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Allergy Week 2 > Pharm of Allergy and Anaphylaxis > Flashcards

Pharm of Allergy and Anaphylaxis Flashcards

1
Q

Broad Allergy Tx Options

A
  • avoidance of triggers; no carpet or upholstered furniture, no pets, maintain heating/cooling systems, no smoking
  • medications
  • allergy injections
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2
Q

Allergy Medication Arsenal

A
  • antihistamines (1st and 2nd generation)
  • decongestants
  • cromolyn sodium (mast cell stabalizer
  • intranasal glucocortioids
  • single most effective agent, need to start in advance b/c takes longer to effect
  • Ipratropium (intranasal cholinergic)
  • Montelukast (leukotriene inhibitor)
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3
Q

Ideal drug for allergic rhinitis should have the following features…

A
  • inhibit both early and late phases
  • H1 blocker
  • fast acting, to control early phase
  • dosing 1x/daily for compliance
  • no side effects
  • manage all symptoms
  • intranasal administration
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4
Q

1st generation Antihistamines

  • drugs
  • MOA
  • onset
  • effect
  • side effects
  • CI
A
  • Diphenyhydramine (Benadryl)
    Hydroxyzine (Atarax), cholrpheniramine (Chlor-trimetion)
  • blocking the actions of h1 (histamine) at receptor sites, does not block histamine release.
  • 15-30mins

=reduced itching sneezing and rhinorrhea not congestion

  • SE- sedation, anticholinergic effects. (no shit, no spit, no pee, no see)
  • CI- lactating mothers, glaucoma, BPH, elderly, children
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5
Q

What is the difference between H1 and H2 blocker?

A

-H1 blocker is in nose and resp. tract induces smooth muscle contraction, ex. benadryl

H2- blocking in GI, ex. Zantac

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6
Q

2nd Generation Antihistamines

  • drugs
  • MOA
  • onset
  • Effect
  • SE
A
  • Loratadine (Claratin)
  • Fexofenadine (Allegra)
  • Cetirizine (Zyrtec)
  • MOA: inhibit histamine H1 reeptors
  • onset: rapid onset, maximum effect 1-2.5hrs
  • effect- reduced sneezing, itching, rhinorrhea, NOT congestion

SE- anticholinergic effects (no shit no spit no see no pee) less SE than 1st generation, less sedating IS long acting

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7
Q

Decongestants in the tx of Allergy

  • drugs
  • MOA
  • Effect
  • SE
  • CI
A
  • pseudoephedrine (Sudafed) (Oral)
    Pseudoephedrine (Afrin) (intranasal)

mech. - alpha adrenergic agonist.
effect: vasoconstriction, restrict blood flow to nasal mucousa that has been dilated by histamine

SE- HA, nervous, irritablitly, tachycardia, palpitations insomnia, HAS NO influence on pruritis, sneezing, or nasal secretion

CI- hypertension, cardovascular disease, hyperthyroidism. glaucoma, co- use w/ MAOIs (monoamines oxidase inhibitors)

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8
Q

What is Rhinitis Medicamentosa? (RM)

A

-prolonged use of topical decongestant, may induce rebound congestion upon withdrawl. leads to inflamm hypertrophy of nasal mucosa.

ex, afrin over use (>3days)

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9
Q

Combo drugs: oral non-sedating antihistamine-decongestant

A
  • Fexofenadine/Pseudoephedrine (Allegra)
  • Loratadine/Pseudoephedrine (Clartin D)
  • Cetirizine/pseudoephedirne (Zyrtec D)
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10
Q

Cromolyn Sodium (Nasalcrom)

  • what drug class?
  • moa
  • effects
  • SE
  • time to efficacy
A
  • leukotriene receptor antagonist
  • mast cell stabalizing agent»> reduces release of histamine and other mediators
  • reduces nasal pruritis, sneezing, rhinorrhea, congestion
  • no serious effects
  • Helpful in prophylaxis only, must start 2-4weeks prior, frequent dosing (Q4hr)
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11
Q

Intranasal Glucocorticoids (INGCs)

  • types
  • mechanism
  • effect
  • SE
  • time to efficacy
A
  • fluticasone proprionate (Flonase)
    -mometasone (nasonex)
    -Beclomethasone dipropriate aqueous (Beconase)
    -Budesonide (Rhinocort)
    -Flunisolide (Nasarel)
    -Triamcinolone acetonide
    (Nasacort)
  • disabling cells that present ag to aby, reduce mast cell degranulation, reduce inflamm by limiting late phase response, suppress neutrophil chemotaxis, mildly vasoconstrictive, reduce intracellular edema.
    effects: reduce nasal blockage, pruritis, sneezing, rhinorrhea

SE- nasal irritation, bleeding

-efficacy; therapeutic 1-3days but MAX efficacy up to 3weeks, compliance is critical

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12
Q

What is Ipatropium Bromide (Atrovent) good for? why?

  • what class of drug is this?
A

goood for runny nose, reduces substance p

Anti-cholinergic nasal spray

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13
Q

What is IMontelukast (singular) good for? why?

A

helpful for runny nose and congestion, not first line therapy

*mainly used for asthma but also approve for AR

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14
Q

Treatment for eye allergies

A
  • Normal saline
  • Azelastine (Optivar)– inhibits histamine release from mast cells
  • Olopatadine (patanol)– inhibits histamine release from mast cells
  • Naphazoline/pheniramine (Opcon-A)– Naphazoline decreases congestion, pheniramine is an antihistamine, has rebound effects
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15
Q

Allergy injections

-when to do

A
  • used when medication and avoidance dont work

- leave this to the “pros” allergist.

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16
Q

Stepwise approach to Medicines for Allergic Rhinitis

A

Step 1: avoidance of allergic factors,

Step 2: if continued mild intermittent sx use non-sedating antihistamine and/or decongestants prn

Step 3: persistent to mild/moderate sx use intranasal steroid therapy 1-2 weeks prior to season, nonstedating antihistamine and/or decongestant prn, topical ocular antihistamine w/ or w/o vasoconstrictor or topical eye mast cells stabalizer

Step 4: Severe sx; use topical nasal corticosteroid, non-sedating antihistamine and or decongestant, short term burst of oral corticosteroids (Prednisone Burst pack- start high dose and then taper them off. If using this more than 1x/yr they need immunotherpy) if inadequate response consider immunotherapy

17
Q

Allergic Rhinitis Physical Exam Findings

A

Eyes- red, allergic shiners, stringy mucus,

Nose- red, sowllen, polyps, clear drainage, cyanotic/boggy nasal mucosa

Throat- post nasal drip

18
Q

Chronic Sinusitis Physical Exam Findings

-what is the key to this dx.

A

Frontal HA, pain, pressure

Nose- thick yellow nasal discharge

Cough- thick yellow-green sputum x1week

Bad breath

  • may experience tooth pain- maxillary sinus runs along trigeminal nerve that innervates the mouth causing pain.
  • key to sinus infection dx is TIMELINE, most clear up on own w/ anti-histamine, once 10days pass w/ no relief its definitely sinusitis.
19
Q

Most common bacterial cause of acute sinusitis? Which abx do we treat this with?

A

strep. pneumo

H. flu

Moraxella Catarrhalis

-amoxicillin

20
Q

Perennial allergic rhinitis Tx

A

antihistamine/decongestant + nasal steroid (+ nasal saline)

21
Q

Tx of Allergies (steps)

A
  • avoidance
  • reduce exposure
  • symptom relief (antihistamine/decongestants, Steroids)
  • Desensitization (refer to specialist)
22
Q

Anaphylaxis

  • what is it?
  • What is it a result of?
  • what type of hypersensitivity is it?
A
  • acute systemic ( multi-system ) allergic rxn (life-threatening rxn)
  • results from re-exposure to Ag that elicits an IgE mediated response, often caused medications, foods, insect stings
  • Type 1 hypersensitivity
23
Q

Steps and Effects of Anaphylaxis on different body systems

A

*Bee sting, Ag enters tissue and binds to IgE on Mast cell.

Mast cell releases chemical mediators (histamine, leukotrienes, prostaglandins, cytokines) that work on these systems…

  • lungs= bronchospasm *(this is what ppl die of acutely), vasoconstriction, edema
  • Heart= decreased output, increased HR, decreased coronary flow, decreased BP d/t vasodilation
  • peripheral blood vessels= vasodilation, leaky
  • tissue= puritus, urticaria, edema
  • GI= smooth muscle contraction and diarrhea
24
Q

When to use epi-pen

A

-at any sign of anaphylaxis, do not hesitate to use, there are no CI.

25
Q

What are the ABC of treating anaphylaxis

A
  • Airway
  • Breathing
  • Circulation
26
Q

Tx of Anaphylaxis

A
  • Simple BLS and ABC’s
  • Epinepherine
  • Anti-histamines (both H1 and H2 receptors)
  • Corticosteroids (for late phase rxn)
  • Treat Hypotension: IV fluids, Epi Drip
  • Tx Bronchodilators; albuterol

Observe min. 24hrs, benadryl for 24hrs

Rebound anaphylaxis (late phase)- repeat epinepherine drip, repeat antihistamine + H2 blocker

*always have them f/u w/ primary care provider

27
Q

What are the 2 phases of anaphylaxis?

A
  • Acute phase

- Late/Delayed Phase

28
Q

Shock symptoms

A

anxiety, agitation

bluish lips fingernails

chest pain

confusion dizziness

light headed

pale. cool clammy skin

profusely sweating

29
Q

Risk Management for anaphylaxis

A

EDUCATE!!!

  • teach avoidance
  • bracelet and an emergency action plan
  • stress importance of always have current EpiPen on hand, practice, emphasize need for follow up care!
30
Q

Screening patients at risk of anaphylaxis

A

Ask if ever had severe allergic rxn that caused

  • trouble breathing
  • severe hives/swelling
  • severe vomiting
  • severe diarrhea
  • dizziness

Allergy Week 2 (8 decks)

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