Antihistamines (lauren 🌭) Flashcards
What are the clinical indications for antihistamines
Allergies (nose, skin, eyes)
Hypersensitivity reactions
Anaphylaxis
Hives (acute and chronic)
Motion sickness
Vertigo
Insomnia
What are the 6 First Generation H1 blockers you need to know?
Diphenhydramine (Benadryl, Nytol, Sominex)
Chlorpheniramine (Chlor-Trimeton)
Dimenhydrinate (Dramamine)
Promethazine (Phernergan)
Meclizine (Antivert)
Hydroxyzine (Atarax, Vistaril)
Which H1 blocker is EXTREMELY SEDATING and would be great for someone who is so itchy that they can’t sleep at night?
Hydroxyzine (Atarax, Vistaril)
Name the Second generation H1 blocker you need to know
Loratadine (Claritin)
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Which 2nd generation H1 blocker can be mildly sedating and is NOT OK for pilots 👨🏼✈️
Cetirizine (Zyrtec)
What are the H2 blockers you need to know?
Ranitidine (Zantac)
Famotidine (Pepcid)
What are the 2 nasal antihistamines you (might) need to know
Azelastine (Astelin, Astepro)
Azelastine + Fluticasone (Dymista)
(She really didn’t say anything about this slide)
What are the antihistamine eye drops you (probably don’t) need to know?
Azelastine (Optivar)
Ketotifen (Zatidor)
Naphazoline (Naphcon A)
Olopatadine (Patanol)
Which class of H1 blockers can cross the BBB and thus, can help with motion sickness and insomnia?
1st generation
What are the side effects of antihistamines?
Anticholinergic
RED as a BEET🍠
DRY as a BONE🦴
BLIND as a BAT🦇
MAD as a HATTER🎩
HOT as a HARE🐇
What is the 1st line medication for allergic rhinitis?
Nasal steroid sprays
If you don’t want to die in a fiery plane crash, what allergy meds should you confiscate from the guy who flies your private jet?🛩
Diphenhydramine (Benadryl)
Cetirizine (Zyrtec)**
Levocetirizine (Xyzal)
Azelastine Nasal Spray (Asteline)
What 2 allergy meds are OK to take if you fly an airplane (as long as you did a trial run to make sure they don’t make you act goofy)?✈️
Loratadine (Claritin)
Fexofenadine (Allegra)
If you REALLY have to take one of the illegal antihistamines and you are employed as an airplane pilot, how long do you have to wait before you get back behind the wheel? Joysticks? Buttons?
5 times the drug’s half life
For Benadryl, that would be 60 hours you must stay on the ground and not fly
What occupations other than a pilot should probably NOT take sedating antihistamines?
Heavy machinery operator 🚀
Construction workers 🚧
Electricians who climb poles 🏗
Light rail driver 🚈 toot toot
Health care providers 👨🏻⚕️
PA students 👵🏻🐈🌭
If someone has BPH, what kinds of allergy meds probably make it even harder for him to pee?
1st generation antihistamines (anticholinergic effect)
Decongestants like Sudafed
If someone has glaucoma, what allergy meds should be avoided because they can increase IOP?
Decongestants
Antihistamines
Steroids (including nasal steroids)
Okayyyy so what am i supposed to do if my patient has glaucoma and allergies?
Call their ophthalmologist and let her decide what to do
Immunotherapy (allergy shots) might be their best option
If you have a patient who has scabies and he CAN’T SLEEP because of the itching, what meds does he need?
Permethrin cream 5% from neck down for 8-12 hours
Hydroxyzine or Benadryl to help him sleep
(And of course you will tell him about the side effects and risks of being sedated)
If a vignette mentions someone has night time itching and “burrow lesions” what do they have
Scabies
Acute hives lasts less than ____ weeks
Chronic hives lasts more than ____ weeks
6
6
What can sometimes cause chronic hives?
“Autoimmune chronic urticaria”
If a patient has autoimmune chronic urticaria, what kind of med may help?
Non-sedating antihistamine
What do you need to give to someone with Poison Ivy?
Steroid cream
Non-sedating antihistamine
+/- oral prednisone if needed
Watch out for signs of infection
Where can you NOT put high-potency steroid cream?
Face
Skin folds like your GENITALS
If someone has a PCN allergy, can they take augmentin?
No
If someone develops a medication rash because they’re an idiot and they used their friend’s augmentin for their poison ivy even though they are allergic to PCN, what can you do for them?
Shame them
Oral antihistamine
IM steroids and/or IM antihistamine (don’t drive after antihistamine)
+/- oral prednisone
(Obviously stop the augmentin too)
If someone has hives that are just not responding to any treatment, including antihistamines and prednisone, what is a last ditch effort that you can add on to their treatment?
H2 blockers
Can you try using H2 blockers by themselves to treat urticaria?
NO. ONLY AS AN ADJUNCT
You give your patient an allergy shot, watch her for 30 minutes and send her on her way. A few minutes later, she develops a tickle in her throat, so she calls your office. Your receptionist should tell her to _____________
Call 911/go to ER
If your patient develops a tickle in her throat after gettin an allergy shot in your office, and your receptionist mistakenly tells her to come back to your office, what meds do you need to get ready?
IV Benadryl
IV Epinephrine
IV/IM Glucocorticoid
What is the DRUG of CHCOICE for anaphylaxis?
Epinephrine
By definition, anaphylaxis involves _____ body systems at the same time
2+
Ex: Skin and mucosa
Respiratory/Airway
GI (abdominal pain, vomiting, diarrhea)
Cardiac (hypotension, tachycardia, syncope)
If you successfully treat someone’s anaphylactic reaction, can you just kick them out the front door empty handed?
NO, need to be aware of rebound possibility.
You need to give them an epi pen and a referral to an allergist
What drug cocktail was given to that little girl who had an anaphylactic reaction to cashews, and is a good regimen for anyone with anaphylaxis
Benadryl
Epinephrine
Dexamethasone
Famotidine (Pepcid)
What route(s) of administration do you use to give meds during an anaphylactic reaction?
IV or IM
NOT ORAL (their freakin throat is swelling shut)
1st generation or 2nd generation H1 blocker:
Longer acting with once daily dosing
2nd gen
1st generation or 2nd generation H1 blocker:
Crosses blood brain barrier
1st
