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49 Cards in this Set
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Often occurs with allergic rhinitis
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Asthma (38%)
Eczema Allergic Conjunctivitis Family history (50% with one parent, 66% with 2) |
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Initial Exposure: What happens clinically
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Sneezing, Stuffy Nose, Runny Nose, Itching
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Re-Exposure:
Early Phase |
Within Minutes
Lasts up to 90 mins Mediators: Histamine (causes itching/nasal congestion) Kinins/PG/Leukotrienes Mast Cells--Mucosal Inflammation |
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Late PHase
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4-8 hrs after initial exposure
Inflammatory response Chronic Symptoms (primarily congestion) Lasts for hours-days |
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Clinical Presentation if Allergic Rhinitis
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CLEAR Rhinorrhea
Watery Eyes Postnasal drip, cough, irritability Itching/Sneezing--More Seasonal Stuffy Nose--More Perennial |
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Seasonal AR
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Repetitive/Predictable
Peaks: Spring/Fall |
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Perennial AR
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All year round, no cyclic pattern
Triggers: pets, dander, cigarette smoke, etc |
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Non-Pharmacologic Therapy
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Avoid exposure
Wash pets/stuffed animals often Change carpet to hardwood/tiles Keep windows shut; AC on Dehumidifier/HEPA filter Encase pillows/mattresses |
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Oral Antihistamines
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1st line (2nd gen) for mild, intermittent symptoms
prevents symptoms more than relieves symptoms **Perennial: take qD **Seasonal: take 1-2 hrs before allergy exposure Side Effects: Dry mouth, drowsiness, Urinary retention/Constipation/GI Upset C/I: Glaucoma, BPH, nursing mothers, abnormal peristalsis **May take several days to show efficacy **Avoid Driving/operating machinery **Children/Elderly: paridoxical excitation |
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Intranasal antihistamines
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ONLY FOR SEASONAL AR
Inc Cost, but faster onset of action Side Effects: Drowsiness, Bitter taste, Nasal burning/dry, Headache |
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Brompheniramine
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Dimetane
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1st Generation PO
OTC 4mg q6h Inc Anticholinergic activity |
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Chlorpheniramine
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Chlor-Trimenton
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1st Generation PO
OTC 4mg q6h Inc Anticholinergic Activity **Least sedating of 1st gen |
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Clemastine
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Tavist
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1st Generation PO
OTC 1.34mg q8h Inc Anticholinergic Activity |
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Diphenhydramine
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Benadryl
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1st Generation PO
OTC 12.5mg-50mg q4-6hr Inc Anticholinergic Actvity |
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Loratidine
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Claritin, Alavert
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2nd Generation PO
OTC 10mg qd Less sedation; Less Antichol. activity |
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Cetirizine
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Zyrtec
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2nd Generation PO
OTC 5-10mg qd Most sedating 2nd Generation Less Antichol activity |
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Desloratidine
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Clarinex
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2nd Generation PO
RX 10mg qd Less sedation/less antichol |
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Fexofenadine
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Allegra
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2nd Gen PO
RX 60 BID or 180qd Less sedation/less antichol |
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Levocertrizine
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Xyzal
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2nd Gen PO
RX 5mg qd Less sedation/Less antichol activity |
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Azelastine
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Astelin/Astepro/optivar ophthalmic solution
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Intransal Spray
RX 1-2 sprays (137mcg) EN BID Good for PRN use; onset=30mins |
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Olopatadine
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Patanase
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Intranasal Spray
RX 2 sprays (665mcg) EN BID Good for PRN; onset = 30 mins |
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Oral Decongestants
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Nasal Congestion ONLY
Not for long term use (PRN) MOA: alpha agonist; produce vasoconstriction in nasal mucosa S/E: CNS Stimulation Hypertension C/I: hyperthyroidism, HTN, CAD, BPH, DM |
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Intranasal Decongestant
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Nasal Congestion ONLY
Not for long term use (PRN) MOA: alpha agonist; produce vasoconstriction in nasal mucosa S/E: Burning/Stinging/Dryness/Irritation; if used for more than 3 days: REBOUND CONGESTION C/I: hyperthyroidism, HTN, CAD, BPH, DM |
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Oral Decongestant Vs. Intranasal Decongestant
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Intranasal: no systemic absorption
Faster Onset of action |
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How to treat Rebound Congestion
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Discontinue
Use Saline Drops if needed Start nasal corticosteroids Oral steroids prn |
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Phenylephrine
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Sudafed PE
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OTC Oral Decongestant
Less effective than pseudoephedirne First pass metabolism in gut/liver 120mg q12h |
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Pseudoephedrine
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Sudafed
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OTC oral decongestant
More effective than SudafedPE 30-60 mg q4-6h |
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Phenylephrine
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Neo-synephrine
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Nasal Decongestant
OTC 1-3 drops/sprays per nostril q4-6 hr (<3days) |
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Oxymethazoline
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Afrin
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Nasal Decongestant
OTC 2-3 sprays per nostril q12 hr (<3days) |
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Intranasal Corticosteroids
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NOT FOR OCULAR SYMPTOMS
First line for moderate-severe or persistent symptoms Perennial Allergic Rhinitis: take all year Seasonal: 2-4 weeks prior and after allergy season S/E: not significant/rare: H/A, Cough, Nosebleeds, Nasal Irritation, Burning, Stinging, Dryness, Nasal Septualperforation optimal effect in 2-3 weeks (maximal benefit: 6-8 months) May use decongestant first to reduce nasal blockage |
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Intranasal Corticosteroids MOA
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Decrease formation/release of inflammatory mediators from mast cells
Decrease # of inflammatory cells Exert direct local anti-inflam effect |
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Ciclesonide
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Omnaris
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Inhaled Corticosteroids QD
Use lowest effect as possible Peds dosing <5/6years old not established |
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Fluticasone Furoate
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Veramyst
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Inhaled Corticosteroids QD
Use lowest effect as possible Nasal steroids with indications for 2 years old |
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Fluticasone Propionate
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Flonase
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Inhaled Corticosteroids BID
Use lowest effect as possible Peds dosing <5/6years old not established |
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Mometasone
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Nasonex
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Inhaled Corticosteroids QD
Use lowest effect as possible Peds dosing <5/6years old not established |
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Cromolyn
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Nasalcrom
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Nasal Spray OTC
Less effective; not for ocular Use up to 1 week before exposure Stabilize mast cells/pervent mediator release Onset: at least 2 weeks But good Safety profile Dosing for 2 years and older |
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Ophthalmic Agents
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Use: Acute allergic conjuctivitis: OTC
Seasonal/Perennial allergic conjunctivitis: RX Ophth agents |
Side Effects: HA, Eye irritation, Dry eyes, Visual distubances
Counseling: Keep eye open, pull lower lid down, place drop there and look up to prevent draining Wait 5-15 mins in between medications |
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Naphazoline/Pheniramine
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Naphcon-A
Opcon-A Ocuhist Privine |
OTC Ophthalmic Agent
do not exceed 3 days For acute conjunctivitis |
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Ketotifen
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Zaditor
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OTC Ophthalmic Agent
Antihistamine and mast cell stabilizer |
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Olopatadine
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Patanol
Pataday |
RX Ophthalmic Agent
Antihistamine and mast cell stabilizer |
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Emedastine
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Emadine
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RX Ophthalmic Agent
Antihistamine |
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Montelukast
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Singulair
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Leukotriene Receptor Antagonist
SEASONAL AR RX only; 10mg qD |
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Omalizumab
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Xolair
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Recombinate humanized anti-IgE comonclonal antibody
Injectable (SC) treatment VERY EXPENSIVE low rist of cancer |
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What to use with: Mild to Moderate Allergic Rhinitis
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Oral Antihistamines (2nd Gen)
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What to use with: Severe Allergic Rhinitis
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Intranasal Corticosteroids
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Congestion
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Oral or topical decongestant
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What to use for:
Acute allergic conjunctivitis |
Ocular Agent
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What do you use for:
Second-Line Treatment |
Singulair, Nasal Cromlyn, Xolair
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What to use for:
Treatment when ALL other treatments are ineffective |
Immunotherapy
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