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Unit 3 Pharm III > L22: Antihistamines > Flashcards

L22: Antihistamines Flashcards

1
Q

Histamine…

A

is released from Mast Cells and causes:
• Vasodilation
• Increased capillary permeability
• Increased GI and pulmonary secretions

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2
Q

Transportation drivers can’t recieve…

A

no first gen
no cetirizine
(sedating)

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3
Q

Most sedation 2nd generation antihistamine

A

Cetirizine

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4
Q

Side effects of antihistamines

A 
Anticholinergic
• RED as a BEET
• DRY as a BONE
• BLIND as a BAT→ mydriasis
• MAD as a HATTER
• HOT as a HARE→ vasodilation
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5
Q

Occupations you don’t want to sedate (give 2nd gen)

A
  • Heavy machinery operator
  • Construction workers or electricians performing tasks at elevated heights
  • Mass transit (bus driver, pilot, etc)
  • Health care providers working 24 hour shifts or night shift
  • PA students who can not fall asleep during class
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6
Q

Antihistamines may used for non-allergic

conditions such as

A
  • Gastroenteritis
  • Labyrinthitis
  • Motion sickness
  • Insomnia
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7
Q

Don’t use 1st generation antihistamines in

A

Glaucoma: increase IOP
BPH: trigger urinary retention

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8
Q

Systems that might be affected by anaphylaxis

A
  • Skin and Mucosa (90%)
  • Respiratory (70%)
  • GI (45%)
  • Cardiac (45%)
  • Hypotension, syncope, tachycardia
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9
Q

Systems that might be affected by anaphylaxis

A
  • Skin and Mucosa (90%)
  • Respiratory (70%)
  • GI (45%)
  • Cardiac (45%)
  • Hypotension, syncope, tachycardia
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10
Q

Antihistamines approved for airline pilots that may be used after adequate trial without side effects

A

Loratadine (Claritin)

Fexofenadine (Allegra)

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11
Q

Antihistamines contraindicated in airline pilots

A

Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
Azelastine (Asteline) Nasal Spray
Diphenhydramine (Benadryl)

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12
Q

If a sedating antihistamine is used in an airline pilot, they:

A

must be grounded for 5x the half life

Ex: Diphenhydramine→ 60 hours

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13
Q

1st line for allergies

A

Nasal steroids

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14
Q

Nasal steroids are contraindicated in

A

Glaucoma, can make it worse

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15
Q

Meds that increase IOP:

A

Steroids
Decongestants
Antihistamines

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16
Q

Scabies

A

Sarcoptes scabiei skin mite infestation:

Intense nighttime pruritus. Rash. Itchy bumps, burrow lesions

17
Q

Scabies diagnosis

A

Clinical, or skin scraping

18
Q

Scabies tx

A

Permethrin cream (Elimite) 5% neck to soles of feet 8-12 hours

19
Q

Acute vs chronic hives

A

Acute hives→ <6 weeks, generally self limited

Chronic hives→ >6 weeks

Chronic autoimmune urticaria→ if negative workup

20
Q

Chronic autoimmune urticaria tx

A

Responds well to non-sedating antihistamine.

21
Q

Chronic autoimmune urticaria is associated with

A

Other autoimmune conditions (hypothyroidism, etc)

22
Q

Poison ivy

A

Linear erythema on legs, arms, face. Vesicular eruption on abdomen.

23
Q

Poison ivy tx

A

Triamcinolone (Kenalog) steroid cream (no high potency on face)
+
Non-sedating oral antihistamine

24
Q

If poison ivy doesn’t improve, consider

A

Oral Steroid Taper

25
Q

PCN allergic rxn tx

A

Continue zyrtec, +/- IM steroids or antihistamine +/- taper oral steroids

26
Q

Refractory PCN allergic rxn tx

A

djunct tx H2 blockers→ Ranitidine, Famotidine. Not first line

27
Q

Immunotherapy (allergies shots)

A

Observe for 30 minutes after shot per protocol
Called triage nurse complaining of “slight tickle” in throat after leaving
Return to clinic (or ER)

28
Q

If someone has a reaction to their allergy shot, even if it’s not full blown anaphylaxis, give _______

A

Benadryl + Epi + IM/IV glucocorticoid

Decadron/dexamethasone

29
Q

Long term tx for anaphylaxis

A

epi-pen on discharge + allergy referral

30
Q

Second generation antihistamine benefits

A

Longer acting (once daily), less side effects due to decreased crossing BBB

31
Q

1st generation antihistamines are sedating because

A

cross BBB

Unit 3 Pharm III (10 decks)

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