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Pharmacology - Winter > 9 - Drugs & Allergy > Flashcards

9 - Drugs & Allergy Flashcards

1
Q

What is an allergy?

A
  • Inflammatory disorder

- Maladaptive immune system response creating memory antigens

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2
Q

What are the key cells involved in allergic reactions?

A
  • Mast cells
  • Basophils
  • Eosinophils
  • Dendritic cells
  • T-cells (Th 1 and 2)
  • B-cells
  • Plasma cells
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3
Q

What are mast cells?

A
  • Tissue cells of immune system found in loose connective tissue, organs, vasculature, nerves, skin, respiratory tract, etc
  • Not present in epidermal cells, CNS, or gastric mucosa
  • Store histamine, interleukins, proteoglycans (ex: heparin), and various enzymes in their granules at cytoplasm
  • Granules released upon stimulation of allergen (degranulation)
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4
Q

What happens when mast cell granules are released?

A
  • Increased blood flow and permeability of blood vessels
  • Contraction of smooth muscles
  • Increased mucous production and fluid secretion
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5
Q

What is the effect of degranulation on the GI tract?

A

Expulsion of contents (diarrhea, vomiting)

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6
Q

What is the effect of degranulation on airways?

A
  • Congestion and blockage of airways (wheezing, coughing, phlegm)
  • Swelling and mucous secretion in nasal passages
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7
Q

What is the effect of degranulation on blood vessels?

A
  • Increased fluid in tissues causing increased flow of lymph to lymph nodes
  • Increased cells and protein in tissues
  • Increased effector response in tissues
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8
Q

What allergy symptoms are caused by histamine and prostaglandins?

A
  • Tickling
  • Itchiness
  • Nose rubbing (allergic salute)
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9
Q

What allergy symptoms are caused by histamine and leukotrienes?

A
  • Sneezing
  • Runny nose
  • Post nasal drip
  • Throat clearing
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10
Q

What allergy symptoms are caused by histamine, leukotrienes, bradykinin, and platelet activating factor?

A
  • Nasal congestion
  • Stuffy nose
  • Congested airway => snoring
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11
Q

Where is histamine stored?

A

Tissue mast cells and blood basophils

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12
Q

What can cause cells to release histamine?

A
  • Antigens (immediate hypersensitivity)
  • Drugs (morphine, succinylcholine)
  • Insect venoms
  • Physical factors (scratching, cold)
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13
Q

Which histamine receptor is most important in allergic disorders?

A

H1

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14
Q

What does activation of the H1 receptor cause?

A
  • Gastric and respiratory smooth muscle contraction
  • Vasodilation
  • Increased vascular permeability
  • Itching
  • Increased bronchial secretions and viscosity
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15
Q

What does activation of the H2 receptor cause?

A

Gastric acid secretion

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16
Q

What is the main function of H3 receptors?

A

Neurotransmitter control

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17
Q

What is the main function of H4 receptors?

A

Immune response regulation

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18
Q

What does activation of H1 and H2 receptors cause?

A
  • Reduced BP

- Skin vasodilation

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19
Q

What is the response when the skin is pricked w/ an allergen?

A
  • Red area at site of injection (vasodilation)
  • Wheal replaces red area (edema)
  • Bright red flare, indirect vasodilation (axonal reflex)
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20
Q

What is the pharmacotherapy for allergic rhinitis?

A
  • Antihistamines
  • Intranasal glucocorticoids
  • Leukotriene modifiers
  • Decongestants
  • Mast cell stabilizers
  • Anticholinergics
  • Anti-IgE therapy
21
Q

What will H1 receptor blockage cause?

A
  • Decreased itching
  • Decreased vascular permeability
  • Decreased bronchial secretions
  • Relaxation of bronchial smooth muscle
  • Decreased cough receptor stimulation
22
Q

What are some additional effects of antihistamines?

A
  • 1st gen have non-histamine blockage actions, like sedation, atropinic, and anti-emetic
  • 2nd and 3rd gen prevent mast cell release of mediators that cause inflammation
23
Q

How can antihistamines be administered?

A
  • Oral
  • Intranasal
  • IV (only used later in anaphylaxis but benefit questionable)
24
Q

How are antihistamines metabolized?

A

CYP P450 system

25
Q

What are indications for antihistamines?

A
  • Mild to moderate allergic rhinitis
  • Best for exudative allergies
  • Seasonal rhinitis
26
Q

Which 2nd gen antihistamine can be given to children?

A

Cetirizine

27
Q

What are indications for fluticasone?

A
  • Nasal and ocular sx (itching, sneezing, discharge, congestion)
  • Severe sx
  • Most effective for prevention and tx
28
Q

What is the dosing for fluticasone?

A

Once daily, produces a plateau of dose response curve

29
Q

What are side effects of fluticasone?

A
  • Epistaxis

- Normal SE of oral glucocorticoids (bone density, cataract formation, intraocular pressure)

30
Q

What is the difference between leukotrienes and prostaglandins?

A
  • Leukotrienes mediate bronchiole constriction, mucous secretion, and inflammation of airway
  • Prostaglandins mediate pain, fever, and inflammation
31
Q

Which drug is a leukotriene receptor antagonist?

A

Montelukast

32
Q

Are intranasal glucocorticoids more effective than leukotriene receptor antagonists?

A

Yes

33
Q

What effect does montelukast have?

A

Modest relief of congestion, itching, and discharge

34
Q

Are leukotriene receptor antagonists normally used alone?

A

No, normally used w/ antihistamine or intranasal glucocorticoid

35
Q

What is phenylephrine?

A
  • Decongestant

- Alpha 1 receptor agonist

36
Q

What symptoms does phenylephrine help w/?

A

Only congestion

37
Q

What is phenylephrine often given w/?

A

Antihistamine

38
Q

What are side effects of phenylephrine?

A
  • Insomina
  • Nervousness
  • Headache
  • Palpitations
  • Hypertension
39
Q

What is an important usage warning for phenylephrine?

A

Only use for a max of 3 days b/c can cause rebound congestion

40
Q

What is the function of cromolyn sodium?

A

Inhibits mast cell degranulation and release of mediators

41
Q

Can mast cell stabilizers be given after exposure to the allergen?

A

No, must be given before exposure

42
Q

What is the function of ipratropium?

A

Reduces mucous secretion, but no effect on inflammation

43
Q

When are anticholinergics useful for allergic rhinitis?

A

If primary symptom is nasal discharge

44
Q

What are side effects of ipratropium?

A
  • Dry mucous membranes, urinary retention

- Caution in glaucoma and prostatic hypertrophy

45
Q

What is omalizumab?

A

Anti-IgE antibody

46
Q

What are indications for immunotherapy?

A
  • IgE in serum or skin sensitivity to allergen (cat, pollen, dog)
  • Poor pharmacotherapy response or SE
  • Px preference
47
Q

When should immunotherapy be avoided?

A
  • Severe asthma
  • CV disease
  • High dose beta adrenergic receptor blocker
  • Do not initiate during pregnancy
48
Q

Immunotherapy is thought to be as effective as _____

A

Intranasal glucocorticoids

Pharmacology - Winter (18 decks)

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