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Spring OD1- Pharmacology > Final 30-33 Antiallergy > Flashcards

Final 30-33 Antiallergy Flashcards

1
Q

Allergy Immunology: Type 1 Hypersensitivity

IgE mediated or Humoral

A
  • immediate allergic response
  • when antigens are reintroduced
  • IgE antibodies produced at first exposure to antigen, attach to Mast Cells and Basophils
  • makes mast cells more susceptible to rupture when individual is reintroduced to same antigen
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2
Q

Type 1 Hypersenstivity Reactions

A
  • inflammatory mediators are released - histamine, prostaglandins, leukotriences
  • histamine activates H1 Receptors on blood vessels = vasodialtion, leakage of fluid, due to increased vascular permeability
  • H1 receptors in heart, bronchial smooth muscles, mucous membranes, and blood vessels of eye
  • H2 receptors located in GI tract, blood vessels, mast cells, and blood vessels of eye
  • commonly occur in hay fever, allergic conjunctivitis, asthma
  • *Ocularly, release of histamine is the main mediator in type 1 allergic reactions: itchy, tearing, conj and lid edema, papillary reaction
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3
Q

Type I Hypersensitivity Ocular Rxns:
Seasonal Allergic Conjunctivitis (SAC)

A

Have Fever - most common ocular allergy
- related to specific pollens - exogenous antigens
- seasonal

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4
Q

Type I Hypersensitivity Ocular Rxns:
Perennial Allergic Conjunctivitis (PAC)

A
  • year round allergic conditions - animal dander, dust, mold, feces
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5
Q

Type I & VI Hypersensitivity Ocular Rxns:
Atopic keratoconjunctivitis (AKC)

A
  • a hypersensitivity state caused by predispositional, constitutional, and hereditary factors (ex: genetic conditions)
  • usually family hx or personal hx of allergy - atopic dermatis
  • sight threatening – tx: topical dual mast cell stabilizers and anti histamines
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6
Q

Type I & VI Hypersensitivity Ocular Rxns:
Vernal Conjunctivitis or Vernal Keratoconjunctivitis (VKC)

A
  • seasonal disorder - adolescent males, bilateral inflammation
  • characterized by formation of large papillae with the appearance of cobblestones on upper tarsal conj.
  • Sx: intense itching and thick, ropy discharge
  • if cornea affected –> photophobia
  • may induce ptosis
  • potentially sight threatening
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7
Q

Type I & VI Hypersensitivity Ocular Rxns:
Contact Len papillary Conjunctivitis (CLPC)

A
  • previously GPC
  • combo of immune + mechanical mechanicals
  • proteins on contact lens +_ inflammatory condition
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8
Q

Type I & VI Hypersensitivity Ocular Rxns:
Contact Dermatitis of the Eyelid

A
  • Allergic = ACD | Irritant = ICD
  • eyelid contact dermatitis is an inflammatory reaction involving the eyelid skin – caused by contact with Trigger Substance
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9
Q

Decongestant Agents

A

actions of adrenergic agonists on alpha-adrenergic receptors, aka sympathomimetics - produce vasoconstriction actions

  • conj blood vessels contract within minutes causing eyes to whiten
  • **Adrenergic agonists stimulate alpha-adrenergic receptors in arterioles of the conj to produce vasoconstriction
  • secondary effect - conc. and dose depend. - potential for mydriasis b/c of alpha adrenergic fx on iris dilator
  • conditions which do not respond to use of decongestants within 48 hrs should be re-evaluated for whether a more serious condition exists
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10
Q

Decongestant Pharmacology

A

Class of Meds called: Imidazole derivatives

  • naphazoline, tetrahydrozoline, oxymetazoline
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11
Q

Decongestant Indications

A
  • Relieve redness and discomfort of the eyes caused by minor eye irritation

contraindications – concern with mydriatic strengths and doses
- narrow angle glaucoma
- anatomically narrow angle without glaucoma

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12
Q

Decongestant Warnings/Precautions

A
  • overuse of all agents can cause rebound vasodilation and INCREASE redness of eyes
  • mydriatic doses – caution for older patients who may develop pigment floaters
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13
Q

Naphazoline:
Decongestant (alpha-adrenergic agonists) - Imidazole Class

A
  • 0.1% conc is Rx only - lower conc is non-rx

Indications:
- relieve redness of eyes caused by minor eye irritation

Admin and Dosage:
- 1 or 2 drops into the conj sac of affected eye every 3-4 hours, up to 4 times daily

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14
Q

Oxymetazoline:
Decongestant (alpha-adrenergic agonists) - Imidazole Class

A

Indications:
- relieve redness of eyes caused by minor eye irritation

Admin and Dosage
- adults and children at least 6 yo: 1 to 2 drops every 6 hours

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15
Q

Tetrahydrozoline
Decongestant (alpha-adrenergic agonists) - Imidazole Class

A

Indication:
- relieve redness and discomfort of the eyes caused by minor eye irritation
- temporary relief of irritation and burning caused by dry eye, or exposure to wind or sun

Admin and Dosage
- 1 or 2 drops into affected eye, MAX 4 Drops a day

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16
Q

Decongestant/ANtihistamine Combo:

Naphazoline and Pheniramine (1st gen)

A
  • combo of product can be used for temporary relief of minor itching and redness symptoms from allergy antigen
  • topical antihistamines are potential sensitizers and may produce local sensitivity reaction
  • use in caution in those with narrow angles or hx of glaucoma
17
Q

Brimonidine Tartrate 0.025% (Lumify)

A

Indication:
- ocular redness (OTC): relief of redness of eye due to minor irritations

Mechanism of Action:
- selective alpha-2 receptor agonist – reduces redness by constricting venule

Dose
- instill one drop in affected eye every 6 to 8 hrs up to 4x daily

18
Q

Ocular Antihistamines

A
  • second generation antihistamines OR selective histamine H1 receptor antagonists
  • selectively block the action of histamine on H1 histamine receptors and DO NOT block other receptors
  • exception is pheniramine (1st gen)
  • first gen oral antihistamines have a low specificity and block other receptors such as cholinergic receptors
19
Q

Mast Cell Stabilizer Effect

A

ability to prevent the release of allergic mediators from mast cell

  • selectively block action of histamine on H1 histamine receptor and stabilizes the mast cell preventing release
    (dual antihistamine/mast cell stabilizers)
20
Q

Emedastine (Emadine)

A
  • only second generation pure ocular antihistamine
  • MoA: selective H1 Receptor antagonist (2nd gen)
  • Indications: temp relief of allergic conjunctivitis
  • dosage: 1 drop in eye, QID

ADE: Headache, burning or stinging on instillation

Caution: Contact Lens Caution

21
Q

Ocular Antihistamine: Pharmacology/Usage

A

use alone or in combine ation of decongestant

  • relief of symptoms of allergic conjunctivitis
22
Q

Ocular Antihistamine:
Warning/Precautions

A

minimal systemic side fx due to localized site of action - ocular side fx

  • use of non-rx agents within same pharmacological classes can be additive
23
Q

Mast Cell Stabilizers

A

MoA:
- stabilize mast cells by inhibiting the degranulation of sensitized mast cells after exposure to specific antigens

  • drugs have no intrinsic vasoconstrictor, antihistaminic or anti-inflammatory activity

Indications
- Pure Mast Cell stabilizers are used for vernal keratoconjunctivitis and season conjunctivitis

24
Q

General Pharmacology: Mast Cell Stabilizers

A
  • Nedocromil has fast onset of action than other mast cell stabilizers
  • symptom relief may occur within 15 min after instillation
  • Perimolast can provide symptomatic relief within days of commencing administration, full effects may require several weeks of therapy
25
Q

Cromolyn - Mast Cell stabilizer

A

MoA:
- stabilize mast cells by inhibiting the degranulation of sensitized mast cells, after exposure to specific antigens

Indications:
- vernal conjunctivitis, vernal keratoconjunctivitis, vernal keratitis

Dosage:
- 1-2 drops in eye 4-6x/day

Onset/Duration:
- within a few days; tx for up to 6 weeks

26
Q

Lodoxamide (Alomide)- Mast Cell Stabilizers

A

MoA:
- stabilizes mast cells by inhibiting degranulation of mast cells

Indications:
- vernal conjunctivitis, vernal keratoconjunctivitis, allergic conjunctivitis (non-FDA approved)

Dosage;
- instill 1 to 2 drops in each eye 4 x daily up to 3 months

27
Q

Nedocromil (Alocril)
Mass cell stabilizer

A
  • Stabilize Mast cell by inhibiting degranulation of mast cells

Indications: Allergic conjunctivitis

Dosage/Onset:
- 15 minutes – FASTEST Mast cell stabilizer
- 2x a day! BIDj

ADE:
- 40% headache, unpleasant taste

28
Q

Pemirolast (Alamast)
- Mass cell Stabilizer

A

MoA- stabilizes mast cells by inhibiting the degranulation of sensitized mast cells

Indication: Allergic conjunctivitis

Dosage - 1 or 2 drops in the eye 4x a day

Onset - requires 4 weeks of therapy

29
Q

Azelastine (generic) Rx

Dual Action: Antihistamine and Mast Cell Stabilizer

A

MoA:
- selective H1 receptor antagonist - 2nd gen - inhibits release of histamine

indications: allergic conjunctivitis

dosage: 1 drop in affected eye, 2x a day

Onset/Duration: 3 minutes - 8 hours

30
Q

Alcaftadine (Lastacaft) Rx

Dual Action: Antihistamine and Mast Cell Stabilizer

A

MoA:
- selective H1 Receptor antagonist, 2nd gen, inhibits release of histamine

indication: allergic conjunctivitis

dosage: 1 drop in each eye. 1x a day!

Onset: 15min/24 hours

31
Q

Epinastine (Elestat)

Dual Action: Antihistamine and Mast Cell Stabilizer

A

MoA:
- selective H1 receptor, second gen
- has h2 receptor antagonist efects
- does not cross BBB, minimal CNS risk

Indication: Allergic Conjunctivitis

Dosage: 1 drop in each eye, BID

Onset: 3-5 min/8 hours

32
Q

Ketotifen - OTC Non Rx

Dual Action: Antihistamine and Mast Cell Stabilizer

A

MoA:
- relative selective, non-competitive H1 receptor antagonist, 2nd gen , inhibits release of histamine

Indications: Allergic Conjunctivitis

Dosage: 1 drop in eye, 2x daily, every 8-12 hours

onset: within minutes/ up to 12 hours

ADE:
- headaches

33
Q

Olapatadine (Pataday and generic) OTC non rx

Dual Action: Antihistamine and Mast Cell Stabilizer

A

MoA
- relatively selective h1 receptor antagonist, 2nd gen, inhibit release of histamine
- lesser H2 receptor antagonist effects, similar to epinastine, crosses BBB
- Inhibit histamine induced effects on conj. epithelial cells

Indications: Allergic Conjunctivitis

Dosage:
0.1% - 2x daily
0.2% - 1xdaily
0.7% - 1x daily

34
Q

Bepotastine (Bepreve)
Dual Action: Antihistamine and Mast Cell Stabilizer

A

MoA:
- Direct H1 receptor antagonist, 2nd gen, inhibits release of histamine from mast cells

Indications: Allergic Conjunctivitis

Dosage: 1 drop in eye, 2x daily

Onset/Duration: within 3 min/ up to 16 hours

34
Q

Bepotastine (Bepreve)
Dual Action: Antihistamine and Mast Cell Stabilizer

A

MoA:
- Direct H1 receptor antagonist, 2nd gen, inhibits release of histamine from mast cells

Indications: Allergic Conjunctivitis

Dosage: 1 drop in eye, 2x daily

Onset/Duration: within 3 min/ up to 16 hours

Spring OD1- Pharmacology (7 decks)

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