Lecture Allergies and Cough

Question 1

pharmacotherapy for allergic rhinitis

Answer 1

remove allergen is 1st choice!

Drugs for allergic rhinitis treat & prevent symptoms.

1. Glucocorticoids (intranasal)
2. Antihistamines (oral & intranasal)
3. Sympathomimetics (oral & intranasal)

Question 2

intranasal glucocorticoids

Answer 2

fluticasone	[Flonase]		
mometasone	[Nasonex]		
budesonide	[Rhinocort Aqua]
beclomethasone
triamcinolone	[Nasacort AQ]
flunisolide

FIRST CHOICE – most effective for treatment & prevention

Anti-inflammatory - Best if used daily

Teach patients:

• “if you taste it, you waste it”
• Spray to bridge of nose, use opposite hand to nostril to spray

AEs – mild – very safe!
drying mucosa, burning, itching, epistaxis, HA, rare adrenal suppression

Question 3

oral antihistamines

Answer 3

1st Generation
chlorpheniramine [Chlor-Trimeton]
diphenhydramine [Benadryl]

2nd Generation
cetirizine	[Zyrtec]
fexofenadine  [Allegra]
loratadine	 [Claritin]
desloratadine  [Clarinex]

H1 receptor antagonists
-Take regularly in allergy season – even when absent – to prevent histamine activation

Most effective as prophylaxis

do NOT reduce nasal congestion

AEs – mild

1. sedation (1st gen > 2nd gen)
2. anticholinergic effects (1st > 2nd)
3. paradoxical excitement in children

Question 4

intranasal antihistamine

Answer 4

azelastine [Astelin, Astepro)]
olopatadine [Patanase]

antihistamine used for rhinitis in those greater than 12 years of age

AEs

1. possible somnolence
2. epistaxis
3. anticholinergic effects
4. unpleasant taste

Question 5

intranasal cromolyn sodium [NasalCrom]

Answer 5

suppress histamine & other inflammatory mediators from mast cells

Best as prophylaxis

responses usually 1-2 weeks

AEs less than any other drug for allergic rhinitis

Question 6

Sympathomimetics relieve ___ only.

Answer 6

congestion

Reduce nasal congestion
via vasoconstriction of nasal blood vessels – shrinkage of swollen membranes – allows nasal drainage

activate alpha1-adrenergic receptors on nasal blood vessels

DO NOT reduce rhinorrhea, sneezing, itching

AE’s:
rebound congestion (topical) - phenylephrine [prep H]
CNS stimulation (oral) - pseudoephedrine [Sudafed]
CV effects/stroke (oral > topical) - oxymetazoline [Afrin]
abuse (ephedrine)

Question 7

antihistamine -sympathomimetic combos

Answer 7

**ipratropium bromide [Atrovent]
anticholinergic
only reduces rhinitis
AEs – nasal drying, irritation

montelukast [Singulair]
blocks leukotriene receptors
relieves nasal congestion

*omalizumab [Xolair]
monoclonal antibody vs IgE
allergic asthma

Question 8

antitussives work by ___.

Answer 8

elevating the cough threshold.

includes
opiod (codeine and hydrocodone) and
nonopioid (dextromethorphan, diphenhydramine, benzonatate)

1. Take cough syrup without water and allow it to coat the throat for soothing effects,
2. follow it with increased fluid intake 30-60 minutes later

Question 9

opioid antitussives

Answer 9

codeine and hydrocodone

most effective cough suppressant
small dose (1/10 for pain) – low risk for dependence
respiratory suppression risk

Question 10

nonopioid antitussives

Answer 10

Dextromethorphan (Delsym),
diphenhydramine,
benzonatate [Tessalon]

higher doses – dizziness, sedation, euphoria

Question 11

___ stimulate flow of secretions, and ___ works directly on mucus to make it more watery.

Answer 11

expectorants - guaifenesin [Mucinex, Robitussin]

mucolytics

• hypertonic saline (netti pots, simply saline)
• acetylcysteine (smells like rotten egg)