Rhinitis, Cold, and Allergy Treatment

• Allergic rhinitis, also known as hay fever or allergies, induces cold-like symptoms
• Colds are caused by viruses while allergic rhinitis is caused by allergens

Rhinitis Treatment

• Intranasal steroids are the primary treatment for chronic, moderate-to-severe rhinitis
• Oral antihistamines treat mild, intermittent symptoms
• Decongestants treat congestion

Cold vs Allergies

• Common colds and allergies share similar symptoms
• Allergy symptoms can persist after contact with allergens

Cold symptoms

• Sore throat
• Body aches
• Thick mucus

Allergies symptoms

• Wheezing
• Red, watery eyes
• Thin mucus

Natural Products for Colds

• Zinc, Vitamin C, and Echinacea

Zinc

• Should not be used for more than five to seven days

Vitamin C

• Ascorbic acid
• Decreases cold duration by 1-1.5 days at 1-3 grams/day

Intranasal Steroids

• Budesonide
• Fluticasone
• Triamcinolone
• Mometasone

Intranasal Steroids Contraindications

• Avoid use in patients with recent nasal septal ulcers, nasal surgery, or recent nasal trauma

Intranasal Steroids Side Effects

• Headache
• Dry nose
• Epistaxis
• Unpleasant taste
• Localized infection

Intranasal Steroid Notes

• May take up to one week to get full relief
• Budesonide is the preferred nasal steroid in pregnancy
• Shake bottle well before each use

Antihistamines

• Antihistamines block histamine at the histamine-1 receptor site
• Second-generation agents are preferred due to less sedation and cognitive impairment

First-generation antihistamines

• Should not be taken by lactating women

First-Generation Drugs

• Diphenhydramine
• Chlorpheniramine
• Action: Oral antihistamines

First-Generation Drugs Contraindications

• Newborns/premature infants
• Lactating women
• Acute asthma
• Use with MAO inhibitors

First-Generation Drugs Side Effects

• Somnolence
• Cognitive impairment
• Strong anticholinergic effects

Second-Generation Drugs

• Cetirizine
• Levocetirizine
• Fexofenadine
• Loratadine

Second-Generation Drugs Contraindications

• Renal impairment

Second-Generation Drugs Side Effects

• Somnolence
• Headache, more with cetirizine and levocetirizine

Pregnancy Notes

• Loratadine and cetirizine are considered low risk during pregnancy

Sedation Notes

• More sedating: cetirizine, levocetirizine, hydroxyzine, and meclizine
• Less sedating: fexofenadine and loratadine

Decongestants

• Phenylephrine and Pseudoephedrine are oral
• Oxymetazoline is topical

Decongestants Actions

• Alpha-adrenergic agonists that cause vasoconstriction
• Decreases sinus vessel engorgement and mucosal edema

Decongestants Contraindications

• Do not use within 14 days of MAO inhibitors

Decongestants Side Effects

• Cardiovascular stimulation, increase BP, tachycardia, palpitations

Oxymetazoline Notes

• Do not use for more than 3 days

Expectorants

• Guaifenesin

Guaifenesin Actions

• Decreases phlegm viscosity in the lower respiratory tract
• Increases secretions in the upper respiratory tract to help move phlegm upwards and out

Guaifenesin Side Effects

• Dose-related nausea
• Vomiting
• Dizziness
• Headache
• Rash
• Diarrhea
• Stomach pain

Cough Suppressants

• Dextromethorphan
• Codeine
• Benzonatate

Cough Suppressants Actions

• Dextromethorphan 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

Cough Suppressants Contraindications

• Dextromethorphan-containing products should not be used within 14 days of MAO inhibitors
• Codeine should not be administered to children under 12 years
• Dextromethorphan: serotonin syndrome

Cough Suppressants Notes

• Used for dry, unproductive cough
• Used to suppress productive cough at night to allow for restful sleep

Ear drop administration

• Administer the drops into the ear canal
• Keep the ear facing up for about five minutes to allow the medication to coat the ear canal

Eye drop administration

• Administer the prescribed number of drops into the eye
• Wait at least 5 -10 minutes to put a second medication in your eye
• If administering a gel, wait 10 minutes after the other eye medication before use

Acne development

• Primarily develops in adolescents during puberty

Acne Determinants

• Androgens, bacteria, and fatty acids present in oil glands

Acne Lesions

• Classified as whiteheads, blackheads, small bumps, cysts and nodules

Acne Treatment

• Determined by severity: mild (few, occasional pimples), moderate (inflammatory papules), or severe (nodules and cysts)

OTC Acne Treatment

• Benzoyl peroxide BPO
• Salicylic acid
• Retinoids
• Topical or systemic antibiotics
• Systemic isotretinoin

First-line Treatment for mild cases

• Topical benzoyl peroxide or retinoids

First-line Treatment for moderate cases

• Oral antibiotic + BP + retinoids

First-line Treatment for severe cases

• Topical BO +Retinoids+ Oral antibiotic
• Systemic isotretinoin

Second-line Treatment for mild cases

• Topical benzoyl peroxide and retinoids

Second-line Treatment for moderate cases

• Spironolactone for females only
• Isotretinoin

Dandruff

• Dandruff occurs when the scalp is itchy and/or scaling with white oily flakes

Dandruff Treatment Options

• Ketoconazole 1% shampoo
• Selenium sulfide
• Pyrithione zinc

Dandruff Treatment Notes

• Rub shampoo in well, leave in for 5 minutes, then rinse out
• Shampoo daily
• If the shampoo stops working, switch products

Lice and Scabies

• Scabies are primarily spread through close body and skin contact

Scabies Treatment

• Permethrin cream or prescription ivermectin

Lice Treatment

• Permethrin or pyrethrin/piperonyl butoxide
• Repeat treatment on day 9
• For resistant/difficult cases, use topical ivermectin
• Oral ivermectin can be used for those weighing at least 15 kg

Scabies treatment options

• Permethrin cream
• Ivermectin

Itchy Lice treatment options

• Dimethicone lotion

Killing Lice treatment options

• Permethrin

Rhinitis, allergies and colds share similar symptoms. Allergic rhinitis is caused by allergens, while colds are caused by viruses. Treatment options include intranasal steroids, oral antihistamines, decongestants, Zinc, and Vitamin C.