Bronchodilators and Antihistamine/Ulcers

Question 1

Where is histamine released from?

Answer 1

-Mast cells and basophils

Question 2

Seasonal Allergy-Allergy Process

Answer 2

Exposure, sensitization, reexposure/histamine release, allergic response

Question 3

What releases histamine?

Answer 3

-Venoms, toxins, radiation, cold temperatures, mechanical injuries, pollen, dust

Question 4

Effects of Histamine on…

Answer 4

• Respiratory tract: nasal congestion, increased secretions, bronchoconstriction (H1)
• Blood vessels: Arteriolar dilation causes heat and sad
• Peripheral nerves: Stimulation of sensory nerves causes itching and pain (mainly H2)

Question 5

Effects of ANTIhistamine on…

Answer 5

Antihistamine drugs only block the effects of H1 receptors.
-Respiratory tract: Decreased swelling and edema, decreased but thickened secretions (partly anti-muscinic action), relieves symptoms of seasonal allergy
-Blood vessels: Antagonism of arteriolar dilation reduces heat
GI Tract-Secretions: None
CNS: Usually drowsiness, sedation (partly an anti-muscarinic) at therapeutic doses.
Peripheral nerves:Blocking itching and pain

Question 6

Treatment of seasonal allergy

Answer 6

CHLORPHENIRAMINE, LORATADINE (CLARITIN), CETIRIZINE (ZYRTEC), FEXOFENADINE (ALLEGRA)

Question 7

Treatment of motion sickness

Answer 7

Dimenhydrinate (Dramamine)

Question 8

Treatment of nausea and vomiting

Answer 8

Promethazine (Phenergan)

Question 9

Treatment of itching

Answer 9

Hydroxyzine, Claritin

Question 10

Which two drugs cause heavy sedation?

Answer 10

Diphenhydramine (Benadryl), Doxylamine (NyQuil)

Question 11

Adverse Effects

Answer 11

First generation drugs have a greater impact-SEDATION.

Anti-muscarinic

Question 12

Short Acting Beta Agonists (SABAs)

Answer 12

Albuterol (Proventil)

Question 13

Long Acting Beta Agonists (LABAs)

Answer 13

-Salmeterol (Serevent) and Fluticasone (Advair)
-Formoterol (Foradil) and Budesonide (Symbicort)
Both SABAS and LABAS activate B2-Adrenergic receptors (j have diff 1/2 lives)

Question 14

What medication is needed for an acute asthma attack?

Answer 14

SABAS (Albuterol, etc)

Question 15

What medication is needed for prophylaxis and upkeep of bronchodilation?

Answer 15

LABAS (Salmeterol, Salmeterol+Fluticasone)

Question 16

Adverse Effects

Answer 16

Fewer effects when given via inhalation than oral because that is more concentrated to the bronchioles
Use carefully in patients with cardiovascular disease and the elder (these drugs worsen tachycardia, palpitations, angina)
Muscle tremor (B2 effect)

Question 17

Theophyline

Answer 17

Taken by mouth PO

Second or third line

Question 18

Methylxanthines

Answer 18

Caffeine, Theophyline

Question 19

Tiotropium (Spiriva)

Answer 19

LAMA
Used for maintenance therapy for COPD and off-label for asthma.
Inhaled, acts locally, poor absorption which limits adverse effects
Adverse effects-dry mouth, airway irritation, GI upset

Question 20

Leukotriene Modifiers

Answer 20

MONTELUKAST AND ZAFIRLUKAST block leukotriene receptors
These drugs reduce leukotriene effects to cause both bronchodilation and reduced inflammation in the airways
Taken orally, not first choice drug
Given 1X PO

Question 21

Adverse Effects and precautions

Answer 21

Headache, GI upset
Joint and muscle pain, soreness
Insomnia, irritability, agitation, depression, suicidal thoughts

Question 22

Monoclonal Antibodies

Answer 22

Omalizumab-targets IgE antibodies
Administered Subq every 2-4 weeks
Reslizumab and Mepolizumab target interleukin-5
Adverse Effects: injection-site reactions, respiratory tract infections, headache, severe allergic reactions. Small increased risks of cancer.