Week 1 Flashcards
What is 1st line treatment in allergic rhinitis?
Antihistamine
MOA of an ICS:
They help relieve congestion and rhinorrhea by limiting late-phase response and reducing inflammation.
Examples of ICS:
Budensonide, Flonase, Nasacort, Nasonex
When would a patient see effect of an ICS?
Begin working in 3-12 hours but patients may not experience max effect for 1-2 weeks.
When should an ICS be started for allergic rhinitis?
2-4 weeks prior to start of allergy season.
Adverse events of ICS:
Irritation, bleeding, septal perforation, can decrease height of children at high doses.
Is a mast cell stabilizer that prevents antigen-induced degranulation, decreasing the inflammatory response.
Intranasal cromolyn
Most common virus in an URI?
Rhinovirus
MOA of topical decongestants:
Stimulate the alpha and beta adrenergic receptors and this causes shrinkage of the tissue and vasoconstriction which relieves congestion and promotes drainage.
Example of a topical decongestant and how long to use for?
Afrin
No longer than 3 days d/t rebound congestion
Side effects of topical decongestants?
Bradycardia, tachycardia, HTN, and hypotension
MOA of oral decongestants:
Vasoconstriction of capillary vessels, theoretically decreasing congestion. They are sympathomimetic (stimulate the sympathetic nervous system).
Example of oral decongestants:
Pseudoephedrine (Sudafed)
Phenylephrine
What age can not relieve oral decongestants?
Do not give to children under 4.
Side effects of oral decongestants?
Tachycardia, HTN, anxiety, restlessness, irritability
Contraindications of oral decongestants:
CAD, uncontrolled HTN, narrow angle glaucoma, MAOI within 14 days
Use caution in elderly
Do not use in children under 4
Oral decongestants and 1st generation antihistamines Together May cause:
Urinary retention in BPH
MOA of expectorants:
Increase the output of respiratory tract fluid by decreasing the adhesiveness and surface tension of the respiratory tract and by facilitating the removal of viscous mucous.
Goal is to loosen bronchial secretion so they can be eliminated:
Expectorants
What is the best expectorant?
Hydration
How long can you use expectorants for?
No longer than 1 week
Example of expectorant:
Quaifenensin (robitussin)
Side effects of expectorants:
Most common GI upset
Drowsiness, HA, dizziness
MOA of antitussives:
Diminish cough reflex by direct inhibition of the cough center in the medulla.
When to use antitussives:
Nonproductive, irritating cough
Examples of antitussives:
Dextromethorphan
Tessalon perles
Codeine
Dextromethorphan plus what may induce a serotonergic syndrome?
Antidepressants
MOA of tessalon perles:
Numbs respiratory tract
Tessalon perles are pregnancy category:
C
Tessalon perles contraindications:
Do not use in kids under 10 or with an MAOI.
Do not use more than 2-3 times daily
Do not use ASA in children with viral illness d/t:
Risk of Reye’s syndrome: sudden inflammation and swelling of the liver and brain that is often accompanied by a scaly rash
MOA of anticholinergic agents:
Local application to the nasal mucosa that inhibits vagally mediated reflexes by antagonizing the action of acetylcholine at the cholinergic receptor, which inhibits secretions from the serous and seromucous glands lining the nasal mucosa.
Example of an anticholinergic agent:
Ipratropium bromide
Anticholinergic agents contraindicated in:
Children under 5
Most common cause of viral sinusitis:
Rhinovirus
Common bacterial pathogens of sinusitis:
S pneumoniae
H influenza
M catarrhalis
S aureus
First-line antibiotics in sinusitis:
Amoxicillin
Augmentin *
Beta-lactamase cephalosporin
Second line antibiotics for sinusitis:
High-dose amoxicillin
Respiratory fluoroquinolone- moxifloxacin or levofloxacin
Antibiotics for sinusitis with PCN allergy:
Kids- macrolides or cefurozime
Adults: doxy or respiratory fluoroquinolone- Moxi/levo
How long before you switch antibiotics with sinusitis:
Worsening after 72 hours on antibiotic
Can take 3-4 days for relief
What is azelastine (astelin, patanase)?
Topical antihistamine used in allergic rhinitis
Side effects of azelastine?
Bitter taste, somnolence, ha, nasal burning
What is Atrovent?
Anticholinergic that is good for a runny nose.
Atrovent is pregnancy category?
C
Indications for Atrovent?
Allergic and non allergic rhinitis
Is intranasal cromolyn safe in pregnancy?
Yes
How long for intranasal cromolyn to work?
Up to 2 weeks
What is an ocular antihistamine?
Patanol, pataday
Are ocular antihistamines safe in pregnancy?
No category c
