OTC - Allergic Rhinitis

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OTC - Allergic Rhinitis
2011-08-22 02:15:53
OTC Allergic Rhinitis

OTC - Allergic Rhinitis
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  1. Etiology of Allergic Rhinitis
    Allergic rhinitis results from exposure to perennial or seasonal allergens, which lead to the development of nasal symptoms
  2. Pathophysiology of Allergic Rhinitis
    The pathophysiology of allergic rhinitis is complex, involving numerous mediators (primarily histamine) and cell types (mast cells).
  3. Clinical presentation of allergic rhinitis
    • Nasal: congestion, rhinorrhea, nasal pruritis, sneezing, & postnasal drip
    • Ocular: itching, lacrimation, redness, & irritation
    • General: HA, malaise, mood swings, and irritability
  4. Non-pharmacological treatment of allergic rhinitis
    • Limit outside exposure during periods of high pollen
    • Avoid indoor & outdoor mold
    • Avoid dust, especially in the bedroom
    • Avoid pet dander, especially cats
  5. Pharmacotherapy for mild allergies
    antihistamines PRN
  6. Pharmacotherapy for moderate allergies
    antihistamine + decongestant
  7. Pharmacotherapy for chronic allergies
    non-sedating antihistamine PRN + cromolyn sodium (Nasalcrom) nasal spray
  8. 1st-Generation antihistamine
    • chlorpheniramine (Chlor-Trimeton)
    • brompheniramine (Lodrane)
    • diphenhydramine (Benadryl)
  9. 2nd-Generation antihistamines
    • clemastine (Tavist)
    • cetirizine (Zyrtec)
    • loratidine (Claritin)
    • desloratidine (Clarinex)
    • fexofenadine (Allegra)
  10. Pharmacology of antihistamines: 1st-Generation vs. 2nd-Generation
    • Antihistamines are H1-receptor antagonists
    • 1st-gen: non-selective & sedating
    • 2nd-gen: peripherally selective, non-sedating, & no anticholinergic effects
  11. SE of antihistamines
    • sedation
    • anticholinergic effect (only for 1st-gen)
    • dry mouth
    • dry eyes
    • urinary retention
    • constipation
  12. Major concern about using antihistamine in children & elderly patients
    • paradoxical stimulation
    • decrease performance in school
    • death in children <2 y/o
  13. CI of antihistamines
    • Do not drive or operate heavy machinery
    • Avoid use with alcohol
    • Prostatic hyperplasia can occur
    • Narrow-angle glaucoma is possible
  14. Two (2) OTC oral decongestants
    • phenylephrine
    • pseudoephedrine (Sudafed)
  15. Pharmacology of oral decongestants
    • alpha-adrenergic agonist & vasoconstriction
    • constriction of blood vessels to decrease blood supply to nasal mucosa & decrease mucosal edema
    • no effect on histamine or allergy-mediated reaction
  16. Four (4) requirements of the 2005 Combat Methamphetamine Epidemic Act
    • 1. Pseudoephedrine must be kept either behind the counter or in a locked cabinet
    • 2. Quantity is limited to 3.6g/d & 9g/month per patient
    • 3. Pharmacist must maintain a logbook with the following information - product name, quantity sold, patient's name & address, & time and date sale
    • 4. Patients must show valid identification and sign a logbook
  17. Are oral decongestants safety to use long-term?
    These products are relatively safe with no dependence. They can be used long term.
  18. SE of oral decongestants
    • nervousness
    • irritability
    • restlessness
    • insomnia
    • incr HR
    • incr BP
    • irregular heart beat
    • palpitations
  19. Two (2) topical decongestant sprays
    • Short-acting: phenylephrine (Neo-Syneprine)
    • Longest-acting: oxymetazoline (Afrin)
  20. The use of topical decongestants > 3-5 days can cause what?
    Rhinitis medicamentosa (rebound congestion)
  21. This solution is very safe & good for use in infants & children. It can be used with oral decongestants.
    Nasal saline solution
  22. Pharmacology: mast cell stabilizer; prevention of the mast cells from releasing inflammatory mediators
    cromolyn sodium (Nasalcrom)
  23. Patient education of cromolyn sodium (Nasalcrom)
    Not efficacious if taken prn; must be taken on a scheduled basis (4-6 times a day)
  24. Three (3) analgesics for the treatment of pain, fever, & headaches associated with cold, flu, or allergies
    • 1. APAP
    • 2. Aspirin
    • 3. NSAIDs (ibuprofen, naproxen, ketoprofen)