Allergies & Asthma; L5 (12-09-15) Flashcards
Beta2 adrenergic agonists (short, long acting)
Classification: __
ROA: Inhalation; oral; subcutaneous (terbutaline)
- *MOA**:
1) Stimulate __ (__ __) -> increases __ -> __
2) Inhibits release of mediators from ____ - *Therapeutic use: symptom relief in __ in __ asthma attacks**
- Unique therapeutic use: is used in combo with corticosteroids in an inhaler
- *Side-effects**:
1) __ __ __
2) __
3) __, __, __
Beta2 adrenergic agonists (short, long acting)
Classification: bronchodilator
ROA: Inhalation; oral; subcutaneous (terbutaline)
- *MOA**:
1) Stimulate AC (adenylyl cyclase) -> increases cAMP -> bronchodilation
2) Inhibits release of mediators from mast cells - *Therapeutic use: symptom relief in bronchospasm in acute asthma attacks**
- Unique therapeutic use: is used in combo with corticosteroids in an inhaler
- *Side-effects**:
1) Skeletal muscle tremors
2) Tachycardia
3) Anxiety, restlessness, apprehension
Theophylline
Classification: __
ROA: oral; slow IV over 40 minutes
- *MOA**:
1) Inhibits __ __, causing increase of __
2) Competitive antagonist at __ receptors - *Therapeutic use: __ therapy for __ asthma**
- Unique therapeutic use: sustained release oral therapy
- *Side-effects**:
1) __ __ __
2) __
3) __
4) __ __
Theophylline
Classification: bronchodilator
ROA: oral; slow IV over 40 minutes
- *MOA**:
1) Inhibits cAMP phosphodiesterases, causing increase of cAMP
2) Competitive antagonist at adenosine receptors - *Therapeutic use: maintenance therapy for chronic asthma**
- Unique therapeutic use: sustained release oral therapy
- *Side-effects**:
1) Narrow therapeutic window
2) Convulsions
3) Tachycardia
4) Circulatory collapse
Ipratropium
Classification: __
ROA: inhalation
MOA: competitively blocks the __ receptors in the airways
- *Therapeutic use: alone or in combo with __ __ __ in __ asthma**
- Unique therapeutic use: used when a coexisting chronic bronchitis or cough is a symptom in an asthmatic patient
Side-effects: __; if dosage is too high it may cause __-__ effects
Ipratropium
Classification: bronchodilator
ROA: inhalation
MOA: competitively blocks the muscarinic receptors in the airways
- *Therapeutic use: alone or in combo with B2 adrenergic agonists in acute asthma**
- Unique therapeutic use: used when a coexisting chronic bronchitis or cough is a symptom in an asthmatic patient
Side-effects: minimal; if dosage is too high it may cause atropine-like effects
Corticosteroids
Classification: ____
ROA: inhalation; oral; IV
MOA: reduce the synthesis of __ __ by __, which inhibits the release of __ and __
- *Therapeutic use: __ therapy for __ asthma**
- Unique therapeutic use: treats the underlying inflammation of asthma, reducing frequency and severity of attacks
- *Side-effects**:
1) Short term: increased __, __, __, __, and __ alterations
2) Long term: __, __, __, __ __ __ suppression, __
Corticosteroids
Classification: anti-inflammatory agent
ROA: inhalation; oral; IV
MOA: reduce the synthesis of arachidonic acid by phospholipase A2, which inhibits the release of leukotrienes and prostaglandins
- *Therapeutic use: maintenance therapy for chronic asthma**
- Unique therapeutic use: treats the underlying inflammation of asthma, reducing frequency and severity of attacks
- *Side-effects**:
1) Short term: increased energy, insomnia, hunger, agitation, and mood alterations
2) Long term: osteoporosis, cataracts, myopathy, hypothalamic/pituitary adrenal axis suppression, depression
Cromolyn
Classification: ____
ROA: inhalation
MOA: decrease in the release of mediators such as __ and __
- *Therapeutic use: __ therapy for preventing __**
- Unique therapeutic use: a) used prior to exercise; b) prior to cold air exposure
Side-effects: occasional __
Cromolyn
Classification: anti-inflammatory agent
ROA: inhalation
MOA: decrease in the release of mediators such as histamine and leukotrienes
- *Therapeutic use: prophylactic therapy for preventing bronchospasm**
- Unique therapeutic use: a) used prior to exercise; b) prior to cold air exposure
Side-effects: occasional coughing
Zafirlukast, Montelukast
Classification: ____
ROA: oral
- *MOA**:
1) Antagonist at the __ __ receptor
2) The __ receptor is also blocked - *Therapeutic use: __ therapy for preventing __**
- Unique therapeutic use: a) aspirin-induced asthma; b) prior to cold air exposure
- *Side-effects**:
1) __
2) __
Zafirlukast, Montelukast
Classification: leukotriene inhibitor
ROA: oral
- *MOA**:
1) Antagonist at the LTD4 leukotriene receptor
2) The LTE4 receptor is also blocked - *Therapeutic use: prophylactic therapy for preventing bronchospasm**
- Unique therapeutic use: a) aspirin-induced asthma; b) prior to cold air exposure
- *Side-effects**:
1) Headache
2) Nausea
Zileuton
Classification: ____
ROA: oral
MOA: inhibits __ to decrease production of __
- *Therapeutic use: __ therapy for preventing __**
- Unique therapeutic use: a) exercise/aspirin-induced asthma; b) antigen-induced asthma
Side-effects: contraindicated in patients with __ disease
Zileuton
Classification: leukotriene inhibitor
ROA: oral
MOA: inhibits 5-lipooxygenase to decrease production of leukotrienes
- *Therapeutic use: prophylactic therapy for preventing bronchospasm**
- Unique therapeutic use: a) exercise/aspirin-induced asthma; b) antigen-induced asthma
Side-effects: contraindicated in patients with hepatic disease
Diphenhydramine
Classification: __ __ receptor antagonist (__ gen)
ROA: oral; IV
MOA: blocks __ __ receptors
- *Indications**:
1) __ __
2) __
3) Adjunctive therapy in __ reactions
Major side-effects: MARKED __ or __ due to muscarinic receptor blockade
Diphenhydramine (Benadryl)
Classification: histamine H1 receptor antagonist (1st gen)
ROA: oral; IV
MOA: blocks histamine H1 receptors
- *Indications**:
1) Allergic rhinitis
2) Urticaria
3) Adjunctive therapy in anaphylactic reactions
Major side-effects: MARKED sedation or agitation due to muscarinic receptor blockade
Chlorpheniramine
Classification: __ __ receptor antagonist (__ gen)
ROA: oral
MOA: blocks __ __ receptors
- *Indications**:
1) __ __
2) Common ingredient in __ medications
Major side-effects: slight __ or __ due to muscarinic receptor blockade
Chlorpheniramine
Classification: histamine H1 receptor antagonist (1st gen)
ROA: oral
MOA: blocks histamine H1 receptors
- *Indications**:
1) Allergic rhinitis
2) Common ingredient in OTC medications
Major side-effects: slight sedation or agitation due to muscarinic receptor blockade
Fexofenadine
Classification: __ __ receptor antagonist (__ gen)
ROA: oral
MOA: blocks __ __ receptors
- *Indications**:
1) __ __
2) __ chronic __
Major side-effects: n/a
Fexofenadine (Allegra)
Classification: histamine H1 receptor antagonist (2nd gen)
ROA: oral
MOA: blocks histamine H1 receptors
- *Indications**:
1) Allergic rhinitis
2) Idiopathic chronic urticaria
Major side-effects: n/a
Loratidine
Classification: __ __ receptor antagonist (__ gen)
ROA: oral
MOA: blocks __ __ receptors
- *Indications**:
1) __ __
2) __ reactions to __
3) Adjunctive therapy in __ reactions
Major side-effects: __, __, __
Loratidine (Claritin)
Classification: histamine H1 receptor antagonist (2nd gen)
ROA: oral
MOA: blocks histamine H1 receptors
- *Indications**:
1) Allergic rhinitis
2) Allergic reactions to blood
3) Adjunctive therapy in anaphylactic reactions
Major side-effects: nausea, fatigue, headache
Certirizine
Classification: __ __ receptor antagonist (__ gen)
ROA: oral
MOA: blocks __ __ receptors AND blocks __ release
- *Indications**:
1) __ __
2) __ chronic __
Major side-effects: __, __, and __ __
Certirizine (Zyrtec)
Classification: histamine H1 receptor antagonist (2nd gen)
ROA: oral
MOA: blocks histamine H1 receptors AND blocks histamine release
- *Indications**:
1) Allergic rhinitis
2) Idiopathic chronic urticaria
Major side-effects: sedation, fatigue, and dry mouth
Doxepin
Classification: __ __ receptor antagonist (__ gen)
ROA: oral
MOA: blocks __ __ receptors
Indications: Chronic __ not responding to other __ __ (**UNIQUE COMPARED TO OTHER FIVE __-__ DRUGS)
Major side-effects: __, __ in non-depressed patients
Doxepin
Classification: histamine H1 receptor antagonist (2nd gen)
ROA: oral
MOA: blocks histamine H1 receptors
Indications: Chronic urticaria not responding to other H1 antagonists (**UNIQUE COMPARED TO OTHER FIVE ANTI-H1 DRUGS)
Major side-effects: disorientation, confusion in non-depressed patients
Allergy Summary:
- __ nasal sprays are the most effective single-agent maintenance therapy for allergic rhinitis
- __ gen agents are familiar to pts and are OTC, but they have several __ __-__
- __ gen agents - preferred when __ therapy is desired
- If __ nasal sprays alone are not sufficient, then add an __ nasal spray
- Pts who are refractory to __ nasal sprays and have asthma or nasal polyposis, __ may be helpful
Allergy Summary:
- Glucocorticoid nasal sprays are the most effective single-agent maintenance therapy for allergic rhinitis
- 1st gen agents are familiar to pts and are OTC, but they have several adverse side-effects
- 2nd gen agents - preferred when antihistamine therapy is desired
- If glucocorticoid nasal sprays alone are not sufficient, then add an antihistamine nasal spray
- Pts who are refractory to glucocorticoid nasal sprays and have asthma or nasal polyposis, montelukast may be helpful