Allergic Rhinitis, Cough and Cold
What is the brand name of fluticasone nasal spray?
(Flonase Allergy Relief, Flonase Sensimist, Children's Flonase)
What is the brand name of triamcinolone nasal spray?
(Nasacort Allergy 24HR OTC)
What is the brand name of budesonide nasal spray?
(Rhinocort Allergy OTC)
Mentol and camphor should be avoided in children less than?
2 years old
What is the dose for Tylenol in children?
Acetaminophen infants' or children's liquid suspensions (both 160 mg/5 mL): 10-15 mg/kg/dose Q4-6H PRN, max 75 mg/kg/day
What is the adult dose of Benadryl?
Adult: 25-50 mg PO Q4-6H (max 300 mg/day) DO NOT USE IN AGE LESS THAN 6 years old for self care
What are CI to dextromethorphan?
All dextromethorphan-containing products should not be used within 14 days of MAO inhibitor use
What is the brand name of Fexofenadine? And with pseudophedrine?
Allegra Allegra D
How do antihistamnies work?
Antihistamines work by blocking histamine at the histamine-1 (Hl) receptor site
What are some things to keep in mind with intranasal steroids?
Can take up to one week to get full relief Budesonide is the preferred nasal steroid in pregnancy
What are side effects to systemic decongestants?
Cardiovascular stimulation (tachycardia, palpitations, Increases BP)
What is a CI to codiene?
Children < 12 years
What causes a cold?
Colds are caused by a virus; allergic rhinitis is caused by exposure to an allergen (e.g., pollen, dust, pet dander).
How does cromoyln work?
Cromolyn is a mast cell stabilizer used for treatment and prophylaxis of allergic rhinitis. It must be started at the onset of allergy season and used regularly (not PRN) to be effective.
What does D stand for in cough and cold medicine?
D = decongestant (e.g., phenylephrine or pseudoephedrine); example: Mucinex D - guaifenesin + pseudoephedrine
What is the brand name of dextromethorphan?
Delsym
Which cough medications are available with a prescription?
Dextromethorphan/promethazine- 15 mg/6.25 mg per 5 mL;5 mL Q4-6H PRN (max 30 mL/day) Brompheniramine/pseudoephedrine/ dextromethorphan (Bromfed DM)- 2 mg/30 mg/10 mg per 5 mL;10 mL Q4H PRN (max 60 mL/day) Promethazine/codeine(C-V)- 6.25 mg/10 mg per 5 mL;5 mL Q4-6H PRN (max 30 mL/day) Chlorpheniramine/hydrocodone (Tussionex, TussiCaps) (C-2)- 8 mg/10 mg ER per 5 mL;5 mL Q12H PRN (max 10 mL/day)
Fexofenadine should be taken with?
Fexofenadine: take with water (not juice due to decreased absorption); avoid administration with aluminum or magnesium-containing products
What is the dose for Ibuprofen in children?
Ibuprofen infants' drops (50 mg/1.25 mL) or children's liquid suspensions (100 mg/5 mL): 5-10 mg/kg/dose Q6-8H PRN. Max daily dose 40 mg/kg/day for both formulations.
What is immunotherapy?
Immunotherapy is a preventative treatment for allergies, either through subcutaneous (SC) injections or sublingual (SL) treatments.
When can montelukast be used?
Montelukast has similar efficacy to antihistamines or pseudoephedrine, and can be recommended for adjunctive relief.
Which second gen antihistamine agents are more sedating?
More sedating: cetirizine, levocetirizine, hydroxyzine and meclizine
What is an example of an intranasal decongestant?
Oxymetazoline 0.05%(Afrin)
What are side effects of Benadryl?
Somnolence, cognitive impairment, strong anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation)
What is the brand name of phenylephrine HCl?
Sudafed PE
What is the brand name of pseudoephedrine?
Sudafed, Nexafed, Zephrex-D Available behind the counter
What is the brand name of benzonatate?
Tessalon Perles Avoid in age <10 years
What are some monitoring parameters for allergies?
The air quality index (AQl) rates the local air as good to hazardous. Pollen counts can be monitored when pollen is a trigger.
What is the maximum amount of pseudoephedrine, phenylpropanolamine and ephedrine that can be brough in a single day and in a month?
Under federal law the maximum amount allowed for purchase is 3.6 grams per day, and 9 grams in a 30-day period.
What are possible natural products for cough and cold?
Zinc, in various formulations including lozenges, is used for cold prevention and treatment. Vitamin C (ascorbic acid) supplements are commonly used, but they have little to no efficacy for cold prevention. Some data has shown a decrease in the duration of the cold by 1 -1.5 days at doses of 1 - 3 grams/day. Echinacea is rated as "possibly effective" for cold treatment. Airborne and Emergen-C Immune+ are popular products that contain a variety of ingredients, including vitamins C, vitamin E, zinc and echinacea.
What is the brand name of ceterizine? And with pseudophedrine?
Zyrtec + pseudoephedrine (Zyrtec D)
What are some side effects of Oxymetazoline 0.05%(Afrin)?
rhinitis medicamentosa (rebound congestion if used longer than 3 days)
What are common allergens?
■ Pollens from trees, grasses and weeds ■ Molds, both indoor and outdoor ■ Dust mites that live in bedding, carpeting and other items that hold moisture ■ Animal dander from furred animals such as cats, dogs, horses and rabbits
How often do you have to prime Flonase/Nasacort? How often do you have to clean it?
(seven days for Flonase, 14 days for Nasacort) Clean the nasal applicator tip regularly (at least once a week for Flonase, after every use for Nasacort) by gently pulling it off and rinsing it under warm water. Let it air dry before replacing back onto the bottle.
What is allergic rhinitis?
Allergic rhinitis, commonly called hay fever or simply "allergies," causes cold-like symptoms [congestion, rhinorrhea (runny nose), sneezing, sinus pressure and itchy eyes). Allergic rhinitis symptoms can be intermittent (e.g., exposure to animal dander when visiting a friend's home) or chronic (e.g., symptoms that last for months whenever the pollen count is elevated).
What can help determine patient specific allergens?
An IgE- mediated skin prick test or blood test can determine patient specific allergens.
What analgesic is used in cough and cold medicine?
Analgesics in combination cough and cold products are usually acetaminophen.
Which component in cough and cold medication can cause sedation?
Antihistamines (e.g., diphenhydramine, chlorpheniramine, brompheniramine) are common and cause sedation. The night-time products, and some anytime products, contain an antihistamine.
Which cough and cold medications should be avoided in children <2?
Avoid OTC cough and cold products (FDA) Avoid promethazine (FDA) Avoid topical menthol and camphor (package labeling)
Which cough and cold medications should be avoided in children <6?
Avoid all OTC cough and cold products (AAP)
Which cough and cold medications should be avoided in children <12?
Avoid codeine-containing products (FDA) No codeine and hydrocodone less than 18
Which cough and cold medications should be avoided in children <4?
Avoid many OTC cough and cold products (package labeling)
What are non-drug treatments for allergies?
Avoiding exposure to known or suspected allergens (if possible) will reduce symptoms (i.e., it might be possible to avoid triggers from dust mites, but it may not be possible to avoid chronic exposure to air pollution). Vacuuming carpets, drapes and upholstery with a HEPA vacuum cleaner often (at least weekly) reduces allergens. Dust mites can be reduced by removing carpets and upholstered furniture, encasing pillows, mattresses and box springs in allergen-impermeable covers and washing bedding and soft toys in hot water weekly.
What is the brand name of diphenhydramine?
Benadryl
Which second gen antihistamine agents work the fastest?
Cetirizine and levocetirizine have a fast onset and may work best for some patients Zyrtec and Xyzal
What is the brand name of Loratadine? With pseudophedrine?
Claritin + pseudoephedrine: Claritin D
What does CEMA stand for?
Combat Methamphetamine Epidemic Act The act applies to any non-prescription product containing pseudoephedrine, phenylpropanolamine and ephedrine, all of which can be converted rather easily into methamphetamine.These products must be kept behind the counter or in a locked cabinet.
What does DM stand for in cough and cold medicine?
DM = dextromethorphan; example: Robafen DM = guaifenesin + dextromethorphan
How do decongestants work?
Decongestants are effective in reducing sinus and nasal congestion. Decongestants are alpha-adrenergic agonists (sympathomimetics) that work by causing vasoconstriction that decreases sinus vessel engorgement and mucosal edema. If a product contains a D after the name (such as Mucinex D or Robitussin D), it usually contains a decongestant such as phenylephrine or pseudoephedrine
How does dextromethorphan work?
Dextromethorphan (DM) and codeine have a high affinity for several regions of the brain, including the medullary cough center, suppressing the cough reflex. Benzonatate suppresses cough by topical anesthetic action on the respiratory stretch receptors. Both DM and codeine have abuse potential. DM acts as a serotonin reuptake inhibitor. At usual antitussive doses, it does not have addictive properties, but at high doses it acts as an NMDA-receptor blocker leading to euphoria and hallucinations similar to PCP, termed "robo-tripping.
What is a CI to systemic decongestants?
Do not use within 14 days of MAO inhibitors
What are brand names of guaifenesin?
Guaifenesin (Mucinex, Robitussin Mucus + Chest Congestion, Robafen)
What does Guaifenesin do?
Guaifenesin is a mucolytic (thins out mucus); single agent is Mucinex.
What are side effects of intranasal steroids?
Headache, dry nose, epistaxis (nose bleeds), unpleasant taste, localized infection
How do expectorants work?
If productive cough is present, expectorants can be used to decrease phlegm viscosity in the lower respiratory tract and increase secretions in the upper respiratory tract to help move phlegm upwards and out.
Which second gen antihistamine agent should be used in pregnancy?
If using in pregnancy, loratadine and cetirizine are considered low risk Zyrtec and Claritin
What can be used for allergic rhinitis?
Intranasal steroids are first-line for chronic, moderate-to-severe rhinitis. Milder, intermittent symptoms can be treated with oral antihistamines. Decongestants are used for congestion (if present) and come in nasal and oral formulations. Opthalmic medications for red, itchy eyes
When are intranasal steroids used?
Intranasal steroids work by decreasing inflammation. They are considered first-line treatment for moderate-severe rhinitis. They are especially effective in reducing the nasal symptoms of allergic rhinitis (e.g., sneezing, itching, rhinorrhea, congestion). Several come OTC [e.g., triamcinolone (Nasacort Allergy 24HR), fluticasone (Flonase Allergy Relief) and budesonide (Rhinocort Allergy)].
Which second gen antihistamine agents are less sedating?
Less sedating: fexofenadine and loratadine
What are side effects of dextromethorphan?
N/V, drowsiness, serotonin syndrome if co-administered with other serotonergic drugs If the product name has DM at the end, such as Robitussin DM, it contains dextromethorphan
What are nasal irrigation products?
Nasal wetting agents (e.g., saline, propylene and polyethylene glycol sprays) or nasal irrigation with warm saline [isotonic (0.9%) or hypertonic (2 - 3.5%)] can reduce symptoms. Nasal irrigation rinses out allergens and mucus, increases ciliary function and reduces swelling. A popular product, the "neti pot," looks like a small genie lamp or teapot. It is used to hold saline solution that is poured into one nostril and drained out of the other nostril.Nasal irrigation is safe for children and pregnant women. Instruct patients to use only boiled (then cooled to room temperature) or distilled water (not directly from the faucet).
What are oral antihistamines used for?
Oral antihistamines are commonly used for mild-moderate disease. They are effective in reducing symptoms of itching, sneezing, rhinorrhea and other types of immediate hypersensitivity reactions, but have little effect on nasal congestion. Antihistamines work by blocking histamine at the histamine-1 (Hl) receptor site.
What does PE stand for in cough and cold medicine?
PE = phenylephrine; example: Sudafed PE = phenylephrine
Which decongestant has poor systemic absorption?
Phenylephrine has poor oral absorption. It comes as a nasal inhaler, but lasts for a shorter time and causes more side effects than the popular oxymetazoline inhalers. Pseudoephedrine is an effective systemic decongestant; pseudoephedrine is a precursor to methamphetamine, and has restricted distribution
What is a boxed warning for codeine?
Respiratory depression and death have occurred in children who received codeine following tonsillectomy and/or adenoidectomy and had evidence of being ultra-rapid metabolizers of codeine due to a CYP450 2D6 polymorphism; deaths have also occurred in nursing infants after being exposed to high concentrations of morphine because the mothers were ultra-rapid metabolizers
It is important not to use aspirin in children because of?
Reye's syndrome
What are s/sx of an allergy?
Sneezing Runny Nose Thin, clear mucus Wheezing Red, watery eyes Symptoms can last for days or months after contact with allergens
What are s/sx of a cold?
Sneezing Runny Nose Thick, dark mucus Sore throat Body aches Symptoms take about three days to appear and usually last for about a week
What indications does benadryl have?
Treatment of acute allergic reactions (+/- epinephrine, depending on severity) Prevention of allergic reactions (included in most premedication regimens for high-risk drugs) Allergic rhinitis Cough (has antitussive properties) Sleep (sedating) Dystonic reactions (anticholinergic properties) Motion sickness
What are four SL immunotherapy treatments?
The first dose must be given in the doctor's office with all of these agents, but subsequent doses can be taken at home. The patient must be monitored for at least 30 minutes for signs of allergic reactions (boxed warning) and the patient should have an epinephrine auto-injector. ■ Oralair contains five different grass pollen extracts. Place one SL tablet under the tongue daily; initiate treatment four months before and during grass pollen season. ■ Grastek contains timothy grass pollen extract. Place one SL tablet under the tongue daily; initiate treatment three months before and during grass pollen season. ■ Ragwitek contains ragweed pollen extract. Place one SL tablet under the tongue daily; initiate treatment three months before and during pollen season. ■ Odactra contains house dust mite allergen extract. Place one SL tablet under the tongue daily.
What is the brand name of Levocetirizine?
Xyzal Allergy 24HR OTC
