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Pharm for Rhinitis

Terms in this set (60)

intranasal glucocorticoids
what is the most effective, single therapy for patients with persistent nasal symptoms associated with allergic rhinitis?
bind to intracellular receptors of inflammatory cells, enter the cell nucleus, bind to glucocorticoid response elements, and activate gene transcription for anti-inflammatory proteins
what is the mechanism of action of action for intranasal glucocorticoids?
hypersensitivity to the drug
what are the contraindications for nasal glucocorticoids?
nose: burning, stinging, dryness, septal perforations (rare), nasal bleeding in chronic use; throat: coughing, runoff down throat, pharyngitis
what are the adverse effects of the nose and throat for nasal glucocorticoids?
frank epistaxis, scant blood found in the nasal mucous
what are the 2 kinds of nosebleeds associated with nasal corticosteroids?
growth inhibition in children, changes in vision
what systemic side effects should you monitor for when using nasal glucocorticoids?
second gen has lower bioavailability therefore less systemic effects, second gen
what is the major difference between first and second generation intranasal glucocorticoids? which is preferred in children?
within a few hours but up to a a couple weeks for full effect
how long do intranasal glucocorticoids take to start working?
tilt head back, spray in nostril, hold breath for a few seconds, exhale through mouth, don't blow nose for 15 min, wipe nose clean
what are the special instructions for use of dry powder intranasal glucocorticoids?
compete with histamine receptors on cells to inhibit the effects of histamines
what is the mechanism of action for antihistamines?
first generations have shorter half lives (multiple daily doses) and are lipophilic (cross blood-brain barrier causing drowsiness and sedation)
what about first generation antihistamines is different from second generation?
antihistamines
what kind of medication is most effective for treating nasal itching, conjunctival itching, tearing, sneezing, and rhinorrhea? Does not relieve nasal congestion
reduce doses for patients with renal and hepatic function impairment
what are the contraindications for antihistamines?
anti-SLUD, confusion, dementia-like symptoms, sedation
what are the adverse drug effects of antihistamines in the elderly?
bitter taste, headache, sleepiness, nasal burning, epistaxis, and pharyngitis
What are the ADRs of antihistamine nasal spray?
combination of intranasal corticosteroid and nasal antihistamine
what is a good treatment option for rhinitis that is resistant to pharmacological monotherapy?
intranasal antihistamines
What is the initial treatment option for patients with seasonal AR, first-line monotherapy option for patients with non-AR, and first-line option for patients with intermittent AR?
second generation antihistamine, 10mg daily, 2 years and older
what kind of medication is Claritin (loratadine)? include dosing and ages it is approved for
second generation antihistamine, 10mg daily for 6yo and up, 5mg daily for 2-5yo, 2.5mg daily for 6-24 mo
what kind of medication is Zyrtec (cetirizine)? include dosing and ages it is approved for
stimulate alpha 1 adrenergic receptors, causing vasoconstriction
what is the mechanism of action of decongestants?
decongestants
what treatment can be used in patients with severe mucosal edema which impairs the delivery of other intranasal agents?
MAO inhibitors (used in the last 2 weeks), children less than 12yo, uncontrolled hypertension
what are the contraindications for decongestants?
CNS stimulation (nervousness, restlessness, insomnia, tremor, dizziness, headache, anorexia, tachycardia, palpitations)
what are the ADRs of oral decongestants?
burning, stinging, dryness, tolerance or rebound if used more than one week, contraindicated for first trimester
what are the ADRs for intranasal decongestants?
rhinitis medicamentosa
Chronic use of nasal decongestants leads to a down regulation of adrenergic receptors after 3-7 days
Continued use results in a cycle of nasal congestion that is caused by and relieved by the medication.
Can lead to dose escalation and dependency
What is this condition called?
never
when are nasal decongestants indicated for monotherapy for chronic treatments of AR?
decongestants
what kind of medications are sudafed and afrin?
antimuscarinic agent that inhibits parasympathetic neurons that control secretions
what is the mechanism of action for Ipratropium bromide (atrovent)?
rhinorrhea associated with persistent AR and non-allergic rhinitis
when is Ipratropium bromide (atrovent) indicated?
hypersensitivity to drug
what is Ipratropium bromide (atrovent) contraindicated?
dryness, nose bleeds, nasal irritation
what are the ADRs for Ipratropium bromide (atrovent)?
significantly reduces rhinorrhea
what is the expected clinical effect of Ipratropium bromide (atrovent)?
blocks leukotriene 1 receptor to decrease inflammation
what is the MOA of Montelukast (singulair)?
seasonal and persistent AR that is not treated effectively with or cannot tolerate alternative therapies
what is the indication for Montelukast (singulair)?
headache, abdominal pain, cough, flu-like symptoms, suicidal thinking, suicide
what are the ADRs for Montelukast (singulair)?
hypersensitivity to drug, active or preexisting anxiety/depression/symptoms of psychiatric disorder
what are the contraindications for Montelukast (singulair)?
mast cell stabilizer which inhibits the release of histamine and other mediators of the inflammatory response
what is the MOA of Cromolyn sodium (nasalcrom)?
option to be taken prior to allergen exposure
when should Cromolyn sodium (nasalcrom) be used?
hypersensitivity to drug
what are the contraindications for Cromolyn sodium (nasalcrom)?
sneezing, nasal irritation, unpleasant taste
what are the ADRs for Cromolyn sodium (nasalcrom)?
Naegleria fowleri
what deadly organism can create problems when patients try to irrigate their nasal cavities?
>4days/week and >4weeks
what are the qualifications for allergic rhinitis to be considered persistent?
<4days/week or <4weeks
what are the qualifications for allergic rhinitis to be considered intermittent?
whether or not any of the following are present: sleep disturbance, impairment of daily activities, impairment of school or work, troublesome symptoms
what determines if allergic rhinitis is considered mild or moderate/severe?
OAH 2G, INAH, OAH 2G + PSE, INCS
what are the 4 recommended initial treatments for mild intermittent AR?
Mometasone (nasonex)
what intranasal corticosteroid has the fastest onset?
OAH 2G, INAH, INCS, INAH + INCS, OAH 2G + PSE
what are the recommended initial treatments for moderate-severe intermittent AR?
faster onset than separate products (5min instead of 15-30min)
what is the benefit of using combination intranasal antihistamine and corticosteroid?
60min
what is the timeline for onset of OAH?
15-30min
what is the timeline for onset of INAH?
1-3hr
what is the timeline for onset of INCS
INCS, OAH 2G, INAH, OAH 2G + PSE, IN cromolyn
what are the recommended initial treatments for mild persistent AR?
INAH + INCS, INAH inhaler + INCS inhaler, INCS inhaler, INAH inhaler
what are the recommended initial treatments for moderate-severe persistent AR?
try different monotherapy, add a symptom specific agent like INAC, IND, PSE, OCS burst
if symptoms of moderate-severe persistent AR are not controlled with the initial treatment, what can you try?
INAH, INCS
what are the recommended initial treatments for mild intermittent non-allergic rhinitis?
INAH, INCS, INAH + CS combo inhaler, INAH inhaler + INCS inhaler
what are the recommended initial treatments for moderate-severe intermittent non-allergic rhinitis?
alternative monotherapy, add symptom specific agent like INAC (ipratropium) for rhinitis, IND, PSE
As a general rule, if symptoms for any of the allergic or non-allergic rhinitis conditions are not controlled with the initial treatment, what can you try?
INAH + PSE or INCS + PSE
what are the recommended initial treatments for mild persistent non-allergic rhinitis?
INAH + INCS combo inhaler, INAH inhaler + INCS inhaler, INAH +/- PSE, INCS +/- PSE
what are the recommended initial treatments for moderate-severe persistent non-allergic rhinitis?
IND or oral PSE for 5-7 days
For severe mucosal edema that interferes with delivery or quick relief is needed for allergic or non-allergic rhinitis, what can be used?
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