Term
Desloratadine indications
What is fexofenadine not indicated for? |
|
Definition
Desloratadine - Allergic rhinitis symptoms including sneezing, rhinorrhea, nasal itch, and conjunctivitis. ALSO - nasal congestion
Fexofenadine is not indicated for relief of nasal congestion |
|
|
Term
How are antihistamines most effectively used ?
Can they be used on an as needed basis?
How are they normally dosed? |
|
Definition
| Best as prophylaxis, but can be as needed. Normally dosed daily. |
|
|
Term
First Generation Antihistamines ?
What should be noted about these ? |
|
Definition
First generation antihistamines - chlorpheniramine & Diphenhydramine
Note - Anticholinergic side effects will be worse with these than second generation. Be weary in the elderly |
|
|
Term
What side effects are to be expected with antihistamines ?
Which newer antihistamine is more likely than the others to cause sedation? |
|
Definition
Sedation & anticholinergic effects with antihistamines. greater SEs: First gen > Second gen.
Cetirizine is more likely to cause sedation that other second generation antihistamines |
|
|
Term
| Explain the management of allergic rhinitis from beginning to end. |
|
Definition
|
|
Term
Managing initial allergic rhinitis symptoms: Rhinorrhea, sneezing, itching, conjunctival symptoms
managing congestion? |
|
Definition
Managing initial allergic rhinitis symptoms: Rhinorrhea, sneezing, itching, conjunctival symptoms --> ANTIHISTAMINE
managing congestion --> DECONGESTANT (phenylephrine of pseudoephedrine) |
|
|
Term
| If management with antihistamines and decongestant are not doing the trick, what regimen should be employed? |
|
Definition
| Regular use of intranasal steroids, along with PRN antihistamine and PRN decongestant |
|
|
Term
If regular use of intranasal steroids, along with PRN antihistamine and PRN decongestant are ineffective, what regimen should be used?
If symptoms are prolonged?
If symptoms are severe? |
|
Definition
Prolonged symptoms - consider immunosuppressive therapy
Severe symptoms: oral prednisone 50 mg qday for a week + intranasal steroids, then continue intranasal steroids |
|
|
Term
| List the intranasal steroids |
|
Definition
| Beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone, triamcinolone |
|
|
Term
| What is recommended oral or topical decongestants for allergic rhinitis? |
|
Definition
| Oral, use of topical decongestants for more than 3-7 days is assocaited with rhinitis medicamentosa |
|
|
Term
| What drugs should be avoided with decongestants? |
|
Definition
|
|
Term
| What conditions is it not recommended to use decongestants with? |
|
Definition
| HTN, hyperthyroidism, ischemic heart disease |
|
|
Term
| What is the mainstay for moderate-severe rhinitis? |
|
Definition
| Intranasal corticosteroids |
|
|
Term
| Which intranasal corticosteroid is available as a dry powder inhaler? |
|
Definition
|
|
Term
| How long of a trial is necessary to determine if the intranasal corticosteroid is working? |
|
Definition
|
|
Term
| Which intranasal corticosteroid has been associated with mild growth suppression? |
|
Definition
|
|
Term
Sodium cromoglycate
Safe?
Dosing?
effectiveness vs corticosteroids? |
|
Definition
Sodium cromoglycate
Safe - YES, excellent safety profile
Dosing - usually QID
effectiveness vs corticosteroids - NOT as effective as corticosteroids |
|
|
Term
Which is the Intranasal antihistamine
benefit?
dose it treat congestion? |
|
Definition
Which is the Intranasal antihistamine - Levocabastine
benefit - no systemic effects
Dose it treat congestion - No |
|
|
Term
Intranasal ipratropium
When is it useful? |
|
Definition
Intranasal ipratropium
When is it useful - When the only symptom is rhinorrhea, eg. "skiers nose" |
|
|
Term
| When is immunotherapy indicated? |
|
Definition
- Indicated when this is evidence of IgE-mediated sensitivity to a specific antigen and the patient cannot avoid it.
- Symptoms are difficult to control with conventional drug therapy and allergen avoidance. |
|
|
Term
| What should be avoided during the first trimester in pregnancy when treating allergic rhinitis? |
|
Definition
|
|
Term
| What anti-allergy agents have been proven somewhat safe in pregnancy? |
|
Definition
BBCCM
Beclomethasone, budesonide, comoglycate, and chlorphinramine, and montelukast |
|
|
Term
| What age group should not use decongestants? |
|
Definition
|
|
Term
| How long should the course of oral corticosteroids be used in severe cases ? |
|
Definition
| 5-7 days, usually along with intranasal steroids that would be continued after the 1 week treatment with oral corticosteroids |
|
|
Term
| Can loratadine be chewed ? |
|
Definition
|
|
Term
| When to refer to a specialist: |
|
Definition
When to refer to a specialist:
- Inadequate control of symptoms despite adherence and correct use of therapies
- adverse reactions
reduced quality of life or ability to function due to the condition
- when trying to identify allergens
- comorbid conditions such as asthma and recurrent sinusitis
- immunotherapy |
|
|
Term
| What intranasal corticosteroids are usually recommended for children? why? |
|
Definition
| mometasone and fluticasone due to bioavailability and lack of growth suppression |
|
|
