Histamine and corticosteroids Flashcards
Name all 5 first generation Histamine type 1 receptor blockers
Diphenhydramine Meclizine Hydroxyzine Promethazine Chlorpheniramine
Name all three 2nd generation type 1 histamine receptor blockers
Loratidine
Ceterizine
Fexofenadine
Drug type
Diphenhydramine
Histamine type 1 receptor blocker first generation
Drug type
Meclizine
Histamine type 1 receptor blocker first generation
Drug type
Hydroxyzine
Histamine type 1 receptor blocker first generation
Drug type
Promethazine
Histamine type 1 receptor blocker first generation
Drug type
Chlorpheniramine
Histamine type 1 receptor blocker first generation
Drug type
Loratidine
Histamine type 1 receptor blocker second generation
Drug type
Ceterizine
Histamine type 1 receptor blocker second generation
Drug type
Fexofenadine
Histamine type 1 receptor blocker second generation
(Side) effects of 1st generation Histamine Type 1 receptor blockers
anti-hypersensitivity (allergy) anti-emetic (motion sickness) sedative effects (from crossing BBB) anti-vertigo effects reduced salivation
most common indication for Type 1 Histamine receptor blocker 2nd generation?
Day time allergies
also rhinitis; runny nose, combined with decongestants and acetaminophen
Main uses/indications for Histamine Type 2 antagonists
PUD peptic ulcer disease
GERD
Prophylaxis against stress ulcers in critically ill pts
(reduces gastrin and gastric acidity)
the 4 Histamine type 2 Receptor antagonists
Famotidine
Ranitidine
Nizatidine
Cimetidine
Adverse effects of Cimetidine
Gynecomastia
many drug-drug interactions
Adverse effects of all H2 receptor antagonists
Dose adjustments in renal insufficiency
CNS side effects (confusion, dizziness)
Increase risk of pneumonia in hospitalized pts (cuz lower acidity in stomach so bacteria can survive easier)
Overall physiological functions of corticosteroids
Increase blood glucose (gluconeogenesis, counteracting with insulin)
Increase sodium and water retention
Down regulates the immune response
2 major types of exogenous corticosteroids, function and an example of each
Glucocorticoids; Anti-inflammatory- Dexamethasone
Mineralocorticoids; Sodium and water retention (increase BP)- Hydrocortisone
Main function of Hydrocortisone
Increase BP via Na and water retention
Main function of Dexamethasone
Anti-inflammatory
Indications for Mineralocorticoids
Critically ill pts with suppressed Hypothalamus Pituitary Adrenal axis
Hypotension and hemodynamic instability; septic shock
How do glucocorticoids achieve their anti-inflammatory nature? (mechanisms)
Inhibit T cell and B cell proliferation
Inhibit leukocyte production
Inhibition of capillary permeability to leukocytes
Inhibit prostaglandin production (key in inflammatory response)
Methylprednisolone, Hydrocortisone, Prednisone, Dexamethasone. List in order from least to greatest in terms of anti-inflammatory activity.
Hydrocortisone
Prednisone
Methylprednisolone
Dexamethasone
Indications for Glucocorticoids?
Autoimmune diseases
(rheumatoid arthritis, Sjogrens, post-transplantation, anaphylactic rxns, asthma, allergic rhinitis, traumatic injuries and inflammation, shock and critically ill pts)
Post dental treatment; i.e. removal of impacted 3rds (trismus)
Key points about Sjogrens Syndrome
Mostly appears ages 45-55
10x more common in women
~50% of pts have Rheumatoid arthritis or other autoimmune disorders
Management of dry mouth (categories and examples)
Salivary substitutions; Carboxymethylcellulose, Glycerin
Muscarenic agonists; Pilocarpine, Cevimeline
Steroids; Prednisone
Salivary stimulation; sugar free gum or lozenges
Drink water
Name the dosage and timing of each for surgery: submucosal injection of dexamethasone Intramuscular injection of dexamethasone oral/IV methylprednisolone pure oral methylprednisolone
SM dex= 4mg 1 hour before surgery
IM dex = 4mg at time of surgery
Oral/IV methyl= 16 mg PO 12 hours before and 20mg IV immediately before surgery
pur Oral methyl= 32 mg + 400 mg ibuprofen 12 hours before and 12 hours post surgery
Steroid adverse effects; cardiovascular
Hypertension; water and Na retention inhibition of prostaglandin synthesis increase renal excretion of potassium (hypokalemia) (pt should be put on K supplement) short term effect reversible
Steroid adverse effects; infections
increase risk of infection because of impaired cell mediated immunity. Especially with prednisone 20-40mg/day
Bacterial, fungal and viral infections
Steroid adverse effects; GI
GI perforations, fistulas; esp with prednisone
Oropharyngeal and esophageal candidiasis (must rinse mouth after use)
Peptic ulcer disease (due to inhibition of prostaglandin synthesis, cumulative prednisone dose of 1000mg and risk factors of concurrent NSAIDs
Mechanism for steroid induced osteoporosis
decrease Ca GI absorption
Increase Ca renal excretion
Decrease androgen and estrogen production
Inhibition of osteoblast proliferation
Inhibition of osteocytes proliferation and induction of apoptosis
Stimulation of osteoclasts bone resorption
(pt should take Ca and Vit D supplements)
Greatest effects in first 6 months. When taking doses greater than 7.5 mg/day, including inhaled steroids
steroid adverse effects; Ophthalmic
Glaucoma: Most common; betamethasone, dexamethasone; moderate: prednisone; mild: hydrocortisone
Cataract (long-term prednisone use)
steroid adverse effects; Dermatologial
Acne (usually disappears after discontinuation)
Cutaneous and subcutaneous atrophy
Delayed wound healing
Mycosis (mucosal, skin, nail fungal infection)
Long term use of steroids can lead to what disease?
Cushing syndrome
