Therapeutics: Allergic Rhinitis

  1. What mediates Allergic rhinitis?
    • Immune IgE mediated
    • Genetically predisposed
    • Inhaled allergens
    • Delayed inflammatory process
  2. What are the Drug therapy general types for Allergic Rhinitis?
    Symptom treatment or Prevention
  3. What are the general types of allergic rhinitis?
    Seasonal and Perennial
  4. When does Seasonal allergic rhinitis usually occur?
    • Generally/Usually spring – Fall
    • Allergens usually found OUTDOORS
  5. What type of allergic rhinitis causative agent is found in Spring?
    Tree pollens
  6. What type of allergic rhinitis causative agent is found in Late Spring – Summer?
    Grass Pollens
  7. What type of allergic rhinitis causative agent is found in Late summer – Fall?
    Weed pollens
  8. When does Perennial allergic rhinitis usually occur?
    • All year
    • Allergens found INDOORS
  9. What usually causes Perennial allergic rhinitis?
    Dust, Dander, animal excretions, Cockroaches, Chemicals, Mold spores
  10. What are the Early stage Symptoms of Allergic rhinitis?
    Rhinorrhea, Sneezing, Congestions, Itchy/water eyes, ears, nose and palate
  11. What general type of drugs would you use for Early stage allergic rhinitis?
    Antihistamines to Dry the secretions – Use drops for only itchy eyes
  12. What are the Late stage Symptoms of Allergic rhinitis?
    Congestions, Hyperresponsive reactions – Inflammation worsens these symtoms
  13. What general type of drugs would you use for Late stage allergic rhinitis?
    Use Decongestants, NSAIDs or Anti-inflammatory sprays
  14. When should you use Systemic route for allergic rhinitis treatment?
    Multiple symptoms
  15. What are the Diagnosis techniques for allergic rhinitis?
    • Epicutaneous (prick or puncture)
    • Intradermal (known amount under dermis)
    • Nasal challenge (inhale), Repeated exposure
  16. What is the 1st type of Treatment you should try for allergic rhinitis?
    • Non-pharmacologic =
    • Avoidance
    • doors/windows closed
    • air conditioning/dehumidifier
    • pets outside
    • dust free bedding casing (not shown effective)
  17. What is the 2nd type of Treatment you should try for allergic rhinitis?
    • Good = Antihistamines, Decongestatns, Nasal steroids, Mast Cell stabilizers, Leukotriene inhibitors, Allergy desensitization
    • Fair= Anti-cholinergics or Surgery (mostly used for broken nose)
  18. When are Antihistamines a good choice?
    Need to Dry secretions in Early phase
  19. Which 2nd gen Antihistamines may cause drowsiness?
    Cetirizine and leveocetirizine cross BBB and may cause sedation
  20. What are the 1st gen Antihistamines?
    Chlorpheniramines, Diphenhydramine, Clemastine
  21. What are the 2nd gen Antihistamines?
    Fexofenadine (allegra)*, Loratadine (Claratin)*, Desloratadine (Clarinex), Cetirizine (Zyrtec)*, Levocetirizine (Xyzal) * = OTC
  22. What are the Decongestants for allergic rhinitis?
    • Topical (Neosnephrine) or systemic Phenylephrine
    • Systemic Pseudophedrine
  23. Why can’t you use Topical Neosnephrine (Phenylephrine) more than 3-5 days?
    • Any more causes Rhinitis Medicamentosa
    • Wash out for 24-48 hours before restarting
  24. What is the efficacy of Systemic Phenylephrine ?
    Doesn’t work
  25. When should you use Systemic Pseudophedrine cautiously?
    • BP at dose >240 mg/day
    • Don’t use if uncontrolled HTN, previous MI, stroke, CV issue
    • Use if: BP controlled by drugs or diet
  26. What are Coticosteroids mostly used for?
    Mostly for perennial (can be used for seasonal)
  27. What is the MOA of corticosteroids?
    Rreduce inflammation, neutrophil chemotaxis, edema, mast cell mediated late phase. Mild vasoconstriction
  28. How long does it take for Corticosteroids to become effective?
    Take days to week to work = Prevention
  29. What are the PO corticosteroids?
    Budesonide, Ciclesonide, Flunisolide, Fluticasone propionate, Mometaseon furoate
  30. What are the aerosol corticosteroids?
    Ciclesonide (Zetonna) and Beclomethasone (Qnasl) = less cheap
  31. What is the MOA of Leukotriene Modifiers?
    Block leukotrieines from arachadonic acid cascade
  32. What is the efficacy of Leukotriene modifiers?
    • Inferior to corticosteroids and antihistamines – may use as add-on
    • Good for asthmatics with allergic rhinitis
  33. What are the alternate methods for treating Allergic Rhinitis?
    • Saline washes (Neti-Pot) – easy and wired sensation
    • Cromolyn Sodium – Delayed onset, start before season starts, OTC
    • Ipratropium Bromide = antisecretory – not very effective = use others first
  34. What are the Ocular therapies?
    • Antihistmaines: Azelastine (Optivar), Olopatadine (Pantanol), Ketotifen (Zaditor)
    • Mast Cell Stabilizers: Lodoxamide (Alomide), Cromolyn (Opticrom), Nedocromil (Alocril)
Card Set
Therapeutics: Allergic Rhinitis
Therapeutics: Allergic Rhinitis