increase risk of adverse effects

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10
Q

What is the mechanism of Mast-cell stabilizers?

A

Drug bind to mast cell -> prevent release of mediators

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11
Q

How effective are mast-cell stabilizers?

A

Moderately effective but less than NS steroid and antihistamines
Have effects on both early and late phases
Onset 4-7 days
Maximal effect 2wks – ok for prn use

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12
Q

What are cromolyn and gastrocrom?

A

PO mast cell stabilizer

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13
Q

What are nasalcrom and crolom?

A

Nasalcrom- IN
crolom- opts get
mast cell stabilizers

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14
Q

What is the indication and SE of nedocromyl?

A

Opthalmic solution:
Allergic conjunctivitis
Rx only
1-2 gtts BID
Useful for mild intermitten sxs, esp. children and pregnant women
SE:
Mild and local – stinging, burning, sneezing, unpleasant taste

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15
Q

How can singulair treat allergic rhinitis?

A

Leukotrienes- Cause nasal congestion in late phase, no effects on itching/sneezing
Inferior to NS steroids and antihistamines
Use together with po antihistamines – better than either one alone
Well tolerated – HA, dizziness, skin rashes, dyspepsia
Case reports – neuropsychiatric and suicidal ideation

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16
Q

What are the DDI of singulair?

A

substrate of Cyp2C9, 3A4
Phenobarbital, primidone, butalbital, rifampin, carbamazepine
induce enzyme -> lower montelukast level

17
Q

What is the mechanism of atrovent?
SE?
DDI?

A

Anticholinergic- control rhinorrhea
SE:
Mild nose bleed; Nasal dryness
DDI:
Atropine, chlorpheniramine, benztropine increase anticholinergic effects
Opioids  increase risk of constipation, ileus  bowel obstruction

18
Q

How do monoclonal antibodies treat AR?

A 
Omalizumab (Xolair)
Binds to IgE
FDA approved for asthma & chronic idiopathic urticaria
SQ injection
Dose determined by pt’s circulating IgE
Best for pts with asthma and AR
19
Q

What are the SE of monoclonal antibody treatment?

A 
Injection site reaction
pain
General pain
Pruritus
Dermatitis
Rash
URI
Headache
Cough
Anaphylaxis – may happen after 1st dose;  or delay 1yr later
20
Q

What meds are generally safe for pregnant women for allergic rhinitis?

A 
NS steroids -- Ex:  beclomethasone, budesonide (category –B), and fluticasone
2nd generation H1 blockers 
Cromolyn: category B 
Disadv:  repeated use  loses efficacy
Montelukast:  cat. B 
use with concurrent asthma
Ipratropium
21
Q

What is naphazoline?

A

Ophthalmic decongestant

22
Q

What are azelestoline, epinastine, ketotifen, olopatadine?

A

Ophthalmic antihistamines

271- F1 (7 decks)

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