Case 1: Continuing the same regimen is not optimal for AJ because his symptoms have worsened upon his move (now mild, persistent), perhaps because of a new allergen source (mold or dust from the old house). Moreover, AJ stated that his last regimen never helped his ocular symptoms. The pharmacist could consider an intranasal antihistamine or corticosteroid, as both are considered options in mild persistent allergic rhinitis and exhibit superior efficacy for nasal congestion compared with oral antihistamines. Use of either is also likely to eliminate the need for pseudoephedrine. However, intranasal antihistamines will likely be no better than his prior regimen in controlling ocular symptoms, whereas an intranasal corticosteroid would be. Consequently, the pharmacist could recommend AJ seek a prescription for an intranasal corticosteroid such as fluticasone.
Case 2: It is likely that because AJ’s ocular symptoms were previously well controlled with the intranasal steroid, this is just an exacerbation due to allergen exposure from mowing the grass. The pharmacist could recommend naphazoline plus pheneramine (Visine-A) for up to 72 hours to manage AJ’s allergic conjunctivitis. If he starts using naphazoline plus pheneramine and does not begin to feel relief by tomorrow, the pharmacist should then recommend he call his doctor to get a different agent, such as the nonsteroidal agent ketorolac ophthalmic (Acular LS) for a week or so to relieve these severe symptoms.
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