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CDM1 > Exam 3: AR > Flashcards

Exam 3: AR Flashcards

1
Q

AR Def

A

IgE-mediated hypersensitivity rxn triggered by allergens

More localized to nose

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2
Q

Classification of AR: Episodic

A

Symtpoms occur when exposure to allergen outside of normal routine

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3
Q

Classification of AR: Intermittent

A

Symptoms occur ≤4 days/week or ≤4 weeks

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4
Q

Classification of AR: persistent

A

Symptoms occur >4 days/week AND >4 weeks

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5
Q

Classification of AR: Mild-moderate

A

symptoms not bothersome, do not interfere with daily activities or sleep

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6
Q

Classification of AR: Moderate-severe

A

Symptoms are bothersome, interfere with daily activities or sleep

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7
Q

S/Sx: Allergic shiners

A

dark circles caused by changes in blood flow due to nasal congestion

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8
Q

S/Sx: allergic salute/crease

A

pushing nose up

creases nose

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9
Q

S/Sx: allergic gape

A

breathing thru mouth bc nose is running

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10
Q

S/Sx: Conjunctival injection

A

Red eyes caused by inflammation of small capillaries in eyes

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11
Q

Complications of untreated AR

A

Sinusitis
Otitis media
Asthma linked to allergies
Speech or dental abnormalities

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12
Q

Self-treatment exclusions

A 
Child <12 yo
Pregnant/lactating
Hx of non-allergic rhinitis
symptoms of upper respiratory tract infection or lower pathology
Hx of symptoms unresponsive to OTC
Unacceptable adverse effects
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13
Q

Treatment options

A

Allergen avoidance, non-pharmacological therapy (NaCl nasal spray, irrigation, drops), or pharmacotherapy

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14
Q

T/F taking meds episodically is better than ~1 week anticipated allergen exposure

A

False - Recommend taking meds ~1 week prior to anticipated allergen exposure to prevent/reduce rxn

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15
Q

T/F: INCS + 1st gen antihistamine is recommended

A

False - INCS monotherapy is recommended (add on causes more side effects, not more effective)

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16
Q

For pts >12yo with moderate-severe symptoms consider initial treatment combo of ____

A

INCS + Intranasal antihistamine

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17
Q

INCS Examples

A 
Fluticasone propionate (Flonase)
Triamcinolone (Nasacort)
Budesonide (Rhinocort) 
Beclomethasone (QNASL, Beconase AQ)
Mometasone furoate (Nasonex)
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18
Q

Fluticasone propionate brand

A

Flonase

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19
Q

Triamcinolone brand

A

Nasacort

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20
Q

Budesonide brand

A

Rhinocort

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21
Q

Beclomethasone brand

A

QNASL, Beconase AQ

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22
Q

Mometasone furoate brand

A

Nasonex

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23
Q

INCS MOA

A

Broad anti-inflammatory properties that reduce inflammation by:
- reducing mediator release
- suppressing neutrophil chemotaxis
- reducing intracellular edema
- mildly vasoconstricting
- inhibiting mast cell-mediated late phase rxn
(tamp down entire immune response)

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24
Q

INCS ADRs/DDI

A

Well tolerated
Epistaxis (nose bleeds), stinging, itching, headache
Nasal septum separation (RARE)

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25
Q

INCS: Counseling

A

Shake before use, prime before first use and if not used >1 week to ensure accurate dosing

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26
Q

2nd Gen Antihistamines Examples

A

Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratadine (Claritin)

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27
Q

Cetirizine brand and notes

A

Zyrtec - most sedating 2nd gen

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28
Q

Fexofenadine brand and notes

A

Allegra - grapefruit/orange/apple juice can inhibit absorption, separate by ≥4 hrs

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29
Q

Loratadine brand and notes

A

Claritin - preferred in pregnancy and pediatrics

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30
Q

2nd Gen Antihistamines: ADE

A

headache, dry mouth, drowsiness (not as much as 1st gen)

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31
Q

___ interfere with fexofenadine absorption

A

Antiacids

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32
Q

Additive CNS depression possible with sedative agents and (2nd gen antihistamine)

A

Cetirizine

33
Q

Precaution for 1st gen and cetirizine

A 
Infants/breastfeeding mothers 
Narrow-angle glaucoma 
Symptomatic BPH
GI/GU obstruction
Elderly
34
Q

Intranasal Antihistamine Examples

A

Azelastine
Olopatadine

*guidelines recommend before oral antihistamines due to less ADEs but require rx and costly – often try AFTER oral
can taste bad

35
Q

Ophthalmic Antihistamine Examples

A

Ketotifen (Zatidore)
Olopatadine (Pataday)
Azelastine (Optivar)

36
Q

Ketotifen brand

37
Q

Olopatadine brand

38
Q

Azelastine brand

39
Q

Mast cell stabilizer example

A

Cromolyn Sodium (NasalCrom)

40
Q

Cromolyn Sodium brand

41
Q

Mast Cell Stabilizer MOA

A

Stabilizes mast cells by interfering with chloride channel fxn – inhibits mast cell activation and subsequent release of mediators from eosinophils/epithelial cells
Inhibits acute response to exercise and cold air

42
Q

Mast Cell Stabilizer ADE/DDI

A

Well tolerated, may cause sneezing, nasal stinging/burning, unpleasant taste

43
Q

Mast Cell Stabilizer: Counseling

A

Most effective if started PRIOR to symptom onset (may take up to 7 days for improvement and 2-4 weeks for full effect)

**does not treat pre-existing symptoms (more for PREVENTION vs treat)

44
Q

Oral decongestants examples

A

Pseudoephedrine (Sudafed)

Phenylephrine (Sudafed PE)

45
Q

T/F: Pseudoephedrine more effective than phenylephrine

46
Q

Oral decongestants: MOA

A

Sympathomimetic - agonists at adrenergic receptors in nasal mucosa, causing vasoconstriction

Phenylephrine - directly on sympathetic receptors

Pseudoephedrine - mixed effect some direct some displacement of NT from storage vesicles

47
Q

Oral decongestants: ADE/DDIs

A

CV stimulation and increase in CV event risk
CNS stimulation
Urinary retention, worsen narrow angle glaucoma

DDI: MAOis and TCAs (dangerous increase in BP, concurrent use CI)

48
Q

Intranasal Decongestants Examples

A

Oxymetazoline 0.05% (Afrin)

Phenylephrine 0.25% or 0.5% (NeoSynephrine)

49
Q

Oxymetazoline 0.05% brand

50
Q

Phenylephrine 0.25% or 0.5% brand

A

Neo-Synephrine

51
Q

Intranasal decongestants: MOA

A

Agonist at local alpha adrenergic receptors in nasal mucosa

52
Q

Intranasal decongestants: ADE/DDI

A

Local irritation, burning stinging, mild systemic effects if any

DDI: MAOis and TCAs (dangerous increase in BP, concurrent use CI)

53
Q

Intranasal decongestant use for >3-5 days may cause ____

A

rhinitis Medicamentosa (rebound congestion)

Slowly withdraw and taper off
Reversible

54
Q

Decongestants Warnings

A

Avoid in pts taking MAOis TCAs
May exacerbate DM or worsen glucose control
May worsen hyperthyroidism, CHD, ischemic HD, glaucoma, BPH
Avoid in HTN
Decongestants are considered illegal or “doping” agents in organized sports
Large quantities of pseudoephedrine used in manufacture of methamphetamine

55
Q

____ considered illegal or “doping” agents in organized sports

A

decongestants

56
Q

___ sold behind the counter

A

Pseudoephedrine

57
Q

Antihistamine + Decongestant Combo Examples

A

Zyrtec D
Allegra D
Claritin D
(antihistamine + pseudoephedrine)

generally better to give separately

58
Q

Intranasal Anticholinergic Example

A

Ipratropium 0.03% or 0.06%

59
Q

Intranasal Anticholinergic Spray: MOA

A

Anticholinergic = antisecretory

  • Dries nasal secretions
  • Relieves rhinorrhea from any cause
60
Q

Intranasal Anticholinergic Spray: ADEs/DDI

A

Bitter taste in mouth, dry nasal mucosa, dry mouth

61
Q

Leukotriene Receptor Antagonist Examples

A

Monteluakst (Singulair)

62
Q

Montelukast brand

63
Q

Leukotriene Receptor Antagonist: MOA

A

Blocks action of LT at their reecptors, prevents inflammation, edema, and sm. m. contraction

64
Q

Leukotriene Receptor Antagonist ADE/DDI

A

Headache

- BBW concerns for psychiatric ADRs

65
Q

For AR, ____ should be reserved for those who are not treated effectively with or cannot tolerate other allergy meds

A

Leukotriene Receptor Antagonist

66
Q

Treatment Summary: For all pts

A

Allergen avoidance

Nasal saline

67
Q

Treatment Summary: Mild symptoms

A

INCS

- takes a while to reach full effect, best when used consistently, can help w ocular symptoms

68
Q

Treatment Summary: Mod-severe symptoms

A

INCS + INAH

69
Q

Treatment Summary: Rhinorrhea

A

Antihistamine or ipratropium nasal spray

70
Q

Treatment summary: Itching/sneezing

A

antihistamine

71
Q

Treatment summary: Nasal congestion

A

Intranasal decongestant (limit 3-5 days) or oral

72
Q

Treatment summary: Ocular

A

INCS fluticasone furoate and propionate have FDA approval for ophthalmic symptoms, ocular antihistamines

73
Q

Treatment summary: for minimal systemic side effects

A

Intranasal cromolyn

74
Q

Treatment summary: If symptoms persist

A

Immunotherapy or brief course of oral steroid

75
Q

Spec pop AR: Pregnant

A

Intranasal cromolyn 1st line for AR
1st gen antihistamines considered safe, 2nd gen loratadine is preferred
oral corticosteroids have caused birth defects but INCS safe
Oxymetazoline preferred decongestant

76
Q

Spec Pop: Breastfeeding

A

Intranasal cromolyn considered safe
Avoid first gen antihistamines
2nd gen use short-acting and take at bedtime after last feed

77
Q

Spec pop: Peds

A

<12yo refer to pediatrician to assess for asthma
Loratadine antihistamine of choice
May experience paradoxical excitation with antihistamines
INCS > 2 months linked with growth inhibition

78
Q

Spec Pop: Geriatrics

A

avoid 1st gen antihistamines

Drugs of choice: intranasal cromolyn + loratadine/fexofenadine

CDM1 (19 decks)

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