Term
| Management of allergic rhinitis is a 3 pronged approach, what are they? |
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Definition
1. Trigger Avoidance
2. Pharmocologic
3. Immunotherpy |
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Term
| There are three mainstays of medication for allery symptoms what are they? |
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Definition
1. Antihistamines
2. Nasal Corticosteriods
3. Decongestants |
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Term
| For severe allergic reactions PO, IM, or IV __________ (depending on the severity) are utilized. |
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Definition
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Term
| Blocks the action of histamines - the cause for many allergy symptoms. |
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Definition
Antihistamines
Ex: diphenhydramine & loratidine |
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Term
| Inhibit the action of leukotrienes that are released by eosinophils and mast cells. |
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Definition
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Term
| Interrupts inflammation by suppressing the synthesis of histamine. |
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Definition
Nasal Corticosteriods
Ex: beclomethasone or beconase |
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Term
| They activatae alpha 1 adrenergic receptors leasing to vasoconstriction of the nasal blood vessels and relief of congestion. |
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Definition
Decongestants
Ex: Oxymetazoline or Sudafed |
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Term
| Antihistamines are either ___ or ___ _________ and may be given topically, orally, intranasally or IV depending on the drug. |
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Definition
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Term
| H1 antagonists are used to treat _______ disorders and to relieve ______ _______ symptoms but not to treat the underlying cause. |
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Definition
allergic
histamine induced |
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Term
| Antihistamines provide relief of ______ and _______ in about 70% of patients. |
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Definition
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Term
| Antihistamines are more effective for ________ than _______ of histamine effects. |
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Definition
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Term
| First generation antihistamines should be avoided in the elderly due to the potential side effects such as _____ _____ ____ ____ and difficulty with urination. |
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Definition
arrhythmias
dizziness
sedation
hypotension
and difficulty with urination |
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Term
| First Generation Antihistamines include _______, _______, and ______. |
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Definition
Chlorpheniramine
Diphenhydramine (Benadryl)
Doxylamine (unisom sleep tabs) |
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Term
| Second Generation Antihistamines include the following. |
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Definition
Loratidine (Claritin)
Pseudoephedrine (Sudafed) |
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Term
| One common effect of first generation antihistamines in children is a paradoxyl reaction where instead of somnolence the child exhibits _______. |
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Definition
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Term
| Second generation antihistamines are less _______ as they do not cross the blood brain barrier. |
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Definition
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Term
| Certirizine is a second generation antihistamine that does cause ______ as compared to other agents. |
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Definition
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Term
| ________ does have drug interations with antifungals and erythromycin and may cause Dysmenorrhea. |
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Definition
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Term
| H2 Antagonists are used to prevent secretion of _____ _____. |
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Definition
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Term
| An H2 Antagonist Cimetidine (Tagamet) may be useful in treating refractory _____ which has not responded to an H1 Antagonist. |
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Definition
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Term
| _____ and _____ have multiple drug to drug interactions and should be used only with extreme caution. |
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Definition
| Cimetidine (Tagamet) and Fexofenadine |
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Term
| An Intranasal Corticosteroid such as ____, _____, _____, _____, and _____ are effective methods of allergic rhinitis prophylaxis in many patients. |
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Definition
Fluticasone (Flonase)
Budesonide (Rhinocort)
Beclomethasone (Beconase)
Mometsone (Nasonex)
Triamcinolone (Nasacort) |
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Term
| It takes approximately ____ days for intranasal steroids to develop the effective barrier in the nares to prevent allergy symptoms. |
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Definition
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Term
| While waiting for intranasal steriods to become effective what should you prescribe? |
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Definition
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Term
| If a patient has seasonal or perennial allergic rhinitis a daily use of a _____ _____ should prevent allergy symptoms. |
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Definition
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Term
| The most common cause of lack of efficacy in intranasal steriods is _____ _____. |
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Definition
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Term
| What are 4 factors that prevent the efficacy of Intranasal Steroids? |
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Definition
1. Not using on daily basis
2. Inserting tip to deep in nares
3. Not following the angle of the nose
4. Not depressing the plunger fully |
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Term
| If multiple antihistamines have been tried without success a five day course of ______ may be administered while waiting for the nasal steroids to become effective. |
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Definition
| Prednisone (same dose once a day for 5 days) |
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Term
| Oral prednisone should not be given to a patient who is _____ because steriods _______ ______ _______. |
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Definition
Diabetic
Elevate Blood Sugar |
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Term
| The only Leukotriene Receptor Antagonists approved in the United States for the treatment of allergies is? |
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Definition
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Term
| A Leukotriene Receptor Antagonists inhibits the action of leukotrienes that are released by ______ and ___ ___. |
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Definition
| Eosinophils and Mast Cells |
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Term
| What is the only corticosteroid that is pregnancy catagory B? |
|
Definition
Budesonide (Rhinocort)
Data is available on use in the 1st trimester only; however given the safety profile in the gestational period of greatest concern is reassuring and due to their high first pass hepatic uptake and low maternal absorbtion, amounts absorbed are probably too small to affect the fetus. |
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Term
| All other intranasal steroids such as Beclomethasone, Flonase, and Nasonex are all considered Caategory ____ and the safety in lactation is ______. |
|
Definition
C
Safety in lactation is unknown |
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Term
| OTC nasal sprays are considered Category ______ possibly unsafe in lactation and may reduce milk supply. |
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Definition
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Term
| The AAP considers _______ compatible with breastfeeding |
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Definition
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Term
| A newer Category B 2nd Generation antihistamine safe for second trimester use is? |
|
Definition
Loratadine (Claritin)
Still not enough information about 1st trimester use. |
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Term
| During pregnancy many women experience worsening allergy symptoms. Which antihistamines have been the most widely studied for the longest time? |
|
Definition
Chlorpheniramine (Chlor-Trimeton)
Diphenhydramine (Benadryl)
Doxylamine (Unisom Sleep Tabs)
These do not have teratogenic effects and can relieve symptoms of both watery eyes and runny nose. |
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Term
| Which category B antihistamine is known for its safety in pregnancy but is possibly unsafe with breastfeeding. |
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Definition
Doxylamine (Unisom Sleep Tabs)
It is thought to pass to breast milk causing sedation and paradoxial CNS stimulation in infant. |
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Term
| Women are more prone to ____, _____, and _____ during pregnancy due to hormonal and _______ changes. |
|
Definition
URI's (Upper Respiratory Infections)
Infections and allergies
Due to hormonal and immunological changes. |
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Term
| When prescribing medications during pregnancy treat the _____ _____ and avoid combination medications. |
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Definition
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Term
| Remember that sore throat sprays and lozenges contain soothing agents, ____ and _____ some of which are contraindicated in ________. |
|
Definition
Antiseptics
Anesthetics
Breastfeeding |
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Term
| Opioids should be avoided in patients with _____? |
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Definition
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Term
| What is the agent that should be prescribed to prevent or relieve a non-productive cough? |
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Definition
| Antitussives such as Codiene, Detromethorphan and Diphenhydramine |
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Term
| First trimester use of narcotic ____ (category C) has been associated with fetal malformations. |
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Definition
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Term
| The four fold rationale for using single rather than combination products are? |
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Definition
1. Helps prevent overdosing
2. Each ingredient can be dosed separtely based on age and weight.
3. to avoid giving a medication that is unncessary.
4. If there is a reaction to a medication single agents are easier to trace. |
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Term
| During breastfeeding the use of any ____ can cause the infant drowsiness and sedation. |
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Definition
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Term
| Guaifenesin is Category ___ and when used in 1st trimester may be _____ ____ ____ _____. |
|
Definition
Category C
Associated with Birth Defects |
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Term
| Dextromethorphan is pregnancy Category ___ and since antitussives are shown to be ineffective it is best to avoid the risk. |
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Definition
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Term
| Decongestants work by stimulating ____ ____ _____ that cause vasocontriction. |
|
Definition
| Alpha-Adrenergic Receptors |
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Term
| The vasoconstriction caused by alpha-adrenergic receptor stimulation results in decreased _____ _____ and ____ _____ which relieves nasal congestion. |
|
Definition
| Blood Flow and Fluid Exudate |
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Term
| A prototype drug that stimulates alpha-adrenergic receptors is _______. |
|
Definition
Pseudoephedrine (Sudafed)
May lead to CNS stimulation causing tremors, elevated heart rate, arrhythmias, elevaated blood pressure and insomnia. |
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Term
| Oral Decongestants are contraindicaated in patients who have _____ _____ and should be used cautiously in those patients who are successfully controlled. |
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Definition
| Uncontrolled Hypertension |
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Term
| _______ or reactive airway disease has grown more common as more people experience serious allergies to environmental or other agents. |
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Definition
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|
Term
| Asthma is a ____ _____ ____ characterized by bronchospasm |
|
Definition
| Chronic Inflammatory Disease |
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Term
| Chronic inflammation of the airways will lead to ____ ____ which quite often results in Chronic Respiratory Problems and COPD. |
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Definition
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|
Term
| These agents promote smooth airway muscle relaxation. |
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Definition
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Term
| Long acting beta agonist such as _____ are used to achieve sustained bronchodilation. Do not use alone use only with glucocorticoids. |
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Definition
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Term
| ________ are the mainstay of maintenance therapy for asthma. |
|
Definition
Glucocorticoids
Because they do not provide immediate relief of bronchoconstriction they should not be used alone in someone having an acute attack.G |
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Term
| Glucocorticoids can be given by ____, ____, or IV. |
|
Definition
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