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99 Cards in this Set
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B2 Agonists MOA
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relax bronchial smooth muscle by selective action on B2 receptors
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Short acting B2 agonist (SABA) drugs
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Albuterol
levalbuterol pirbuterol fenoterol isoproterenol metaproterenol |
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long acting B2 agonist drugs
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salmeterol
formoterol alformoterol |
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systemic B2 agonist drugs
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epinephrine
terbutaline |
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combination B2 agonist drugs
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advair (salmetrerol/fluticasone)
sybicort (formoterol/bedesonide) |
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Indications for SABA drugs
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bronchospasms
exacerbation of asthma prevention of exercise-induced asthma |
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most effective drug for bronchodilation
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SABA
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1st choice of management of severe acute asthma
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SABA
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Indications for long acting B2 agonists
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maintenance treatment of asthma
prevention of exercise-induced asthma |
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B2 agonist drugs that are ineffective for acute severe asthma
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long acting B2 agonists
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Black box warning for long acting B2 agonists
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May increase the risk of asthma-related deaths (because of long onset)
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B2 agonist drug not recommended for long term monotherapy for asthma control
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long acting B2 agonists
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B2 agonist drugs not recommended for regular, scheduled use.
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SABA
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MOA of corticosteroids
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prevention of activation and migration of inflammatory cells
interferes with arachidonic acid metabolism and synthesis of leukotrienes |
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Corticosteroid drugs for oral inhalation
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Beclomethasone (QVAR)
budesonide (pulmicort) flunisolide (aerobid) fluticasone (flovent) mometasone (asmanex) triamcinolone (azmacort) |
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Corticosteroids drugs for systemic use
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hydrocortisone (solu-cortel)
prednisone (sterapred) prednisolone (orapred) methylprednisolone (solu-medrol) dexamethasone (decadron) |
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Adverse effects of systemic corticosteroid drugs
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Growth retardation (not good for kids)
osteoporosis cataract formation impaired wound healing psychiatric disturbances |
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Adverse effects of inhalation corticosteroid drugs
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h/a
upper respiratory tract infections burning throat irritation |
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Type of drug:
beclomethasone (QVAR) |
Corticosteroid oral inhalation
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Type of drug:
budesonide (Pulmicort) |
Corticosteroid oral inhalation
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Type of drug:
Flunisolide (Aerobid) |
Corticosteroid oral inhalation
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Class of drug:
Fluticasone (Flovent) |
Corticosteroid oral inhalation
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"flow" "vent"
vent = passageway for air |
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Type of drug:
Mometasone (Asmanex) |
Corticosteroid oral inhalation
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Class of drug:
Triamcinolone (Azmacort) |
Corticosteroid oral inhalation
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Class of drug:
Hydrocortisone (Solu-Cortel) |
Systemic corticosteroid
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solu = soluble
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Class of drug:
Prednisone (Sterapred) |
Systemic corticosteroid
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Class of drug:
Prednisolone (Orapred) |
Systemic corticosteroid
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Class of drug:
Methylprednisolone |
Systemic corticosteroid
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Class of drug:
Dexamethasone (Decadron) |
Systemic corticosteroid
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Indications for Corticosteroid drugs
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prevention of symptoms and acute severe asthma not responding to initial B2 agonists
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Class of corticosteroid most effective for long term control in all steps of persistent asthma
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Inhalation
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Oral, inhalation or topical
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MOA of anticholingeric drugs
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acts on bronchial muscles causing bronchodilation
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Class of drug:
Ipratropium (Atrovent) |
Anticholingeric
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Adverse effects of anticholingerics
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Upper respiratory tract infections
Bronchitis sinusitis flu-like symptoms |
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Treatment use of anticholingerics
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Used with SABA to produce added benefit in moderate to severe exacerbations in emergency setting
Alternate bronchodilator for persons who cannot tolerate SABA Can be used in acute asthma attacks. |
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MOA of Mast Cell Stabilizers
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prevent the mast cell release of histamine, leukotrienes, and slow reacting substances of anaphylaxis
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Mast Cell Stabilizer drugs
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Cromolyn (inhalation, nasal spray, oral)
Nedocromil (inhalation) |
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Generic name for Intal
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Cromolyn - inhalation mast cell stabilizer
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Nasalcrom
Class and Generic name |
Cromolyn - nasal spray mast cell stabilizer
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gastrocrom
Class and generic name |
cromolyn - oral mast cell stabilizer
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Generic name for tilade and drug class
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nedocromil - inhalation mast cell stabilizer
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Class of asthma drugs with no systemic effects
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mast cell stabilizers
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Leukotriene Modifier MOA
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bind to active site of leukotriene receptors, leukotrienes are released after exposure to allergens and inflammation or inhibits leukotriene formation
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Two types of leukotriene modifier meds
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Leukotriene receptor antagonists
Leukotriene synthesis inhibitor |
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Two types of leukotriene receptor antagonists
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montelukast (singulair)
Zafirlukast (accolate) |
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Montelukast (Singulair) and Zafirlukast (Accolate) are what types of drugs
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Leukotriene modifiers
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Luekotriene synthesis inhibitor drug
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Zileuton (Zyflo)
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Zilueton (Zyflo) is what class of drug
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Leukotriene synthesis inhibitor
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Adverse reactions to leukotriene modifiers
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elevations in LFT's
abdominal pain rash dizziness |
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Indications for leukotriene modifiers
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allergen-, exercise-, irritant-, and aspirin-induced asthma
Not for use in acute asthma attacks |
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Drugs that can be used but are not preferred for step 2 care of asthma
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Leukotriene modifiers
mast cell stabilizers |
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Most common used methylxanthine
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Theophylline: Theo-24, Uniphyl
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Most common used methylxanthine
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Theophylline
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Anti-IgE-monoclonal antibody drug
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Omalizumab-Xolair
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just one!
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Theophylline (Theo-24, Uniphyl)
Class of drug |
Methylxanthine
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MOA of Methylxanthines
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directly relaxes smooth muscle of respiratory tract, producing relief of bronchospasms
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Indications for Methylxanthines
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symptomatic treatment of asthma
relief of acute symptoms exercise-induced bronchospasms |
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Adverse effects of Methylxanthines
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tachycardia
GI upset |
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Omalizumab-Xolair
Class of drug |
anti-IgE-Monoclonal Antibody
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MOA of Anti-IgE-Monoclonal Antibody
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decreases IgE binding to its receptors on mast cells and basophils, thereby decreasing activation and release of allergic mediators
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Indications for Anti-IgE-Monoclonal Antibody
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moderate to severe asthma not well controlled on inhaled corticosteroids
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Adverse effects of Anti-IgE-Monoclonal Antibody
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h/a
local injection site reactions |
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Drug steps in treatment of acute asthma exacerbation
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B2 agonists: inhaled or nebulized
anticholingerics: inhaled or nebulized corticosteroids (systemic): oral or IV oxygen intubation and mechanical ventilation |
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Degree (step) of asthma when symptoms are present at least once daily during the day and more than 1 night per week
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Step 3- moderate persistent
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Category (step) of asthma when symptoms are present continually throughout the day and frequently at night
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severe persistent step 4
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Preferred dosing for step 4 chronic asthma patient
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high dose ICS + LABA + (if needed) oral corticosteroids long term
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preferred dosing for step 3 chronic asthma
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low to medium dose ICS + LABA
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Preferred dosing for step 2 chronic asthma
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low dose ICS
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Quick relief of asthma symptoms for all asthma patients
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2-4 puffs SABA prn: up to 3 tx at 20 min intervals or single nebulizer
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Pt should start long-term control therapy if using SABA -
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using SABA > 2X per week in intermittent asthma
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Treatment drugs for allergic rhinitis
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Antihistamines
Decongestants Corticosteroids Anticholingerics |
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Antihistamines MOA
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Histamine 1 (H1) receptor antagonists
competitively bind to histamine receptors preventing histamine from binding to receptors |
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1st Generation antihistamine drugs
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Chlorpheniramine (chlor-trimeton)
clemastine (tavist, dayhist) diphenhydramine (benadryl) brompheniramine (lodrane) |
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2nd generation antihistamine drugs
non-sedating |
fexofenadine (allegra)
loratadine (claritin, alavert) desloratadine (clarinex) |
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2nd generation antihistamines
mildly sedating |
cetirizine (zyrtec)
levoceritizine (xyzal) |
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Nasal antihistamines
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azelastine (astelin, optivar)
olopatadine (patanase) |
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Ophthalmic antihistamines
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olopatadine (patanol)
emedastine (emadine) levocarbastine (livostin) |
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Other uses for 1st generation antihistamines
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insomnia, motion sickness
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Degree of sedative effects of 1st generation antihistamines
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low-to-high
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Degree of anticholingeric effects of 1st generation antihistamines
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moderate to high
responsible for clearing up secretions (rhinorrhea) |
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Treatment tips for prescribing Antihistamines
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for symptomatic relief
may have some antiinflammatory effects use 1-2 hrs prior to exposure if tolerance develops, change to another agent in different class |
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MOA of nasal decongestants
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sympathomimetic agents, work on adrenergic receptors in nasal mucosa producing vasoconstriction
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Types of systemic nasal decongestants
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pseudophedrine (sudafed)
phenylephrine (sudafed PE, triaminic) |
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types of topical nasal decongestants
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phenylephrine (neo-synephrine)
naphazoline (privine, naphcon) tetrahydrozoline (tyzine, visine) oxymetazoline (afrin, visine LR) |
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Rhinitis medicamentosa
definition and how it relates to decongestants |
"rebound" vasodilation
prolonged use of topical decongestants (3-5 days) can cause "rebound" congestion |
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Pseudoephedrine is condraindicated in what type of patient
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hypertensive
causes tremors, tachycardia, excitability |
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MOA of corticosteroids
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work on nasal mucosa by reducing inflammation by reducing mediator release, cause mild vasoconstriction
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Drug class:
beclomethasone (beconase) |
corticosteroids
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drug class:
budenoside (rhinocort) |
corticosteroids
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drug class:
flunisolide (nasarel) |
corticosteroids
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drug class:
fluticasone (flonase, veramyst) |
corticosteroids
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drug class:
mometasone (nasonex) |
corticosteroids
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drug class:
triamcinolone (nasacort) |
corticosteroids
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Adverse effects of corticosteroids
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sneezing
stinging h/a epistaxis upper respiratory tract infections |
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Drug class that treats sneezing, rhinorrhea, itching, conjunctivitis
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antihistamines
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Drug class that treats nasal congestion
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Decongestants
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Drug class that treats sneezing, rhinorrhea, itching, nasal congestion
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corticosteroids
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Drug class that treats sneezing, rhinorrhea, itching, conjunctivitis (not antihistamine)
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Mast cell stabilizers (controls same symptoms as antihistamines)
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ASTHMA
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ASTHMA
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