Allergic Rhinitis and other
what are findings of allergic rhinitis?
What is:
-shiners
-boggy red turbinates
-cobblestoning in throat/mouth
what triggers/causes rhinitis medicamentosa?
nasal congestion from overuse of topical vasoconstrictive medications, usually intranasal decongestants
what are other names for viral rhinosinusitis?
cold, URI
what is the first line treatment for bacterial rhinosinusitis?
symptom control
ex: anti-inflammatory, decongestion, corticosteroid
what is the treatment for nasal polyps?
topical intranasal corticosteroids
what are environmental control options for allergic rhinitis?
-ID and avoid triggers
-remain inside
-keep windows/doors closed
-wear a dust mask
-keep pets out of bedroom
-remove carpet in bedrooms
-get rid of mold/mildew
how do you treat rhinitis medicamentosa?
stop decongestant and educate patient
what is a pharmacologic therapy option for viral rhinosinusitis?
oral decongestant (unless contraindicated)
what is the biggest differentiator when diagnosing bacterial vs viral rhino sinusitis?
DURATION
> 7-10 days = bacterial
< 7-10 days = viral
What population are nasal polyps commonly seen in?
- Adults with allergic rhinitis
- children with cystic fibrosis
what are pharmacologic therapy options for allergic rhinitis?
- intranasal corticosteroids
-antihistamines
-antihistamine/decongestant combination
-leukotriene receptor antagonist
-mast cell stabilizer
what is an example of a medication that causes rhinitis medicamentosa?
Afrin
what medication should NOT be prescribed with viral rhinosinusitis?
antibiotics
what is the second line of treatment for bacterial rhinosinusitis? When should it be used?
1. antibiotic therapy;
ex. amoxicillin
amoxicillin-clavulanate (augmentin)= if beta-lactam taken within last 30 days
*penicillin allergy= doxycycline or clindamycin
*penicillin allergy= doxycycline or clindamycin
2. Pt has fever, Infection is long lasting, Infection is getting worse, Underlying comorbidities
Adults with concomitant asthma should avoid what mediation? Why?
ASA; can lead to asthma exacerbation
WHat is the first line treament for allergic rhinitis?
intranasal corticosteroids
what is the time frame that a patient should use an intranasal decongestant?
2-3 days
what is the first line treatment for viral rhinosinusitis?
ex: Sudafed
symptomatic relief (lifestyle measures)
-rest & hydrate
-nasal saline lavage
-humidifier
-avoid smoking
what is the 2nd line of antibiotic options for bacterial rhinosinusitis?
cephalosporin, macrolide, fluoroquinolone, clindamycin
where does anterior epistaxis originate? what are the steps of treatment for an anterior epistaxis?
1. kiesselbach plexus
2.
direct pressure on site for 15 mintues
short acting topical nasal decongestants
silver nitrate if persistent bleeding
nasal tampon
who QUALIFIES for medical therapy for influenza? what is the medical therapy?
- outpatient < 48 hrs of symptoms
- inpatient (always gets medical therapy)
- oseltamavir
What is the patient presentation for influenza? What test helps confirm influenza?
-ABRUPT onset of fever, non-productive cough, myalgia
- Nucleic acid amplification test
what complication can occur from acute viral rhinosinusitis?
bacterial rhinosinusitis
what are the most common bugs that cause acute bacterial rhinosinusitis?
s. pneumoniae
m. catarrhalis
h. influenzae
What type of nosebleed is an emergency? where does this nosebleed originate? how is it treated?
posterior nasal bleeding; sphenopalatine artery; hospital admission, posterior packing, surgery