Nose drugs Flashcards
drug classes for allergic rhinitis
anti-histamines decongestants intranasal steroids mast cell stabilizer leukotriene inhibitors
nasal anithistamines (names and generations)
1st: meclizine hydroxyzine dimenthydrinate diphenhydramine promethazine brompheniramine chloropheniramine doxylamine 2nd: loratadine desloratadine fexofenadine certizine levocetirizine
nasal decongestant (names)
pseudoephedrine
phenylephrine
intranasal steroids (names)
beclomethasone budesonide ciclesonide flunisolide fluticasone mometasone triamcinolone
mast cell stabilizer (names)
cromolyn sodium
leukotriene inhibitors (names)
montelukast
zafirlukast
zileuton
histamine (actions, where it is and where it goes, what causes its release)
- mediates allergic and inflamm rxns
- gastric acid secretion
- NT
- in mast cells and basophils (released upon contact with allergen)
- receptors H1 (smooth musc, brain, heart, CNS), H2 (gastric), H3 (CNS), H4 (immune)
- released with ROTA (red-man [vancomycin], opioids, tubocurarine [anestehtic], amphoteicin [antifungal])
epinephrine class
?
epinephrine MOA
functional antagonist to hist-induced bronchoconstriction alpha agonist (decreas vasodilation) B2 agonist (relax bronchial smooth musc)
epinephrine indications
emergency tx of type I allergic rxns
epinephrine cautions
elderly
heart conditions
epinephrine ADR
anxiety restlessness tremor weakness palpitations pallor N/V HA respiratory probs
antihist (1st gen) class
antihist
antihist (1st gen) MOA
block H1 receptor (nonselective) inhibit hist effect on smooth musc anticholinergic effects alpha blocker effects serotonin blocker effects
antihist (1st gen) indications
allergies motion sickness (meclizine/dimenhydrinate) nausea (promethazine) insomnia block EPS (extra pyramidal side effects) local anesthesia itching (hydroxyzine)
antihist (1st gen) ADRs
increased sedation
decreased cognitive and psychomotor performance
increased appetite
stim CNS (restless, nervousness, insomnia, etc)
fexofenadine class
antihist (2nd gen)
fexofenadine MOA
still H1 blocker, but more selective (b/c 2nd gen)
fexofenadine indications
allergic rhinitis > 2 y/o
chronic urticaria > 6 mo
fexofenadine ADR
HA cough URI fever back pn dysmenorrhea
fexofenadine drug interactions
ketoconazole
erythromycin
P450
Al and Mg antacids
fexofenadine caution
renal dosing
cetirizine class
antihistamine
cetirtizine MOA
H1 receptor blocker (crosses BBB –> a little less selective for 2nd gen)
cetirizine indication
allergic rhinitis > 6 mo
chronic urticaria > 6 mo
cetirizine ADRs
somnolence
dizziness
HA
abd pn/nausea
cetirizine caution
dosing with renal probs
antihistamine uses
tx of allergic rhinitis (ocular s/s, nasopharyng itch, sneeze, rhinorrhea)
not good for URI (except 1st gen for sedation)
sympathomimetics
excite blood vessels, salivary/sweat glands
vasoconstrict
inhib gut
relax bronchial tree
increase HR and squeeze
increase gluc
CNS: awake, decrease appetite, increase NT
phenylephrine class
alpha agonist (decongestant)
phenylephrine MOA
alpha 1 selective agonist
phenylephrine indication
nasal decongestant
mydriatic
hemorroid treatment
phenylephrine ADR
increase HR increase BP HA dizziness sweats/shakes
phenylephrine caution
HTN
heart dz
hyperthyroid (graves)
BPH
pseudoephedrine class
alpha agonist (decongestant)
pseudoephedrine indications
congestion due to rhinitis or URI
ET congestion
pseudoephedrine ADRs
vasoconstriction
increase BP
arrhythmia
pseudoephedrine drug interations
MAOIs
B-blockers
Digoxin
pseudoephedrine caution
HTN
cardiac dz
hyperthyroid
taking after exercise (tachy)
intranasal steroid class
steroid
intranasal steroid MOA
decrease inflammation of nasal mucosa
block inflammatory mediators
antihist + decongest
differences in intranasal steriod drug efficacy
they’re all the same!!
intranasal steroid indication
allergic rhinitis (ocular s/s/, nasopharyng itch, sneezing, rhinorrhea, nasal congest)
intranasal steroid caution
peds: different times for diff drugs
intranasal steroid ADRs
epistaxis
HA
cough/URI/pharyngitis
some systemic (nasal septal perforation, candidia, glaucoma)
Cromolyn sodium class
mast cell stabilizer
cromolyn sodium indications
tx and prevention of allergic rhinits
cromolyn sodium MOA
prevents mast cell degranulation and hist release
cromolyn sodium ADRs
sneezing, stinging
leukotriene inhib MOA
leukotriene receptor antag --> inhib leukotrienes that: from arachadonic acid produced by airway inflammatory cells increase cap perm, WBC mvt, adhesion & aggreg.
leukotriene inhibitor indications
nasal congestion rhinorrhea conjunctivitis bronchial symptoms chronic asthma
montelukast class
leukotreine inhibitor
montelukast MOA
selective antag for leukotreine receptor (found in airway and inflammory cells)
montelukast indications
asthma > 1 y/o
allergic rhinits > 6 mo
exercise-induced asthma > 15 y/o
montelukast ADRs
some GI discomfort HA fever dizziness neuropsych (rare) in peds (anxiety, agitate, depress, dreams, hallucinate)
zafirlukast class
leukotriene inhibitor
zafirlukast MOA
compeititive antag for diff leukotreine receptor.
prevent increased vasc perm
zafirlukast indication
chronic asthma > 5 y/o (prevent and tx)
zafirlukast CI
hepatic probs (includes cirrhosis)
zafirlukast ADRs
neuropsych (insomia, depress)
liver damage (jaundice, n/v, abd pn…)
churg-strauss syndrome (syst vasculitis, asthma, rash, GI bleed, extremity pn)
zileuton class
leukotriene inhibitor
zileuton MOA
prevent leukotriene synthesis
zileuton indications
asthma > 12 y/o (prevention and tx)
zileuton CI
active liver dz
zileuton drug interactions
increases warfarin levels
increases [propranolol]
zileuton ADRs
neuropsych (insomia, behavior) hepatotoxicits sinusitis nausea sore throat
