Module 6: Study Guide and Discussion board Flashcards
What is the difference between H1RAs and H2RAs?
The H1 receptor is the primary receptor that creates symptoms during allergic reactions. The functions mediated by H1 receptor bindings are contraction of smooth muscles, increase in capillary permeability, and mediating neurotransmission in the central nervous system, among other necessary functions.
H2 are responsible for regulating the gastric acid level.
Which histamine receptor antagonist has generations? What is the difference between the generations?
The H1 receptor antagonists are broken down to 1st generation antihistamines and 2nd generation antihistamines.
1st generation: Cross blood brain barrier, have more CNS symptoms (Sedation).
quick onset of action - 15-30 min
tolerance w/regular use (after several weeks to months)
2nd: act peripherally (less sedating)
large molecules, low lipid solubility → can’t cross BBB
onset 1 - 2.5 hours, takes 1-3 days to reach steady state
What are anticholinergic side effects? Who should avoid drugs with anticholinergic side effects?
sinus tachycardia dry skin / mucous membranes dilated pupils constipation, ileus urinary retention agitated delirium **Use caution in elderly**
Which drugs in this unit have anticholinergic side effects?
diphenhydramine (Benadryl) cetirizine (Zyrtec) fexofenadine (Allegra) Sudafed Tessalon Perles Benzonatate
What is the recommendation on cough and cold medicine in regard to combination products? Why?
CCMs are unsafe in pediatric population → FDA recommends that OTC products not be used in those under the age of 2
CCMs contain other ingredients (alcohol, tylenol) → liver
educate to use single products (less likely to overdose, can identify reactions, etc.)
What is the potential side effect of nasal decongestants? What patient teaching is indicated with these products?
rebound nasal congestion (rhinitis medicamentosa)
patient teaching: not recommended for more than three days b/c pt may develop rhinitis medicamentosa or may have rebound or recurring congestion
Which patients should avoid oral decongestants?
HTN - d/t increase in BP SE
Arrhythmias - d/t SE of increase in HR and palpitations
Patients with sleeping problems - d/t SE of insomnia
When is drug therapy indicated for cough? When should it be avoided? Why?
Non productive cough that is affecting sleep.
Antitussives (diphenhydramine, codeine, dextromethorphan- Robitussin) may be used for non-productive cough for rest at night
AVOID if COPD or hx of substance abuse.
What is the difference between antitussive and expectorants?
antitussive - relieves nonproductive cough (opioid antitussive and non-opioid)
expectorant - relieves productive cough (thins mucus)
When should expectorants be used?
first few days for a productive cough
Can you group drugs in this unit into controllers or relievers?
Controllers: Flonase, Singulair
Relievers: Claritin, Astelin, Patano
The controllers are prescribed in order to help keep the symptoms at bay, “to control them.” The relievers will relieve the more acute symptoms
What are the benefits and potential side effects of nasal antihistamines?
Benefits: rapid onset, reduce nasal congestion
Potential SEs: sedation, bitter taste
How are Leukotriene modifiers used in the treatment of allergies?
They inhibit leukotrienes, inflammatory mediators produced by mast cells, eosinophils, basophils, macrophages, and monocytes which contribute to symptoms of AR. Best taken at bedtime and take a few days to work.
What is the Black Box Warning for Leukotriene modifiers?
rare drug induced neuropsychatric event including aggression, depression, suicidal thinking and behavior
What treatment options are available for cough, cold, or allergies during pregnancy or lactation?
Intranasal Corticosteroids: first line in pregnancy
Antihistamines
pregnancy - start with 1st gen as they have been the most studied
breastfeeding (diphenhydramine & chlorpheniramine in small doses)
use second gen, non-sedating antihistamine, esp with newborn or preemie
Decongestants
not considered first-line
if other methods are not effective, may be used for acute congestive episodes
Pseudoephedrine (Sudafed) can decrease milk production (AAP cautions against its use in b/f moms)
What are the three methods of inhaled medication delivery? What are the pros and cons of each?
Can you classify drugs in the module into either asthma controllers or asthma relievers?
Why are steroids used in the treatment of asthma?
