Exam 1 Study Guide.
Key concepts:
o Atrovent
Anticholinergic nasal spray, Local application of anticholinergic agents to the nasal
mucosa inhibits vagally mediated reflexes by antagonizing the action of acetylcholine at the
cholinergic receptor. Inhibits secretions.
Pregnancy category B* - good for pregnant women with rhinorrhea
Common S/E’s
Bad taste
Nasal dryness
Epistaxis
Indications: Allergic Rhinitis, rhinorrhea associated with common cold
Precautions: hypersensitivity to atropine, caution in pt’s with narrow angle glaucoma,
prostatic hyperplasia, bladder neck obstruction.
Adverse Rx: HA, epistaxis, pharyngitis, and nasal dryness
• Astelin/ Azelastine
Topical antihistamine, histamine receptor antagonist
S/E’s: Bitter taste, HA, nasal burning,
somnolence Decrease in somnolence with
Patanase
• Somnolence
• HA’s
• Nasal burning
,Exam 1 Study Guide.
o Decrease in somnolence w. Patanase
,Exam 1 Study Guide.
o Indication
▪ Allergic rhinitis: treatment algorithm:
-suspect allergic rhinitis – do nasal smears, skin testing RAST testing
- if diagnosis confirmed, begin non-pharm management (avoidance of irritants, A/C)
-if symptoms persist: start antihistamine either alone or in combination with nasal
decongestant or intranasal corticosteroids.
-if symptoms persist, immunotherapy.
o NasalCrom
▪ Mast cell stabilizer
▪ Useful as prophylaxis
▪ Safe in pregnancy
▪ Indicated for allergic rhinitis
o Topical Steroids – Intranasal (Flonase)
Act directly to block the effects of inflammation on the nasal mucus membrane
May take up to 1 week to become fully effective
Typically considered safe in pregnancy
For children, there is a risk of impacting growth
Best for established seasonal or perennial rhinitis*
First line therapy for allergies: intranasal steroids (+ 2nd gen antihistamine)
• 2nd line: antihistamines + nasal
decongestants 3rd: intranasal cromolyn
Children age 2 and up can have mometasone and fluticasone, children age 4
and up can have fluticasone propionate, and children age 6 and older can have
, Exam 1 Study Guide.
ciclesonide, budesonide, and flunisolide
Ocular Antihistamine
o Patanol and Pataday
o H1 receptor antagonist and mast cell inhibitor for eyes
o Pregnancy C*
o Indications
▪ Allergic conjunctivitis
▪ Allergic rhinitis
◦ Decongestants -oral and nasal
Cause vasoconstriction, assist in clearance of nasal mucous, not for use if < 4
years old. Sympathomimetics that stimulate alpha & beta adrenergic receptors. Stimulant
CNS effects.
Topical: Oxymetazoline, Phenlephrine, neo-synephrinem Afrin
Oral: Pseudoephedrine, Phenylephrine, Sudafed
◦ C/I’s
◦ Narrow angle glaucoma
◦ Severe uncontrolled HTN
◦ CAD
◦ p/ts treated w. MAOI w/in 14 days
◦ Caution
◦ HTN
◦ Cardiac disease
◦ Renal impairment
◦ Hyperthyroidism
◦ Diabetes
Key concepts:
o Atrovent
Anticholinergic nasal spray, Local application of anticholinergic agents to the nasal
mucosa inhibits vagally mediated reflexes by antagonizing the action of acetylcholine at the
cholinergic receptor. Inhibits secretions.
Pregnancy category B* - good for pregnant women with rhinorrhea
Common S/E’s
Bad taste
Nasal dryness
Epistaxis
Indications: Allergic Rhinitis, rhinorrhea associated with common cold
Precautions: hypersensitivity to atropine, caution in pt’s with narrow angle glaucoma,
prostatic hyperplasia, bladder neck obstruction.
Adverse Rx: HA, epistaxis, pharyngitis, and nasal dryness
• Astelin/ Azelastine
Topical antihistamine, histamine receptor antagonist
S/E’s: Bitter taste, HA, nasal burning,
somnolence Decrease in somnolence with
Patanase
• Somnolence
• HA’s
• Nasal burning
,Exam 1 Study Guide.
o Decrease in somnolence w. Patanase
,Exam 1 Study Guide.
o Indication
▪ Allergic rhinitis: treatment algorithm:
-suspect allergic rhinitis – do nasal smears, skin testing RAST testing
- if diagnosis confirmed, begin non-pharm management (avoidance of irritants, A/C)
-if symptoms persist: start antihistamine either alone or in combination with nasal
decongestant or intranasal corticosteroids.
-if symptoms persist, immunotherapy.
o NasalCrom
▪ Mast cell stabilizer
▪ Useful as prophylaxis
▪ Safe in pregnancy
▪ Indicated for allergic rhinitis
o Topical Steroids – Intranasal (Flonase)
Act directly to block the effects of inflammation on the nasal mucus membrane
May take up to 1 week to become fully effective
Typically considered safe in pregnancy
For children, there is a risk of impacting growth
Best for established seasonal or perennial rhinitis*
First line therapy for allergies: intranasal steroids (+ 2nd gen antihistamine)
• 2nd line: antihistamines + nasal
decongestants 3rd: intranasal cromolyn
Children age 2 and up can have mometasone and fluticasone, children age 4
and up can have fluticasone propionate, and children age 6 and older can have
, Exam 1 Study Guide.
ciclesonide, budesonide, and flunisolide
Ocular Antihistamine
o Patanol and Pataday
o H1 receptor antagonist and mast cell inhibitor for eyes
o Pregnancy C*
o Indications
▪ Allergic conjunctivitis
▪ Allergic rhinitis
◦ Decongestants -oral and nasal
Cause vasoconstriction, assist in clearance of nasal mucous, not for use if < 4
years old. Sympathomimetics that stimulate alpha & beta adrenergic receptors. Stimulant
CNS effects.
Topical: Oxymetazoline, Phenlephrine, neo-synephrinem Afrin
Oral: Pseudoephedrine, Phenylephrine, Sudafed
◦ C/I’s
◦ Narrow angle glaucoma
◦ Severe uncontrolled HTN
◦ CAD
◦ p/ts treated w. MAOI w/in 14 days
◦ Caution
◦ HTN
◦ Cardiac disease
◦ Renal impairment
◦ Hyperthyroidism
◦ Diabetes
