Term
| Antihistamines block __________________. (MOA) |
|
Definition
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Term
| Oral antihistamines block the ______________ allergic reaction. |
|
Definition
|
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Term
| Since oral antihistamines block the early phase allergic reaction, they are effective in controlling what? |
|
Definition
sneezing
pruritis
rhinorrhea
ocular symptoms |
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|
Term
| Antihistamines are ineffective in alleviating _________________. |
|
Definition
Congestion
(you'd dry them up which would be bad) |
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Term
| First generation antihistamines have a duration of about _____________. |
|
Definition
|
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Term
| How are first generation antihistamines metabolized and excreted? |
|
Definition
generally metabolized by liver thru hydroxylation
excreted in urine |
|
|
Term
| What is the primary reason first generation antihistamines fell into disfavor? |
|
Definition
| because the cross the BBB and can cause drowsiness, sedation, confusion, dizziness and slowed reaction time |
|
|
Term
| List the first generation antihistamines. |
|
Definition
Diphenhydramine (benadryl)
Chlorpheniramine
Brompheniramine
Dimenhydrinate (Dramamine)
Meclizine (antivert)
Hydroyzine
Cyproheptadine |
|
|
Term
| Which antihistamine is used for vertigo? |
|
Definition
|
|
Term
| Which antihistamine is used for nausea and motion sickness? |
|
Definition
| Dimenhydrinate (Dramamine) |
|
|
Term
| Which antihistamines are used for itching and are by prescription only? |
|
Definition
Hydroxyzine (also used for anxiety)
Cyproheptadine (also used as an appetite stimulant) |
|
|
Term
| Why should you avoid using 1st generation antihistamines in the elderly? |
|
Definition
| because they may cause stimulation rather than sedation |
|
|
Term
| How long do 2nd generation antihistamines work? |
|
Definition
|
|
Term
| What are the 3 main differences between the 1st and 2nd generation of antihistamine? |
|
Definition
1. 2nd generation drugs have a longer DOA
2. 2nd gen. drugs do not readily cross the BBB
3. 2nd gen. drugs are not assc with ACh SEs |
|
|
Term
| List the 2nd generation antihistamines |
|
Definition
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratadine (Claritin)
Desloratidine (Clarinex) |
|
|
Term
| Are 1st generation antihistamines or 2nd generation antihistamines more effective? |
|
Definition
| They are both equally effective, 2nd generation drugs are preferred because of their more favorable SEs and increased safety |
|
|
Term
| Which 2nd generation antihistamine undergoes extensive first pass metabolism and rarely is metabolized by CYP450? |
|
Definition
|
|
Term
| What is the first line of treatment for symptoms of allergic rhinitis? |
|
Definition
Axelastine (Astelin)
an intranasal antihistamine |
|
|
Term
| The _______________ activity of 1st generation antihistamines accounts for their ability to combat motion sickness and aid in parkinsonism. |
|
Definition
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Term
| Decongestants stimulate ___________ receptors in the vascular smooth muscle of the turbinates, leading to nasal mucosal ___________________ and relief of nasal congestion. (MOA) |
|
Definition
alpha-adrenergic
capillary vasoconstriction |
|
|
Term
| Decongestants are often incorporated into ____________________ products. |
|
Definition
|
|
Term
| Decongestants have no effect on ___________, ___________ or _________________. |
|
Definition
sneezing
itching
rhinorrhea |
|
|
Term
| What is rhinitis medicamentosa? |
|
Definition
When you use nasal decongestants for >5 consecutive days you may get rebound congestion.
(does not occur with oral decongestants) |
|
|
Term
| List the AEs of Decongestants |
|
Definition
CNS stimulation
Increased BP
tachycardia |
|
|
Term
| What can occur if you combine decongestants with MAOIs or TCAs? |
|
Definition
|
|
Term
|
Definition
Phenylephrine
Naphazoline
Tetrahydrozoline
Oxymetazoline (Afrin) - nasal
Xylometazoline
Pseudoephedrine (Sudafed) |
|
|
Term
| Which drugs are recommended when allergic rhinitis require continuous therapy? |
|
Definition
| intranasal corticosteroids |
|
|
Term
| Intranasal corticosteroids should be reserved for: |
|
Definition
| moderate to severe allergic rhinitis |
|
|
Term
| Intranasal corticosteroids will reduce... |
|
Definition
| congestion, sneezing, rhinorrhea, thick postnasal discharge and nasal pruritis |
|
|
Term
| What do you need to educate your patient on when prescribing or recommending antihistamines? |
|
Definition
the risk for drowsiness
you should take it and make sure you know how you react before driving |
|
|
Term
| How long does it take intranasal corticosteroids to start working? |
|
Definition
| about 12 hours after the first dose |
|
|
Term
| The maximal efficacy of intranasal corticosteroids is achieved in _____________. |
|
Definition
|
|
Term
| By instructing the patients to direct the intranasal corticosteroid spray away from the ________________ you can prevent SEs. |
|
Definition
|
|
Term
| List the SEs of intranasal corticosteroids. |
|
Definition
| nasal irritation, burning and drying |
|
|
Term
| Which intranasal corticosteroids should you prescribe for patients with drier noses? |
|
Definition
Fluticasone (Flonase)
Beclomethasone (Beconase AQ)
Triamcinolone (Nasacort) |
|
|
Term
| Which intranasal corticosteroids should you prescribe for patients with rhinorrhea or "wet" noses? |
|
Definition
Budesonide (Rhinocort)
Beclomethasone (Beconase)
Tramcinolone |
|
|
Term
| Intranasal corticosteroids can be used in patients who... |
|
Definition
| should NOT receive antihistamines or decongestants |
|
|
Term
| When would you use oral steroids in allergic reactions? |
|
Definition
| late-phase allergic reactions |
|
|
Term
| Oral steroids, when used for allergic reactions, should be reserved for: |
|
Definition
| patients with severe symptoms that are refractory to intranasal steroids |
|
|
Term
| Which oral steroids can be used for allergic reactions and how long should you use them? |
|
Definition
Prednisone
Methylprednisone
5-7 days |
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