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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
Q

Side effects of 1st gen antihistamines?

A

Somnolence, cognitive impairment, strong anticholinergic effects

26
Q

Which type of inhibitors should 1st gen antihistamines not be taken with?

A

MAO inhibitors (especially clemastine and carbinoxamine)

27
Q

List the most common 2nd gen antihistamines

A
  1. Cetirizine (Zyrtec)
  2. Levocitirizine (Xyzal)
  3. Fexofenadine (Allegra)
  4. Loratadine (Claritin)
28
Q

Which 2nd gen antihistamines can have + pseudoephedrine

A
  1. Ceterizine (+ PSE is Zyrtec D)
  2. Loratadine (+ PSE is Claritin D)
  3. Fexofenadine ( + PSE is Allegra D)
29
Q

2nd gen antihistamine: Cetirizine

30
Q

Zyrtec

A

cetirizine

31
Q

2nd gen antihistamine: levoceterizine

32
Q

Xyzal

A

levocitirizine

33
Q

2nd gen antihistamine: fexofenadine

34
Q

Allegra

A

fexofenadine

35
Q

2nd gen antihistamine: Loratadine

36
Q

Claritin

A

loratadine

37
Q

More sedating 2nd gen antihistamines AND also have FAST ONSET?

A

Cetirizine and levocitirizine

38
Q

Which 2 Second gen antihistamines are PREFERRED in PREGNANCY?

A

Loratadine and Cetirizine

39
Q

Less sedating 2nd gen antihistamines?

A

Fexofenadine and Loratadine

40
Q

How to take fexofenadine

A

take with WATER (NOT fruit juice due to decreased absorption), and avoid administration with Al+ or Mg+ containing products

41
Q

Contraindications of Levocetirizine

A

ESRD (CrCl < 10), HD, and infants/kids 6 mo - 11 yrs with renal impairment

42
Q

Name intranasal antihistamines

A
  1. Azelastine (Astepro)
  2. Olopatadine (Pantanase)

Note: can be combined with/intranasal steroids

43
Q

Alpha adrenergic agonists (vasoconstrictors)

A

decongestants

44
Q

Can be easily converted to methamphetamine

A

pseudoephedrine, phenylprpanolamine, ephedrine

45
Q

Methamphetamine Epidemic Act 2005: Max amount allowed for purchase?

A

3.6 g/day (120 tabs of 30 mg tab) and 9 g in a 30-day period

EXCEPTION: 60 mg single pack

46
Q

Most common systemic (oral) decongestants

A
  1. Phenylephrine (Sudafed PE)
  2. Pseudoephedrine (Sudafed, Nexafed, Zephrex-D)
47
Q

Intranasal decongestants

A
  1. Oxymetazoline (Afrin)
  2. Phenylephrine
48
Q

Side effects of nasal decongestants

A

Rhinitis medicamentosa (rebound congestion if used longer than 3 days)

49
Q

Warnings for nasal decongestants

A

BPH

do Not use with MAOi

50
Q

Contraindications of systemic decongestants

A

Do not use within 14 days of MAO inhibitors

51
Q

Oral decongestants should be avoided in which pregnancy trimester?

A

Avoid in 1st trimester

52
Q

Side effects of systemic decongestants

A

tachycardia, palpitations, increased BP, insomnia, decreased appetite

53
Q

Systemic decongestants should be used with caution in which patients?

A

CV disease, BPH (can cause urinary retention)….diabetes (increase BG), glaucoma (increase IOP)

54
Q

Additional Allergy Meds:

OTC Mast Cell Stabilizer

A

Intranasal Cromolyn (NasalCrom)

use regularly NOT PRN: start @ onset of allergy season

Safe to use in children and pregnancy

55
Q

Additional Allergy Meds:

Oral Leukotriene Receptor Antagonists

A

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
Q

Additional Allergy Meds:

Intranasal Ipratropium

A

effective for decreasing rhinorhhea by causing nasal dryness (is NOT as effective for other nasal symptoms)

57
Q

Immunotherapy: Oralair

A

contains 5 diff grass pollen extracts

58
Q

Immunotherapy: Grastek

A

Timothy grass pollen extract

59
Q

Immunotherapy: Ragwitek

A

ragweed pollen extract

60
Q

Immunotherapy: Odactra

A

house dust mite allergen extract

Allergic Rhinitis/Cough & Cold (1 decks)

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