Rhinitis Flashcards
What is Perennial Rhinitis?
Persistent indoor allergens (ex: House dust mites, Pet Dander, Mold, Cock roaches)
What is seasonal Rhinitis
Intermittent allergic rx in the Spring and Fall to outside allergens such as Pollen, Fungi. (Hay Fever, Rose Fever)
(General Glucocorticoids) What is the Route?
Nasal
(General Glucocorticoids) Action?
Prevent inflammatory Response
(General Glucocorticoids) Adverse Affects?
Nasal Irritation/ Possibly effects linear growth in children
General Antihistamines-Route?
Nasal/Oral
General Antihistamin- Action?
Block H1 receptors
General Antihistamine-Adverse Effects?
oral = sedation/Anticholergenic
nasal= bitter taste
General Cromolyn- Route?
Nasal
General Cromolyn-Action?
Prevents release of inflammatory mediators
General sympathomimetics- Route?
Oral/Nasal
General sympathomimetics- Action?
Activate vascular alpha 1 receptor
General sympathomimetics- Adverse Effects?
Oral- restless, insomnia, and increase in BP
Nasal= rebound nasal congestion
General Anticholinergics-Route?
Nasal
General Anticholinergics-Action?
Block nasal cholinergic receptors
General Anticholinergics- Adverse Effects?
Nasal drying/ irritation
General Antileukotrienes- Route?
Oral
General Antileuktrienes- Action?
Block leukotriene receptors
General Antileukotrienes- Adverse Effects?
RARE but neuropsychiatric effects
General Goal of Rhinitis meds?
Reduce inflammation/Nasal symptoms (Patient exhibits no adv effects and can sleep.
What drug is the most effective drug when treating both seasonal and perennial rhinitis? And a 1st line therapy?
Intranasal Glucocorticoid: “Rhinocort”; Fluticason (Flonase) Mometasone (Nasonex)
How is intranasal glucocorticoids admin? (Flonase, Nasonex, Rhinocort)
Using a metered dose spray
When should Intranasal glucocorticoids be started? (Flonase, Nasonex, Rhinocort)
Before the patient has symptoms
Should intranasal glucorticoids (Flonase, Nasonex, Rhinocort) be used PRN?
No, best outcomes when used once daily
What needs to be done before using intranasal glucorticoids?
Use a topical decongestant agent before spraying in the nose, we need to “unstuff the nose” so the medicine can get into the passage
What is a first generation antihistamine?
diphenhydramine (Benadryl)
Are first generation antihistamines sedating?
Yes
What is an example of a 2nd generation antihistamine?
loratidine (Claritin, Alavert)
Are second generation antihistamines sedating?
No
What is the MOA of antihistamines?
Selectively blocks the effects of histamine at the histamine receptor site (H1 receptor antagonists)
Do antihistamines help with nasal congestion?
No
When are antihistamines most effecttive?
When they are taken prophalatically before symptoms appear
Some 1st generation antihistamines cause anticholinergic effects, what would some of these effects look like?
Dry mouth
Constipation
Urinary hesitancy
Side effects of intranasal antihistamines?
Solomnence (sleep), nosebleed, unpleasant taste
What is the MOA of intranasal Cromolyn Sodium (Nasocrom)?
Suppresses release of histamine and other inflammatory mediators from mast cells
What is Nasalcrom best for?
Prophylaxis-not treatment
What is an advantage of nasalcrom?
Extremely safe
What is a disadvantage of Nasalcrom?
It is only moderately effective
What do we need to do prior to admin. Intranasal Cromlyn Sodium?
Use a topical decongestant prior to admin if nasal congestion present
What is the dosage of the intranasal cormolyn sodium?
Should be dosed on a regular schedule throughout the allergy season
Types of Sympathomimetics (Decongestants)
pseudoephedrine (Sudafed)
MOA of sympathomimetic (Sudafed)?
Reduce nasal congestion by activating alpha 1-adrenergic receptors on nasal blood vessels, causing vasoconstriction, shrinking swollen membranes, followed by nasal drainage (ONLY RELIEVES STUFFINESS)
What are the adverse effects of sympathomimetics (pseudophedrine?)
Rebound congestion CNS stimulation Restlessness Irritability Anxiety Insomnia Cardiovascular effects- r/t widespread vasoconstriction
How can we prevent rebound congestion with Sudafed?
Do not take for longer than 5 days
How should the head be positioned with nasal drops?
tilted back
How should the head be positioned with nasal sprays?
Nose to toes (NOT tilted back)
What are the benefits of using sympathomimetics and antihistamines together?
Provides relief of itchy eyes, sneezing, and rhinorrhea, along with fixing nasal congestion
What are the type of combo meds?
Claritin-D, Allegra-D
MOA of Ipratropium and Anticholinergic agents? (Atrovent)
Blocks cholinergic receptors which inhibits glandular secretions, thereby decreasing rhinorrhea (runny nose)
Side effects of anticholinergic agent?
Nasal drying and irritation
What is the MOA of Leukotriene Antagonist (montelukast; singulair)?
Blocks the binding of leukotrienes to their receptor sites
Adverse effects of Leukotriene Antagonist? (singulair)
Rare, but serious neuropsychiatric effects such as: agitation aggression hallucinations depression insomnia restlessness suicidal thoughts/behavior
What is the MOA of Omalizamab (Xolair) injections?
Monoclomal anitbody that inhibits IgE response
What is Omalizamab (Xolair) indicated for?
Ragweed induced allergy
What is Xolair only approved for at this time?
Asthma
