ENT-3 Flashcards
What are the IN antihistamines?
Azelastine (Astelin, Astepro)
Olopatadine (Patanase)
What are the effects of IN antihistamines?
More effective for nasal congestion than PO antihistamines
Onset 30min
Have some mast cell stabilizing effects
What are the SE of IN antihistamines?
Bitter taste
~10% systemic absorption -> sedation
What are the effects and mechanism of decongestants?
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
What are the 2 PO decongestants?
Pseudoephedrine (Sudafed)
Phenylephrine (Neo-synephrine®)
What are the nasal spray decongestants?
Phenyephreine Afrin Naphazoline (Privine®) Tetrahydrozoline (Tyzine®) Xylometazolone (Otrivin®)
What are the SE of decongestants?
Due to sympathetic stimulation Dose related Cardiovascular Increase BP CNS Insomnia Nervousness Irritability Anxiety Decrease appetite Tremors, HA, hallucination W/ BPH-> urinary retention
What is the hazard of long term use of nasal decongestants?
rebound congestion (i.e. Rhinitis Medicamentosa) – use no longer than 3-7 days
What are the DDI of nasal decongestants?
+ 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
What is the mechanism of Mast-cell stabilizers?
Drug bind to mast cell -> prevent release of mediators
How effective are mast-cell stabilizers?
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
What are cromolyn and gastrocrom?
PO mast cell stabilizer
What are nasalcrom and crolom?
Nasalcrom- IN
crolom- opts get
mast cell stabilizers
What is the indication and SE of nedocromyl?
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
How can singulair treat allergic rhinitis?
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
What are the DDI of singulair?
substrate of Cyp2C9, 3A4
Phenobarbital, primidone, butalbital, rifampin, carbamazepine
induce enzyme -> lower montelukast level
What is the mechanism of atrovent?
SE?
DDI?
Anticholinergic- control rhinorrhea
SE:
Mild nose bleed; Nasal dryness
DDI:
Atropine, chlorpheniramine, benztropine increase anticholinergic effects
Opioids increase risk of constipation, ileus bowel obstruction
How do monoclonal antibodies treat AR?
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
What are the SE of monoclonal antibody treatment?
Injection site reaction pain General pain Pruritus Dermatitis Rash URI Headache Cough Anaphylaxis – may happen after 1st dose; or delay 1yr later
What meds are generally safe for pregnant women for allergic rhinitis?
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
What is naphazoline?
Ophthalmic decongestant
What are azelestoline, epinastine, ketotifen, olopatadine?
Ophthalmic antihistamines
