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Allegic Rhinitis
Allergic Rhinitis
61
Agriculture
3rd Grade
02/03/2013

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Term
Atopy
Definition
the inherited tendency to develop IgE mediated immune responses
Term
Step 1 Sensitization
Definition
Allergen-specific IgE produced by B-lymphocytes
Term
Step 2 Early phase reaction
Definition
Occurs within minutes, upon re-exposure to allergen, mast cell degranulation and mediator release
Term
Step 3 Late phase reaction
Definition
Occur hours to days after exposure, influx of inflammatory cells
Term
Seasonal signs/symptoms
Definition
sneezing, rhinorrhea, itching
Term
Perennial signs/symptoms
Definition
congestion, post-nasal drip, cough
Term
Mainstay of therapy; rapid onset, but best results when taken continuously
Definition
Histamine-1 receptor antagonists (systemic antihistamines)
Term
Sedating systemic antihistamines
Definition
Bromphniramine, Chlorpheniramine, Clemastine, Diphenhydramine
Term
Nonsedating systemic antihistamines
Definition
Cetirizine, Fexofenadine, Levocetirizine, loratadine, Desloratadine
Term
ADRs with sedating antihistamines
Definition
sedation, cognitive impairment, anticholinergic: dry mouth, urinary retention
Term
Nasal Corticosteroids
Definition
Beclomethasone diproprionate, Budesonide, Ciclesonide, Flunisolide, Fluticasone furoate, Fluticasone propionate, Mometasone furoate monohydrate, Triamcinolone acetonide
Term
most effective; treat inflammatory component; first line when obstruction
Definition
nasal corticosteroids
Term
have lower systemic bioavailability; more lipophilic, faster absorption; lower potential for systemic adverse effects
Definition
fluticasone and mometasone
Term
Local ADRS (nasal corticosteroids)
Definition
stinging, burning, dryness, sneezing, epistaxis
Term
systemic ADRS (nasal corticosteroids)
Definition
growth velocity, osteoporosis?
Term
Montelukast (Singulair)
Definition
Leukotriene Antagonist
Term
Seasonal allergic rhinitis in patients 2 years of age and older; comparable or inferior to oral antihistamine; inferior to nasal corticosteroid
Definition
Montelukast
Term
Montelukast precautions
Definition
suicidal thoughts, hallucinations, insomnia, irritability, aggression, agitation
Term
Montelukast ADRs
Definition
headache, upper respiratory infections
Term
Systemic Decongestants
Definition
Pseudoephedrine and phenylephrine
Term
Pseudoephedrine and phenylephrine
Definition
sympathomimetics; alpha adrenergic agents produce nasal vasoconstriction
Term
Pseudoephedrine and phenylephrine ADRS
Definition
hypertension, restlessness, tremor, insomnia, headache, urinary retention, palpitations
Term
Systemic decongestants cautions
Definition
glaucoma, hypertension, CV disease, urinary retention, BPH, antidepressants, hyperthyroidism, diabetes
Term
Topical Decongestants
Definition
oxymetazoline, tetrahydrozoline, xylometazoline
Term
topical decongestants compared with systemic decongestants
Definition
more rapid, more effective, fewer systemic side effects
Term
rebound congestion
Definition
rhinitis medicamentosa
Term
treatment of rhinitis medicamentosa
Definition
DC topical decongestants (can taper); nasal corticosteroids; oral corticosteroids
Term
Cromolyn (Nasalcrom) OTC
Definition
Nasal Mast cell stabilizers
Term
blocks early and late phase reaction; inhibits mast cell degranulation; prevents mediator release; effects persist 4-8 hours after administration
Definition
Cromolyn
Term
Cromolyn ADRs
Definition
sneezing, burning
Term
Azelastine and olopatadine
Definition
Intranasal Antihistamines
Term
Intranasal antihistamines ADRs
Definition
sedation, bitter taste
Term
Ipratropium
Definition
Intranasal Anticholinergics
Term
Ipratropium ADRs
Definition
nasal dryness, bleeding
Term
Preferred agent selection: Intermittent mild:
Definition
antihistamine, decongestant
Term
Preferred agent selection: Intermittent moderate-severe
Definition
Antihistamine, decongestant, intranasal corticosteroids
Term
Treat symptoms: Persistent mild
Definition
antihistamine, decongestant, intranasal corticosteroid, cromolyn
Term
Treat symptoms: Persistent moderate-severe
Definition
intranasal corticosteroid first-line, add if needed decongestant, nasal ipratropium, antihistamine
Term
season allergic conjunctivitis, perennial allergic conjunctivitis
Definition
Ocular Allergy Disease
Term
Ocular Allergy Disease Systemic therapies
Definition
Antihistamines, nasal corticosteroids, leukotriene antagonists
Term
Opthalmic agents
Definition
mast cell stabilizers, antihistamines, mast cell stabilizers/antihistamines, decongestants, decongestants/antihistamines, NSAIDs, corticosteroids
Term
Bepotastine, cromolyn, lodoxamide, nedocromil
Definition
Mast Cell Stabilizers
Term
mast cell stabilizers
Definition
most effective as prophylaxis
Term
mast cell stabilizers ADRs
Definition
burning and stinging on instillation, headache
Term
Ophthalmic Antihistamines
Definition
Emedastine
Term
Emedastine ADRs
Definition
burning and stinging on instillation, fatigue, dry mouth, headache
Term
Mast Cell Stabilizers/Antihistamines
Definition
Alcaftadine, azelastine, epinastine, keotifen, olopatadine
Term
Mast Cell Stabilizers/Antihistamines ADRs
Definition
stinging and burning on instillation, bitter taste, headache
Term
Naphazoline, oxymetazoline, phenylephrine, tetrahydrozoline
Definition
Ophthalmic Decongestants
Term
Ophthalmic Decongestants ADRs
Definition
stinging/burning, decreased accommodation, blurred vision, pupil dilation, rebound vasodilation
Term
Ophthalmic Decongestants Precautions
Definition
hypertension, heart disease, narrow angle glaucoma
Term
Naphazoline/pheniramine maleate
Definition
Ophthalmic Decongestant/antihistamines
Term
Ketorolac
Definition
Ophthalmic NSAID
Term
Ketorolac ADRs
Definition
stinging/burning, allergic reactions, ocular irritation/inflammation; cross sensitivity aspirin/NSAIDs, bleeding
Term
Ophthalmic corticosteroids
Definition
last coice-- severe conjunctivitis; very effective; significant ADRs
Term
Ophthalmic corticosteroidsd ADRs
Definition
cataracts, glaucoma, superinfections
Term
Immunotherapy ("allergy shots")
Definition
considered when: allergen exposure is unavoidable, allergic response all year or most of the year, difficulty treating pharmacologically, significant potential benefit (children and young adults)
Term
Immunotherapy Cautions
Definition
major risk: anaphylaxis, beta blockers: reduce epi response, chronic medical conditions that reduce ability to survive a reaction; sublingual may be safer
Term
Preferred therapies for Pediatric Patients
Definition
Cromolyn, oral non-sedating antihistamiens, nasal corticosteroids, Montelukast (mild persistent asthma)
Term
Preferred therapies for Pregnant Patients
Definition
Cromolyn first line, antihistamines if cromolyn fails, nasal corticosteroids, montelukast
Term
Preferred therapies for nonallergic rhinitis
Definition
nasal corticosteroids, nasal ipratropium, nasal azelastine, nasal saline irrigation
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