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What is Allergic Rhinitis?
Highly prevalent allergen-induced upper airway inflammatory disease
Seasonal
Perennial (year-round)
Most common atopic (susceptible to developing allergies) disease in the US
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What are the Risk Factors of Allergic Rhinitis?
- Increased age
- Early food exposure
- Heavy maternal smoking
- Indoor allergen exposure
- Parental Allergic Disorder
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What is the Treatment for Allergic Rhinitis?
- A cure does not exist
- The goal is to lessen symptoms & increase the patient's quality of life
- Implement lifestyle changes
- Pharmacologic Therapy
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What are H-1 Antihistamines?
- H-1 antagonists, also called inverse agonists:
- -bind to and stabilize the H-1 receptor
- -Inhibit mast cell and basophil mediator release
- -Reduces sneezing, itching, ocular irritation
Reduces or eliminates the effects of Histamine (recall Histamine released during an allergic reaction)
Anti-cholinergic effects
First generation drugs (more adverse effects)
- Second-generation drugs (less adverse effects)
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What are some examples of First-generation Anti-histamines?
- Diphenhydramine
- Meclizine
- Hydroxyzine
- Promethazine
- Brompheniramine
- Chlorpheniramine
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What are characteristics of First-generation Anti-histamines?
- short half-life (dosed q 4-6 hours)
- Crosses the blood brain barrier
- CNS adverse effects:
- dry mouth
- dry eyes
- constipation
- urinary retention
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What are some examples of Second-generation Anti-histamines?
- Fexofenadine
- Loratadine
- Desloratadine
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What are characteristics of Second-generation Anti-histamines?
- Non-sedating
- Poor penetration of blood brain barrier
- Decreased CNS effects
- Some OTC products
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What are the indications of Anti-histamines?
allergic rhinitis
allergic conjunctivitis
allergic dermatological conditions (contact dermatitis)
urticaria (hives)
angioedema
pruritus (atopic dermatitis, insect bites)
anaphylactic or anaphylactoid reactions
nausea and vomiting
sedation (first-generation H1-antihistamines)
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Savannah is a 5 year old child who suffers from allergic rhinitis. Her Dad comes to your pharmacy asking how much Benadryl Savannah can take. She weighs 43 pounds and has no fever. You have Benadryl liquid on the shelf dosed as 6.25 mg/teaspoonful.
Recall the dose is 5 mg/kg/DAY for Benadryl, and it is dosed every 4 to 6 hours.
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What is the point of coughing?
- Keeps airways clear
- Dry vs. productive cough
- Acute
- Chronic
- Only a symptom...NOT a disease
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What may cause a cough?
Allergies and asthma
Lung infections (pneumonia or acute bronchitis)
Chronic obstructive pulmonary disease (COPD)
Sinusitis leading to post-nasal drip
Lung disease
Gastroesophageal reflux disease (GERD)
Cigarette smoking
Exposure to secondhand smoke
Exposure to air pollutants
ACE inhibitors
Croup
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What agents are used to treat cough?
Mucolytics (breaks down mucus)
- Expectorants (helps bring up mucus and other
- material from the lungs, bronchi, and trachea)
Suppressants
Decongestants
Antihistamines
Pain relievers
Others
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Warning! Cough Medicines are dangerous to children!
FDA Recommendation: OTC Cough and Cold Medications Should Not Be Used in Infants and Children < 2 Years of Age -January, 2008
FDA Recommendation: do not use in children <4 years of age UNLESS under guidance of health care professional -October 2008
CDC: ~ 7,000 children under age 11 go to the ER each year after taking cough and cold medicines
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What other drug is found in many cough products?
Codeine (and derivatives)
Narcotic, Opioid
- Affects of Codeine:
- binds to opiate receptors in the CNS
- causes cough suppression by direct central action in the medulla
- produces generalized CNS depression
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diphenhydramine
Brand name(s): Benadryl
Drug Class: Antihistamine (first generation)
Indications for use: relief of allergic symptoms; for moderate or severe allergic reaction
Adverse Effects: drowsiness, dizziness, dry mouth
- Patient Education:
- -Enters breast milk
- -May cause drowsiness, fatigue, diarrhea
Children's Dosing: 5 mg/kg/day (divided doses q 6-8 hrs
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meclizine
Brand name(s):
Drug Class: Antihistmaine (first generation)
Indications for use:
Adverse Effects:
Patient Education:
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hydroxyzine
Brand name(s):
Drug Class: Antihistamine (first generation)
Indications for use:
Adverse Effects:
Patient Education:
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promethazine
Brand name(s): Phenergan (also available with Codeine)
Drug Class: Antihistamine (first generation), Antiemetic, Sedative
Available Formulations: Table, syrup, suppository, injection
Indications for use: allergic reactions, sedative, motion sickness, post-operative pain
Adverse Effects: drowsiness, dizziness, dry mouth
- Patient Education:
- -Enters breast milk
- -May cause drowsiness, fatigue, diarrhea
- Other information:
- -Refrigerate suppositories
- -onset of action for suppositories: 15-30 mins
- -not for children < 2 years
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fexofenadine
Brand name(s):
Drug Class: Antihistamine (second generation)
Available formulations:
Indications for use:
Adverse Effects:
Patient Education:
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desloratadine
Brand name(s):
Drug Class: Antihistamine (second generation)
Available formulations:
Indications for use:
Adverse Effects:
Patient Education:
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guaifenesin
Brand name(s):
Drug Class: Expectorant
Indications for use: loosens phlegm, increases lubrication of lungs, allow for a productive cough and decreased chest congestion
Adverse Effects:
-Drink water! - Other Information:
-comes in many dosage forms
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Chlorpheniramine & Hydrocodone
Brand name(s): Tussionex
Drug Class: Antitussive
Indications for use: relief of cough
Adverse Effects: drowsiness, constipation
- Patient Education:
- -SHAKE WELL!
- -Avoid alcohol
- -could be habit forming
- -not for children < 6 years old
- -not for asthmatics
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benzonotate
Brand name(s): Tessalon or Tessalon Perles
Drug Class: Antitussive
Indications for use: relief of cough
Adverse Effects: headache, constipation, nausea
- Patient Education:
- -*LIFE THREATENING RXN with patients allergic to tetracaine or procaine
- -Do not crush, chew or dissolve
- -not for children < 10 years old
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codeine (and derivatives)
Brand name(s):
Drug Class: Narcotic; Opiod
Indications for use: found in many cough products
Adverse Effects:
Patient Education:
- Other Information:
- -Binds to opiate receptors in the CNS
- -causes cough suppression by direct central action in the medulla
- -produces generalized CNS depression
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