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Histamine H1 receptor antagonists:
Azelastine
Decongestants (α1 agonists):
Oxymetazoline, xylometazoline
Anticholinergics:
Ipratropium (bromide)
Corticosteroids:
Budenoside, fluticasone
Which oral drugs are important in the treatment of allergic rhinitis?
Histamine H1 receptor antagonists (2nd generation):
Cetirizine, loratadine, fexofenadine
Phenylephrine, pseudoephedrine
Anti-leukotrienes:
Montelukast
Which symptoms of allergic rhinitis are treated by histamine antagonists?
Itchy nose and eyes, sneezing, rhinorrhoea, but not nasal congestion
Which symptoms of allergic rhinitis are treated by anticholinergic drugs?
Rhinorrhoea (nasal secretions)
What are the indications for topical steroid use in allergic rhinitis?
Severe cases where symptoms are not treated by the first-line drugs
What is the mechanism of action of nasal decongestants?
Nasal decongestants are α1 agonists. They constrict venules in the nasal mucosa. This reduces the volume of venous blood in the mucosa, thereby decreasing the oedema.
Anticholinergics block the M3-receptor-mediated nasal secretion.
What is the mechanism of action of steroids in relation to rhinitis?
Glucocorticoids decrease the allergen-mediated inflammation.
Describe the tolerance which develops to nasal decongestants.
Tolerance develops quickly to the decongestant effect of α1 agonists, most likely due to a down-regulation of α receptors. This occurs after continous use of nasal decongestant for 10 days straight and results in rebound-congestion, which causes the patient to take more and more decongestant.
What are the indications for anti-tussive drugs?
We never want to stop coughing completely, but we can suppress the reflex in cases where:
the cough is dry (not productive) and painful
the cough is exhausting, like in patients with hypertension or heart failure
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