URT conditions and infections I

Question 1

Describe rhinitis

Answer 1

Inflammation and swelling of the
mucous membrane of the nose,
* Characterized by a runny nose
and stuffiness

Question 2

What causes rhinitis? list the symptoms

Answer 2

• Usually caused by the common
  cold or allergy.
• Symptoms: runny nose, sneezing,
  and stuffiness.

Question 3

Duration of allergic/viral rhinitis

Answer 3

2-3 days. May extend to 5-7 days

Question 4

Duration of bacterial rhinitis

Answer 4

7-10 days

Question 5

Symptoms of viral/allergic rhinitis

Answer 5

Nasal congestion / obstruction,
Watery discharge (rhinitis) from
BOTH nostrils, general illness

Question 6

Symptoms of bacterial rhinitis

Answer 6

Headache, fever,
facial/dental
tenderness (facial
pain), purulent nasal
discharge (especially
unilaterally)

Question 7

Common bacteria causing rhinitis

Answer 7

Streptococcus pneumoniae
Haemophilus influenza
Moraxella catarrhalis

Question 8

Explanation of allergic rhinitis

Answer 8

Inflammation of the mucous membranes of
the nose and paranasal sinuses in response
to an allergen e.g. pollen, house dust,
grasses, and animal hair.

Question 9

Signs and symptoms of allergic rhinitis

Answer 9

Characterised by recurrent episodes of:
* blocked stuffy nose
* watery nasal discharge
* frequent sneezing, often accompanied by nasal
itching and irritation
* conjunctival itching and watering
* oedematous pale nasal mucosa
* mouth breathing
* snoring at night

Question 10

What other things can cause similar symptoms as allergic rhinitis?

Answer 10

such as infections,
vasomotor (non-allergic) rhinitis, overuse of decongestant
drops, and side effects of antihypertensives
and antidepressants.

Question 11

Non-drug treatment of allergic rhinitis

Answer 11

Avoid triggers/allergens

Question 12

Pros and cons of using antihistamine in allergic rhinitis

Answer 12

Relieve the itching, sneezing, and runny nose of allergic rhinitis, but
they do not relieve nasal congestion.

Question 13

How to make up for the cons of antihistamine use in Tx of allergic rhinitis?

Answer 13

Using them along with nasal steroids or decongestants may provide
greater symptom relief than using one of these medications alone.

Question 14

What medication is most effective in Tx of allergic rhinitis

Answer 14

Topical intranasal steroids are the most effective, evidence-based
maintenance therapy

Question 15

Adv. Effects of topical steroids

Answer 15

Adverse effects: transient burning, stinging, dry nose, or sneezing

Question 16

How long do topical intranasal steroids take to work optimally?

Answer 16

Maximal response only seen after 2 weeks of treatment i.e.
continuous, prophylactic use, even when symptom free.

Question 17

Pt education on how to use topical intranasal steroids

Answer 17

Usually administered as sprays, blow nose before administration,
spray away from the nasal septum, while breathing in gently (do not
sniff up the spray), bend head forward towards the knees for 20
seconds, while occluding the nose to prevent leakage out the nose

Question 18

Drugs to use in allergic rhinitis Tx in adults and children>6yrs

Answer 18

Corticosteroid, e.g.: Fluticasone, aqueous nasal solution

Question 19

drug used for short term relief from allergic rhinitis

Answer 19

Chlorphenamine, oral, 6–8 hourly.

Question 20

Tx for relief of nocturnal nasal blockage

Answer 20

Topical nasal decongestant e.g.:
* Oxymetazoline 0.05%, intranasal, administered at night for a maximum of 5
days

Question 21

long term drug tx of allergic rhinitis in both adults and children

Answer 21

Cetirizine, once daily

Question 22

What is a special caution with regards to antihistamines in terms of age?

Answer 22

Do not give children <2yrs

Question 23

When should you refer a pt with allergic rhinitis?

Answer 23

• Chronic persistent symptoms.
• Severe symptoms.
• Patients on protease inhibitors, requiring nasal corticosteroids.

Question 24

How long do colds last?

Answer 24

usuallybegin to resolve in 3 days. But may last up to 14 days in some cases

Question 25

Who is at risk of complications from colds?

Answer 25

Malnourished children, the elderly and debilitated patients

Question 26

Complications pf colds

Answer 26

Secondary bacterial infections, including:
* pneumonia
* otitis media
* sinusitis

Question 27

General considerations for viral rhinitis

Answer 27

Limit strenuous activity.
* Ensure adequate hydration.
* Advise patient to return to clinic if earache, tenderness or pain over
sinuses develops or symptoms persist for > 14 days.

Question 28

Drug tx for viral rhinitis

Answer 28

Symptomatic treatment for pain, fever and nasal congestion
* 0.9% saline (NaCl) nose drops: relieves dryness, liquefies mucus
* Pain & fever: paracetamol, aspirin, ibuprofen = antipyretic analgesics
Antibiotics – only if Bacterial infection!

Question 29

List nasal decongestant drugs(4)

Answer 29

Oxymetazoline
* Phenylephrine
* Xylometazoline
* Pseudoephedrine

Question 30

MOA of nasal decongestants

Answer 30

ɒ1 agonists: Phenylephrine, oxymetazoline, (pseudoephedrine)
* Mechanism of action: stimulate alpha rec on nasal arterioles, causing
constriction, less blood flow, less mucous produced.

Question 31

what happens when you overuse nasal decongestants?

Answer 31

could damage the nasal mucosa and cause
rebound nasal congestion

Question 32

Inhaled treatments for URTIs and allergies

Answer 32

Inhaled Moisturisers i.e. vaporisers , humidifiers and steam inhalants.
* Inhaled decongestants – Eucalyptus oil, Friar’s balsam
* Bronchodilators and / or corticosteroids – Multidose inhalers and
nebulisers

Question 33

Combination drugs for URTIs and allergies

Answer 33

Antihistamines + sympathomimetics + analgesics