18 Questions
What is the primary goal for a patient with an NSAID-induced ulcer?
Heal the ulcer as rapidly as possible
Which therapy is recommended as an alternative for patients allergic to penicillin?
Bismuth based quadruple therapy
What does the non-bismuth quadruple therapy include?
PPI, Amoxicillin, Clarithromycin, Metronidazole
In H.pylori-positive patients with an active ulcer, which of the following is a goal of treatment?
Eradicate H.pylori, cure the disease
When should all medications except the PPI be taken in the treatment of ulcers?
With meals and at bedtime
Which therapy has demonstrated higher eradication rates than traditional triple-therapy?
Non-bismuth quadruple therapy
How do intranasal corticosteroids work?
By blocking mediator release and suppressing neutrophil chemotaxis
What is the main function of Cromolyn Sodium in allergic rhinitis treatment?
Preventing antigen-triggered mast cell degranulation
What is a common side effect of using Cromolyn Sodium for allergic rhinitis treatment?
Sneezing and nasal stinging
When should treatment with Cromolyn Sodium be initiated for seasonal rhinitis?
Just before the start of the allergen season
What symptom does Ipratropium bromide provide relief for in allergic rhinitis?
Nasal congestion
For which age group is Montelukast approved for treatment of allergic rhinitis?
Children as young as 2 years for seasonal allergic rhinitis
What is the position of montelukast in the treatment hierarchy for allergic rhinitis?
Third-line therapy
What is the purpose of immunotherapy in the treatment of allergic rhinitis?
To induce tolerance to allergens
What are the common adverse reactions associated with subcutaneous immunotherapy?
Local adverse reactions and rare severe reactions
How can exposure to dust mites be reduced in non-pharmacologic treatment of allergic rhinitis?
Washing bedding in hot water and using impermeable covers
What actions can be taken to prevent poor air quality in homes for patients with allergic rhinitis?
Controlling moisture to prevent mold growth
What is a key aspect to monitor when evaluating outcomes of allergic rhinitis management?
Improvement in sleep quality and nonallergic symptoms
Study Notes
Treatment Goals
- Relieve ulcer pain, heal the ulcer, prevent ulcer recurrence, and reduce ulcer-related complications
- Eradicate H.pylori, heal the ulcer, and cure the disease in H.pylori-positive patients
- Heal the ulcer as rapidly as possible in patients with NSAID-induced ulcers
Pharmacologic Treatment
- PPI-based therapy: PPI, Clarithromycin, Amoxicillin or Metronidazole
- Bismuth-based quadruple therapy: PPI or H2RA, Bismuth subsalicylate, Metronidazole, Tetracycline
- Non-bismuth quadruple therapy (concomitant therapy): PPI, Clarithromycin, Amoxicillin, Metronidazole
- All medications except PPI should be taken with meals and at bedtime
Nasal Corticosteroids
- Relieve sneezing, rhinorrhea, pruritus, and nasal congestion with minimal side effects
- Reduce inflammation by blocking mediator release, suppressing neutrophil chemotaxis, causing mild vasoconstriction, and inhibiting mast cell-mediated late-phase reactions
- Examples: Beclomethasone, Budesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone
Cromolyn Sodium
- A mast cell stabilizer, available as a non-prescription nasal spray for symptomatic prevention and treatment of allergic rhinitis
- Prevents antigen-triggered mast cell degranulation and release of mediators, including histamine
- Most common side effect is local irritation (sneezing and nasal stinging)
Ipratropium Bromide
- An anticholinergic agent that may be useful in persistent allergic rhinitis
- Exhibits antisecretory properties when applied locally and provides symptomatic relief of rhinorrhea
Montelukast
- A leukotriene receptor antagonist approved for treatment of persistent allergic rhinitis in children as young as 6 months and for seasonal allergic rhinitis in children as young as 2 years
- Effective alone or in combination with an antihistamine
- Less effective than intranasal corticosteroids, making it a third-line therapy
Immunotherapy
- Process of administering doses of antigens responsible for eliciting allergic symptoms to induce tolerance
- Subcutaneous immunotherapy: very dilute solutions are given initially once or twice weekly
- Sublingual immunotherapy: available for ragweed and certain grass allergies
Adverse Reactions
- Subcutaneous immunotherapy: mild local adverse reactions (induration and swelling at the injection site), rare severe reactions (generalized urticaria, bronchospasm, laryngospasm, vascular collapse, and death from anaphylaxis)
- Sublingual immunotherapy: pruritus of the mouth, ears, and tongue, throat irritation, and mouth edema
Non-Pharmacologic Treatment
- Avoiding offending allergens
- Reducing exposure to dust mites
- Preventing poor air quality in homes
- Keeping windows closed and minimizing time spent outdoors during pollen seasons
Evaluation of Outcomes
- Monitor patients regularly for reduction in severity of identified target symptoms and presence of side effects
- Ask patients about their satisfaction with the management of their allergic rhinitis
- Management should result in minimal disruption to their normal lifestyle
- Use the Medical Outcomes Study 36-Item Short Form Health Survey and the Rhinoconjunctivitis Quality of Life Questionnaire to measure symptom improvement and quality of life.
Learn about the treatment goals for ulcers which include pain relief, ulcer healing, prevention of recurrence, and reduction of complications. Explore pharmacologic treatment options for H.pylori-positive and NSAID-induced ulcers.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
