Common Illnesses and Treatments Flashcards

Question

Second generation OA's

Answer 1

Peripheral histamine blockers Little or no CNS effect Cetirizine, loratidine, fexofenadine Induce CYP P450 system

Answer 2

All first generation antihistamines are on the BEERS list  should not be used in the elderly due to the anticholinergic effects May also be associated with a higher SIDS rate in the premature or term neonate Not for OTC use under the age of 2 yo

Answer 3

Benadryl 1st generation H1 blocker Used for allergies, sleep, prevention of motion sickness, dystonic reactions, Parkinson’s Side effects: Hypotension, palpitations, tachycardia, sedation, dizziness, paradoxical excitement, xerostomia, thickened bronchial secretions  Dosing: 5 mg/kg/day, not to exceed 300 mg/24 hrs

Answer 4

Atarax, Vistaril 1st generation H1 blocker Syrup may contain sodium benzoate Uses: anxiety, antihistamine, antiemetic s/e drowsiness, dizziness, xerostomia, anticholinergic effects Dose: 2 mg/kg/day divided q 6-8 hrs

Answer 5

Chlor-Trimeton 1st generation H1-blocker Use: perennial & seasonal allergic rhinitis, urticaria In many OTC cold preparations s/e: drowsiness, excitability, thickening of bronchial secretions Cytochrome P450 substrate Can be dosed down to age 2 – dose by form (maleate vs dexclorpheniramine maleate)

Answer 6

Zyrtec 2nd generation H1 blocker Use: allergic rhinitis, urticaria s/e: BP changes, headache, GI s/s, drowsiness, photosensitivity Cytochrome P450 , CYP3A4 substrate Dosing: down to 6 months 6 mo-23 months 2.5 mg daily 2-5 yo 2.5-5 mg daily 6 yo + 5-10 mg daily

Answer 7

Alavert, Claritin, Tavist ND, Triaminic Allerchews 2nd generation H1 blocker Use: allergic rhinitis, urticaria Less sedating than other antihistamines Cytochrome P450 isoenzyme CYP 2D6 & CYP3A3/4 s/e: Xerostomia, drowsiness, photosensitivity Dose: 2-5 yo 5 mg daily 6 yo + 10 mg once daily

Answer 8

Allegra 2nd generation H1 blocker Use: allergic rhinitis, urticaria s/e: GI s/s, drowsiness, fatigue Cytochrome P450 isoenzyme CYP2D6 inhibitor and CYP3A4 substrate Dose: Age 6 months – for urticaria – 15 mg BID  Age 2-11 30 mgs BID  Age 12+ 60 mg BID OR 180 mg QD  *fruit juices interfere with absorption* 

Answer 9

Plasma levels in the elderly are generally higher than those observed in other age groups. Once daily dosing is recommended when starting therapy in elderly patients or patients with decreased renal function (Lexi- comp, 2014)

Answer 10

Seldane or terfenadine was widely used in the US prior to the 1990s for allergies Fexofenadine is a metabolite of terfenadine ``` Terfenadine was pulled from the market by the FDA when they found that it interacted with other medications and foods (erythromycin, grapefruit) and caused QT prolongation and Torsade de Pointes ``` Fexofenadine levels increase with other CYP 450 medications but no QT prolongation has been seen

Answer 11

Clarinex Marketed as “purified” Loratidine Metabolite of loratidine Peripheral H1 blocker Some people are slow metabolizers Can be used in Seasonal or perennial allergic rhinitis and chronic urticaria Desloratadine Dose down to 6 mo of age: 1 mg daily 1-5 yo: 1.25 mg daily 6-11 yo: 2.5 mg once daily 12 yo + 5 mg daily No reductions in dose for the elderly in general but MUST reduce dose in Hepatic disease and/or Renal disease Pregnancy category C Not recommended in breastfeeding women

Answer 12

Purified H1 antagonist Licensed for urticaria and allergic rhinitis Dosing: Usual Children 6 months to 5 years: 1.25 mg once daily  Children 6-11 years: 2.5 mg once daily  Children ≥12 years and Adults: 5 mg once daily  Pregnancy category B In Elders – start at lowest dose and go up if needed Also need to reduce dose for altered renal function

Answer 13

Rhinoviruses Parainfluenza Respiratory syncytial virus Coronaviruses Adenoviruses Enteroviruses Influenza Mycoplasma pneumonia Reoviruses

Answer 14

Dextromethorphan Tessalon perles Codeine Hydrocodone

Answer 15

Acts on cough center in medulla to suppress cough Pharmacologically related to morphine Efficacy???? s/e: nausea, dizziness, drowsiness Cytochrome P450 isoenzyme CYP2D6, CYP2E1, CYP3A3/4 substrate Dosing: available down to 1 mo of age, most recommend NO meds prior to 4 years of age.

Answer 16

Tessalon Perles Chemically similar to Tetracaine Local anesthetic effect of lung passages to calm cough Can be used for common cold, bronchitis, pneumonia, asthma Adult dosing only! 100-200 mg TID Must be swallowed whole!

Answer 17

Act directly on medulla to suppress cough Good for night time cough relief Hydrocodone: various cough suspensions available – best is Tussionex – hydrocodone + Chlorpheniramine maleate – available down to age 6 yo. All can cause drowsiness, dizziness, pruritis, dependence Pregnancy category C  addiction in neonate with chronic use

Answer 18

Many preparations with codeine available for children – used to be mainstay of postop pain for T&A’s and for cough Codeine is metabolized into morphine Many fatalities occurred after codeine administration (after T&A) and noted to be ultrarapid metabolizers due to CYP2D6 polymorphism  toxic levels of morphine in serum – resp depression and death Black Box Warnings

Answer 19

No codeine under the age of 12 No codeine in breastfeeding mothers ``` If codeine must be used: Codeine should be prescribed in all patients in the lowest effective dose and for the shortest period of time; patients and caregivers should be informed about risks and signs of morphine overdose ``` (FDA.gov, Lexi-comp, 2014)

Answer 20

Guiatuss, Mucinex, Robitussin Expectorant Thought to act by stimulating respiratory tract secretions, increasing fluid volume and decreasing viscosity of sputum Efficacy???? Good safety profile s/e: headache, dizziness, nausea, vomiting, stomach pain, rash Can dose down to age 2

Answer 21

2007  Public health advisory that advised NO over the counter cough or cold medicine in children under the age of 2  In 2008 recommendation was updated to recommend no cough and cold meds under the age of 6  No ban as of fall 2008  Deaths have occurred, but most are due to giving too much or giving too often.  FDA recommendations (2007) No cough or cold products under 2 yo unless directed by health care provider  Never use adult medicines for children  Pay attention to different dosage strengths  Be aware of drug interactions  Read the warnings on the package  Do not exceed recommended dose  Use measuring device that comes with medicine OR one that is provided by pharmacy  Cough and cold medicine do not “cure” colds 