IPAP Pharm 2 Exam 1.1 - Allergic Rhinitis/Conjunctivitis Lecture

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Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.

Brompheniramine

Brompheniramine (Dimetane) - Gen 1 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.

Chlorpheniramine

Chlorpheniramine (Chlor-Trimeton) - Gen 1 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the generic name.


Astelin/Astepro

Azelastine (Astelin/Astepro)- Gen 2 Intranasal

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.


Fexofenadrine

Fexofenadrine (Allegra) - Gen 2 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.


Diphenhydramine

Diphenhydramine (Benadryl) - Gen 1 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the generic name.


Optivar

Azelastine (Optivar) - ?? Gen Opthalmic

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.

Promethazine

Promethazine (Phenergan) - Gen 1 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.


Loratadine

Loratadine (Claritin) - Gen 2 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.

Hydroxyzine

Hydroxyzine (Atarax/Vistaril) - Gen 1 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.

Levocabastine

Levocabastine (Livostin) - ?? Gen Opthalmic

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.

Meclizine

Meclizine (Antivert) - Gen 1 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.


Cetirizine

Cetirizine (Zyrtec) - Gen 2 Oral

Of the following Antihistamines, determine if the drug is:
a Gen 1 or Gen 2
Oral, Intranasal, or Opthalmic
and give the brand name.


Cyproheptadine

Cyproheptadine (Periactin) - Gen 1 Oral

Differentiate between Intermittent vs persistant allergic rhinitis and mild vs moderate symptoms.

Intermittant: < 4days/wk; < 4 wks
Persistant: > 4days/wk; > 4 wks

Mild: (No major disturbances to ADLs)
Moderate: (Major disturbances to ADLs)

What are the treatment options for Intermittent mild allergic rhinitis?

1 of the following:

1: Oral Anti-Hist, +/- Decongestant
2: Intranasal Anti-Hist, +/- Decongestant
3: LTRA

What are the treatment options for Intermittant moderate allergic rhinitis?

1 of the following:

1: Oral Anti-Hist, +/- Decongestant
2: Intranasal Anti-Hist, +/- Decongestant
3: LTRA
4: Intranasal Steroid (or mast cell stabilizer)
5: ENT Consult

What are the treatment options for persistant mild allergic rhinitis?

1 of the following:

1: Oral Anti-Hist, +/- Decongestant
2: Intranasal Anti-Hist, +/- Decongestant
3: LTRA
4: Intranasal Steroid (or mast cell stabilizer)
5: Consult ENT for Allergen Specific immunotherapy

What are the treatment options for persistant moderate allergic rhinitis?

In order (PRN):
1: Intranasal Steroid and either an Oral Antihistamine or LTRA
2: if Rhinorhea, add Ipratropium
3: If congestion, add oral decongestant or oral steroid
4: Consult ENT for Allergen Specific immunotherapy

Decide whether the following is an oral, intranasal, or ocular decongestant, and give the brand name.

Sudafed PE

Phenylephrine (Sudafed PE) - oral

Decide whether the following is an oral, intranasal, or ocular decongestant, and give the brand name.

Sudafed PSE

Pseudophedrine (Sudafed PSE) - oral
oral

Decide whether the following is an oral, intranasal, or ocular decongestant, and give the brand name.

Oxymetazoline

Oxymetazoline (Afrin) intranasal

Decide whether the following is an oral, intranasal, or ocular decongestant, and give the brand name.


Neo Synephrine

Phenylephrine (Neo Synephrine) intranasal

Give the active ingredient, class, and clinical use of:

Vasocon

Naphazoline (Vasocon) - ocular decongestant for redness

Give the active ingredient, class, and clinical use of:


Visine Original

Tetrahydrozoline (Visine Original) - ocular decongestant for redness

Give the active ingredient, class, and clinical use of:

Vinine LR

Oxymetazoline (Vinine LR) - ocular decongestant for redness

Of the following COMBO agents, give the class, the agents combined, and the brand name.

Dimetapp

Dimetapp (Brompheniramine + PE)

1st Gen Antihistamine with Phenylephrine (Sudafed PE)

Of the following COMBO agents, give the class, the agents combined, and the brand name.


Rondec

Rondec (Carbinoxamine + PE)

1st Gen Antihistamine with Phenylephrine (Sudafed PE)

Of the following COMBO agents, give the class, the agents combined, and the brand name.

Actifed

Actifed (Chlorpheniramine + PE)

1st Gen Antihistamine with Phenylephrine (Sudafed PE)

Of the following COMBO agents, give the class, the agents combined, and the brand name.



Allegra-D

Allegra-D (Fexofenadine + PSE)

2nd Gen Antihistamine with Pseudophedrine (Sudafed PSE) BID Dosing

Of the following COMBO agents, give the class, the agents combined, and the brand name.

Claritin-D

Claritin-D (Loratidine + PSE)

2nd Gen Antihistamine with Pseudophedrine (Sudafed PSE) BID Dosing

Of the following COMBO agents, give the class, the agents combined, and the brand name.

Zyrtec-D

Zyrtec-D (Cetirizine + PSE)

2nd Gen Antihistamine with
Pseudophedrine (Sudafed PSE) BID Dosing

Of the following COMBO agents, give the class, the agents combined, and the brand name.

Ketotifen

Ketotifen (Zaditor) - OTC

Ophthalmic antihistamines + Mast Cell Stabilizers

Of the following COMBO agents, give the class, the agents combined, and the brand name.

Olopatadine

Olopatadine (Patanol)

Ophthalmic antihistamines + Mast Cell Stabilizers

Of the following COMBO agents, give the class, the agents combined, and the brand name.



Naphazoline & pheniramine

Naphazoline & pheniramine (Naphcon-A; Visine-A)

Ophthalmic antihistamines + decongestants

Of the following COMBO agents, give the class, the agents combined, and the brand name.

Naphazoline & antazoline

Naphazoline & antazoline (Vascon-A)

Ophthalmic antihistamines + decongestants

Of the following drugs, give the class, route of administration, and brand name.

Mometasone

Mometasone (Nasonex)
Intranasal Steroids

Of the following drugs, give the class, route of administration, and brand name.

Fluticasone propionate

Fluticasone propionate (Flonase) Intranasal Steroids

Of the following drugs, give the class, route of administration, and brand name.

Montelukast

Montelukast (Singulair) - intranasal

Leukotriene Receptor Inhibitor

Of the following drugs, give the class, route of administration, and brand name and it's clinical use.


Ipratropium

Ipratropium (Atrovent)
Anticholinergic Agent for congestion only

Of the following drugs, give the class, route of administration, and generic name.


Nasalcrom

Cromolyn Sodium (Nasalcrom)

Intranasal Mast Cell Stabilizer

Of the following drugs, give the class, route of administration, and generic name.

Opticrom

Cromolyn (Opticrom) - ocular mast cell stabilizer

Of the following drugs, give the class, route of administration, and brand name.

Nodocromil

Nodocromil (Alocril) - ocular mast cell stabilizer

Of the following drugs, give the class, route of administration, and brand name, and clinical use.

Ketoralac

Ketoralac (Acular) - ocular NSAID; itching associated with allergic conjunctivities

Of the following drugs, give the class, route of administration, and brand name.

Loteprednol suspension

Loteprednol suspension (Alrex) - ocular steroid

Regarding the Gen 1 Oral Antihistamine, give the DOC for the following condition?

DOC in Pregnancy

OTC Sleep Aid

N&V

Urticaria/Itching

Vertigo

Serotonin Syndrome

Chlorpheniramine (Chlor-Trimeton) - DOC in pregnacy (Cat B)

Diphenhydramine (Benadryl) - OTC sleep aid

Promethazine (Phenergan) - N&V

Hydroxyzine (Atarax/Vistaril) - uticaria/itching

Meclizine (Antivert) - vertigo

Cyproheptadine (Periactin) - anti-serotonin

What makes the Gen 2 oral antihistamines more popular than the Gen 1?

Gen 2 have less systemic effects, specifically less CNS and GI upset/complaints, and they are single doses per day, rather than multiple doses per day.

What is the differnce between the 2 available Gen 2 Intranasal Antihistamines?

Azelastine (Astelin/Astepro) crosses the BBB, thus has more systemic effects.

Olopantadine (Patanase) dose not cross the BBB, is more H1 selective, thus less systemic effects.

What types of pts should use caution when selecting Gen 1 Oral Antihistamines?

Pediatrics: they can cause excitation

Pts with BPH or Narrow Angle Glaucoma: they can cause urinary retention and mydriasis (Anti-SLUDE)

Pts with orthostatic HoTN: they have an A-1 suppression effect which may exacerbate the HoTN

Which oral decongestant is suitable for pregnancy, and during which portion of the pregancy?

Pseudophedrine (Sudafed PSE) - DOC in Preg, in the 2nd and 3rd trimester only

Which types of pts should use caution with Oral Decongestants?

Pts with arrythymias, HTN, and hyperthyroidism as they are known to increase BP and pulse

Pts with BPH, as they cause urinary retention

Diabetic pts, as they may increase blood glucose

What pts are oral decongestants contraindicated in?

pts currently on MAOI therapy,

While intranasal steroids are more effective than antihistamines or mast cell stabilizer, they do not have as quick of therapeutic effect. Describe their onset of action and what methods you can take to ease delay of symptom relief.

Intranasal steroids take approx in 1-2 days to take effect, and their maximal effect takes approx 1-2 wks. The provider may give oral burst steroids for 5-7 days to assist with quick symptom relief.

Of the two commonly prescribed intranasal steroids, which is has the least systemic bioavailability, thus least systemic side effects?

Mometasone (Nasonex) less systemic bioavailability, thus less systemic side effects than Fluticasone propionate (Flonase)

LTRA's (Singular) has equal efficacy as antihistamines, however, which specific pts benefit the more from the LTRA?

pts with a reactive airway component

For which pts would you consider dosing with the Anti-cholinergic Ipratropium (Atrovent). Additionally, how is it administered, and is it suitable for pregnant women?

Ipratropium (Atrovent) is an adjuct therapy solely for rhinorhea, as it will dilate the nasal blood vessels (Anti-SLUDE); it is adminstered via a nasal spray to maximize the local effects; and it is considered a pregnancy Cat B drug

Are intranasal mast cell stabilizers suitable for pregnant women, and when should pts use them?

intranasal mast cell stabilizers (Cromolyn Sodium - Nasalcrom) is a pregnancy cat B drug, so it can be used for pregnant women.

It is to be taken 1-2 weeks before the onset of allergen exposure (monitor the seasonal allergy calendars)

Which pts should use caution when taking the ocular antihistamine Optivar or Livostin or the ocular decongestants Vasocon, Visine LR, and Visine Original?

they are both contraindicated in pts with angle closure glaucoma as it's anticholinergic effect will cause mydriasis and increase the intra ocular pressure

How many days should ocular decongestants, Vasocon, Visine LR, and Visine Original, be limited to, and why?

ocular decongestants α-agonists that work by constricting conjunctival vessels thereby reducing redness & swelling

they should be limited to < 10 days of use, preferrably only 3-5 days

if not, rebound hyperemia (conjuctivitis medicamentosa) may occur

A pt presents with moderate allergic conjunctivitis x 2 weeks. He has tried benadryl-OTC, and Visine Orininal-OTC, but both have failed to relieve his symptoms. What is the drug therapy would be the most effective in relieving all of his symptoms, without referring his to opthalmology? Defend you answer.

Olopatadine (Patanol) (for the would be the most effective drug to prescribe in this situation.

As a combination of Opthalmic antihistamine and mast cell stabilizer, it would have the combined effect of reducing the current symptoms of itching, tearing, and swelling, plus provide future protecting by stabilizing the mast cell degranulation during subsequent allergen exposure.

Ketotifen (Zaditor) is another drug in this class, but it is an OTC drug and is less superior to Patanol.

If a pt presents with the single symptom of ocular itching, which single drug can you prescribe for the sole condition?

Ketoralac (Acular) - an ocular NSAID

If a pt suffering from allergic conjunctivitis is unresponsive to your aggressive treatment of his symptoms with ocular antihistamines, decongestants, mast cells stabilizers, and/or combo products, what is the next step?

refer him to opthalmology for treatment with ocular steroids

Loteprednol suspension (Alrex)

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