Background

• Inflammation of nasal membrane. Also called "hay fever"
• Neti-pot, avoid exposure, environmental control.

 

Intranasal corticosteroid

• Drugs: Beclomethasone (Beconase), Budesonide (Rhinocort), Ciclesonide (Omnaris), Flunisolide (Nasarel), Fluticasone (Veramyst,Flonase), Mometasone (Nasonex), Triamcinolone (Nasacort)
• 1st line therapy for mild-moderate disease

 

 

Oral antihistamine

• Antagonist of histamine at H1 receptor

1st generation
Chlorpheniramine Clemastine (Tavist) Diphenhydramine (Benadryl) Cyproheptadine(Periactin)	CNS effect: sedation, cognitive changes; Anticholinergic effect: Caution in BPH, glaucoma, constipation, urinary retention
2nd generation
Cetirizine (Zyrtec) Desloratadine (Clarinex) Fexofendadine (Allegra) Levocetirizine (Xyzal) Loratadine (Claritin)	Onset: cetirizine/levocetirizine work faster Less sedation (esp. cetirizine, levocetirizine)

 

Intranasal antihistamine

• Drugs: Azelastine (Astelin, Astepro), olopatadine (Patanase)
• Bitter taste, helps nasal congestion

 

Decongestant

• MOA: alpha adrenergic agonist, cause vasoconstriction
• SE: insomnia, loss of appetite, increase BP, palpitation
• Caution in: arrhythmia, angina, HTN, coronary artery disease

 

Combat Meth Act

• Daily limit of pseudoephedrine (PSE): 3.6g
• Monthly limit: 9g
• Log book keep at least 2-yr

 

Intranasal cromolyn (Nasalcrom)

• Good safety profile, DOC in children and pregnancy

 

Ipratropim bromide (Atrovent nasal)

• Effective in rhinorrhea, but not other symptoms

 

Montelukast (Singulair)

• 4mg granule (6mos-5 yrs) chewable (2-5 yrs)
• 5mg chewable (6-14 yrs)
• 10mg (>15 yrs)

 

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