Exam 2: Histamine Flashcards

1
Q

Histamine formed by the action of ___ on ___.

A

Histamine decarboxylase

histidine

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2
Q

The slowly turning over pool refers to…

A

histamine stored in granules in mast cells and basophils

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3
Q

Histamine Release

Mechanisms

A
  • Antigen-mediated
    • Ag binds to IgE-sensitized mast cell
  • Non-antigen mediated
    • Induced by drugs, high MW proteins, venoms, and other process that disrupt cell membranes
    • May induce release by displacing histamine from storage granules
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4
Q

Allergic reactions involve an antigen interacting with an ___.

A

IgE-sensitized mast cell

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5
Q

Anaphylatoxic Drugs

A
  • Morphine
  • Codeine
  • Curare ⇒ competitive Ach inhibitor
  • Some neuromuscular blockers
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6
Q

___ and ___ can contain polypeptides that cause histamine release.

A

Venom ⇒ basic polypeptides

Complement ⇒ C5a and C3a

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7
Q

Stimulation of ___ inhibits release of histamine.

A

adrenergic β2 receptors

(May be one mechanism of epinephrine in treating anaphylactic shock)

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8
Q

Many effects of histamine mediated by…

A

histamine-1 receptor (H1)

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9
Q

H1 Receptor

Transduction

A

Gq ⇒ IP3 ⇒ ↑ [Ca2+]intracellular

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10
Q

Histamine

Effects

A
  • Phosphorylation of myosin light chain
    • Smooth muscle contraction
      • Bronchoconstriction
  • Production of NO
    • Vasodilation of post-capillary venules and arterioles
    • Engorgement of local microvasculature
      • Enhances diapedesis
      • Responsible for erythema
    • See some constriction of veins
    • Predominant systemic effect is hypotension
  • Contraction of endothelial cells
    • Release of plasma proteins and fluids from post-capillary venules
    • Responsible for edema
  • Depolarizes nerve endings
    • Sensation of itch and pain
    • Itching can be mediated by central mechanisms in some patients
  • Stimulate NF𝜅B mediated transcription
    • Important in the immune response
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11
Q

Histamine used as a ___ in allergy testing.

A

positive control

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12
Q

The rapidly turning over pool is contained with…

A

enterochromaffin-like (ECL) cells

&

histaminergic neurons in CNS

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13
Q

Histaminergic neurons originate in the ___ and project ___.

A

tuberomamillary nucleus

diffusely throughout the brain

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14
Q

H2 Receptor

Transduction

A

Gs ⇒ cAMP

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15
Q

The CNS activation of histamine may be responsible for…

A

wakefulness

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16
Q

Histamine released from ECL cells acts via ___ to stimulate ___ by ___.

A

H2 receptors

stimulate acid secretion

Parietal cells

17
Q

Most H1 receptors appear to have ___ activity, ___ of histamine.

A

constitutive

independent

18
Q

Most histamine antagonists are ___.

A

inverse agonists

(Reduces constitutive activity of the receptor)

19
Q

First Generation

Antihistamines

A
  • Diphenhydramine (Benadryl)
  • Hydroxyzine (Atarax)
  • Promethazine (Phenergan)
  • Chlorpheniramine
  • Dimenhydrinate (Dramamine)
  • Meclizine (Motion relief)
20
Q

Second Generation

Antihistamines

A
  • Fexofenadine
  • Loratadine (Claritin)
  • Cetirizine (Zyrtec)
  • Desloratadine (Clarinex)
21
Q

Allergy Mechanism

A

Includes allergic rhinitis, acute urticaria, and pruritis.

  • Ag crosses epithelium ⇒ underlying tissues
  • Encounters previously sensitized mast cell
  • Cross-linking of IgE/Fc receptor complex on mast cell
  • Degranulation releasing histamine + inflammatory mediators
  • Activation of H1 receptors
    • Vasodilation
    • ↑ vascular permeability
22
Q

Allergy Disorders

Treatment

A
  • Antihistamines block edema caused by histamine
  • Best used prophylactically
  • Actions due in part to inhibition of NF𝜅B pathway
  • 1st and 2nd generation antihistamines equally effective
    • 2nd gen preferred d/t better adverse effect profile
  • Topical admin via nasal sprays and creams faster acting but requires more frequent administrations
23
Q

Pruritis

Treatment

A
  • Antihistamines can be used for generalized itching
  • In some cases, sx can originate from systemic abnormality
    • Ex. renal insufficiency
    • Successful treatment of underlying condition usually relieves itch
    • Antihistamines not effective here
24
Q

Motion Sickness

Treatment

A
  • First generation antihistamines can be used
    • Dimenhydrinate
    • Meclizine
    • Promethazine
    • Diphenhydramine
  • Some marketed as “less sedating” but all cause some sedation
25
Q

Insomnia Treatment

A
  • First generation antihistamines can be used
    • Are not the preferred agents
  • Also found in nighttime OTC meds
26
Q

Antihistamines

Excluded Conditions

A
  • Are not used for:
    • Bronchial asthma
    • Anaphylaxis
    • Severe angioedema
  • Because there are other mediators that contribute to disease
  • Epinephrine is the drug of choice for anaphylaxis
27
Q

1st gen antihistamines are ___ at physiological pH and readily cross the ___.

A

neutral @ physiological pH ⇒ crosses BBB

28
Q

1st gen antihistamines are ___ and also block ____.

A

Less selective ⇒ blocks cholinergic, α-adrenergic and serotonergic receptors

29
Q

1st Gen Antihistamine

Adverse Effects

A
  • Due to ⊗ cholinergic receptors
    • CNS depression
      • The elderly more susceptible to sedative effects
    • Blurred vision
    • Dry mouth
    • Urinary retention
  • Due to ⊗ α-adrenergic receptors
    • Hypotension
    • Reflex tachycardia
30
Q

2nd gen antihistamines have a ___ structure and do not cross the ___.

A

amphoteric

BBB

31
Q

2nd gen antihistamines have improved ___, with less ___ activity.

A

H1 selectivity

anticholinergic

32
Q

Of 2nd gen antihistamines, ___ causes the most sedation.

A

cetirizine (Zyrtec)

33
Q

2nd Gen Antihistamines

Adverse Effects

A
  • Sedation (milder)
  • Dry mouth
  • Headache
  • Fatigue