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NRSG Pharm CH 39

Allergic Rhinitis, cold

QuestionAnswer
URT immunologic defenses Ciliated epithelium, nasal mucous, mast cells lining nasal mucosa
Allergic Rhinitis Inflam. of nasal mucosa, exposure to antigen causes histamine release 1. Exposure to antigen (pollen). 2> Plasma cell release iGE antibodies. 3>IgE binds to mast. 4> antigen (pollen) binds to IgE antibodies, causes histamine release. 5>Histamine -> s/sx
Allergic Rhinitis Preventers Antihistamines, IN corticosteroids, mast cell stabalizers
Allergic Rhinitis Relievers Oral / IN decongestants, usually sympathomimetic
Histamine Chem mediator of inflammatory response
H1 Smooth muscle of vascular system and bronchial tree, many of s/s of allergic rhinitis
H2 Found in stomach, responsible for peptic ulcers
Diphehydramine (Benadryl) classes, mech Drug for allergies, H1 receptor antagonist; antihistamine
Diphenhydramine (Benadryl) uses Minor s/sx of allergy, common cold, sneezing, runny nose, motion sickness, insomnia often OTC combined w/ analgesic, decongestant, expectorant - topic rashes, IV for severe
Diphenhydramine (benadryl) adverse Significant drowsiness, paradoxical CNS stim and excitability. Anticholinergic effects - dry mouth, tachy, mild hypo
IN corticosteroids Choice for allergic rhinitis, high efficacy, good safety, admin 2-3 wk prior to exposure, dec sec of inflammatory mediators, reduce edema, mild vasoconstriction
fluticasone (flonase) classes, mech Allergic rhinitis, asthma, corticosteroid. IN corticosteroids for seasonal. Also available inhalation and topical - dec local inflam in nasal passage -> red. nasal stuffiness
Inhalation corticosteroid to reduce bronchial inflammation for asthma Flovent
fluticasone (Flonase) side/adverse IN, few adverse. Swallowing large amounts = inc potential for systemic corticosteroid adverse. IN nasal = irritation, epistaxis
IN decongestants More efficacious, only 3-5 days for rebound, OTB sprays and drops. Local action in min, few systemic
Oral decongestants More systemic effects, slower response time, less effective at severe congestion, often combined w/ antihistamine prep
oxymetazoline (Afrin) classes, mech Nasal decongestant, sympathomimetic. Stim alpha-adrenergic receptors in SNS -> vasoconstrict arterioles in nasal, drying mucous membranes - relief in minutes, lasts up to 10 hr
oxymetazoline (Afrin) adverse Rebound congestion if used more than 3-5 days, minor stinging and dryness in nasal mucosa
Antitussives Inhibit cough, dextromethorphan (Delsym, Robitussin DM)
Opioids to inhibit severe cough Codeine
Expectorants Inhibit mucous prod, guaifenesin (Mucinex)
Mucolytics Loosen bronchial secretions, dornase alfa (Pulmonzyme)
Dextromethorphan (Delsym, Robitussin DM) classes, mech Antitussive, centrally acting antitussive Nonopioid drug acts in medulla, lacks analgesic and euphoric effects, does not produce dependance In many OTC cold and flu prep
Dextromethorphan (Delsym, Robitussin DM) onset rapid onset, 15-30 min. not relieved after several days should notify healthcare provider
Dextromethorphan (Delsym, Robitussin DM) side/adverse Therapeutic = rare. Dizziness, drowsiness, GI upset. Contraindicated in chronic cough r/t excessive bronchial secretions ex asthma, smoking, emphysema. Do not want to suppress cough in these pt
Created by: kmulla
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