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PHARM CH 24
| Question | Answer |
|---|---|
| T lymphocytes- CD4+, CD8+, T cells | Immune system treats allergen as an invader and produces antibodies: ➢ Engineered by: |
| Antibodies (IgE) | formed during immune system response to allergen - attach to mast cells, which contain histamine cause wheezing, rash, runny nose, itching |
| localized allergix reaction | affect nose, eyes, skin |
| generalized allergic reactions | involve multple systems widespread itching, hives, or systemic responses |
| Allergic Shiners | dark circles under the eyes. Caused by increased blood flow and congestion near the sinuses due to chronic nasal inflammation. They are a visible sign of allergic rhinitis |
| Allergic Salute | a crease across the bridge of the nose. Caused by persistent upward rubbing of the nose with the palm or fingers to relieve itching or congestion. Common in children with allergies and considered a classic physical marker of allergic rhinitis |
| Urticaria | HIVES - Causes ➢ insect bite, drug or food allergy, or injection of allergen extracts (allergy shots). |
| Urticaria treatment | ➢ Antihistamines ➢ Glucocorticosteroids |
| drugs ending in -ine | antihistamines |
| : diphenhydramine, cetirizine, loratadine. | antihistamines - block histamine to reduce itching and swelling |
| Glucocorticosteroids | suppress inflammation Typically prescribed for short courses to avoid side effects Reduce the number of inflammatory cells: ➢ Reduction in mucus and swelling |
| Acute pharyngeal or laryngeal angioedema | swelling of throat (pharynx) or voice box larynx (larynx) blocks airflow/difficult breathing |
| treatment for pharyngeal or laryngeal angioedema | Short-Acting Beta2-Adrenergic Agonists - (albuterol, levalbuterol) |
| Short-Acting Beta2-Adrenergic Agonists MOA | Activates adenyl cyclase → increases cyclic AMP → relaxes smooth muscle. Results in bronchodilation, |
| Allergic Rhinitis occurs seasonly due to | presence of memory CD4+ T cells: ➢ Allergen specific antibodies (tree, grass, pollen) |
| Conjunctivitis medicamentosa | rebound redness and congestion from decongestants |
| H1 Receptor Antagonists : Ethanolamines Class | ➢ Diphenhydramine ➢ Clemastine |
| H1 Receptor Antagonists : Alkylamines Class | ➢ Brompheniramine ➢ Chlorpheniramine |
| H1 Receptor Antagonists : Piperazine class | Cetirizine |
| First generation antihstamines | ➢ Diphenhydramine, chlorpheniramine, hydroxyzine, brompheniramine |
| second generation antihistamines | ➢ Cetirizine, levocetirizine, loratadine, desloratadine, and fexofenadine |
| Hydroxyzine metabolizes to | Cetirizine |
| H1 Receptor Antagonists: MOA | Prevents histamine binding to H1 receptor sites |
| antihistamine Precautions | caution in ➢ men with prostate disease ➢ Women who are breastfeeding Not recommended for children under 2 years |
| Avoid orange, grapefruit, and apple juice | fexofenadine |
| ends in -one and -ide Beclomethasone Budesonide Flunisolide Fluticasone propionate and fluticasone furoate Triamcinolone Mometasone | Glucocorticosteroids |
| Glucocorticosteroids: Adverse Reactions | Nasal burning or stinging Throat irritation Nose bleed Nasal Candida infection |
| Mast Cell Stabilizers | Cromolyn sodium (Opticrom, Rhinaris) Nedocromil (Alocril) |
| Mast Cell Stabilizers MOA | Reduces reactivity to allergens: ➢ Decreases mast cell degranulation ➢ Decrease release of inflammatory substances Not useful for acute symptoms |
| Mast Cell Stabilizers: Adverse Reactions | Unpleasant taste Dry throat, cough Difficulty breathing Headache Nose bleeds Runny nose, sneezing Stinging, burning, or irritation inside the nose |
| Immunotherapy (ALLERGY SHOTS) | For perennial or seasonal allergies ➢ Reduce the levels of IgE ➢ Stimulate the production of IgG |
| IgG antibodies | “blocking antibodies.” They bind allergens before IgE can, preventing mast cell activation and histamine release. |
| IgE antibodies | responsible for allergic reactions. |
| angioedema | swelling beneath the skin or mucosa caused by fluid leaking into tissues |
| Treatment of Angioedema near the airways | Intubation- tube is inserted into the trachea (windpipe) through the mouth or nose. The tube keeps the airway open and allows oxygen to be delivered directly to the lungs. |
| Treatment of Angioedema With anaphylaxis | Epinephrine, O2 and IV fluids |
| Treatment of Angioedema with acture allergic reactions | Antihistamines or glucocorticoids |
| Anaphylaxis | Caused by the sudden release of mast cell mediators ➢ Immunoglobulin E (IgE)-mediated reactions Severity ranges from self-limiting mild to fatal death |
| treatment for anaphylaxis | Intramuscular (IM) injection of epinephrine and PRN (EpiPen or IV Epinephrine) |
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