PHARM MSN 571 FINAL PAPER 2025/2026 QUESTIONS
WITH ANSWERS GRADED A+
✔✔allergic rhinitis: definition, s/s, rx - ✔✔-IgE mediated inflammatory disorder effecting
upper airway
-s/s: rhinorrhea, sneezing, pruritis, nasal congestion (d/t dilated + increased permeability
of nasal blood vessels via H1)
-seasonal/hay fever=spring/fall; pollen + fungi
-perennial/nonseasonal=indoor allergens; dust mites, pet dander
-rx: glucocorticoids, antihistamines, decongestants/sympathomimetics
✔✔allergic rhinitis: intranasal glucocorticoids - ✔✔-MOA: prevent inflammatory
response to IgE/allergens; more effective than antihistamines
-Rx for: prevent + tx of seasonal + perennial rhinitis
-Admin: metered dose device; takes 2-3 weeks for initial response to develop, long term
prophylactic rx
-AE: nasal irritation, potential slowing of linear growth in kids, epistaxis, drying of
mucous membranes, headache, sore throat
-ex: budesonide (rhinocort), fluticasone propionate (flonase), triamcinolone (nasacort)
✔✔allergic rhinitis: antihistamines (H1RAs) - ✔✔-MOA: blocks H1 receptor to decrease
s/s (itching, sneezing rhinorrhea); DOES NOT REDUCE CONGESTION
-rx for mild-mod allergic rhinitis
-AE: nasal=bitter taste, PO=sedation, anticholinergic s/s (1st gen)
-PO rx: most effective when taken prophylactically, even in absence of s/s; less helpful
after s/s appear (benadryl, vistaril, claritan, levocetirizine, etc)
-intranasal rx: 12 y/o+ only; ex=azelastine (astelin), olopatadine (patanase), cromolyn
sodium
✔✔allergic rhinitis: glucocorticoid + antihistamine combinations - ✔✔-
glucocorticoids=prevent congestion & response to IgE/allergens
-antihistamine=helps with s/s (itching, sneezing, redness); does NOT reduce congestion
-ex: azelastine/fluticasone (dymista)
✔✔allergic rhinitis: antihistamine + sympathomimetic combinations - ✔✔-reduces
congestion (sympathiomimetic) & s/s r/t allergic rhinitis (antihistamine)
-usually PO
-ex: loratidine-pseudoephedrine (claritan-D)
-fexofenadine-pseudoephedrine (allegra-D)
,✔✔sympathomimetics/decongestants: MOA, rx uses, ex - ✔✔-MOA: activates alpha 1
adrenergic receptors in nasal blood vessels to promote vasoconstriction; reduces blood
flow, promotes sinus drainage, improves air passage, relieves stuffiness and obstruction
-topicals=act faster + more effective (local admin), but risk of rebound congestion; limit
use to 3-5 days
-PO=longer acting, but also causes CNS stimulation & HTN
-Rx for: sinusitis & common cold; only relieves congestion in allergic rhinitis
-ex: pseudoephedrine (sudafed), phenylephrine
✔✔sympathomimetics/decongestants: pseudoephedrine vs phenylephrine - ✔✔-
pseudoephedrine/sudafed=oral, longer acting, better absorbed, more effective;
associated w/ making meth + abuse. 12 y/o+
-phenylephrine=oral not very effective; use nasal/topical; drops=2y/o+, PO=4y/o+,
spray=6y/o+
✔✔sympathomimetics/decongestants: AE + CI - ✔✔PO AE: HTN, anx/agitation,
insomnia
Nasal AE: rebound congestion
-drops: admin w/ patient in lateral , head low position; drops better for kids than sprays
d/t more control of dose
-CI: PO CI w/ HTN, pre-existing heart dx, DM, hyperthyroidism, BPH (d/t systemic
effects); MAOIs
✔✔Ipratropium Bromide (Atrovent): MOA, rx uses, SE, CI - ✔✔-
Anticholinergic/Bronchodilator (Inhaler or nebulizer)
-MOA: blocks cholinergic receptors to inhibit secretions; DOES NOT decrease s/s
(nasal congestion, postnasal drip, sneezing)
-Rx for: asthma, common cold, allergic rhinitis
-SE: nasal dryness + irritation
-CI: <12y/o
✔✔Montelukast (Singulair): MOA, rx uses, AE - ✔✔-Leukotriene receptor antagonist
-MOA: blocks leukotrienes (which cause nasal congestion)
-relieves nasal congestion; little effect on sneezing/itching
-Rx for: allergic rhinitis, asthma, bronchoconstriction
-reserved for allergic rhinitis pts unresponsive to other agents (glucocorticoids)
-AE: neuropsych effects (rare); anx/agitation/dep, insomnia, SI/SIB, AVH
-does not cause liver injury, no interaction w/ theopylline
✔✔Omalizumab (Xolair) - ✔✔-MOA: IgG monoclonal antibody that inhibits IgE binding
to the IgE receptor on mast cells and basophils
-admin SQ q2-4 weeks; 6y/o+
, -Rx for: moderate to severe persistent, allergy mediated asthma; rx off label for pt w/
positive skin test to perennial allergens and inadequate controlled symptoms on inhaled
steroids (step 5 or 6 per guidelines)
-AE: anaphylaxis (monitor for 2h after first 3 doses, 30min for all others), increased risk
of cancer & infection (URIs, sinusitis, viral infections), EXPENSIVE AF
-common SE=injection site reaction, flu-like s/s (fatigue, headache, fever, nausea,
myalgia)
✔✔cough + productive vs nonproductive - ✔✔-cough: complex reflex involving CNS,
PNS & muscles of respiration; initiated by irritation of bronchial mucosa or distal resp
tract
-benefit: remove foreign matter, excessive secretions
-nonproductive cough=use cough suppressant (URIs, common cold)
-productive cough=DO NOT SUPPRESS; beneficial in removing secretions (chronic dx
like asthma, bronchitis, emphysema)
✔✔antitussives: opioid vs nonopioid vs off label - ✔✔-opioid: codeine & hydrocodone
-nonopioid: dextromethorphan (DXM); can enhance analgesic effect of opiates & reduce
opi tolerance
-other antitussives: benadryl (d/t anticholingergic properties), benzonatate (tessalon
pearls)
✔✔antitussives: opioids - ✔✔-hydrocodone=more potent/more liability for abuse
-codeine=more effective/less abuse potential d/t low dose (1/10 dose needed for pain)
-MOA: Suppresses cough via CNS by increasing cough threshold (all opi possess this)
-Use: nonproductive cough
-AE: dizziness, drowsiness, lightheadedness, respiratory depression, GI distess, abuse
potential
-Caution: asthma, head trauma, liver/renal dysfunction, substance abuse
-CI: <18 y/o
✔✔antitussives: DXM - ✔✔-nonopioid; most effective OTC cough suppressant, can
enhance analgesic effects of opiates
-MOA: works in CNS via blocking NMDA receptors in brain
-opi derivative, but does not provide opi-like euphoria or physical dependence unless
very high dose (PCP-like mind/body distortion; "robo tripping")
-caution w/ liver + renal impairment
✔✔Antitussives - Benzonatate (Tessalon) - ✔✔-MOA: suppress cough via decreasing
sensitivity of resp tract stretch receptors
-SE: sedation, dizziness, constipation
-AE: seizures, EKG changes, confusion, chest numbness, AVH, burning eye sensation
-CI: <10y/o; increase in fatal OD risk in kids <2/o
WITH ANSWERS GRADED A+
✔✔allergic rhinitis: definition, s/s, rx - ✔✔-IgE mediated inflammatory disorder effecting
upper airway
-s/s: rhinorrhea, sneezing, pruritis, nasal congestion (d/t dilated + increased permeability
of nasal blood vessels via H1)
-seasonal/hay fever=spring/fall; pollen + fungi
-perennial/nonseasonal=indoor allergens; dust mites, pet dander
-rx: glucocorticoids, antihistamines, decongestants/sympathomimetics
✔✔allergic rhinitis: intranasal glucocorticoids - ✔✔-MOA: prevent inflammatory
response to IgE/allergens; more effective than antihistamines
-Rx for: prevent + tx of seasonal + perennial rhinitis
-Admin: metered dose device; takes 2-3 weeks for initial response to develop, long term
prophylactic rx
-AE: nasal irritation, potential slowing of linear growth in kids, epistaxis, drying of
mucous membranes, headache, sore throat
-ex: budesonide (rhinocort), fluticasone propionate (flonase), triamcinolone (nasacort)
✔✔allergic rhinitis: antihistamines (H1RAs) - ✔✔-MOA: blocks H1 receptor to decrease
s/s (itching, sneezing rhinorrhea); DOES NOT REDUCE CONGESTION
-rx for mild-mod allergic rhinitis
-AE: nasal=bitter taste, PO=sedation, anticholinergic s/s (1st gen)
-PO rx: most effective when taken prophylactically, even in absence of s/s; less helpful
after s/s appear (benadryl, vistaril, claritan, levocetirizine, etc)
-intranasal rx: 12 y/o+ only; ex=azelastine (astelin), olopatadine (patanase), cromolyn
sodium
✔✔allergic rhinitis: glucocorticoid + antihistamine combinations - ✔✔-
glucocorticoids=prevent congestion & response to IgE/allergens
-antihistamine=helps with s/s (itching, sneezing, redness); does NOT reduce congestion
-ex: azelastine/fluticasone (dymista)
✔✔allergic rhinitis: antihistamine + sympathomimetic combinations - ✔✔-reduces
congestion (sympathiomimetic) & s/s r/t allergic rhinitis (antihistamine)
-usually PO
-ex: loratidine-pseudoephedrine (claritan-D)
-fexofenadine-pseudoephedrine (allegra-D)
,✔✔sympathomimetics/decongestants: MOA, rx uses, ex - ✔✔-MOA: activates alpha 1
adrenergic receptors in nasal blood vessels to promote vasoconstriction; reduces blood
flow, promotes sinus drainage, improves air passage, relieves stuffiness and obstruction
-topicals=act faster + more effective (local admin), but risk of rebound congestion; limit
use to 3-5 days
-PO=longer acting, but also causes CNS stimulation & HTN
-Rx for: sinusitis & common cold; only relieves congestion in allergic rhinitis
-ex: pseudoephedrine (sudafed), phenylephrine
✔✔sympathomimetics/decongestants: pseudoephedrine vs phenylephrine - ✔✔-
pseudoephedrine/sudafed=oral, longer acting, better absorbed, more effective;
associated w/ making meth + abuse. 12 y/o+
-phenylephrine=oral not very effective; use nasal/topical; drops=2y/o+, PO=4y/o+,
spray=6y/o+
✔✔sympathomimetics/decongestants: AE + CI - ✔✔PO AE: HTN, anx/agitation,
insomnia
Nasal AE: rebound congestion
-drops: admin w/ patient in lateral , head low position; drops better for kids than sprays
d/t more control of dose
-CI: PO CI w/ HTN, pre-existing heart dx, DM, hyperthyroidism, BPH (d/t systemic
effects); MAOIs
✔✔Ipratropium Bromide (Atrovent): MOA, rx uses, SE, CI - ✔✔-
Anticholinergic/Bronchodilator (Inhaler or nebulizer)
-MOA: blocks cholinergic receptors to inhibit secretions; DOES NOT decrease s/s
(nasal congestion, postnasal drip, sneezing)
-Rx for: asthma, common cold, allergic rhinitis
-SE: nasal dryness + irritation
-CI: <12y/o
✔✔Montelukast (Singulair): MOA, rx uses, AE - ✔✔-Leukotriene receptor antagonist
-MOA: blocks leukotrienes (which cause nasal congestion)
-relieves nasal congestion; little effect on sneezing/itching
-Rx for: allergic rhinitis, asthma, bronchoconstriction
-reserved for allergic rhinitis pts unresponsive to other agents (glucocorticoids)
-AE: neuropsych effects (rare); anx/agitation/dep, insomnia, SI/SIB, AVH
-does not cause liver injury, no interaction w/ theopylline
✔✔Omalizumab (Xolair) - ✔✔-MOA: IgG monoclonal antibody that inhibits IgE binding
to the IgE receptor on mast cells and basophils
-admin SQ q2-4 weeks; 6y/o+
, -Rx for: moderate to severe persistent, allergy mediated asthma; rx off label for pt w/
positive skin test to perennial allergens and inadequate controlled symptoms on inhaled
steroids (step 5 or 6 per guidelines)
-AE: anaphylaxis (monitor for 2h after first 3 doses, 30min for all others), increased risk
of cancer & infection (URIs, sinusitis, viral infections), EXPENSIVE AF
-common SE=injection site reaction, flu-like s/s (fatigue, headache, fever, nausea,
myalgia)
✔✔cough + productive vs nonproductive - ✔✔-cough: complex reflex involving CNS,
PNS & muscles of respiration; initiated by irritation of bronchial mucosa or distal resp
tract
-benefit: remove foreign matter, excessive secretions
-nonproductive cough=use cough suppressant (URIs, common cold)
-productive cough=DO NOT SUPPRESS; beneficial in removing secretions (chronic dx
like asthma, bronchitis, emphysema)
✔✔antitussives: opioid vs nonopioid vs off label - ✔✔-opioid: codeine & hydrocodone
-nonopioid: dextromethorphan (DXM); can enhance analgesic effect of opiates & reduce
opi tolerance
-other antitussives: benadryl (d/t anticholingergic properties), benzonatate (tessalon
pearls)
✔✔antitussives: opioids - ✔✔-hydrocodone=more potent/more liability for abuse
-codeine=more effective/less abuse potential d/t low dose (1/10 dose needed for pain)
-MOA: Suppresses cough via CNS by increasing cough threshold (all opi possess this)
-Use: nonproductive cough
-AE: dizziness, drowsiness, lightheadedness, respiratory depression, GI distess, abuse
potential
-Caution: asthma, head trauma, liver/renal dysfunction, substance abuse
-CI: <18 y/o
✔✔antitussives: DXM - ✔✔-nonopioid; most effective OTC cough suppressant, can
enhance analgesic effects of opiates
-MOA: works in CNS via blocking NMDA receptors in brain
-opi derivative, but does not provide opi-like euphoria or physical dependence unless
very high dose (PCP-like mind/body distortion; "robo tripping")
-caution w/ liver + renal impairment
✔✔Antitussives - Benzonatate (Tessalon) - ✔✔-MOA: suppress cough via decreasing
sensitivity of resp tract stretch receptors
-SE: sedation, dizziness, constipation
-AE: seizures, EKG changes, confusion, chest numbness, AVH, burning eye sensation
-CI: <10y/o; increase in fatal OD risk in kids <2/o
