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PC 707 Pharmacology > Module 6: Allergy and URI > Flashcards

Module 6: Allergy and URI Flashcards

1
Q

1st Generation antihistamines example

A

Benadryl, promethazine (phenergen)

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2
Q

Indication for Bendryl

A 
Flu, cold, and allergy symptoms
Insomnia
Anaphylaxis
Motion sickness
Parkinsonism
Pruritus
Anxiety
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3
Q

MOA benedryl

A

Acts as an antihistamine by competing with histamine for receptor sites on effector cells.

Block both histaminic and muscarinic receptors as well as passing the blood-brain barrier

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4
Q

Safety Benedryl

A

SEDATION

Anticholinergic effects

Use with or within 14 days of MAO inhibitor therapy

To sedate a child

Do not use: Newborns, premature infants, nursing mothers

Caution about sedative effects and use caution in using in the elderly

D2D: CYP2D6 inhibitor, weak, anticholinergic effects, CNS depression, decrease central histamine effects

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5
Q

BBW Promethazine (phenergan)

A

in children less than two years old: serious behavioral and other adverse effects

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6
Q

Education with benedryl

A

Avoid concomitant use of MAO inhibitors or CNS depressants.
No alcohol

Avoid applying occlusive dressings, cosmetics, or other skin products over areas treated with topical formulation.
Patient should not use topical form on eyes or eyelid.

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7
Q

Pediatric considerations Benedryl

A

Cr at baseline (peds)

Young children may experience a paradoxical excitation effect.

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8
Q

2nd Generation antihistamines example

A

*cetirizine (Zyrtec)

**Fexofenadine (Allegra)

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9
Q

Indication Zyrtec and Allegra

A 
Allergic rhinitis
Sneezing
Itchy/watery eyes
Itchy nose/throat
Chronic idiopathic urticaria
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10
Q

MOA zyrtec and allegra

A

Acts as an antihistamine by competing with histamine for receptor sites on effector cells.

Blocks histaminic receptors and does not pass the blood-brain barrier

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11
Q

Caution with zyrtec and allegra

A

Caution in patients 65 yo and older
*Caution if concurrent CNS depressant use
Cr at baseline, then in elderly pts consider periodically

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12
Q

D2d with allegra and zyrtec

A
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13
Q

Zyrtec safety

A

Sedating, CNS depression, decreases central histamine effects

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14
Q

Safety allegra

A

prolonged Qt, OATP1A2 substrate, OATP2B1 substrate, P-gp substrate, binds to polyvalent cations

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15
Q

Nasal Decongestants example

A

Oxymetazoline (Afrin)

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16
Q

Afrin indication

A

Nasal congestion, sinus congestion/pressure

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17
Q

MOA afrin

A

Stimulates smooth muscle alpha adrenergic receptors, producing vasoconstriction and reducing nasal congestion

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18
Q

Safety afrin

A

MAO inhibitor use within 14 days
Caution in individuals with glaucoma, angle-closure, HTN, cardiovascular disease, diabetes, hyperthyroidism
D2D: hypertensive effects, interferes with radiolabeled norepinephrine analog effect

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19
Q

Special considerations/education afrin

A

No routine tests recommended
Rebound congestion
Use for 3 days or less

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20
Q

Oral decongestants example

A

Sudafed

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21
Q

Indication Sudafed

A

Nasal congestion due to common cold, hay fever, or upper respiratory allergies

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22
Q

MOA sudafed

A

Enhance norepinephrine and epinephrine or adrenergic activity by stimulating the alpha1-adrenergic receptor which induces vasoconstriction.

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23
Q

Caution and D2D Sudafed

A

Anticholenergic
Caution: pregnancy
Caution in individuals with glaucoma, angle-closure, HTN, cardiovascular disease, diabetes, hyperthyroidism
D2D: (alpha-1 agonist; beta-2 agonist) hyperglycemic effects, hypertensive effects, interferes with radiolabeled norepinephrine analog effect, urine pH sensitivity.

24
Q

Sudafed in children

A

Use in pediatric patients <4 years of age has limited efficacy, the AAP warns against the use in young children.

25
Q

Antitussives example

A

Tessalon Perles

Benzonatate

26
Q

Indication tessalon pearls and Benzontate

A

Cough suppressant

27
Q

MOA Tessalon pearls and benzonatate

A

Anesthetizes respiratory passage, lung, and pleural stretch receptors, reducing cough reflex

28
Q

Safety antitussives

A

Hypersensitivity can cause bronchospasm and laryngospasm
May cause bizarre behavior (confusion, visual hallucinations)
May cause sedation

29
Q

Expectorants example

A

Mucinex

guaifenesin

30
Q

Indication Mucinex and guaifenesin

A

Help loosen mucus and thin bronchial secretions

31
Q

MOA mucinex and guaifenesin

A

Increases volume and decreases viscosity of respiratory tract secretions

32
Q

Safety Mucinex and guaifenesin

A

Caution in nephrolithiasis
Caution in patients <6 yo
D2D: None

33
Q

Intranasal Antihistamines examples

A

Astelin (azelastine)

Olopatadine

34
Q

Astelin (azelastine)
Olopatadine
Indication

A

Perennial allergic rhinitis
Seasonal allergic rhinitis
Vasomotor rhinitis

35
Q

MOA Astelin (azelastine) and Olopatadine

A

Antagonizes central and peripheral histamine H1 receptors

Inhibits histamine release from mast cells

36
Q

Safety Astelin (azelastine) and Olopatadine

A 
Caution if concurrent CNS depressant use
Caution if depression history
must be >6 yo
D2D: None
May cause nasal septal perforation, nasal ulcer, hyposmia, anosmia, depression in long-term use
37
Q

Leukotriene Modifiers/Blockers

A

Montelukast (Singular)

zafirlukast (Accolate)

38
Q

Indication Montelukast (Singular) and zafirlukast (Accolate)

A

Allergic rhinitis
Asthma
Bronchoconstriction

39
Q

MOA Montelukast (Singular) and zafirlukast (Accolate)

A

Selectively binds to cysteinyl leukotriene receptors

40
Q

Safety Montelukast (Singular) and zafirlukast (Accolate)

A

Caution severe asthma
Caution if PKU
D2D: CYP2C8 substrate, CYP2C9 substrate, CYP3A4 substrate
Monitor s/sx neuropsychiatric events incl. depression, behavior changes, sleep disturbances, suicidality
Can cause suicidality, aggressive behavior, hallucinations, depression
Can cause pulmonary eosinophilia
Can cause hepatic failure
Can cause Churg-Strauss syndrome

41
Q

BBW Montelukast (Singular) and zafirlukast (Accolate)

A

Neuropsychiatric events

42
Q

Nasal Corticosteroids example

A

Flonase (fluticasone)

43
Q

Flonase indication

A 
Allergic rhinitis
Asthma
Bronchoconstriction
Allergic rhinitis
Nasal polyps
Nonallergic rhinitis
44
Q

MOA flonase

A

Exact mechanism unknown; inhibits multiple inflammatory cytokines; produces multiple glucocorticoid and mineralocorticoid effects

45
Q

Safety and D2D flonase

A

Unhealed nasal septal ulcer or wound
Caution if hepatic impairment, recent long-term systemic corticosteroid, glaucoma, cataracts
D2D: CYP3A4 substrate, immunosuppressive effects

46
Q

What can be suppressed with long term use of Flonase

A 
Can cause growth suppression (long-term use in peds patients)
Adrenal suppression (long-term use)
47
Q

Intranasal Cromolyn example

A

NasalCrom

48
Q

Indication NasalCrom

A

Allergic rhinitis

49
Q

MOA NasalCrom

A

Inhibits mast cell degranulation (mast cell stabilizer)

50
Q

Safety NasalCrom

A

Can cause bronchospasm, nasal burning, sneezing

51
Q

Optic decongestant/antihistamine example

A

Naphazoline/pheniramine (Naphcon-A, Opcon-A)

52
Q

Naphazoline/pheniramine (Naphcon-A, Opcon-A) Indication

A

Decrease eye redness

53
Q

Naphazoline/pheniramine (Naphcon-A, Opcon-A) MOA

A

Binds to histamine 1 receptors, thereby inhibiting phospholipase A2 and production of endothelium-derived relaxing factor

54
Q

Caution and D2D Naphazoline/pheniramine (Naphcon-A, Opcon-A)

A

Caution: individuals with diabetes, glaucoma, heart problems, HTN, hyperthyroidism, eye infection/injury
D2D: Hypertensive effects, interferes with radiolabeled norephinephrine analog effect

55
Q

Side effects Naphazoline/pheniramine (Naphcon-A, Opcon-A)

A

Can cause dilated pupils, blurred vision

Can cause worsening eye redness, itching swelling, eye pain

PC 707 Pharmacology (39 decks)

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