allergic rhinitis

Question 1

s and sx of allergic rhinitis

Answer 1

• sneezing, nasal obstruction, rhinorrhea, postnasal drip that causes coughing, itching of nose and eyes

Question 2

allergic rhinitis tx

Answer 2

• Step 1: Environmental Controls: avoidance, remove source, air conditioning
• Step 2: combination product will improve Sx control (OTC antihistamines)
• Step 3: Rx product as single agents for moderate to severe AR
• Step 4: Use alternative agent if symptoms could be controlled or combination
• Step 5: Consider montelukast
• Step 6: Consider immunotherapy

Question 3

antihistamines and allergic rhinitis

Answer 3

• Less effect on nasal congestion
• 1st generation include more lipid solubility = more CNS = sedation, drowsiness, cognitive function effected
• Anticholinergic Effects: dry mouth, urinary retention, constipation
• Loratadine 10mg dose is non-sedating but less efficacy, can be up to 40mg
• Intranasal: 40% of each dose reaches systemic circulation = helps ocular symptoms
• Ocular Drops

Question 4

nasal decongestants

Answer 4

• Topical Side Effects: burning, stinging, dryness, rebound congestion = avoid use of more than 3 days
• Systemic Side Effects: tachycardia, tremor, insomnia
• Caution: HTN, IHD, DM, hyperthyroid

Question 5

coricosteroid nasal sprays

Answer 5

• Most effective at relieving nasal symptoms but not ocular symptoms
• With regular use = usually very effective
• Improvement in 3-7 days
• Works against multiple mediators: chemical and non-allergic
• AE: systemic absorption, dryness, epistaxis (technique)
• Nasacort, Veramyst, Dymista

Question 6

cromolyn

Answer 6

• Especially effective in patients with seasonal rhinitis d/t mast cells
• Slow onset = preventative measure (4 weeks to evaluate efficacy)

Question 7

ipratropium bromine

Answer 7

• Anticholinergic

- Decreases rhinorrhea, best for vasomotor (non-allergic rhinitis)

Question 8

montelukast

Answer 8

• Leukotriene receptor anatagonist
• Ideal for patients with asthma
• Oral granules: place directly in mouth or mix with solid, soft food
• Do not mix with liquids, except 1tsp formula breast milk
• Ingest within 15 minutes

Question 9

immunotherpy in allergic rhinitis

Answer 9

• SQ injections weekly -> monthly

- Patients who do not demonstrate adequate response to pharmacologic interventions or environmental controls