Rhinitis

Question 1

What is rhinitis?

Answer 1

Acute or chronic inflammation of nasal mucosa

Question 2

What are the symptoms of rhinitis?

Answer 2

Sneezing 
Rhinorrhea
Itching 
Nasal congestion
Obstruction
Difficulty breathing in

Question 3

What causes obstruction in rhinitis?

Answer 3

Swelling of nasal mucosa (particularly in cavernous sinusoids) largely due to dilated blood vessels

Question 4

What are the three types of rhinitis?

Answer 4

Allergic
Non-allergic
Mixed

Question 5

Outline the immunology of allergic rhinitis on FIRST exposure

Answer 5

Inhale allergen
Increase (specific) IgE levels
IgE binds to receptors on mast cells and basophils

Question 6

Outline the immunology of allergic rhinitis on SECOND exposure

Answer 6

Re-exposure
Mast cell and basophils degranualte
Release mediators (histamine, cyst Its, tryptase, prostaglandins)
Cause acute and delayed symptoms

Question 7

What are the acute symptoms of allergic rhinitis?

Answer 7

Itching
Sneezing
Rhinorrhoea

Question 8

What are the delayed symptoms of allergic rhinitis?

Answer 8

Congestion and obstruction

Question 9

What causes the delayed symptoms of allergic rhinitis?

Answer 9

Lymphocyte and eosinophil recruitment to nasal mucosa

Question 10

What re causes of non-allergic rhinitis?

Answer 10

Infectious (mainly viral) 
Hormonal (pregnancy) 
Vasomotor disturbances
Eosinophilia syndrome 
Medication
Occupational (may be mixed)

Question 11

What are the pharmacological agents used in Rhinitis?

Answer 11

Glucocosteroids
Anti-histamines
Anti-cholinergic drugs Sodium cromoglicate
CysLT Receptor Antagonist 
Vasoconstrictors

Question 12

What are examples of glucocosteroids?

Answer 12

Beclometasone
Fluticasone
Prednisolone (oral)

Question 13

What is the effect of glucocosteroids?

Answer 13

Reduce vascular permeability, recruitment and activity of inflammatory cells and release of cytokines and mediators

Question 14

What is the most common route of administration for glucocosteroids?

Answer 14

Spray to mucosa (usually OD)

Question 15

Glucocosteroids are effective as a mono therapy but may be combined with _______ in moderate-severe rhinitis

Answer 15

Anti-histamines

Question 16

What are the antihistamines used in rhinitis?

Answer 16

Competitive antagonists of H1 receptors

Question 17

What is the effect of antihistamines?

Answer 17

Reduce mast cell derived histamine effects

Question 18

Antihistamines are more effective in?

Answer 18

Allergic rhinitis

Question 19

What are examples of antihistamines?

Answer 19

Loratidine
Fexofenadine
Cetirizine

Question 20

Which antihistamine also has a mild anti-inflammatory effect?

Answer 20

Cetirizine

Question 21

Antihistamines are effective as?

Answer 21

Monotherapy

Question 22

Which anticholinergic drug is used in rhinitis?

Answer 22

Ipratroprium

Question 23

What is the effect of ipratropium?

Answer 23

Block ACh release from postganglionic parasympathetics

Question 24

Anticholinergic drugs are also known as?

Answer 24

Muscarinic receptor antagonists

Question 25

Ipratroprium blocks the muscarinic receptors on nasal glands that cause?

Answer 25

A watery secretion (contributes to rhinorrhea)

Question 26

Ipratroprium reduces rhinorrhea but has no effect on?

Answer 26

Sneezing Tiching Congestion

Question 27

How is ipratroprium administered?

Answer 27

Nasal route

Question 28

What is the side effect of ipratroprium?

Answer 28

Dryness of nasal membranes

Question 29

What is sodium cromoglicate?

Answer 29

Mast cell stabiliser

Question 30

What is sodium cromoglicate used for?

Answer 30

Maintenance treatment of allergic rhinitis

Question 31

What is the onset of action of sodium cromoglicate?

Answer 31

4-7 days (may take weeks for full effect)

Question 32

How is sodium cromoglicate administered?

Answer 32

Nasal

Question 33

Sodium cromoglicate is not effective as a nasal ..?

Answer 33

corticosteroid

Question 34

Which CysLT1 receptor antagonist is used?

Answer 34

Montelukast

Question 35

Montelukast reduces the effects of CysLTs on the?

Answer 35

Nasal mucosa

Question 36

Montelukast may show an additive effect with?

Answer 36

Anti-histamine

Question 37

Montelukast should be particularly considered if the patient has allergic rhinitis and ?

Answer 37

asthma

Question 38

How is montelukast administered?

Answer 38

Orally

Question 39

Vasoconstrictors are direct/indirect sympathomimetics to mimic the effects of?

Answer 39

Noradrenaline

Question 40

How do vasoconstrictors act?

Answer 40

Activate alpha-1-adrenoceptors to decrease swelling of vascular muscoa

Question 41

What is oxymetazoline?

Answer 41

Selective alpha-1-adrenoceptor agonist

Question 42

How is oxymetazoline administered?

Answer 42

Intranasally

Question 43

Oxymetazoline is effective short-term in reducing?

Answer 43

Congestion in allergic rhinitis

Question 44

Long-term nasal administration of oxymetazidine is not recommended because?

Answer 44

Rebound increase in nasal congestion upon discontinuation due to receptor desensitisation and down regulation

Question 45

What is rhinitis medicaments?

Answer 45

Rebound increase in nasal congestion upon discontinuation of medication such as oxymetazidine