Pharmacology of Nasal Congestion Treatments

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Questions and Answers

What is the primary role of ocular antihistamine drops?

To treat nasal congestion

To provide long-lasting relief for all allergy symptoms

To alleviate symptoms of allergic conjunctivitis (correct)

To reduce itching and sneezing

Which nasal treatment is considered the most effective single therapy for allergic rhinitis?

Oral antihistamines

Ocular antihistamines

Nasal corticosteroids (correct)

Nasal decongestants

What symptom can indicate a need for nasal antihistamines?

Nasal obstruction (correct)

Post-nasal drainage

Throat irritation

Itchy eyes

Which of the following allergens is associated with an increased risk of asthma development in children?

Animal dander Signup and view all the answers

What is indicated by 'cobblestoning' in the posterior pharynx?

Allergic rhinitis Signup and view all the answers

What is a notable effect of oral antihistamines compared to nasal treatments?

Reduce itching and sneezing Signup and view all the answers

What causes the transverse crease across the nose observed in allergy sufferers?

Allergic salute Signup and view all the answers

What is the expected peak age range for allergy symptom development?

Childhood to adolescence Signup and view all the answers

What is the main purpose of a skin prick test?

To help identify allergy-related eye symptoms Signup and view all the answers

What is a significant potential consequence of using nasal decongestants as monotherapy?

Rhinitis medicamentosa Signup and view all the answers

Which treatment approach is recommended when stopping nasal decongestants?

Administer nasal glucocorticoids Signup and view all the answers

What typically occurs after the cessation of oxymetazoline when used alone?

Worsening nasal congestion Signup and view all the answers

What does a positive skin prick test indicate?

Sensitivity to allergens causing wheal and flare Signup and view all the answers

Why should nasal decongestant sprays not be used for extended periods?

They may lead to rebound nasal congestion Signup and view all the answers

What does serum IgE testing primarily assess?

Allergic sensitivity Signup and view all the answers

What is often advised in conjunction with nasal decongestants to optimize treatment efficacy?

Combination with nasal steroids Signup and view all the answers

What is the primary use of pseudoephedrine in treatment?

To alleviate nasal congestion Signup and view all the answers

Which medication is most effective for managing profuse rhinorrhea?

Ipratropium bromide Signup and view all the answers

What type of rhinitis is characterized by persistent symptoms throughout the year?

Perennial rhinitis Signup and view all the answers

In immunotherapy, what is the main purpose of gradually administering allergens over several years?

To desensitize the immune system Signup and view all the answers

Which of the following treatments is NOT effective for non-allergic rhinitis?

Oral antihistamines Signup and view all the answers

What is the typical treatment recommendation for patients with nasal polyps?

Surgical removal from ENT specialists Signup and view all the answers

Which medication can be combined with a second-generation antihistamine in a single pill?

Pseudoephedrine Signup and view all the answers

What is the risk associated with subcutaneous and sublingual immunotherapy?

Small risk of anaphylaxis Signup and view all the answers

Samter's triad is characterized by the presence of which three conditions?

Nasal polyps, aspirin sensitivity, asthma Signup and view all the answers

Which of the following is the first line treatment for non-allergic rhinitis?

Intranasal glucocorticoids Signup and view all the answers

Study Notes

Oral Decongestant

Supplement for nasal congestion
Available over-the-counter
Can be combined with second-generation antihistamines, for example, Claritin D.
Multiple adverse effects

Montelukast

Useful for patients with asthma

Cromolyn Sodium Intranasal Spray

Take 4 times per day
Can be taken throughout allergy season

Ipratropium Bromide

Effective for managing profuse rhinorrhoea

Immunotherapy

Administered by an allergist or immunologist
Subcutaneous and sublingual immunotherapy
Prevents the progression of asthma in children
Requires weekly administration of minute allergen amounts for 2-3 years
Dosing is gradually increased over 2-3 years to desensitize the immune system
Customized based on allergy testing results
Small risk of anaphylaxis

Non-Allergic Rhinitis

Absence of allergic findings and post-nasal drip
Symptoms often worse during winter months
First-line treatment: Intranasal glucocorticoids + intranasal antihistamine
Oral antihistamines are unhelpful
Nasal ipratropium bromide is effective for managing rhinorrhoea

Nasal Polyps

Benign, pedunculated tumors of the nasal mucosa
Caused by chronically inflamed nasal mucosa
Symptoms include: anosmia, nasal passage obstruction, hypo-nasal speech, mouth breathing
Associated with Samter’s Triad: nasal polyps, aspirin sensitivity, asthma
Often a sign of underlying nasal mucosal inflammation
Manage underlying nasal mucosal inflammation with oral steroid, short-course if total nasal obstruction due to polyp
ENT referral for surgical removal if total nasal obstruction
Anterior rhinoscopy shows inflamed nasal mucosa and a polyp that resembles a peeled grape

Kawasaki Disease

Rare, but significant immune dysfunction
Repeated exposure to triggers like pollens, dust mite feces, animal dander, cockroaches, can lead to a release of histamine
Characterized by fever > 101.3 degrees for five or more days
Cardiac imaging is necessary
Managed with antihistamine therapy: nasal antihistamines for "on-demand" use, azelastine spray for nasal congestion, ocular antihistamine drops for allergic conjunctivitis, oral antihistamine for itching, sneezing, rhinorrhea

Allergy Testing

Skin prick test (most common) - positive result is a "wheal and flare"
Serum IgE testing - no risk of anaphylaxis

Nasal Symptoms

Transverse crease across the nose due to the "allergic salute"
Rhinoscopy shows pale, boggy, blue-tinged nasal mucosa and clear nasal discharge

Allergic Rhinitis Treatment

Nasal corticosteroids are the most effective single therapy for allergic rhinitis
First-line treatment: Fluticasone (Flonase), Triamcinolone (Nasacort)
More effective for nasal symptoms than oral antihistamines
Provides relief for eye symptoms as well
Takes several days for maximum effect

Decongestants

Nasal decongestants are effective for nasal congestion
Examples: Oxymetazoline
Should be combined with nasal steroid (not monotherapy)
Rhinitis medicamentosa: severe rebound nasal congestion following cessation of nasal decongestant spray as monotherapy
Treatment: Start nasal glucocorticoid and gradually withdraw nasal decongestant

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Description

Test your knowledge on the pharmacological treatments for nasal congestion and related conditions. This quiz covers oral decongestants, montelukast, intranasal sprays, immunotherapy, and non-allergic rhinitis. Review the indications, adverse effects, and treatment protocols involved.