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Respiratory Block: Pharmacology > Treatment of Coughs and Colds > Flashcards

Treatment of Coughs and Colds Flashcards

1
Q

What is rhinitis?

A

Inflammation of the nasal mucous membranes

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2
Q

What are some of the common symptoms of rhinitis?

A
  • nasal congestion
  • rhinorrhoea
  • sneezing
  • itching
  • and / or post nasal drainage
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3
Q

What can the causes of rhinitis be classified as?

A

Causes of rhinitis may be either
1. Infectious
or
2. Non-infectious

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4
Q

What are some of the infectious causes of rhinitis?

A
  • viral (colds and flu)

- bacterial (sinusitis)

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5
Q

What are some of the non-infectious causes of rhinitis?

A
  • allergic (IgE-mediated)

- non-allergic (vasomotor = chronic)

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6
Q

What are some of the treatment options for rhinitis associated with the common cold?

A
  1. Steam inhalations
  2. Mesna
  3. Antihistamines
  4. Systemic decongestants
  5. Local decongestants
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7
Q

What is the purpose of steam inhalations in the management of rhinitis associated with the common cold?

A

Steam inhalations liquefy nasal secretions used with volatile compounds
- Friar’s Balsam, Menthol, Eucalyptus
= Symptomatic relief in coryza conditions
RELIEVES CONGESTION

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8
Q

What is the purpose of Mesna in the management of rhinitis associated with the common cold?

A

Mesna is a mucolytic agent
- nasal spray
= Relieves nasal obstruction

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9
Q

What is the purpose of antihistamines in the management of rhinitis associated with the common cold and what are some of the common adverse effects of these agents?

A

Polycomponent Cold Medications!
- increase tenacity of secretions
- interfere with normal ciliary function
- cause drowsiness
(These are usually 1st generation antihistamines)

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10
Q

What is the purpose of systemic decongestants in the management of rhinitis associated with the common cold?

A

Symptomatic relief of congestion

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11
Q

What is an example of a systemic decongestant used in the management of the common cold?

A

Pseudoephedrine

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12
Q

What are examples of local decongestants used in the management of the common cold?

A

Local decongestants usually contain sympathomimetic agents e.g:

  • Xylometazoline
  • Oxymetazoline
  • Phenylephrine
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13
Q

What is the purpose of local decongestants in the management of rhinitis associated with the common cold?

A

Cause vasoconstriction of mucosal blood vessels = decreased oedema

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14
Q

Why should local decongestants not be used for longer than 5 days continuously?

A

Cause rebound congestion a.k.a. Rhinitis Medicamentosa

  • Secondary vasodilation
  • Temporary increased nasal congestion
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15
Q

How should purulent rhinitis be managed?

A

This condition is usually associated with sinusitis and therefore antibiotic treatment is advised.
In addition, symptomatic management is also advised.

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16
Q

Which antibiotics are commonly used to treat purulent rhinitis?

A
  • Amoxiclav
  • Levofloxacin
  • Moxifloxacin
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17
Q

What is commonly used for the symptomatic management of purulent rhinitis?

A
  1. Nasal decongestants = symptomatic relief (either oral or topical)
  2. Nasal irrigation with saline = removes thick mucous secretions
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18
Q

What agents are used in the management of allergic rhinitis?

A
  1. Systemic antihistamines
  2. Systemic corticosteroids
  3. Local decongestants
  4. Topical preparations
  5. Hyposensitization
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19
Q

When is hyposensitization useful in the management of allergic rhinitis?

A

Useful when specific antigen is identified and symptoms induced by exposure may be dangerous.

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20
Q

When should systemic antihistamines be used in the management of allergic rhinitis?

A

In mild cases with / without systemic nasal decongestants

- 2nd, 3rd generation = less sedation

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21
Q

What is an example of a systemic nasal decongestant?

A

Pseudoephedrine

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22
Q

What are some examples of 2nd / 3rd generation antihistamines that may be used in the management of allergic rhinitis?

A
  • Cetirizine
  • Loratidine
  • Desloratidine
  • Ebastine
  • Levocetirizine
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23
Q

Why are systemic corticosteroids used in the management of allergic rhinitis?

A

Used for short periods to relieve severe mucosal oedema

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24
Q

What are local decongestants?

A

Vasoconstrictor nose drops

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25
Q

What are local decongestants used for in the management of allergic rhinitis?

A

Only for relief during acute attack until systemic antihistamine and / or decongestant or topical preparation takes effect.

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26
Q

What topical preparations are used in the management of allergic rhinitis?

A
  1. IN (intranasal) corticosteroids

2. Antihistamines intranasally

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27
Q

What are examples of intranasal corticosteroids used in the management of allergic rhinitis?

A
  • Beclomethasone
  • Fluticasone
  • Budesonide
  • Ciclesonide
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28
Q

What are intranasal corticosteroids used for in the management of allergic rhinitis?

A

Most effective for seasonal and perennial allergic rhinitis
- these drugs have a localized effect and are poorly absorbed thus very little reaches the systemic circulation intact = very little systemic effect

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29
Q

What are examples of intranasal antihistamines used in the management of allergic rhinitis?

A
  • Levocabastine

- Azelastine

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30
Q

What are intranasal antihistamines used for in the management of allergic rhinitis?

A

Seasonal allergic rhinitis

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31
Q

What is another use of the topical preparations used in the management of allergic rhinitis?

A

These drugs can also be used as prophylactic treatment - before onset of allergy season and continued until it is over
Perennial rhinitis: dose slowly decreases until symptoms disappear = maintenance dose

32
Q

What is vasomotor rhinitis?

A

A type of non-allergic rhinitis
= An exaggerated physiological reaction to stimuli
e.g. heat, smoke, cold, dust etc.
- Mediated through PSNS stimulation

33
Q

What can be done to manage vasomotor rhinitis?

A

If possible avoid precipitating factors or situations

  • short term topical decongestants = symptomatic relief
  • anti-inflammatory action of topical steroids
34
Q

What is the mechanism of action of decongestants?

A

Sympathomimetic drugs

  • decrease blood slow through oedematous tissue
  • opens up nasal passages
35
Q

What is the mechanism of action of direct effect decongestants?

A

Direct effect on alpha-adrenoceptors (agonist)

36
Q

What is the mechanism of action of indirect effect decongestants?

A

Presynaptic release of NA

37
Q

What is the mechanism of action of non-selective decongestants?

A

Mixed action

- act on alpha and beta adrenoceptors

38
Q

What is the mechanism of action of selective decongestants?

A

Stimulate alpha-adrenoceptors

= vasoconstriction of arterioles in nasal mucosa

39
Q

What are the sympathomimetics used systemically as nasal decongestants?

A
  1. Ephedrine
  2. Pseudoephedrine
  3. Methylephedrine
  4. Phenylpropanolamine
  5. Phenylephrine
40
Q

What are the sympathomimetics used topically as nasal decongestants?

A
  1. Phenylephrine
  2. Imidazolines (long-acting)
    - Oxymetazoline
    - Xylometazoline
41
Q

What do systemic sympathomimetic preparations often contain?

A

Many preparations contain an antihistamine (usually a first generation antihistamine in the case of a cold and flu preparation or a second generation antihistamine in the case of a preparation for allergic rhinitis)
- usually a first generation anti-histamine, as it dries up nasal secretions

42
Q

What is the onset of action of systemic sympathomimetic preparations?

A

Slower onset of action

43
Q

When are systemic sympathomimetic preparations useful?

A

When the patient already suffers from rebound congestion

44
Q

What are some of the SE associated with systemic sympathomimetic agents?

A

Many CI and SE

45
Q

What are some of the uses of short term systemic sympathomimetic agents?

A

Short term:

  • Acute coryza associated with nasal congestion
  • Severe nasal congestion (both of an allergic or viral nature)
46
Q

What form of topical sympathomimetic agent is preferred?

A

Sprays are preferred over drops

47
Q

What are the pharmacokinetics of topical sympathomimetic agents?

A

Decreased systemic effects

Rapid onset of action

48
Q

Which is the short acting topical sympathomimetic agent?

A

Phenylephedrine

49
Q

What is the duration of action of the short acting topical sympathomimetic agents, and what is significant about their SE?

A

Approx. 4 hours

- more likely to cause rebound congestion

50
Q

Which are the long acting topical sympathomimetic agents?

A
  • Oxymetazoline

- Xylometazoline

51
Q

What is the duration of action of the long acting topical sympathomimetic agents?

A

Approx. 6 hours

- 2-3 x daily

52
Q

What are the topical sympathomimetic agents used for?

A

Short-term relief of nasal congestion

53
Q

What are some of the drug interactions of systemic sympathomimetic agents?

A
  • MAOI
  • Non-selective beta-adrenoreceptor blockers e.g. propranolol
  • TCA
  • Other sympathomimetic agents
  • Digoxin
  • Quinidine
  • Halogenated volatile anesthetics
54
Q

In which age-group are both topical and systemic sympathomimetic nasal decongestants contraindicated?

A

Infants < 6 months old

55
Q

What are some of the SE of systemic sympathomimetic agents?

A
  1. Mild CNS stimulation with anxiety, nervousness, insomnia
  2. Headache, tremors, tachycardia, palpitations, cardiac arrhythmia and drowsiness
  3. Fixed skin eruptions
  4. Hypertension, cerebral haemorrhage, pulmonary oedema
56
Q

What do systemic sympathomimetic agents cause in high doses?

A

Dizziness and nausea

57
Q

What is a dangerous SE of Phenylpropanolamine when used in high doses?

A

Hemorrhagic stroke in high doses

58
Q

What is important about systemic sympathomimetic agents and athletes?

A

In sport ephedrine is banned

- others are considered “specific substances” and are monitored

59
Q

What is important about topical sympathomimetic agents and athletes?

A

Can be used in sport

60
Q

What are some of the SE of topical sympathomimetic agents?

A
  1. Direct toxic effect on cilia
  2. Cause rebound congestion (rhinitis medicamentosa) if used for more than 5 days consecutively
  3. Systemic effects possible in small children
  4. Transient burning or dryness of mucosa
  5. May become reservoirs for bacteria and fungi
    DRUG INTERACTIONS present
61
Q

What are contraindications of topical sympathomimetics?

A

Careful observation in certain high risk patients:

  • hyperthyroidism
  • ischaemic heart disease
  • hypertension
  • DM
62
Q

What are absolute contraindications of systemic sympathomimetics?

A
  • Severe hypertension or ischaemic heart disease

- MAOI therapy

63
Q

What are relative contraindications of systemic sympathomimetics?

A
  • Hyperthyroidism
  • DM
  • Coronary Artery Disease
  • Raised intraocular pressure
  • Prostatic hypertrophy
  • Severe renal & hepatic impairment
64
Q

What are the topical corticosteroids?

A
  • . Beclomethasone
  • Fluticasone
  • Budesonide
  • Momethasone
  • Triamcinolone
65
Q

What are topical corticosteroids used for?

A

Most effective maintenance therapy (prophylaxis) for seasonal and perennial allergic rhinitis
- also useful in non-allergic rhinitis

66
Q

What are the systemic effects of the topical corticosteroids?

A

Poorly absorbed

= little systemic effect

67
Q

When are topical corticosteroids contraindicated?

A

CI in rhinitis associated with influenza or the common cold

- caution in patients with infection of the nasal cavity

68
Q

What are some adverse effects of the topical corticosteroids?

A
  • transient burning or stinging
  • headache
  • dry nose
  • sneezing
  • nasal bleeding
  • stuffy nose
  • irritation of the throat
69
Q

What can occur with excessive use of topical corticosteroids?

A

Adrenal suppression

  • takes some time to take effect
  • useful for weaning patients with rebound congestion off topical decongestants
70
Q

What can the other topical agents be used for?

A

Less effective for maintenance therapy.

May be useful in allergic rhinitis

71
Q

What is Cromoglicic Acid used for in SA?

A

Not used in nasal preparations in SA
Used topically for allergic conjunctivitis but only of use when taken prophylactically
- in SA used to prevent eye involvement in patients with allergy (eye drops)

72
Q

What are the pharmacokinetics of Cromoglicic Acid?

A

Safe, but has weak anti-inflammatory effects

- short duration of action

73
Q

What is the mechanism of action of Cromoglicic Acid?

A
  • mast cell stabilizer
  • prevent histamine release from mast cells
  • decreases exaggerated neuronal reflexes
  • may decrease release of T-cell cytokines
  • various other effects
74
Q

What are the two topical antihistamines?

A
  1. Azelastine

2. Levocabastine

75
Q

What is Azelastine used for?

A
  • allergic rhinitis
  • blocks H-1 receptors
  • inhibits the release of inflammatory mediators from mast cells
76
Q

What is Levocabastine used for?

A
  • long acting

- for the short-term symptomatic treatment of seasonal allergic rhinitis

Respiratory Block: Pharmacology (8 decks)

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