Chapter 11 - Cold & Allergies Flashcards

Question

Cold Evaluation Outcomes

Answer 1

- Monitor for worsening symptoms, temperature increases, nasal secretions, respirations, and face/neck pain - If complications are suspected, seek medical attention - Should clear up or improve in 7-14 days

Answer 2

- 20% of adults and 40% of kids affected in the US - $3.4 billion in direct costs and $11 billion in indirect - More prevalent in the south and in young to middle aged population

Answer 3

- Affected upper respiratory system (URS) - Risk factors: family history, filaggrin gene mutation, increased IgE, socioeconomic class, eczema, diet - Triggered by indoor or outdoor allergens - Common indoor allergens: house dust mites, cockroaches, mold spores, cigarette smoke, pet dander, wool dust, latex, resins, dust based on work - Common outdoor allergens: pollen, mold spores, pollutants

Answer 4

1. Sensitization: initial exposure stimulating IgE production 2. Early Phase - minutes after subsequent exposure, rapid release of mast cell mediators - symptoms 3. Cellular Recruitment - leukocytes, eosinophils, mast cells release more inflammatory mediators 4. Late Phase - begins 2-4 hours after exposure and causes hypersecretion secondary to gland hypertrophy and congestion, priming tissues to decrease the threshold for triggers

Answer 5

- Seasonal and perennial allergic rhinitis - "hay fever" - Intermittent (IAR) and persistent allergic rhinitis (PAR) - more accepted medical terminology - Classifications depends on timing and duration of symptoms - Symptoms can also vary from mild to severe - Systemic symptoms: fatigue, irritability, malaise, and cognitive impairment

Answer 6

- Sinusitis - Otitis media - Nasal polyps - Sleep apnea - Hyposmia

Answer 7

NOT CURE - Reduce symptoms - Improve patient's functional status and well-being

Answer 8

3 Steps 1. Allergen avoidance 2. Pharmacotherapy 3. Immunotherapy

Answer 9

- Allergen avoidance is usually not enough and single entity drugs are initiated, but is the primary recommendation - Nasal wetting agents or nasal irrigation may relieve mucosal irritation and dryness - Reduces stuffiness, rhinorrhea, and sneezing

Answer 10

- Intranasal corticosteroids (INCS) are most effective and only recently went OTC - Before that oral and ocular antihistamines were used, topical and oral decongestants and mast cell stabilizers were also utilized - Use regularly rather than episodically for most effective treatment

Answer 11

- Aka glucocorticoids - Very effective - Treat itching, rhinitis, sneezing, and congestion - Stop the "allergic cascade" - Triamcinolone and Fluticasone are the only non-Rx approved for use - Triamcinolone: use in 2 y.o. + - Fluticasone: use in 4 y.o. + - Complete symptom control may not occur for at least a week, so use regularly rather than episodically - SE: nasal discomfort, bleeding, sneezing, glaucoma, cataracts, increased infection risk, growth inhibition in children - Budesonide is preferred during pregnancy now

Answer 12

- One of the most frequently prescribed drug classes - Sedating = 1st generation (crosses CNS, lipophilic), Nonsedation = 2nd generation (doesn't cross CNS) - Sedating antihistamines have a risk of anticholinergic effects, controversial to use - Compete with antihistamines at receptors to block their effects, highly selective for H1 receptors - 2nd generation also inhibit mast cell release and decrease cellular recruitment - Sedating overdoses: cardiac symptoms, CNS symptoms, drowsiness, restlessness, hyperactivity, tachycardia - Adverse Effects: CNS, anticholinergic in 1st generation - Don't use sedating histamines in newborns, premature infants, BF, and narrow-angle glaucoma patients - Don't use if patients are asthmatic, have peptic ulcers, prostatic hypertrophy, or use MAOIs

Answer 13

- Combined with decongestants and analgesics | - Use with caution since increased risk of adverse effects like insomnia

Answer 14

- Used to treat congestion common with allergic rhinitis | - Systemic or short-term topicals

Answer 15

- Mast cell stabilizer - No systemic effects - Use in 2 y.o. + - Better to use before symptoms start if possible - SE: sneezing, nasal stinging, burning

Answer 16

- INCS - most effective for moderate to severe IAR and all types of PER, 1st line monotherapy - Combine with antihistamines, decongestants, and mast cell stabilizers if additional control is needed - Sedating antihistamines are effective, possible more than nonsedating, but have risks of sedation and cognitive impairment making the nonsedating the preferred recommendation

Answer 17

- Pregnant women and children < 12 y.o. need differential diagnosing to ensure nonallergic rhinitis, asthma, or other conditions are the cause - Intranasal cromolyn, diphenhydramine, and chlorpheniramine are first recommendations for preggo - Can also use fluticasone, loratidine, or cetirizine if medications aren't well tolerated in the pregnant woman - BF - intranasal cromolyn is primary recommendation, triamcinolone and fluticasone are PROBABLY okay too - Antihistamines = contraindication in BF, can pass into milk - Cromolyn sodium, triamcinolone and fluticasone are also recommended in kids (as long as they meet age requirements) - Consult doctor if you are using a nasal spray on a child for 2 or more months out of the year - Avoid sedating antihistmaines in kids (paradoxical effects) and elderly (increased CNS depression effects) - Loratidine and cromolyn are the best choices for elderly

Answer 18

- Ephedra and feverfew - common herbals - Ephedra has serious adverse effects like stroke and is banned by the FDA - Feverfew's active ingredient is proven for safety and efficacy - All other options aren't proven for safety and efficacy

Answer 19

- Avoid allergens - best method - Advise about proper use of allergy medications and SE/interactions, as well as warnings - Let them know when to seek medical attention

Answer 20

- Relief may take up to 2-4 weeks - After this, follow up should be done if symptoms aren't controlled or SE are occuring - If not controlled, increasing the dosage, changing medications, or changing formulations may help - If not responding to non-Rx methods, go to doctor for Rx option and other methods (immunotherapy) - Anyone with warnings or serious reactions, see PCP - If STILL not treated, reconsider diagnosis

Answer 21

Rare cause of viral and bacterial co-infection with cold

Answer 22

- Self-inoculation | - Aerosol transmission

Answer 23

- Fever > 100.4 F - Chest pain - SOB - Worsening/development of symptoms - Cardiopulmonary diseases - AIDS or immunosuppressant therapy - Frail patients or advanced age - Infants < 3 mo. - Hypersensitivities

Answer 24

Systemic - Low bioavailability - Half life: 2.5 hours - Peak concentraionts: 1/2 - 2 hours Nasal - Short acting - Not recommended for children < 6 y.o.

Answer 25

- Afrin - Nasal - Long acting, ~ 12 hours - Not recommended for children < 6 y.o.

Answer 26

- Well absorbed after oral admin. - Half life ~ 6 hours - Peak concentrations: 1/2 - 2 hours - Not recommended for children < 2 y.o. (FDA) or < 4 y.o. (manufacturers) - More bioavailable and effective than phenylephrine

Answer 27

- Symptoms occurs < 4 days a week OR for < 4 weeks - Mild - doesn't impair sleep and daily activity - Moderate - severe - Imapirment of sleep/daily activities with troublesome symptoms

Answer 28

- Symptoms occur > 4 days per week AND for > 4 weeks - -Mild - doesn't impair sleep and daily activity - Moderate - severe - Imapirment of sleep/daily activities with troublesome symptoms

Answer 29

- Occur when individual is in contact with trigger that is not normally part of their environment - Can have mild, moderate, or severe reaction - First line is antihistamines due to their quick onset of action

Answer 30

- Children < 12 y.o. - Pregnant or lactating women - Symptoms of nonallergic rhinitis - Symptoms of otitis media, sinusitis, bronchitis, or other infections - Symptoms of asthma, COPD, or other respiratory disorders - Severe or unacceptable SE

Answer 31

- Chlorpheniramine - Diphenhydramine - Doxylamine

Answer 32

- Cetirizine - Fexofenadine (don't take with fruit juice, approved for pilots) - Levocetirizine - Loratidine

Answer 33

- Most potent 2nd generation antihistamine - Some sedative properties in 10% of the population - Aka Zyrtec

Chapter 11 - Cold & Allergies Flashcards

(57 cards)