RT Book, Section
A1 May, J. Russell
A2 DiPiro, Joseph T.
A2 Talbert, Robert L.
A2 Yee, Gary C.
A2 Matzke, Gary R.
A2 Wells, Barbara G.
A2 Posey, L. Michael
SR Print(0)
ID 1149712208
T1 Allergic Rhinitis
T2 Pharmacotherapy: A Pathophysiologic Approach, 10e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259587481
LK accesspharmacy.mhmedical.com/content.aspx?aid=1149712208
RD 2024/04/20
AB Patient  Care  Process  for  the  Management  of  Allergic  RhinitisCollectPrimary  complaint(s)  (e.g.,  sneezing,  clear  rhinorrhea,  postnasal  drip,  nasal  congestion,  ocular  or  otic  symptoms,  pruritic  nose  or  palate)Patient  characteristics  (e.g.,  age,  race,  sex,  pregnant)Past  medical  history  and  allergy  testing  Patient  family,  social  history—dietary  habits;  presence  of  pets,  mold,  or  wall-to-wall  carpeting;  times  of  year,  situations,  or  locations  (indoor  or  outdoor)  when  symptoms  are  worseCurrent  OTC  products,  prescription  medications,  dietary  supplements;  past  medications  or  interventions  used  for  treating  rhinitis  symptomsPast  or  current  use  of  environmental  controls  of  potential  allergens  (e.g.,  removal  of  carpeting  or  pets,  air-filtration  systems)Objective  data  (see  Box  13-1)Presence  of  allergic  "shiners"  (dark  circles  under  eyes)  or  "salute"  (crease  across  nose  caused  by  constant  rubbing)Labs  when  available  (e.g.,  IgE,  serum  eosinophil  count)Other  diagnostic  tests  when  available  (e.g.,  allergy  testing)AssessPresence  of  atopic  disorders  (e.g.  asthma,  atopic  dermatitis)  and  complications  of  allergic  rhinitis  (e.g.  acute  otitis  media,  middle  ear  effusion,  sinusitis,  epistaxis)Timing  of  symptoms  –  seasonal  or  persistent  (see  Figure  95-2)Effectiveness  for  environmental  controls  of  allergens  (primarily  for  persistent  cases)Which  symptoms  to  control  (e.g.  nasal  congestion,  clear  rhinorrhea,  sneezing,  pruritus,  ocular  conjunctivitis)Appropriateness  and  effectiveness  of  current  regimenPlan*Nonpharmacologic  interventions  (e.g.,  allergen  avoidance,  nasal  rinses,  nasal  strips;  see  Table  95-3)Drug  therapy  regimen  including  specific  agent(s),  dose,  route,  frequency,  and  duration;  specify  the  continuation  and  discontinuation  of  existing  therapies  (see  Table  95-2  and  Figure  95-2)Monitoring  parameters  including  efficacy  (e.g.,  bothersome  symptoms),  safety  (e.g.  drowsiness,  anticholinergic  effects,  effects  on  blood  pressure;  medication-specific  adverse  effects;  see  Table  95-8)Patient  education  (e.g.,  purpose  of  treatment,  allergen  avoidance,  nonpharmacologic  interventions,  drug  therapy;  immunotherapy)Self-monitoring  of  symptoms  and  adverse  effects—where  and  how  to  record  resultsReferrals  to  other  providers  when  appropriate  (e.g.,  physician,  allergist)Implement*Provide  patient  education  regarding  all  elements  of  treatment  plan  Use  motivational  interviewing  and  coaching  strategies  to  maximize  adherenceSchedule  follow-up  if  neededFollow-up:  Monitor  and  EvaluateAssess  patient  perception  of  control  of  bothersome  symptomsPresence  of  adverse  effectsContinued  presence  of  physical  signs  of  nasal  and  ocular  pruritusPatient  adherence  to  treatment  plan  using  multiple  sources  of  information*Collaborate  with  patient,  caregivers,  and  other  health  professionals