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Allergy, Cough Allergy, Cough and Cold and Cold

TreatmentsTreatmentsAntihistaminesAntihistaminesDecongestantsDecongestants

AntitussivesAntitussivesExpectorantsExpectorants

Causes of RhinitisCauses of Rhinitis• Allergic

– Seasonal– Perennial

• Infectious– Viral, Bacteria,

Fungal

• Occupational– Intermittent– Persistent

• Nasal Irritants

• Drug Induced– ASA, NSAIDS

• Hormonal– Pregnancy, Thyroid

• Food– Lemon, MSG

• Anatomic– Mucosal & bone

atrophy

• Idiopathic

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Symptoms of Allergic Symptoms of Allergic RhinitisRhinitis

• Itchy nose, ears, palate, throat• Red, watery eyes• Sneezing episodes• Thin, clear rhinorrhea, cough• Nasal congestion, post nasal drip• Snoring, sleep disturbances• Altered hearing, frontal headaches

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AntihistaminesAntihistamines• Therapeutic Use

– Allergy,insomnia, rash,nausea, vomiting

• Mechanism - Histamine1 receptor antagonist

• Side Effects– Sedation, dizziness– Anticholinergic : dry mouth, blur vision,

constipation & urinary retention– Hyperactivity in some children

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Antihistamines Antihistamines contcont..• First Generation

– Diphenhydramine– Dimenhydrinate– Clemastine/Meclizine– Chlorpheniramine

• Others– Azelastine, Hydroxyzine

HCL, Hydroxyzine Pamoate, Promethazine

• 2nd Generation– Fexofenadine– Loratadine– Cetirizine

Deconsal II (phenylephrine 20mg & guaifenesin 375mg)

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DecongestantsDecongestants• Mechanism of action• Side effects & caution with concurrent dz.• Rhinitis Medicamentosa

Topical Duration Dose

Oxymetazoline 12 hr 2 puffs q 12

Phenylephrine 4 hr 2 puffs q 4h

Oral

Pseudoephedrine 4-6hrSR12hr

60mg q 4-6h120 mg q 12

Intranasal SteroidsIntranasal Steroids

Medication Onset SpecialUses

Beclomethasone(Beconase)

Within 3 days Nasal polypprevention

Budesonide(Rhinocort)**

10 hours Non-allergicrhinitis

Fluticasone(Flonase) **

12 hours Non-allergicrhinitis

MometasoneFuroate **(Nasonex)

7-12 hours Seasonal allergy prophylaxis

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Side Effects of Intranasal Side Effects of Intranasal CorticosteroidsCorticosteroids

• Local Reactions– Nasal burning and stinging– Sneezing, throat irritation– Drying of the mucous membranes

• Systemic Reactions– Headaches– Nausea, vomit, dizziness

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Ocular PreparationsOcular Preparations

DRUG CLASS Drug Name

Antihistamine Livostin (Levocabastine)

Mast Cell Stabilizer Crolom (Cromolyn)

NSAID Acular (Ketoralac)

AH-DG combo OpconA, Naphcon A

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Allergy Rhinitis Treatment Allergy Rhinitis Treatment PlanPlan

• Most effective when start before onset of symptoms.

• Compliance• Maintenance therapy

Mild antihistamine/decongestant or combo non sedating preferred OR intranasal steroid spray

Moderate intranasal steroid spray, antihistamine-decongestant combo, >2-3 months consider immunotherapy

Severe intranasal steroid, AH-DG combo, consider short course 3-7 days oral corticosteroid, consider immunotherapy

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AntitussivesAntitussives• Suppress coughing• Effective in dry, non-productive• MOA

– CNS depression of the cough center• Block transmission to the brain

– Suppression of the nerve receptors in the respiratory tract• Block irritation of receptors

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Side Effects AgentsSide Effects Agents• Anesthetizing• Drowsy• Impair motor co-

cordination• Impair vision• Constipation• Urinary retention

• Benzonatate (Tessalon)

• Codeine• Dextromethrophan• Diphenhydramine• Hydrocodone-

homatropine

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ExpectorantsExpectorants• Defined• Mechanism of Action• Indication• Side Effects

• Guaifenesin (Robitussin, Mucinex, Humibid)

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Summary SlideSummary Slide• Causes of Rhinitis• Symptoms of Allergic Rhinitis• Antihistamines, Decongestants• Intranasal Steroids & Side Effects• Ocular Preparations• Antitussives• Expectorants