Term
| Intermittent Allergic Rhinitis (IAR) |
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Definition
| Symptoms ≤ 4 days/week or ≤4 weeks |
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Term
| Persistent Allergic Rhinitis (PER) |
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Definition
| Symptoms >4 days/week and >4 weeks |
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Term
| Mild severity symptoms of allergic rhinitis |
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Definition
| Do not impair sleep or daily activities no troublesome symptoms |
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Term
| Moderate-Severe symptoms of allergic rhinitis |
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Definition
| Sleep disturbance, impaired daily activities (work, school) |
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Term
| Allergic Rhinitis exclusions for self-treatment |
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Definition
-Children<12 years
-Pregnant or lactating women
-Non-allergic rhinitis
-Otitis media, sinusitis, bronchitis, or other infection
-Undiagnosed or uncontrolled asthma (wheezing, SOB), COPD or other lower respiratory disorder
-Severe or unacceptable side effects of treatment |
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Term
| Non-allergic rhinitis causes |
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Definition
-hormonal: pregnancy, puberty, thyroid disorders
-structural: septal deviation , adenoid hypertrophy
-drug-induced: cocaine, beta-blockers, ACEIs, chlorpromazine, clonidine, reserpine, hydralazine, oral contraceptives, aspirin or other topical decongestants
-Systemic Inflammatory: eosinophilic nonallergic rhinitis (NARES)
-Lesions: nasal polyps, neoplasms
-Traumatic: recent facial or head trauma
-autonomic: age-related, physical or chemical agent causes |
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Term
| Symptoms of allergic rhinitis |
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Definition
-bilateral, worst in the a.m. improve during the day, worsen in the p.m.
-frequent sneezing, paroxysmal
-sneezing anterior, watery
-variable nasal obstruction
-frequent conjunctivitis
-sinus pain due to congestion, throat pain due to postnasal drip
-anosmia: loss of sense of smell is rare
-epistaxis is rare
-facial, nasal or throat features: allergic shiners, Dennie's lines, allergic crease, allergic salute, allergic gape, non-exudative cobblestone appearance of posterior oropharynx |
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Term
| Symptoms of non-allergic rhinitis |
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Definition
-unilateral common, can be bilateral, constant day/night
-little or none
-rhinorrhea: posterior, watery, thick and/or mucopurulent
-nasal obstruction is often present, often severe
-pain is variable depending on the cause
-anosmia: loss of sense of smell is frequent
-epistaxis is recurrent
-facial, nasal or throat features: nasal polyps, nasal septal deviation, enlarged tonsils and/or adenoids |
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Term
| Treatment of allergic rhinitis |
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Definition
-sequential: allergen avoidance, pharmacotherapy, and allergen immunotherapy
-intranasal corticosteroids are the most effective: beclomethasone, budesonide, fluticasone, or triamcinolone
-antihistamine are commonly used, but less effective: non-sedating antihistamines are preferred over sedating based on efficacy and safety |
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Term
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Definition
-check local pollen counts and air quality index
-keep windows shut
-avoid yard work/outdoor sports with high pollen
-remove triggers (i.e. cats, dust mites, tobacco smoke, mold)
-lower humidity to reduce molds (ie: vent kitchen and bathrooms)
-remove house plants
-wash bedding (130F) weekly, encase mattresses and pillows in coverings resistant to dust mites |
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Term
| Intranasal Corticosteroids (INCS) |
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Definition
-Budensonide (Rhinocort Allergy): >6 years
-Fluticasone (Flonase Allergy Relief): >4 years
-Triamcinolone (Nasacort Allergy 24 hour) >2 years
-may take 1 week to control symptoms
-shake before use |
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Term
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Definition
-Alkylamines
-Ethanolamines
-Phenothiazines
-piperidines
-piperazines |
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Term
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Definition
Moderately sedating, strong anticholinergic effects, higher risk of paradoxical CNS stimulation compared with other classes.
-brompheniramine
-chlorpheniramine
-dexbrompheniramine
-dexchlorpheniramine
-pheniramine
-triprolidine |
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Term
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Definition
Highly sedating, strong anticholinergic effects, large doses cause seizures and arrhythmias
-clemasine
-diphenhydramine
-doxylamine |
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Term
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Definition
Weak CNS effects, increase GI effects
-pyrilamine
-tripelennamine
-thonzylamine |
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Term
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Definition
Highly sedating, strong anticholinergic effects, block alpha-adrenergic receptors, more likely to cause hypotension, akathisia and dystonic reactions may occur
-promethazine |
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Term
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Definition
Non-sedating
-fexofenadine
-loratadine
-phenindamine |
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Term
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Definition
Minimally to moderately sedating
-cetirizine
-chlorcyclizine
-hydroxyzine
-levocetirizine
-meclizine |
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Term
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Definition
-common with allergic rhinitis
-can treat with systemic decongestants or short term ≤5 days of topical nasal decongestants
-effective for congestion, but litle effect on other symptoms |
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Term
| Nasal Cromolyn (NasalCrom) |
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Definition
-prevents allergic rhinitis
--> use before exposure-stabilizes mast cells
--> initial effect 3-7 days, maximum effect 2-4 weeks
-less effective than intranasal corticosteroids
-simiar efficacy to antihistamines
-more effective than placebo
-ADRs: sneezing, brief nasal burning or stinging, nose bleeds, wheezing
-≤2 years of age |
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Term
| When to seek medical attention regarding allergic rhinits |
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Definition
-symptoms worsen on OTC medication
-no improvement in 2-4 weeks of treatment
-secondary bacterial infection:
--> non-clear, thick nasal or respiratory secretions
--> temperature > 101.5F
--> SOB
--> Chest congestion
--> wheezing
--> ear pain
--> rash |
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Term
| Allergic rhinitis conjunctivitis |
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Definition
-oral antihistamines
-intraocular antihistamines
-saline |
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Term
| Nasal corticosteroids: Budesonide, fluticasone, triamcinalone (nasal) allergic effects in pregnancy |
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Definition
| -facial clefts in some studies |
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Term
| Piperazines and Piperadine allergic effects in pregnancy |
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Definition
| -not expected to increase the risk of malformations |
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Term
| Nasal corticosteroids: Budesonide, fluticasone, triamcinalone (nasal) allergic effects on lactation |
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Definition
-infant exposure expected to be minimal
-considered compatible with breastfeeding |
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Term
| Fexofenadine effects on lactation |
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Definition
-lack of sedation and low milk levels--> no expected to cause any adverse effects in breastfed infants
-might have a negative effect on lactation |
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Term
| Cetirizine effects on lactation |
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Definition
-Small occasional doses of cetirizine are probably acceptable in breastfeeding
-larger doses/prolonged use= may cause drowsiness and other effects in the infant or decrease the milk supply |
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Term
| Loratadine effects on lactation |
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Definition
-lack of sedation and low milk levels--> no expected to cause any adverse effects in breastfed infants
-might have a negative effect on lactation |
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Term
| Issues with drugs in pregnancy |
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Definition
-49% of pregnancies are unintended
-women listen to the negative effects of drugs that are not harmful (25% increase)
-Underying illness associated with maternal, fetal and neonatal morbidity and mortality
-PK and PD are altered in pregnancy
-Timing of exposure matters |
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Term
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Definition
-pregnancy including labor and delivery
-lactation including nursing mothers
-female and male reproductive potential |
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Term
| Normal pregnancy duration |
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Definition
| 37-42 weeks, average is 40 weeks |
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Term
| Embryonic/fetal development stages |
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Definition
1. Zygote
2. bilaminar embryo
3. embryonic period
4. fetal period |
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Term
| Most organs have developed in the fetus after __weeks |
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Definition
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Term
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Definition
Increased: CYP3A, CYP2C9, CYP2D6, UGT, P-gp, OCT2, CrCl
Decreased: CYP1A2, possibly CYP2C19 |
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Term
| Good references for drug toxicity during pregnancy |
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Definition
-Drugs in pregnancy and lactation (Briggs)
-Reprotox
-Teris
-Product label if updated drug, if not, the label is not useful |
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Term
| Drugs that should not be given during pregnancy |
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Definition
1. Thalidomide (25% major malformations)
2. Isotretinoin (50% major human teratogen)--wait one month before trying to get pregnant
3. Mycophenolate (Immunosuppressant for transplant patients) (27% malformations in patients): microtia (small head), cleft lip and palate, hypoplastic nails, shortened fingers, external auditory duct atresia, diaphragmatic hernias, heart malformations |
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Term
| Malformation risk_______ when underlying conditions are uncontrolled |
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Definition
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Term
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Definition
Long term complications
-higher rate of impaired glucose tolerance at 2-5 years
-higher rate of type 2 diabetes
-higher rate of metabolic syndrome
-childhood obesity |
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Term
| Should sertraline be used in pregnancy? |
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Definition
-Yes--does not adversely affect outcome. Depression should be treated!
-has risk of neonatal pulmonary hypertension in some studies
-has risk if reuptook late in pregnancy: of mild transient neonatal syndrome of CNS, motor, respioratory, and GI signs |
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Term
| Benefits of breastfeeding |
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Definition
-maternal-neonatal bonding
-uterine contraction and decreased risk of bleeding
-increased IQ in offspring (possibly)
-complete nutrition for 1st 6 months, except possibly vitamin D
-Less odor from neonatal bowel movements
-decreased cost |
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Term
| Breastfeeding prevents/reduces risk of |
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Definition
-middle ear infections
-respiratory tract infections
-colds and infections
-gut infections
-intestinal tissue damage
-sudden infant death syndrome
-allergic diseases
-celiac disease
-IBD
-Diabetes
-childhood leukemia |
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Term
| 3 methods of drug transfer into breast milk |
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Definition
1. Closed junction transcellular diffusion
2. Open junction paracellular diffusion
3. Milk fat paracellular diffusion |
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Term
| Breast milk and maternal plasma pH |
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Definition
-breast milk: 7.0
-maternal plasma: 7.4 |
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Term
| Factors that influence movement of drugs to breast milk |
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Definition
-maternal plasma level the higher the plasma level, the higher the breast milk concentration
-Protein binding: only unbound drug crosses, lower protein concentration in milk
-lipid solubility: more likely to cross
-acid/base: weak bases transfer to acidic milk and then are trapped
-MW: higher MW (than 800Da--like insulin or heparin) are too large to cross the alveolar acini (glandular tissue where milk is produced) |
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Term
| Factors in infant toxicity in breast feeding |
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Definition
-the dose in breast milk relative to the therapeutic amount
-the amount absorbed by a nursing infant
-the infant's ability to clear the drug |
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Term
| Relative infant dose (RID) calculation |
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Definition
Infant dose (mg/kg/day)/maternal dose(mg/kg/day)
-RID is usually safe under 10% |
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Term
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Definition
-24-48hours
-teaspoons
-low in fat
-high in carbs, protein and secretory IgA |
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Term
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Definition
-beginning of feeding
-oz
-low in fat
-high in volume |
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Term
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Definition
-end of feeding
-higher in fat |
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Term
| Different drugs are absorbed differently in different milks in the breastfeeding process: T or F? |
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Definition
| True, sampling data is not easily correlated with this due to the collection of samples being at different stages of the feeding process. |
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Term
| Best resource for medication safety during lactation |
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Definition
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Term
| Is codeine safe during lactation? |
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Definition
NO!!! Even though RID is <1.4% (less than 10)
-codeine is a precursor of morphine--2005 baby died of morphine toxicity |
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Term
| Is it okay for lactating mothers to give wait a few hours after taking their medication to nurse to avoid drug meeting the maximum concentration that could be passed on to the infant? |
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Definition
-No, peak concetrations of drug can be met 2 hours after taking the drug! The peak is unpredictable!
-Also note that outliers in RIDs may be above the 10% cut-off, but are still safer when considering that the infant plasma levels measured are usually lower |
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Term
| Infant age affects the types of metabolizing enzymes present? T or F? |
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Definition
| True, CYP450 for example is only present for about 24 hours and other enzymes develop thereafter with organ development= this changes the ability to metabolize drugs! |
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Term
| Can sertraline be taken during lactation? |
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Definition
-Yes, little risk of withdrawal effects when some is lost in breastmilk
-since the baby has already been exposed, they have a lower risk of poor neonatal adaptation than if they were not exposed |
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