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Fall 2024 > Rhinitis and Sinusitis Pharm > Flashcards

Rhinitis and Sinusitis Pharm Flashcards

1
Q

What is the treatment plan for moderate to severe rhinosinusitis

A

Symptomatic:
Analgesics
Antihistamine/decongestant combinations
Saline nasal spray
Zinc
Dextromethorphan
Expectorants
Intranasal ipratropium
Intranasal cromolyn sodium
Humidifiers

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2
Q

Use of Zinc

A

May decrease sold symptoms severity and duration
Adverse side effects:
Loss of smell (nasal solutions)
Taste disturbances
Nausea

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3
Q

Use of saline nasal spray

A

Ocean nasal spray
Symptomatic relief of nasal symptoms
Sodium chloride 0.65% - active ingredient
Squeeze twice in each nostril as needed

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4
Q

Use of decongestants

A

Mild relief as monotherapy
Oral: pseudoephedrine and phenylephrine
Linked to manufacturing amphetamines

Topical: oxymetolazine - Afrin
Limit to 2-3 days to avoid rebound rhinitis
Side effects: Nosebleeds, Agitation, insomnia, HTN

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5
Q

Medicated nasal spray use - intranasal cromolyn sodium

A

Well tolerated
Reduces duration of rhinitis symptoms
Mast cell stabilizer - inhibits mast cell degranulation

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6
Q

Medicated nasal sprays - Ipratropium bromide (Atrovent)

A

improved rhinorrhea and sneezing
Does NOT help with congestion
Common cold - 0.06%; 2 in each nostril 3-4 times a day
Adverse effects: Nasal dryness, blood tinged mucus, epistaxis

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7
Q

Humidifier use

A

May reduce nasal congestion
cool mist humidifier
drain and clean daily to prevent bacteria
Several feet away from bed

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8
Q

Allergic rhinitis nonpharm treatment

A

Avoid irritant

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9
Q

Treatment options allergic rhinitis

A

Antihistamines
Corticosteroids
Leukotriene inhibitors
Decongestants

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10
Q

Antihistamine MOA

A

block action of histamine at histamine receptors - topical and systemic

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11
Q

Corticosteroids MOA

A

Inhibit production of inflammatory cytokines and chemokines - topical and systemic

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12
Q

Leukotriene inhibitor MOA

A

Blocks action of leukotriene to reduce inflammation - systemic

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13
Q

Decongestants MOA

A

stimulate smooth muscle alpha adrenergic receptors to produce vasoconstriction and reduce nasal congestion - topical and systemic

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14
Q

Intranasal antihistamine clinical pearls

A

First line agent for mild allergic rhinitis
Best if patients prefer non-corticosteroid treatment or that have irritation/epistaxis with them - less effective

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15
Q

Intranasal antihistamine dosing

A

Azelastine nasal spray 0.1%, 0.15%
Seasonal: either dose, 1-2 sprays in each nostril BID
Perennial: 0.15%, 2 sprays in each nostril twice daily

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16
Q

Intranasal corticosteroid options

A

Beclomethasone
Budesonide
Ciclesonide
Fluticasone
Mometasone
Triamcinolone

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17
Q

Intranasal corticosteroid info

A

Treatment of choice for mod-severe allergic rhinitis
Efficacy best when on scheduled basis rather than PRN
Epistaxis risk
Only use mometasone and fluticasone if <6
Superior even to other options combined
Once or twice daily dosing

18
Q

first generation oral antihistamine info

A

Diphenhydramine
Relieves allergic rhinitis symptoms
prevents motion sickness
Anticholinergic, antiemetic and sedative effects
Crosses BBB
Interacts with other sedatives
Some children may have reverse effect of hyperactivity

19
Q

Second generation oral antihistamine options

A

Cetirizine (zyrtec)
Levocetirizine (Xyzal)
Fexofenadine (Allegra)
Loratadine (Claritin)
Desloratadine (Clarinex)

20
Q

Second generation oral antihistamine clinical pearls

A

First line agent, but ineffective for nasal congestion alone
preferred over first gen
Desloratadine not as effective as others
Avoid combining first and second gen

21
Q

Second generation oral antihistamine extra info

A

Adverse effects:
Dry mouth, HA, somnolence
Safety:
Loratadine and cetirizine are preg catB
Efficacy:
Effective for treatment of seasonal or perennial
Dosing is once or twice daily
Good to be used in combo with decongestants

22
Q

Oral decongestants info

A

Phenylephrine and pseudoephedrine*
Can cause insomnia or palpitations
Caution with patients with CVD, DM, or hyperthyroidism
Most effective when used with oral antihistamine

23
Q

What are the leukotriene receptor inhibitors

A

Montelukast
Zafirlukast
Zileuton

24
Q

Leukotriene inhibitor pearls

A
  1. For patients who do not have adequate symptom control with oral antihistamine, intranasal corticosteroids, or combination
  2. Montelukast used most frequently
  3. May be used in combo with oral antihistamine
25
Q

Leukotriene inhibitor adverse effects and efficacy

A

Adverse effects: HA, Abd. pain, Nasal congestion/cold like symptoms
Efficacy: Less effective than intranasal corticosteroids, same as oral antihistamines
*neuropsychiatric disorders have been reported

26
Q

What are some of the regulators that are not working properly and cause vasomotor rhinitis?

A
  1. Acetylcholine PNS neurotransmitter
  2. Norepinephrine and neuropeptide Y
  3. Neuropeptides and nociceptive type C fibers of the trigeminal nerve
27
Q

What is the treatment for vasomotor rhinitis?

A
  1. Avoid triggers
  2. topical nasal corticosteroids (first line)
  3. Topical anticholinergic agents (first line if rhinorrhea predominant)
  4. Oral antihistamines
  5. Topical antihistamines
  6. Topical decongestants
28
Q

Use of topical nasal corticosteroids for vasomotor rhinitis

A

Fluticasone Propionate (Flonase) 1-2 puffs in each nostril daily

decreases neutrophil and eosinophil chemotaxis on the nasal mucosa, decreases mast cell and basophil mediator release, decreases edema and inflammation

29
Q

Use of Anticholinergic agents in vasomotor rhinitis

A

Ipratropium bromide 0.03% 21 mcg per puff, 2 puffs in each nostril BID - TIB

Blocks parasympathetic input to the nasal mucosa

30
Q

Use of oral antihistamines in vasomotor rhinitis

A

limited role
No approved agents
May help with sneezing/itching

31
Q

Topical antihistamine use in vasomotor rhinitis

A

Azelastine 0.1% 2 puffs in each nostril twice daily

H1 receptor antagonist

Combine with topical intranasal corticosteroid and topical antihistamine for chronic vasomotor rhinitis tx

32
Q

Topical decongestant use in vasomotor rhinitis

A

oxymetazoline, phenylephrine

Primarily for nasal congestion

Short term relief

Rhinitis medicamentosa - limit 5 days

33
Q

What covers which symptoms for vasomotor rhinitis?

A

IN corticosteroids and IN antihistamines cover all 4 symptoms and can be combined

Intranasal cholinergics - rhinorrhea only

Decongestants - congestion only

34
Q

Treatment of rhinitis medicamentosa

A

Stop decongestant
Sx worsen before improving
intranasal corticosteroids
Oral prednisone 0.5mg/kg for 5 days

35
Q

When should acute sinusitis be treated with antibiotics?

A

Symptoms progress beyond a viral infection (5-7 days)
Worsening symptoms
Sinus discharge purulent and discolored

36
Q

AB treatment for sinusitis

A

First line - Amoxacillin/Clavulanate
PCN allergy - Doxycycline or Fluoroquinolone

37
Q

AB treatment for sinusitis if initial treatment failure

A

High dose Amoxicillin/clavulanate
Doxycycline
Levofloxacin or moxifloxacin

38
Q

AB treatment for sinusitis if resistant strep pneumoniae

A

High dose Amoxicillin/clavulanate
Levofloxacin, moxifloxacin

39
Q

Treatment duration for sinusitis ABs

A

5-7 days
longer if increased resistance risk

40
Q

Dosing of Augmentin for sinusitis

A

Amoxicillin/clavulanate - 500mg/125mg 3x daily or 875/125mg twice daily

High dose:
2000mg/125mg twice daily

41
Q

Doxycycline, Levaquin and Moxifloxacin dosing for sinusitis

A

Doxy - 100mg BID or 200mg daily
Levaquin - 500mg daily
Moxifloxacin - 400mg daily

Fall 2024 (34 decks)

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