G.B. is a 21-year-old college student who

G.B. is a 21-year-old college student who recently moved away from home for the first time. She has been at college since the beginning of the fall semester, approximately 2 weeks. She presents today with a chief complaint of fits of sneezing(sometimes 10 in a row); a runny, itchy, stuffy nose; and red, tearing eyes. Her temperature is 99°F; her blood pressure is 118/78. She denies cough and headache. Her chest is clear. Her past medical history is unremarkable, except she states that her mother told her she had hay fever when she was younger, which she “outgrew” during high school. These symptoms are the same. She is having difficulty studying because of the sneezing and itching nose, and she is embarrassed to be in class with these symptoms. She picked up diphenhydramine recently and has been taking it once or twice daily as needed, but she says that it makes her too sleepy to study or concentrate. GB is supporting herself through college, so she is concerned about the costs of treatment. What would you consider first-line pharmacological treatment for the patient and why? Please write the order for the treatment as a prescription. Please provide rationale for your choice of treatment. List one or two adverse effects to the therapy you recommended in #1. Are there any adverse effects that would cause you to change therapy, if so, please explain? If your first-line agent were unsuccessful or a significant adverse drug event occurred, what would be your second-line pharmacological treatment for the patient and why? Please write the order for the treatment as a prescription. Please provide a rationale for your choice of treatment. Discuss specific patient education based on both your first- and second-line choices.

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