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Pharm1 > Histamine and corticosteroids > Flashcards

Histamine and corticosteroids Flashcards

1
Q

Name all 5 first generation Histamine type 1 receptor blockers

A 
Diphenhydramine 
Meclizine
Hydroxyzine
Promethazine
Chlorpheniramine
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2
Q

Name all three 2nd generation type 1 histamine receptor blockers

A

Loratidine
Ceterizine
Fexofenadine

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3
Q

Drug type

Diphenhydramine

A

Histamine type 1 receptor blocker first generation

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4
Q

Drug type

Meclizine

A

Histamine type 1 receptor blocker first generation

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5
Q

Drug type

Hydroxyzine

A

Histamine type 1 receptor blocker first generation

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6
Q

Drug type

Promethazine

A

Histamine type 1 receptor blocker first generation

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7
Q

Drug type

Chlorpheniramine

A

Histamine type 1 receptor blocker first generation

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8
Q

Drug type

Loratidine

A

Histamine type 1 receptor blocker second generation

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9
Q

Drug type

Ceterizine

A

Histamine type 1 receptor blocker second generation

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10
Q

Drug type

Fexofenadine

A

Histamine type 1 receptor blocker second generation

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11
Q

(Side) effects of 1st generation Histamine Type 1 receptor blockers

A 
anti-hypersensitivity (allergy)
anti-emetic (motion sickness)
sedative effects (from crossing BBB)
anti-vertigo effects
reduced salivation
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12
Q

most common indication for Type 1 Histamine receptor blocker 2nd generation?

A

Day time allergies

also rhinitis; runny nose, combined with decongestants and acetaminophen

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13
Q

Main uses/indications for Histamine Type 2 antagonists

A

PUD peptic ulcer disease
GERD
Prophylaxis against stress ulcers in critically ill pts
(reduces gastrin and gastric acidity)

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14
Q

the 4 Histamine type 2 Receptor antagonists

A

Famotidine
Ranitidine
Nizatidine
Cimetidine

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15
Q

Adverse effects of Cimetidine

A

Gynecomastia

many drug-drug interactions

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16
Q

Adverse effects of all H2 receptor antagonists

A

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)

17
Q

Overall physiological functions of corticosteroids

A

Increase blood glucose (gluconeogenesis, counteracting with insulin)
Increase sodium and water retention
Down regulates the immune response

18
Q

2 major types of exogenous corticosteroids, function and an example of each

A

Glucocorticoids; Anti-inflammatory- Dexamethasone

Mineralocorticoids; Sodium and water retention (increase BP)- Hydrocortisone

19
Q

Main function of Hydrocortisone

A

Increase BP via Na and water retention

20
Q

Main function of Dexamethasone

A

Anti-inflammatory

21
Q

Indications for Mineralocorticoids

A

Critically ill pts with suppressed Hypothalamus Pituitary Adrenal axis
Hypotension and hemodynamic instability; septic shock

22
Q

How do glucocorticoids achieve their anti-inflammatory nature? (mechanisms)

A

Inhibit T cell and B cell proliferation
Inhibit leukocyte production
Inhibition of capillary permeability to leukocytes
Inhibit prostaglandin production (key in inflammatory response)

23
Q

Methylprednisolone, Hydrocortisone, Prednisone, Dexamethasone. List in order from least to greatest in terms of anti-inflammatory activity.

A

Hydrocortisone
Prednisone
Methylprednisolone
Dexamethasone

24
Q

Indications for Glucocorticoids?

A

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)

25
Q

Key points about Sjogrens Syndrome

A

Mostly appears ages 45-55
10x more common in women
~50% of pts have Rheumatoid arthritis or other autoimmune disorders

26
Q

Management of dry mouth (categories and examples)

A

Salivary substitutions; Carboxymethylcellulose, Glycerin
Muscarenic agonists; Pilocarpine, Cevimeline
Steroids; Prednisone
Salivary stimulation; sugar free gum or lozenges
Drink water

27
Q 
Name the dosage and timing of each for surgery:
submucosal injection of dexamethasone
Intramuscular injection of dexamethasone
oral/IV methylprednisolone
pure oral methylprednisolone
A

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

28
Q

Steroid adverse effects; cardiovascular

A 
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
29
Q

Steroid adverse effects; infections

A

increase risk of infection because of impaired cell mediated immunity. Especially with prednisone 20-40mg/day
Bacterial, fungal and viral infections

30
Q

Steroid adverse effects; GI

A

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

31
Q

Mechanism for steroid induced osteoporosis

A

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

32
Q

steroid adverse effects; Ophthalmic

A

Glaucoma: Most common; betamethasone, dexamethasone; moderate: prednisone; mild: hydrocortisone
Cataract (long-term prednisone use)

33
Q

steroid adverse effects; Dermatologial

A

Acne (usually disappears after discontinuation)
Cutaneous and subcutaneous atrophy
Delayed wound healing
Mycosis (mucosal, skin, nail fungal infection)

34
Q

Long term use of steroids can lead to what disease?

A

Cushing syndrome

Pharm1 (6 decks)

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