Rhinitis Flashcards

1
Q

What are the symptoms of allergic rhinitis (hayfever)?

A

nasal itch, sneeze, watery rhinorrhoea, nasal congestion, runny nose

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2
Q

what is the causative allergen of AR in April and May-July?

A

April - tree pollen

MAy-july - grass pollen

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3
Q

When would you refer a pt that has rhinitis?

A
  1. wheezing (difficulty breathing)
  2. when a severe secondary infection (purulent conjunctivitis) affects the eyes
  3. painful ear
  4. nasal obstruction that fails to clear
  5. unilateral discharge (could be due to foreign body)
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4
Q

What are ways to avoid allergen exposure/?

A

stay indoors, close windows when pollen counts are high, wear ‘wrap on’ sunglasses, hoovering the house and keeping pets away from certain areas of the house

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5
Q

What tx options are available for pts with AR?

A
  1. oral antihistamines
  2. nasal steriods
  3. oral and topical decongestants
  4. eye drops
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6
Q

What is the antihistamine of choice?

A

Loratadine because it causes less sedation

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7
Q

What is the most effective type of tx used for pts with AR?

A

intranasal corticosteriods

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8
Q

Name some intranasal corticosteriods. Can you use them in children?

A

beclometasone (beconase) 2 sprays BD, fluticasone (pirinase) 2 sprays OD, triamcinolone 2 sprays OD (NASACORT)
once symptoms are controlled use, the lowest effective dose
use only >18 years

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9
Q

What are the side effects asssociated with beclometasone/fluticasone AND triamcinolone?

A
  • Nasal irritation, bitter taste, headache, nosebleeds

- headache, nosebleeds, dyspepsia, bronchitis flu-like symptoms and cough

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10
Q

In which pts should you avoid using nasal corticosteroids?

A

avoid in glaucoma

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11
Q

Can decongestants be used?

A

only for short term relief of nasal congestion as there is risk of rebound congestion and cannot be used for a long period of time

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12
Q

Are mast cell stabilisers useful?

A

only useful when pt can predict well in advance the onset of symptoms so they can use a week in advance
also sodium cromoglicate and lodoxamide are poorly absorbed and the amount reaching the circulation is very low
safe in pregnancy

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13
Q

Name ocular and nasal mast cell stabilisers, the side effects that occur with it and the age restrictions

A
ocular: lodoxamide (alomide allergy), >4 years, headache/nausea/dizziness 
sodium cromoglicate (opitcrom allergy, optrex, murine) >6 years local irritation, blurred vision 

Nasal: sodium cromoglicate (Rynacrom 4% nasal spray) >5 years, nasal irritation

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14
Q

What are ocular sympathomimetics? What is the purpose of their use?

A

combination of sympathomimetic and antihistamine (antazoline/xylometazoline - otrivine antistin)

  • reduces redness in the eye
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15
Q

What are the age restrictions/side effects and interactions of otrivine antistin and naphazoline?

A

Otrivine: >12 years, local irritation, avoid in glaucoma as it increases intraocular pressure , avoid pts taking MAOIs
naphazoline ( murine irritation and redness): >12 years, local irritation, avoid in pts taking MAOIs

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16
Q

How do systemic antihistamines work? When can you acquire maximum effect?

A

inhibit histamine H1 receptors and suppress vascular effects

maximum effect is achieved if used on a regular basis

17
Q

Which antihistamine is safest for pregnancy? What is the age restriction?

A

sedating antihistmine like chlorphenamine

>1 year

18
Q

Name 3 non-sedating antihistamines and the age restrictions associated with them?

A
  1. Acrivastine (benadryl Allergy Relief) >12 years) one tds
  2. Cetirizine - 10mg daily, >2 years
  3. Loratadine - 10mg >2 years
19
Q

What is the onset of action of:

  1. Oral antihistamines
  2. Nasal steriods
  3. Nasal decongestants
  4. Nasal cromone
A
  1. 1 hour
  2. 12 hours
  3. 5-15 mintes
  4. variable
20
Q

what is the duration of:

  1. Oral antihistamine
  2. nasal steriod
  3. nasal decongestants
  4. Nasal cromone
A
  1. 12-24hours
  2. 12-48 hours
  3. 3-6 hours
  4. 2-6 hours