Antihistamines and Allergic Rhinitis/URI Drugs Flashcards

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1
Q

Histaminergic neurons

A

Located exclusively in the posterior hypothalamus, associated with peak release at night as regulated by circadian rhythm

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2
Q

Agents that trigger histamine release without prior sensitization (3)

A

Drugs, radiocontrast media, direct cell injury

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3
Q

Efffects of H1 receptor stimulation

A
  • Vasodilation
  • increased capillary permeability
  • bronchoconstriction
  • increased itching or pain
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4
Q

Can you treat asthma with antihistamine?

A

No, the antihistamine has minimal benefit

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5
Q

effects of H2 stimulation (1)

A

Secretion of gastric acid

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6
Q

Can antihistamines treat anaphylaxis?

A

No, they have minimal impact and are used as primarily adjunctive therapy

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7
Q

2 classes of H1 antagonist

A

1st gen - diphenhydramine and chlorpheniramine

2nd gen - cetirizine, levocetirizine, fexofenadine, loratidine, desloratidine

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8
Q

Diff between 1st and 2nd gen H1 antagonists

A
  • 1st gen are highly sedating, 2nd not very much
  • 1st gen have anticholinergic effects leading to dry mouth, difficulty in micturition, tachycardia, constipation, virtually absent in 2nd generation
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9
Q

H1 antagonist mech of action

A

Competes with antihistamine for H1 receptors, does not inhibit histamine already attached to receptors so therefore should be taken 2 to 5 hours before allergen exposure (prophylactically)

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10
Q

Therapeutic uses of H1 antagonist (5)

A
  • mild allergy
  • severe allergy (supplemental)
  • motion sickness
  • insomnia
  • useless for the common cold
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11
Q

ADR’s of H1 (primarily 1st gen but some 2nd gen) antagonist (4)

A
  • sedation (1st gen)
  • psychomoor performance
  • GI disturbances
  • anticholinergic effects (primarily 1st gen)
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12
Q

Drug interactions of H1 antagonists (2)

A
  • CNS depressants

- alcohol

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13
Q

Name the 5 big 2nd gen H1 blockers (brand name and generic)

A
Fexofenadine (allegra)
Cetirizine (zyrtec)
Loratadine (claritin and alavert)
Desloratadine (clarinex)
Levocetirizine (xyzal)
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14
Q

Loratadine (claritin and Alavert) indications (2)

A
  • allergic rhinitis

- chronic idiopathic urticaria

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15
Q

Cetirizine (zyrtec) indications (3)

A
  • seasonal allergic rhinitis
  • Perennial allergic rhinitis
  • Chronic idiopathic urticaria
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16
Q

Fexofenadine (allegra) indications (2)

A
  • seasonal allergic rhinitis

- Chronic idiopathic urticaria

17
Q

What decreases the absorption of allegra?

A

Some fruit juices

18
Q

Desloratadine (clarinex) indications (2)

A
  • allergic rhinitis

- chronic urticaria

19
Q

Levocetirizine (xyzal) indications (3)

A
  • perennial allergic rhinitis
  • seasonal allergic rhinitis
  • Chronic idiopathic urticaria
20
Q

Pseudoephedrine is a ___ often included in 2nd gen H1 blockers under the suffix ___

A

decongestant, -D

21
Q

1st line of drugs for patients with mild to moderate symptoms (2 things)

A

Antihistamine

Nasal corticosteroid

22
Q

This drug class is most effective at preventing and treating seasonal allergic rhinitis. What is the one big concern with children using this class?

A

Intranasal corticosteroids, stunted growth rate concerns

23
Q

Mast cell stabilizers mech of action

A

Inhibit release of histamine and other mediators of inflammation from sensitized mast cells as preventative measure

24
Q

Intranasal cromolyn (Nasalcrom) drug class, who is it primarily recommended for?

A

Nasal mast cell stabilizer, young children, pregnant, and elderly because it is very safe but only moderately effective

25
Q

Sympathomimetics mech of action

A

Decongestants through stimulating a1 adrenergicc receptors on nasal blood vessels resulting in vasoconstriction and shrinkage of swollen membranes followed by nasal drainage breaking up mucus

26
Q

Sympathomimetics nasal vs PO administration

A

Intranasal results in rapid intense action, PO is delayed but prolonged response

27
Q

Rhinitis medicamentosa

A

Rebound congestions resulting from down regulation of a adrenergic receptors when prolonged repeated use of intranasal decongestants occurs, requiring limitation of 3-5 days of use of intranasal decongestants, occurs orally as well requiring slow withdrawal to prevent sharp increase in congestion

28
Q

Sympathomimetics ADRs (3)

A
  • rebound congestion
  • CNS stimulation
  • cardiovascular effects raising blood pressure and heart rate slightly
29
Q

Nasal saline

A

Drops and sprays used to relieve dryness and congestion

30
Q

Ipratropium bromide (atrovent nasal spray) mech of action

A

Anticholinergic agent that decreases mucus secretions

31
Q

Who is recommended to use Ipratropium bromide (atrovent nasal spray)

A

-Those who have watery rhinorrhea as a main complaint, otherwise no effect on congestion, sneezing, or itching

32
Q

Ipratropium bromide (atrovent nasal spray) ADR’s )2_

A
  • Transient nasal dryness

- Bleeding

33
Q

Omalizumab(Xolair) mech of action

A

Composed of monoclonal antibodies directed against IgE preventing release of inflammatory mediators from mast cells and basophils

34
Q

What is omalizumab (xolair) used to treat

A

Assist albuterol or another asthma medication to alleviate symptoms of an attack