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Allergic Rhinitis/Cough & Cold > Intranasal Steroids > Flashcards

Intranasal Steroids Flashcards

1
Q

What is the drug tx for allergic rhinitis and when is it indicated?

A

Intranasal steroids: 1st line for CHRONIC, MOD-SEVERE sx’s

Antihistamines: milder, intermittent sx’s

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2
Q

Antihistamines and decongestants can be found in what type of formulations?

A

Oral and nasal formulations

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3
Q

How do intranasal steroids work?

A

By decreasing inflammation

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4
Q

List the most common intranasal steroids

A
  1. Budesonide: Rhinocort Allergy
  2. Fluticasone: Flonase (Allergy Relief,Semimist, Children’s Flonase)
  3. Triamcinolone: Nasacort Allergy 24H (Children)
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5
Q

Budesonide

A

Rhinocort Allergy

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6
Q

Intranasal Steroid: Rhinocort Allergy

A

Budesonide

OTC

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7
Q

Intranasal Steroid: Fluticasone

A

Flonase (Allergy Relief, Semimist, Children’s Flonase)

Rx and OTC

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8
Q

Intranasal steroid: Triamcinolone

A

Nasacort Allergy 24H (and Childrens’s Nasacort 24H)

OTC

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9
Q

Flonase

A

Fluticasone

Rx and OTC

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10
Q

Nasacort 24H

A

Triamcinolone

OTC

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11
Q

Intranasal Steroid: Mometasone

A

Nasonex 24H Allergy

Rx and OTC

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12
Q

Nasonex 24H

A

mometasone

Rx and OTC

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13
Q

Intranasal Steroid: Beclomethasone

A

Qnasl

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14
Q

Which 2 nasal steroids are PREFERRED in PREGNANCY?

A

Budesonide and Beclomethasone

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15
Q

How long can intranasal steroids take to get full relief?

A

Up to 1 week

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16
Q

Side effects of intranasal steroids?

A

*EPISTAXIS (nose bleeds), HA, dry nose, unpleasant taste, localized infection

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17
Q

Intranasal steroids should be used in caution in patients with…..?

A

Cataracts/Glaucoma (can increase IOP)

note: open-angle glaucoma and cataracts have occurred with PROLONGED use

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18
Q

How do antihistamines work?

A

Block histamine at the histamine-1 (H1) receptor site

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19
Q

List the most common First Generation antihistamines?

A
  1. Diphenhydramine: Benadryl
  2. Chlorpheniramine
  3. Doxylamine
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20
Q

Benadryl Adult dosing

A

25 mg PO Q4-6H OR 50 mg PO Q6-8H

(Max 300 mg/day)

Rx and OTC

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21
Q

At what age should OTC Benadryl NOT be used?

A

< 6 years (unless directed by healthcare provider)

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22
Q

when should 1st and 2nd gen antihistamines be stopped prior to allergy skin testing?

A

≥ 72 hrs (3 days)

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23
Q

Contraindications of 1st gen antihistamines

A

Neonates/premature infants, breastfeeding

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24
Q

1st gen antihistamine warnings/cautions

A

AVOID in ELDERLY (BEERs criteria)

Use caution in pts with PROSTATE ENLARGEMENT and GLAUCOMA

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25
Side effects of 1st gen antihistamines?
Somnolence, cognitive impairment, strong anticholinergic effects
26
Which type of inhibitors should 1st gen antihistamines not be taken with?
MAO inhibitors (especially clemastine and carbinoxamine)
27
List the most common 2nd gen antihistamines
1. Cetirizine (Zyrtec) 2. Levocitirizine (Xyzal) 3. Fexofenadine (Allegra) 4. Loratadine (Claritin)
28
Which 2nd gen antihistamines can have + pseudoephedrine
1. Ceterizine (+ PSE is Zyrtec D) 2. Loratadine (+ PSE is Claritin D) 3. Fexofenadine ( + PSE is Allegra D)
29
2nd gen antihistamine: Cetirizine
Zyrtec
30
Zyrtec
cetirizine
31
2nd gen antihistamine: levoceterizine
Xyzal
32
Xyzal
levocitirizine
33
2nd gen antihistamine: fexofenadine
Allegra
34
Allegra
fexofenadine
35
2nd gen antihistamine: Loratadine
Claritin
36
Claritin
loratadine
37
More sedating 2nd gen antihistamines AND also have FAST ONSET?
Cetirizine and levocitirizine
38
Which 2 Second gen antihistamines are PREFERRED in PREGNANCY?
Loratadine and Cetirizine
39
Less sedating 2nd gen antihistamines?
Fexofenadine and Loratadine
40
How to take fexofenadine
take with WATER (NOT fruit juice due to decreased absorption), and avoid administration with Al+ or Mg+ containing products
41
Contraindications of Levocetirizine
ESRD (CrCl < 10), HD, and infants/kids 6 mo - 11 yrs with renal impairment
42
Name intranasal antihistamines
1. Azelastine (Astepro) 2. Olopatadine (Pantanase) Note: can be combined with/intranasal steroids
43
Alpha adrenergic agonists (vasoconstrictors)
decongestants
44
Can be easily converted to methamphetamine
pseudoephedrine, phenylprpanolamine, ephedrine
45
Methamphetamine Epidemic Act 2005: Max amount allowed for purchase?
3.6 g/day (120 tabs of 30 mg tab) and 9 g in a 30-day period EXCEPTION: 60 mg single pack
46
Most common systemic (oral) decongestants
1. Phenylephrine (Sudafed PE) 2. Pseudoephedrine (Sudafed, Nexafed, Zephrex-D)
47
Intranasal decongestants
1. Oxymetazoline (Afrin) 2. Phenylephrine
48
Side effects of nasal decongestants
Rhinitis medicamentosa (rebound congestion if used longer than 3 days)
49
Warnings for nasal decongestants
BPH do Not use with MAOi
50
Contraindications of systemic decongestants
Do not use within 14 days of MAO inhibitors
51
Oral decongestants should be avoided in which pregnancy trimester?
Avoid in 1st trimester
52
Side effects of systemic decongestants
tachycardia, palpitations, increased BP, insomnia, decreased appetite
53
Systemic decongestants should be used with caution in which patients?
CV disease, BPH (can cause urinary retention)….diabetes (increase BG), glaucoma (increase IOP)
54
Additional Allergy Meds: OTC Mast Cell Stabilizer
Intranasal Cromolyn (NasalCrom) use regularly NOT PRN: start @ onset of allergy season Safe to use in children and pregnancy
55
Additional Allergy Meds: Oral Leukotriene Receptor Antagonists
Montelukast (Singulair)- should be reserved for those who are unable to be tx effectively with other meds used for both allergic rhinitis and asthma commonly used in children
56
Additional Allergy Meds: Intranasal Ipratropium
effective for decreasing rhinorhhea by causing nasal dryness (is NOT as effective for other nasal symptoms)
57
Immunotherapy: Oralair
contains 5 diff grass pollen extracts
58
Immunotherapy: Grastek
Timothy grass pollen extract
59
Immunotherapy: Ragwitek
ragweed pollen extract
60
Immunotherapy: Odactra
house dust mite allergen extract

Allergic Rhinitis/Cough & Cold (1 decks)

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