JT is a 33 year-old-male who presents to your pharmacy asking for help. He complains of sneezing and nasal congestion recurring every fall and wants to know what OTC medication you recommend. He states his symptoms started 2 days ago and are bothersome but do not affect his sleep or daily activities.
PMH:
Asthma
Current medications:
ProAir 90 mcg/actuation inhaler 2 inhalations Q4-6H prn shortness of breath
Artificial Tears 1-2 drops into each eye TID prn dry eyes
Motrin 200 mg PO Q6H prn pain
Vitals and Labs:
Wt: 72 kg
Ht: 5’8”
HR: 75 BPM
RR: 18 BPM
BP: 116/76 mmHg
Temp: 99.1 F
JT mentions his friend uses Afrin and asks if this would be appropriate to treat his symptoms.
Which of the following is true?
A. Afrin is classified as a mast cell stabilizer that works by inhibiting the release of inflammatory mediators.
B. Afrin should not be used for more than 3 days due to the risk of developing rebound congestion.
C. Afrin is considered to be a first line agent in the treatment of allergic rhinitis.
D. Afrin is not recommended for patients with asthma.
Allergic Rhinitis involves upper airway inflammation triggered by airborne allergens. Symptoms include nasal congestion, nasal irritation, rhinorrhea, and sneezing. Management of allergic rhinitis may involve the use of intranasal corticosteroids, antihistamines, decongestants, mast cell stabilizers, intranasal anticholinergic agents, and leukotriene receptor antagonists. Pharmacists should be prepared to recommend and counsel patients on available OTC medications to treat this common disease state.
Oxymetazoline (Afrin) is an intranasal decongestant that causes vasoconstriction in the nose to relieve inflammation. It works quickly with an onset of action of 10 minutes and provides relief for up to 12 hours. It’s recommended to administer 2-3 sprays in each nostril twice daily and to avoid use for greater than 3 days. Adverse effects include temporary nasal burning or stinging and rebound nasal congestion.
Answer A is incorrect. Afrin is classified as an intranasal decongestant. An example of a mast cell stabilizer is cromolyn sodium (Nasalcrom). Cromolyn sodium may also be used in the treatment of allergic rhinitis and is unique from other available nasal sprays as it may be initiated a week prior to allergen exposure to prevent symptoms.
Answer B is correct. Intranasal decongestants are associated with rhinitis medicamentosa, also known as rebound congestion, when used for greater than 3 days. Treatment of rebound congestion involves slowly stopping the intranasal decongestant and utilizing alternative agents to ease symptoms.
Answer C is incorrect. Although intranasal decongestants may be used for the treatment of allergic rhinitis, the first line agents for treatment are intranasal corticosteroids. Examples include fluticasone propionate (Flonase), budesonide (Rhinocort), and triamcinolone (Nasacort). Intranasal corticosteroids work by reducing nasal inflammation and may take a few days to a few weeks to exhibit maximal effects.
Answer D is incorrect. Afrin may be safely used by patients with asthma. However, patients with heart disease, hypertension, thyroid disorder, diabetes, or urinary obstruction should use Afrin with caution.
Medications: Oxymetazoline (Afrin), Albuterol (ProAir), Carboxymethylcellulose sodium (Refresh), Ibuprofen (Motrin)
NAPLEX Competencies:
Area 2 - Identify Drug Characteristics
2.1 - Pharmacology, mechanism of action, or therapeutic class
2.2 - Commercial availability; prescription or non-prescription status; brand, generic, or bio similar names; physical descriptions; or how supplied
Area 3 - Develop or Manage Treatment Plans
3.4 - Drug dosing or dosing adjustment; duration of therapy
3.6 - Drug contraindications, allergies, or precautions
3.7 - Adverse drug effects, toxicology, or overdose
Create a Free MyAccess Profile
AccessMedicine Network is the place to keep up on new releases for the Access products, get short form didactic content, read up on practice impacting highlights, and watch video featuring authors of your favorite books in medicine. Create a MyAccess profile and follow our contributors to stay informed via email updates.