Term
| After quitting smoking for 2 weeks to 3 months, what kind of benefits already occur? |
|
Definition
| Improved circulation, walking becomes easier, increase in lung function up to 30% |
|
|
Term
| When can you expect your lung cilia to regain normal function, increased ability to clear mucus, and decrease in coughing, fatigue, and shortness of breath after quitting smoking? |
|
Definition
| 1-9 months after quitting |
|
|
Term
| When does your risk for CHD decrease by half after quitting smoking? |
|
Definition
|
|
Term
| After 5 years of quitting smoking, what benefit do you gain? |
|
Definition
| Risk of stroke is reduced to that of people who have never smoked |
|
|
Term
| After 10 years of quitting, what benefits do you gain? |
|
Definition
| Lung cancer death rate halves, rick of cancer of mouth, throat, esophagus, bladder, kidney, and pancreas decrease |
|
|
Term
| When can you expect your risk of CHD to become similar to someone who has never smoked after quitting? |
|
Definition
|
|
Term
| Is tobacco use an acute condition? |
|
Definition
| No, it is a chronic disease |
|
|
Term
| What are the three targets of tobacco use behavior? |
|
Definition
Physical addiction - nicotine craving
Habit - behavior
Psychological dependence - perceived benefits |
|
|
Term
| Main difference between the 2000 and 2008 Clinical practice guidelines? |
|
Definition
In 2000, there were 5 FDA approved medications
In 2008, there are now 7 FDA approved medications and added a great emphasis on counseling, especially in regards to special populations |
|
|
Term
| What are the special populations of the 2008 Clinical Practice Guidelines? |
|
Definition
Pregnant patients
Light smokers
Adolescents (<18 yo)
Smokeless tobacco users
These populations should be encouraged to use counseling cessation rather than medications. |
|
|
Term
|
Definition
Ask
Advise
Assess
Assist
Arrange |
|
|
Term
|
Definition
This is when you decide if the patient is ready to quit.
If they are not, you would use the 5 R's, else move on with the remaining A's |
|
|
Term
|
Definition
Relevance
Risks
Rewards
Roadblocks
Repetition |
|
|
Term
| Name all the pharmacological tobacco cessation treatments. |
|
Definition
NRT (nicotine replacement therapies)gum, patch, lozenge, nasal spray, inhaler
Bupropion SR (Zyban)
Varenicline (Chantix) |
|
|
Term
| What are precautions and DIs in regards to NRTs? |
|
Definition
Precautions - patients with underlying cardiovascular conditions such as recent MIs
There are no significant DIs |
|
|
Term
| Nicotine gum - OTC dosages and administration/frequency? |
|
Definition
2mg or 4mg
2mg if less than one pack a day
4mg if greater than one pack a day
Gum must be used on a scheduled basis and not just chewed
Chew and park between cheek and gum for buccal absorption ELSE GI IRRITATION FROM SWALLOWING NICOTINE
Weeks 1-6 = 1 piece every 1-2 hours
Weeks 7-9 = 1 piece every 2-4 hours
Weeks 10-12 = 1 piece every 4-8 hours
Max 24/day
DO NOT EAT OR DRINK 15 MIN ESPECIALLY ACIDIC FOODS AND DRINKS |
|
|
Term
| Nicotine Lozenge - OTC dosages and administration/frequency? |
|
Definition
2mg - if patient can avoid smoking for 1 hour after waking up
4mg - if within 30 minutes
Don't chew!
Weeks 1-6 = 1 every 1-2 hours
Weeks 7-9 = 1 every 2-4 hours
Weeks 10-12 = 1 every 4-8 hours
Max = 20 per day
DO NOT EAT/DRINK 15 MIN BEFORE |
|
|
Term
| Nicotine CQ OTC - strengths and administration/frequency? |
|
Definition
21mg - Start here is 10+ cigarettes/day; 6 weeks (4 if generic brand)
14mg - 2 weeks (start here if <10 cigarettes /day)
7mg - 2 weeks
1 patch over a 24 hour duration on a new area each time that is CLEAN, DRY, NATURALLY HAIRLESS, and on the upper body/arm (do not use the same area for at least 1 week) |
|
|
Term
|
Definition
|
|
Term
| What is one odd side effect of the NRT patch? |
|
Definition
| Vivid dreams; can tell patients to remove before sleeping |
|
|
Term
| Nicotrol NS (NRT nasal spray) - dosages and administration/frequency? |
|
Definition
0.5 mg per spray
ONE DOSE = 1 mg nicotine; thus 1 spray in each nostril for a total of 2 sprays
1-2 doses every hour; max = 5 per hour
Use for 12 weeks; start with 8 doses daily for first 6-8 weeks and gradually taper off for an additional 2-4 weeks after the 3 months |
|
|
Term
| Nicotine inhaler prescription - dosing and administration/frequency? |
|
Definition
10mg cartridge that delivers 4mg of nicotine
Start with at least 6 cartridges (first 3-6 weeks) to a max of 16 per day while gradually reducing over the following 6-12 weeks
20 minutes of actual puffing that can be paused and restarted later (cartridge is good for 24 hours)
NO EATING/DRINKING 15 MIN BEFORE; inhale into back of throat or puff in SHORT breaths |
|
|
Term
| Bupropion SR - MOA, dosages, administration, warnings? |
|
Definition
MOA - affects levels of brain neurotransmitters such as dopamine and norepinephrine to decrease craving and withdrawal symptoms
START TREATMENT 1-2 WEEKS BEFORE QUIT DATE TO ENSURE THERAPEUTIC LEVELS ARE REACHED
150 mg orally in the morning for 3 days THEN 150 mg orally twice a day for 7-12 weeks
Common side effect - insomnia
Rare - seizure risk
Precaution/Contraindications - history of seizures, anorexia/bulimia; medications that lower seizure threshold |
|
|
Term
| Varenicline - MOA, dosages, administration, warnings? |
|
Definition
MOA - binds to alpha4beta2 neuronal nicotinic acetylcholine receptors to stimulate low activity while competing with nicotine to reduce craving and withdrawal symptoms
START TREATMENT 1 WEEK BEFORE QUIT DATE FOR NAUSEA AND INSOMNIA ADJUSTMENT
0.5 mg daily for first 3 days
0.5 bid for days 4-7
1 mg bid for 12 weeks
Potential neuropsychiatric symptoms |
|
|
Term
| Explain combination theory for tobacco cessation. |
|
Definition
Combination NRT
Using a long acting formulation (patch) with a short acting formulation (gum, lozenge, inhaler, spray) for sudden increase in withdrawal symptoms at peak times in the day
OR
Bupropion SR + nicotine patch |
|
|
Term
| Are there any exclusions for self care in regards to tobacco cessation? |
|
Definition
| NO; ALL patients should be provided with smoking cessation medications unless a contraindication or special population, which would be given counseling instead |
|
|
Term
|
Definition
| 5 days before ovulation and during day of ovulation = highest chance of pregnancy (5-45% chance) |
|
|
Term
| Name all the natural methods of contraception. |
|
Definition
AKA Natural family planning; typically used to TRY TO GET PREGNANT
All have 25% typical failure rate
Calendar method
Basal body temperature - drop in temperature 12-24 hours before ovulation; 0.4 degrees F rise at ovulation
Cervical mucus method - increase in amount and elasticity
Symptotermal method - use BBT and cervical methods together
Lactational Amenorrhea method - patient is postpartum and meets 3 requirements (not having menses yet, breastfeeding exclusively without pumps, within 6 months after birthing) |
|
|
Term
| Name the barrier methods. |
|
Definition
Male condom
Female condom
Sponge
Spermicides
Diaphragm and cervical caps |
|
|
Term
|
Definition
15% typical failure rate
Latex, polyurethane, spermicide-treated
Can break due to incorrect placement, reuse, OIL BASED OINTMENT, increase duration/frequency of intercourse, exposure to heat
3-5 years of shelf life |
|
|
Term
|
Definition
FC1 - polyurethrane (no longer in use)
FC2 - nitrile
21% typical failure rate
Pre-lubricated
Can be put in 8 hours before intercourse
Smaller ring inserted first to cover cervical opening; larger ring covers external vaginal mucosal area |
|
|
Term
|
Definition
Discontinued
Barrier, spermicide, and absorbs semen
16%(nulliparous)-32%(parous) typical failure rate
6 hours prior to intercourse; at least 6 hours after up to 24 hours
Toxic shock syndrome |
|
|
Term
|
Definition
Foams, gels, suppositories, and film
29% typical failure rate
Active ingredients = nonoxynol-9 (most common), octoxynol-9, and menfegol
use higher concentrations with diphragms and caps |
|
|
Term
|
Definition
Both require professional fitting
Diaphragm
Silicone device filled with spermicide
16% typical failure rate
Cervical cap
Thimble-shaped silicone device
16-32% failure rate depening on parous status |
|
|
Term
| Which contraceptives offer STD protection? |
|
Definition
| Only male and female condoms |
|
|
Term
| A female and male condom used together will decrease chances of pregnancy? |
|
Definition
| FALSE; using both will most likely cause breakage and increase chances of pregnancy |
|
|
Term
| What is the mechanism of emergency contraceptives that is the cause of much debate? |
|
Definition
| Interference with implantation because this depends on personal opinions of whether pregnancy begins at fertilization or at implantation |
|
|
Term
| What are the four options for EC? |
|
Definition
Plan B One-step (Levonorgestrel)
Ella (Ulipristal Acetate)
Yuzpe (Combination estrogen and progestin)
Copper IUD insertion |
|
|
Term
|
Definition
90% within 72 hours
Take one tablet (1.5mg of levonorgestrel) asap
CYP3A4 inducers (phenobarbital etc.) make reduce efficacy
Nausea and vomiting are common side effects |
|
|
Term
| Ella (Ulipristal Acetate)? |
|
Definition
90% within 120 hours
Delays ovulation by tricking body into thinking it already has
Take one 30 mg tablet asap
CYP3A4 inducers (phenobarbital and etc.) may reduce efficacy
Headache and nausea |
|
|
Term
|
Definition
75% within 72 hours
Dosing depends on brand name, but more than 1 pill
50% of patients get nausea (higher than other options) 25% vomiting |
|
|
Term
|
Definition
| Less than 0.1% failure rate within 7 days |
|
|
Term
| Points on counseling for EC? |
|
Definition
How to take
Expected side effects
98% of patients should have menses within 21 days of EC, else need to see doctor to rule out pregnancy
Patient education on contraceptive use and STDs |
|
|
Term
|
Definition
Only for 17+ year olds regardless of gender without prescription
Pharmacy Access Programs - in 9 states, anyone despite age can obtain without prescription
Pharmacist's right to refusal |
|
|
Term
|
Definition
|
|
Term
Majority of the flora in the vagina is?
Normal pH? |
|
Definition
|
|
Term
| What can cause vaginal infections? |
|
Definition
| Changes in flora, hormones, pH, sexual partners |
|
|
Term
| What are the three symptoms for differentiating vaginal infections? What is a good OTC device for self-testing? |
|
Definition
Color
Consistency
Odor
A vaginal pH self-testing device is good for testing |
|
|
Term
| Bacterial Vaginosis (BV)? Risk factors? Complications? |
|
Definition
33% of vaginal symptoms
Due to imbalance in normal flora
Polymicrobial
Risk factors
higher occurence in African americans
IUD use
Douching
Antibiotic use
Pregnancy
Tobacco use
30-50% of women are asymptomatic
Increase discharge that is watery, thin, and off-white
Fishy odor
Increased vaginal pH
Can itch, have inflammation, irritation
Complications include pelvic inflammatory disease, increased risk of HIV, UTIs, cervicitis, endometriosis, pregnancy issues |
|
|
Term
| Trichomoniasis? Risk factors? Complications? |
|
Definition
Considered STD
Caused by Trichomonas vaginalis
Risk factors include multiple sex partners or new partner, lack of barrier contraceptives, other STDS
50% are asymptomatic
Yellow-gray or green discharge that is foamy; may have fishy odor
A great amount of discharge (copious)
Increased pH
Dysuria
Irritation
Pruritis (itchiness)
Complications - 40% increased risk for low-birth weight babies if untreated; increased risk for tubal infertility; increased risk for HIV (secondary to infection) |
|
|
Term
| Vulvovaginal candidiasis (VVC; yeast infection)? Risk factors? Complications? |
|
Definition
Candida albicans is most common cause
Risk factors
African American women
Pregnancy
Oral contraceptives
Diabetes
Diet
Antibiotic use
IUD use
Use of barrier contraceptives
HIV
Sexual intercourse
GI colonization
Cottage-cheese discharge
Vaginal redness
Dysuria
Pruritis
LACK OF ODOR
Normal pH
Complications = increased risk of other infections |
|
|
Term
| VVC treatment pharmacologic options? Precautions? |
|
Definition
Imidazole antifungals (miconazole, butoconazole, clotrimazole, tloconazole) as vaginal creams, suppositories, and tablets
1, 3, or 7 day treatments
Well-tolerated, some burning, irritation, and itching
WARFARIN INTERACTION (can increase warfarin efficacy)
Cream can degrade condom so use a backup contraceptive |
|
|
Term
| VVC non-pharmacologic treatments? |
|
Definition
Dietary changes
Avoidance of non-absorbent clothing
Sitz (sodium bicarbonate) bath - 1 TSP in bath for at least 10 minutes
Modifications to drug therapy
Tea tree oil (200 mg vaginal suppository)
Gentian Violet (soak tampon and insert each night for 5 days)
Boric acid (FOR NON CANDIDA INFECTION; 600 mg vaginal capsule for 14 nights)
Yogurt |
|
|
Term
| Exclusions to self care for VVC self-care? |
|
Definition
<12 years
Pregnant
First time yeast infection
More than 3 infections in one year
Recent previous infection within 2 months
Breastfeeding and geriatric patients do no require special considerations
Treatments should have some effect by 3 days |
|
|
Term
| Is one imidazole superior to another in terms of treating VVC? |
|
Definition
| No, all are equally efficient |
|
|
Term
Common cold is usually caused by?
Symptoms?
Self-limiting? |
|
Definition
Rhinovirus
1-3 days after inoculation = water nasal secretions, sore throat, fever
2-5 days later = greater nasal symptoms and thicker secretions
4-5 days after = weaker nasal symptoms; 20% develop coughing
It is self-limiting within 7-14 days |
|
|
Term
| Differentiating the cold from other illnesses? |
|
Definition
Allergic rhinitis - itchy eyes, nose, and throat; more seasonal; possible sneezing
Ifluenza - severe muscle aches
Asthma/pneumonia/bronchitis - shortness of breath (REFER!)
Sinusitis - facial pain; tender sinuses |
|
|
Term
| Treatment goals of the common cold? |
|
Definition
NO CURE
Prevent transmission
Alleviate symptoms |
|
|
Term
| Exclusions for common cold self-care? |
|
Definition
Chronic conditions suspected or symptoms lasting longer than 14 days
Fever >101.5 degrees F
Chest pain
Shortness of breath
Worsening of symptoms with treatment
Underlying cardiopulmonary conditions such as COPD or asthma
Immunosuppresive conditions or medications
Frail, elderly patients
Infants younger than 9 months (children less than 4 years can be recommended NON-pharmacological treatments) |
|
|
Term
| Non-pharmacologic treatments for common cold? |
|
Definition
These should be main options
Fluid intake (tea with lemon or honey; chicken soup; broths)
Rest
Healthy diet
Increased humidification (humidifiers or vaporizers; okay for babies)
Topical aromatic products (not for children under 2 years)
Saline gargles for throat
Breathe Right strips
Saline nasal sprays/drops (okay for babies)
Neti-pot WITH STERILE WATER
Upright position (for babies)
Bulb syringe for cleaning nasal passageways (for babies) |
|
|
Term
| Cough/cold products for young children |
|
Definition
Pain/fever relievers such as acetaminophen and ibuprofen
Saline drops
Nasal suctioning
Humidifier/vaporizer
Honey (AT LEAST ONE YEARS OLD ELSE botulism) |
|
|
Term
| Can antibiotics help with the common cold? |
|
Definition
| NO; the common cold is a virus! |
|
|
Term
| Are antihistamines good for the common cold? |
|
Definition
|
|
Term
| Pharmacologic options for the common cold? |
|
Definition
Decongestants
Antihistamines - not really
Local anesthetics
Systemic analgesics
Antitussives
Protussives |
|
|
Term
| Decongestants? MOA, precautions? |
|
Definition
Alpha-adrenergic receptor stimulation to cause blood vessels to constrict, decreasing mucosal edema
Pseudoephedrine
Phenyleprhine
Similar side effects to adrenaline
Increased CV stimulation (increase BP, tachycardia, palpitations, arrhythmia), CNS stimulation (insomnia, tremor, anxiety, restlessness)
Topical versions can have some of the side effects
Drug interactions - MAOIs, antihypertensives, tricyclic antidepressants
Diseases - hypertension (usually okay if CONTROLLED), hyperthyroidism, diabetes (may increase glucose), heart disease, glaucoma, BPH, Raynaud's syndrome (blue fingers) |
|
|
Term
| Which is better, pseudoephedrine or phenylephrine? |
|
Definition
| Pseudoephedrine because of its good and consistent absorption and strong evidence of efficacy; topical forms may not be as affected |
|
|
Term
| Pseudoephdrine sales restrictions? |
|
Definition
Behind the counter
Need valid ID
Sign for purchase
Records maintained for 2 years
3.6 grams max per day
9 grams max per month |
|
|
Term
| Intranasal decongestant sprays/drops? |
|
Definition
Oxymetazoline - not for children under 6 unless doctor supervision, 2-3 sprays every 10-12 hours as needed
Xylometaoline (NOT IN US) - not recommended for children under 12; 2-3 sprays q8-10 hours prn
Phenylephrine - Not recommended for children under 6 unless supervised; 1-3 sprays q4-6 hours prn |
|
|
Term
| Intranasal decongestant inhalers? |
|
Definition
Propylhexedrine - 250 mg; 2 puffs q1-2 hours prn
Levmetamfetamine - 50mg; 2 puffs q2 hours prn
Same side effects at systemic versions |
|
|
Term
| Points of counseling for intranasal decongestants? |
|
Definition
Burning, stinging, sneezng, bad taste, drying of the nose, nosebleeds
RHINITIS MEDICAMENTOSA IF DECONGESTANT USED FOR MORE THAN 5 DAYS!! |
|
|
Term
| Are there any benefits from using antihistamines for the common cold? |
|
Definition
| The only one may be the sedating effect for first generation antihistamines, but little evidence |
|
|
Term
| Local anesthetics for common cold? |
|
Definition
Numb or alleviate paint through interruption for nerve conduction; ONLY SORE THROAT
lozenges, throat sprays, oral strips
ingredients include benzocaine, dyclonine, and phenol; may include menthol or camphor
take every 2-4 hours prn |
|
|
Term
| Systemic analgesics for common cold? |
|
Definition
Aspirin, acetaminophen, NSAIDs
Good for aches, fever, and sore throat caused by common cold
DO NOT USE ASPIRIN IN CHILDREN due to risk of Reye's syndrome |
|
|
Term
| Name the two combination cough/cold products. |
|
Definition
Dayquil - usually has decongestant
Nyquil - usually has sedating antihistamine |
|
|
Term
| Alternative therapies for common cold |
|
Definition
Zinc (Cold-Eze, Zicam) - antiviral effect; ONLY ONE DAY DECREASE IN DURATION OF SYMPTOMS
Vitamin C (Emergen-C) - NOT EFFECTIVE can cause kidney stones etc.
Echinacea - has immunostimulant effects; can cause allergies and etc.
AIRBORNE - NO EFFECT! |
|
|
Term
| 3 Classifications of cough? 2 types of cough? |
|
Definition
Acute - <3 weeks; usually due to viral illness
Subacute - 3-8 weeks; usually bacterial
Chronic - >8 weeks; usually postnasal drip; CAN BE CAUSED BY ACE INHIBITORS (20% OF PATIENTS) OR BETA-BLOCKERS
Productive - mucus, usually bacterial
Nonproductive - no mucus, dry, hacking, usually viral, GERD, cardiac disease, medications, NO PHYSIOLOGIC PURPOSE |
|
|
Term
| Exclusions for cough self-care |
|
Definition
Thick yellow sputum or green phlegm (bacterial cause)
101.5 degrees F
Unintended weight loss (cancer?)
Nighttime sweats (TB)
Hemoptysis
Underlying chronic condition such as asthma, COPD, CHF
Foreign object aspiration
Drug-induced cough
Cough >7 days
Cough that worsens with self-treatment or new symptoms
Children less than 4 years old UNLESS NON-PHARMACOLOGICAL |
|
|
Term
| Non-pharmacologic therapies for cold? |
|
Definition
Lozenges - reduce throat irritation
Humidification - soothe irritated airways
Hydration
Bulb syringe / Saline drops (good if child is less than 2 years)
Honey (not for children less than 1 year; 2-5 years = 1/2 TSP, 6-11 = 1; 12-18 = 2) |
|
|
Term
|
Definition
GOOD FOR DRY COUGHS NOT WET ONES
Codeine
Dextromethorphan
Diphenhydramine
Topical antitussives such as menthol, camphor, lozenges |
|
|
Term
|
Definition
MOA - weak opiate agonist; increase cough threshold, drying effect on respiratory tract mucosa
CONVERTED TO MORPHINE BY CYP2D6
Not much evidence for common cold cough
Schedule 5 thus max is 200mg/100 mL
NOT OTC in VT or NYS
NOT FOR CHILDREN!
Adults - max 60mg/dose, 360mg/day
DIs - CNS depressants; CYP2D6 inducers or inhibitors (can have genetic/ethnic variation) |
|
|
Term
| Dextromethorphan? Issues? |
|
Definition
Non-opioid, but related to codeine
ABUSE potential
Can also antagonize NMDA receptors for pain relief (uncommon usage)
10-20mg q4 hours or 30mg q6-8 hours; max daily dose is 120 mg
Side effects are drowsiness and dizziness
DIs - serotonergic effects (caution with antidepressants or serotonin OD), avoid with MAOIs
It is a 2D6 and 3A4 substrate |
|
|
Term
|
Definition
1st generation antihistamine
Not first line for cough, but approved
Increases cough threshold |
|
|
Term
|
Definition
Local
menthol, camphor, vick's vapor rub |
|
|
Term
|
Definition
Protussive
Helps cough up thick secretions
Side effects include N/V, dizziness, headache, rash, stomach pain, drowsiness
NO DRUG INTERACTIONS
200-400 mg q4 hours (max = 2.4 grams/day |
|
|
Term
| ACCP guidelines for coughs? |
|
Definition
If UACS cough - 1st genreation antihistamine and decongestant combination
If viral UTI - 1st generation / decongestant, naproxen, non-sedating antihistamines DO NOT WORK, codeine and dextromethorphan DO NOT WORK
If bronchitis etc. - short term relief with codeine or dextromethorphan |
|
|
Term
| Pregnant / lactation considerations for self-care cough treatment |
|
Definition
1st generation - Chlorpheniramine (B) if pregnant
Decongestant - avoid pseudoephedrine (C) during 1st trimester; usually okay for breastfeeding
Antitussive - dextromethorphan (C) okay during pregnancy, but consider risks and is okay for breastfeeding
Protussive - avoid gauifenesin (C) during 1st trimester; okay for breastfeeding |
|
|
Term
| Classification of allergic rhinitis? |
|
Definition
Intermittent if <4 days/week OR <4 weeks
Persistent if 4+ days/week or >4 weeks |
|
|
Term
| Exclusions for allegic rhinitis self-treatment? |
|
Definition
<12 years unless doctor confirms it is allergies
Pregnant or lactating (some options are available, but need to be referred)
Symptoms of nonallergic rhinitis, otitis media, sinusitis, bronchitis, or other infections
Symptoms of undiagnosed respiratory disorder
Symptoms worsen
Symptoms do not improve |
|
|
Term
| Non-pharmacologic therapies for allergic rhinitis? |
|
Definition
AVOID ALLERGEN EXPOSURE
Nasal wetting agents such as saline, PEG sprays or gels, propylene
Neti pots
Bulb syrine |
|
|
Term
| Pharmacologic therapy for allergic rhinitis? |
|
Definition
Antihistamines
Decongestants
Mast cell stabilizers |
|
|
Term
| Antihistamines for allergic rhinitis? |
|
Definition
Not really considered effective for congestion, but can treat itchiness or runny nose
Competes with histamine for H1 receptor; 1st generation is more lipophobic than 2nd generation thus sedating effect
Certirizine, although 2nd gen, has some sedation
1st gen = diphenhydramine (25-50mg q4-6 hours), doxylamine (10mg q4-6 hours), chlorpheniramine (4mg q4-6 hours), dimenhydrinate (actually for motion sickness; 50-100 mg q4-6 hours), clemastine (1.34mg BID)
2nd gen = fexofenadine (60mg BID or 180mg QD), loratadine (10mg QD), cetirizine (5-10mg QD) |
|
|
Term
| Do 1st gen antihistamines always have a sedative effect? |
|
Definition
| No, some people may become more active, especially children and older patients |
|
|
Term
| Anticholinergic side effects of antihistamines? |
|
Definition
ABCDS - anorexia, blurry vision, constipation, dry mouth, and sedation/stasis of urine
can't see, can't spit, can't pee, can't shit
sunlight sensitivity |
|
|
Term
| Antihistamines and older men? |
|
Definition
|
|
Term
| Antihistamine interactions? |
|
Definition
CNS depressants - increase sedation
MAOIs - many
Phenytoin - chlorpheniramine decreases phenytoin elmination
Erthyromycin, ketoconaole, cimetidine - increase loratadine concentration
Theophyline at >400mg - increase cetirizine concentrations
Juice - reduced absorption of fexofenadine |
|
|
Term
| Cetirizine versus levocetirizine? |
|
Definition
|
|
Term
| What can babies 6 months and older use as an antihistamine for allergic rhinitis? |
|
Definition
Cetirizine
Usually have to be at least 2 years for 2nd generation, 6 years for first generation |
|
|
Term
|
Definition
OTC if intranasal spray
mast cell stabilizer
1 spray in each nostril 3-6 times a day
can be used in children at least 2yo
NO DRUG INTERACTIONS |
|
|
Term
| Allergic rhinitis treatment options for pregnant women? |
|
Definition
Cromolyn sodium = 1st line, B
Chlorpheniramine = 1st line, B
Pseudoephedrine = avoid during 1st trimester
Nasal decongestant = oxymetazoline C |
|
|
Term
| Allergic rhinitis treatment options for breastfeeding? |
|
Definition
Cromolyn sodium - probably safe
Antihistamines - sedating = usually no; loratadine may be antihistamine of choice
Pseudoephedrine = ok
Nasal decongestant over oral decongestants |
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