Allergic Rhinitis

Front 1

Intranasal corticosteroids

Back 1

1st line for chronic, moderate to severe rhinitis

Triamcinolone (Nasacort), budesonide (Rhinocort), fluticasone(Flonase)- OTC

Warning- adrenal suppression, delayed wound healing, lower growth in kids, infection risk, eye problems

Shake bottles before use and discard after approx doses

Front 2

Beclomethasone

Back 2

Beconase AQ, Qnasi

For >6yo

1-2 sprays BID

Front 3

Budesonide

Back 3

Rhinocort Aqua, OTC

For >6yo

1 spray daily

Preferred for pregnancy (B)

Front 4

Ciclesonide

Back 4

Omnaris, Zetonna

For >6yo

2 sprays daily, 1 spray daily

Front 5

Fluticasone

Back 5

Flonase, OTC, Veramyst

+azelastine-Dymista

Veramist >2 yo, 1-2 sprays daily

Flonase >4yo, 1 spray daily, 2 sprays for adult

Dymista >6yo, 1 spray BID

Front 6

Mometasone

Back 6

Nasonex

For >2yo

1 spray daily, 2 daily for adults

Front 7

Triamcinolone

Back 7

Nasocort, OTC

For >2yo

1-2 spray daily

Front 8

Oral antihistamines

Back 8

1st for mild-moderate, little for congestion, 2nd generation preferred (less sedation)

1st- clemastine, diphenhydramine, carbinoxamine, chlorpheniramine

2nd- cetirizine, levoceterizine, fexofenadine, loratidine, desloratidine

Intranasal- azelastine, olopatadine

Front 9

2nd gen oral antihistamine

Back 9

Contra(levoceterizine)- ESRD, renal impairment

Side fx- somnolence

Fexofenadine: take with water, avoid aluminum, magnesium

D/c 4 days before allergy skin test

Loratidine and ceterizine preferred in pregnancy

Front 10

Cetirizine

Back 10

Zyrtec

Cap,.tab, sol, syrup, chew, otc

5-10mg po daily

>2yo

Front 11

Levoceterizine

Back 11

Xyzal

Tab, sol

For >6month old

1.25mg po qhs

6-11yo; 5mg qhs

Adult 5-10mg qhs

Front 12

Fexofenadine

Back 12

Allegra

Tab, susp, odt

>2yo

30-60mg po bid or 180mg daily

Front 13

Loratidine

Back 13

Claritin, Alavert

Tab, cap, chew, sol, syrup, odt

>2yo

5mg po daily or 10 mg po daily

Front 14

Desloratidine

Back 14

Clarinex

Tab, syr, odt

>6month old

1mg daily for <1yo, 1.25mg for 1-5yo, 2.6mg for 6-11, 5mg po daily

Front 15

Intranasal antihistamine

Back 15

Azelastine(Astelin) and Olopatadine (patanase)

1-2sprays BID

Front 16

Decongestants(oral)

Back 16

Contra- MAOI within 14 days

Warning- avoid with children <2 yo, caution in cardiac diseases

Pregnancy C

Sale limited- logbook kept of people buying pseudoephedrine (3.6g at purchase and 9 grams in 30 day period)

Front 17

Phenylephrine HCl

Back 17

Sudafed PE

Tab, liquid, sol, inj

2.5-10mg q4hr prn, max 15-60

Front 18

Pseudoephedrine

Back 18

Sudafed, Nexafed, Zephrex-D

Tab, liquid, syr

15-60mg q4-6hr prn, max 60-240mg daily

Front 19

Topical(intranasal)

Back 19

Naphazoline (privine), oxymetazoline (Afrin), phenylephrine 0.125%-1% (Neo-synephrine), tetrahydrozoline 0.05-1% (tyzine)

Limit use to <3days to avoid rebound congestion

Tyzine is Rx

Front 20

Intranasal cromolyn

Back 20

Nasalcrom

1 spray q6-8hr

Used in kids and pregnancy due to side fx profile

Front 21

Sublingual immunotherapy

Back 21

Alternative to allergy shots

Oralair, grastek, ragwitek for grass, and ragweed

Started 4:3:3 months before allergy season and during

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Expectorants

Back 22

Guaifenesin- mucinex

Tab, cap, liquid, syrup, granule

Not for otc <2yo

Front 23

Cough suppressant

Back 23

For dry unproductive coughs or productive cough at night

Dextromethorphan, codeine, benzonatate, diphenhydramine

Front 24

Dextromethorphan

Back 24

Delsym, dayquil

Cap, liquid, lozenge, strip

Max 120mg day, q4-12hr dosing

Contra- MAOI within 14 days

Front 25

Codeine

Back 25

C-II

Max 120mg/day, q4-6hr dosing

Boxed- respiratory depression following tonsillectomy/adenoidectomy, rapid 2D6 metabolizer

Contra- paraltic ileus, during labor

Front 26

Benzonatate

Back 26

Tesaalon, Perles, Zonatuss

Max 600mg/day, TID dosing

Front 27

Products in kids

Back 27

Safety concern in products for children

Avoid:

Promethazine with codeine in <6yo

Decongestants, 1st gen antihist <4yo

Promethazine <2yo

Acetaminophen suspension(160mg/5ml)- 10-15mg/kg/dose q4-6hr prn, max 5 dose q24hr

Ibuprofen liq drop(50mg/1.25ml)/suspension(100mg/5ml)- 5-10mg/kg/dose q6-8hr prn, max 40mg/kg/day for both

Front 28

Combo products

Back 28

Dextromethorphan/promethazine

Brompheniramine/pseudoephedrine/dextromethorphan- bromfed DM

Promethazine/phenylephrine/codeine- promethazine VC/codeine(C-V)

Guaifenesin/codeine- robafen AC, Virtussin AC(C-V)

Guaifenesin/codeine/pseudoephedrine- cheratussin DAC, Mytussin DAC(C-V)

Chlorpheniramine/hydrocodone- Tussicaps, Tussionex, Vituz(C-ii)

Chlorpheniramine polistirex/codeine polistirex- Tuzistra XR(C-iii)