PHARM EXAM 3 Flashcards
Addison’s Disease (too little cortisol)
- Decrease in Cortisol
- Thin
- Decrease in BS
- Fatigue
- Hypo HTN
- Bronze color
Cushing’s disease (too much cortisol)
- moon face/ buffalo hump
- Fat redistribution
- increased in weight
- decreased immune system
- increased BS/ HTN
- alopecia
- mood change
- insomia/ anxiety
- osteoprosos
Hyponatremia
Hypo-< 135 mEq/L
- Tachycardia, thready pulse
- Fatigue
- Muscle cramps, especially abdominal, and muscle weakness
- Nausea, vomiting, dizziness
- Postural hypotension (possibly from hypovolemia) or hypertension
- Headache, confusion, or seizures (from swelling of brain cells)
- Weight changes
- Personality changes
- Dry mucous membranes and cool, clammy skin
Hypernatremia
Hyper- > 145 mEq/L
- Restlessness, agitation (with fluid overload), twitching, coma, seizures
- Weight loss or changes in weight
- Intense thirst with dry, rough mucous membranes
- Flushed ∫©skin
hypokalemia
Hypo-< 3.5 mEq/L
Muscle weakness; may ascend to the respiratory muscles as deficiency progresses; paralysis, decreased reflexes
- Weak and thready pulse, bradycardia,
- Ventricular dysrhythmia, cardiac dysthymias, cardiac arrest
- Abdominal distention, decreased bowel sounds
- Fatigue, vomiting
- Polyuria
- Hyperglycemia
hyperkalemia
Hyper- > 5.0 mEq/L
- Vomiting and diarrhea
- Abnormal cardiac function and cardiac arrest
- Begins with twitching and leads to weakness and flaccidness
Hypoglycemia
symptoms: Lethargic/ dizzy/ altered mental status/ HA/ sweaty & shaky
Treatment:
Awake: (need 15 gm of sugar) 4oz of OJ, 15 saltines, 1 tbsp. honey
Unable to swallow but able to follow directions: Glucagon SQ (need glucose storage, takes 30 minutes)
If they are anorexia and has no storage can not give glucagon
Altered LOC, very low sugar: D50 IV
Hyperglycemia
Symptoms: Thirsty/ Dry/ increase urnation/ increased hunger/ leads to mental status change
No ADH
- increased Urine Output
- Dehydration
- increased Na+
Too much ADH
- decreased Urine Output
- fluid
- decreased Na+ (headache/ confusion/ seizures)
Liver disease findings
Symptoms: Jaundice/ ascites/ Edema/ Abd Pain (RUQ)/ weight gain
At risk: ETOH usage/ Hepatitis / transplant
Labs: AST/ ALT/liver fx test
Renal findings
Symptoms: decrease Urine Out put/ Edema/ increased weight/ HTN
At risk: DM/ Old/ HTN
Labs: BUN/ Crat/ GFR
Sensitivity/ culture
** obtain sensitivity/ culture before treatment **
Determine type of bacteria.
Obtain sample; view under microscope.
Grow a sample over 24 to 48 hr.
Expose to various antibiotics.
skin/ wound infection
- puss
- skin break down/ stink
ear infection
- dizzy
- decrease in hearing
- pain
bladder infection
- dysuria (painful)
- difficulty
- frequency
- change in appearance
nails/ bones infection
nails: color/ shape change/ gone
bone: pain/ redness
lungs infection/ Upper RI
deep coughing / sputum color/ Rhonchi/ SOB/ wheezing / stradior
Upper RI: Cough/ running Nose/ sore throat
Brain infection
altered LOC/ HA/ dizzy/ increased IOP
Eyes infection
discharge/ change in VA/ light sensitivity/ red
If the pt has fever after 48 hours on the antibiotic the fever should go away otherwise it is not the right antibiotics
Anti fever: Tylenol/ IBU/ ASA
Gram NEG
- Harder to kill with 3 layered cell wall ( thicker cell wall)
- non oxygen dependent (anaerobic )
Gram positive
thin cell wall - oxygen dependant
Speisis
decrease BP/ increased HR/ increased RR/altered LOC
Antibiotic Admin:
- ora: sc food if possible
IV: med calculations - complete full course
- use only when necessary
ABX common side effects
-GI: N/V (recommend- Probiotics/ yougurt), diarrhea
Supra Infections
- C-diff: liquid diarrhea/ smell (oral Vanco) - gloves and gowns before entering and off before leaving
- Fungal - Mouth : Oral thrush, white pathces, change in taste, stinky breath
- Vagina: Drainage cottage cheese like (fungal infection)
Antibiotic Resistance
Antibiotics kill some bacteria and allow drug resistant bacteria to grow unrestrained.
- develops mutation
Bacteriostatic
Stops from replicating
Bactericidal
Kills Bacteria
Allergic reaction
-Angio edema
-anaphylaxis
Skin reactions:
-Steve Johns Syndrome: Starts with upper resp.. then pimple rash
-Toxic epidermal Necrosis
Droplet Precautions
Remove the mask before you have left the room and then close the door
Airbone Percautions
Remove the mask after you have left the room outside the closed door
Contact percautions
A mask is not needed for this type of percaution
PCN-> prototype AMOX
- Binds to bacterial cell wall, weakening the wall allowing water to enter, killing the cell.
- has beta-lactum ring that cuts cells wall and fluid rushes in
AMOX + Clavulanate
**Resistance to PCN develops when bacteria secrete betalacamase which destroys the beta lactam ring.
-Some drugs inhibit bacterial betalactamase and can be combined with penicillin (clavulanate, sulbactam, tazobactam)
Kills Bactalactamase
PCN SE
- Diarrhea, nausea and vomiting
- Supra-infections (pseudo-colitis - blood in stool)
- Allergy is the most common adverse event
- Decrease effectiveness of oral contraceptives
- Cannot be used with aminoglycosides
Cephalosporin: Cefazolin
Prototype: Cefazolin*
-Useful against gram negative infections.
Has a beta-lactam ring (cross allergy with PCN 5-10%)
(if they have Anaphylactic to PCN they may react to this med)
-Binds to cell wall and stops cell wall synthesis
-Five generations, each generation widening the spectrum of targets and attempting to decrease resistance to betalacamase.
Cephalosporin: Cefazolin Side Effects
allergy, rash, GI complaints. Renal toxicity decreases with subsequent generations (esp with early gen) Labs: BUUN/ CR
S&S decreased OU/ Increased BP/ fluid retention/ edema
Normal BUN/ CR
CR: 1.2 – 1.5
BUN: 10-25
Tetracycline: Doxycycline
Doxycycline*
Give with full glass of water - try to take it sc food if you can - avoid GERD
-Inhibit bacterial protein synthesis, bacteriostatic
-Lipid soluble and can cross the blood brain barrier
Wide spread resistance
-Should take with food but not metal ions like calcium of iron. ( will bind + make med unuseful)
Tetracycline: Doxycycline Side Effects
Effect fetal bone growth and teeth development should not be given to pregnant women or children (8 or younger) ** DISCOLORATION of TEETH Grey/ Brown
GERD, irritation of the esophagus
Supra-infection
Macrolide: Erythromycin, Azithromycin
Give with full glass of water on an empty stomach, not with fruit juice
Inhibit protein synthesis by binding to bacterial ribosome
Bacteriostatic
Extended half lives allow for shorter durations of therapy (eg Z-pack)- long half life & loading dose
** can take amirarone because it will prlong the heart contraction**
Macrolide: Erythromycin, Azithromycin Side effects
mild GI upset, diarrhea and abd pain
Adverse effects: hearing loss (can be permanent) , vertigo and dizziness. Cardiac dysrhythmia.
Aminoglycoside: Gentamycin
- Narrow Spectrum
-IV medication (peak and trough levels drawn)
-Can be used against gram negative bacteria, mycobacteria and protozoans
Inhibit protein synthesis, bactericidal, powerful
-Normally reserved for serious gram negative infection and must give IV as poorly absorbed.
-Sometimes given orally to sterilize the GI tract prior to intestinal surgery
Aminoglycoside: Gentamycin Side effects
Possible serious ototoxicity/neurotoxicity (decrease LOC, change in mental status, confusion, seizures, HA, peripheral neuropathy)/nephrotoxicity
- tinitus
- vertigo
peak and trough levels drawn
Peak: Highest concentration of the med in the blood
Trough: Lowest point = drawn 30 min prior to the next dose (before the med start)
Fluoroquinolones: Ciprofloxacin
Bactericidal, inhibit DNA synthesis
Good action against gram negative species (UTIs)
Good agents against anthrax and other agents of biologic warfare
Good absorption (can be oral or IV) **No first pass effect*
Can give with food but not with MVI or mineral supplements (separate by 4 hours or 1 hour before)
Fluoroquinolones: Ciprofloxacin Side effects
Mild side effects: nausea, vomiting, diarrhea
Dysrhythmia, hepatotoxicity(AST/ALT/Bilirubin), cartilage toxicity and rupture, insomnia, agitation/anxiety/ mood change/
psychotic change
Sulfonamides: Trimethropin-Sulfamethaxazole (Bactrim)
Full glass of water
Bacteriostatic Inhibit synthesis of folic acid.
Combined with trimethoprim reduces resistance
Sulfonamides: Trimethropin-Sulfamethaxazole (Bactrim) Side effects / AD Effects
Side effects include nausea and vomiting, urinary crystal formation, photosensitivity.- sensitive to sun ( long sleeves)
Adverse effects: SJS, hepatic necrosis, hyperkalemia(tachy, mucle cramps), severe anemia (Fatigue/SOB)
Carbapenems: Ertapenem
Widest spectrum
Bactericidal with super strong beta-lactam ring and destruction of the cell wall.
Can only be given IV
Carbapenems: Ertapenem Side Effects
Adverse effects: confusion and seizures
Clindamycin
Flagyl-reaction with alcohol, metal taste
Synercid-treatment of VRE
Linezolid-treatment of MRSA, thrombocytopenia. Serotonin reaction causing HTN.
Vancomycin-when taken GI there is no systemic absorprtion, IV can be nephrotoxic. Needs peak, trough.
Daptomycin
Vancomycin
Oral- no systemic absorption, treatment of Cdiff
IV must be given dilute over 60 minutes to prevent flushing (redman syndrome)
Adverse effects: nephrotoxicity, otoxicity
Peak/ Trough measurements needed.
Tuberculosis
M. Tuberculosis causes hypersensitivity reaction in the body creating walls around microbes called tubercles. Infection can be re-activated.
Needs prolonged, multi drug treatment.
Active and latent doses
S&S: Cough/ fever/ malaise/ Bloody Spetum(hemaptosis) /night sweats
Anti-TB Isoniazid -Can be used for latent or active TB.
Adverse Events: peripheral neuropathy, optic neurtitis, hepatotoxicity, blood dyscrasia (change to RBC in bone)
Anti-TB Rifampin - for active
side effect: orange discoloration of body fluids. Adverse effect: renal failure, hepatotoxicity, hyperuricemia, blood dyscrasias (change to RBC in bone)
Systemic Anti-Fungals: Amphotericin IV
Systemic: Lungs/ abd/ blood stream
(old treatment) toxic medicine with multiple side effects pancytopenia, cardiac arrest, liver and kidney failure
Systemic Anti-Fungals: Micafungin
headache, nausea, rash, phlebitis, leukopenia allergic reactions, delirium
Azole: Diflucan
Broad spetrum
Interfere with biosynthesis of ergosterol which is essential to fungal cell membranes.
Broad spectrum and can be used for systemic, cutaneous and superficial infections.
Azole: Diflucan Side effects
Severe nausea and vomiting, allergy
Liver failure with ketoconazole (rare with diflucan)
Medication interactions (increased bleeding with warfarin, hypoglycemia with diabetic meds, increased effect of some narcotics)
Protozoan Infection
Malaria is caused by infection of RBC in Liver. Mosquito illness.
Parasite-> RBC-> RBC Burst-> More parasite
S&S: Fever/ chills/ bones and joint/ anemia
SE: Visual Change/ photo phobia
Anti-Malarial Therapy Chloroquine
Chloroquine* heme complexing agent, prevent transmission into red blood cells.
Treatment or prevention
Hydroxycholorquine like
Side effects: photophobia, visual changes
Adverse: hemolytic anemia, irreversible retinal damage
Anti-Protozoa Metronidazole (Flagyl)
Other protozoa infection
- Cryptosporidiosis- diarrhea/ cramping
- Giardiasis-drinking contaminated water-iarrhea alternating with greasy stools. Fatigue, cramps
- Trichomoniasis STD-> Red/ burning/ white and running discharge
Disulfram reaction with alcohol ** Cause severe N/V + abd pain*
Side effect: metallic taste
Adverse effect: seizures, peripheral neuropathy
Anti-Helminth Mebendazole
-Can be used against multiple types of warms
Used during adult and larvae stage
High concentration in the intestines
Chew and take with fatty meal
As worms die will experience abd pain, distention and diarrhea
Virus
Intracellular parasite
Contain DNA or RNA information and a protein coat or capsid
Find a target cell and use that cell for replication
Anti-viral:
Used as treatment or prophylaxis
After exposure could receive treatment with vaccine.
Some treatment decreases length or severity of symptom.
Helminthic /Worm infection from
Worm species: water/ soil continimation
Related to proper sanitation / GI: wt loss- worm absorbs nutrients in body
Protozoan Infection from
Single celled organisms
Parasites
Water, soil, and animal hosts
Herpes: Acyclovir
S&S: Blistering/ fluid filled + hurts
-Used to shortened the length
Administer around the clock with food (oral)
IV administration can be painful to vein
Topical use gloves
PO no side effects
IV nephron (hydration)(make sure to drink a lot of fluids), neurotoxicity, thrombophlebitis, vesicant
Influenza (Tamaflu)
*Oseltamivir
Prophylaxis or treatment
Must be given within 48 hours (24-48 hours trying to tshorten 7 days - 5days)
Adverse effects: neuro-psychosis, SJS
HIV: Zidovudine NRTI
If mom has HIV will used mets when prego and IV in labor to prevent transfer from mother to baby
Oral or IV
Bone marrow suppression (may need therapy interruption)
Fever/muscle aches
GI side effects
CNS side effects
HIV: Delavirdine NNRTI
PO, TID, can be dissolved, no antacids
Rash SJS
GI can be severe
Liver disease
HIV: Raltegrevir-Integrase Inhibitor
PO with or without food
Liver disease
GI
CNS
HIV: Ritonavir-Protease Inhibitors
PO with snacks Hyperglycemia, diabetes Fat redistribution Elevated cholesterol and triglycerides Osteoporosis Liver disease GI
Pituitary: Anterior and posterior lobes
Controls growth and metabolism
Secretes hormones that travel to target tissues
hypothalamus
Connects to brain by nerves
Connects to pituitary by nerves and blood vessels
Secretes releasing or inhibiting hormones for the pituitary
Thyroid
Hypothalamus secretes thyroid releasing hormone (TRH).
Anterior pituitary produces thyroid stimulating hormone (TSH).
TSH stimulates the follicular cells of thyroid to produce thyroxine (T4) and triiodothyronine (T3).
Iodine is needed for production of T3 and T4
Growth Hormone- Somatropin
IM or SQ
- used in Growth hormone deficiencies, such as Turner’s syndrome in children
- Growth hormone deficiency in adults to increase lean muscle mass
- AIDS wasting syndrome
- Stimulates release of insulin-like growth factor-1 (IGF-1) from liver/other tissues*
Growth Hormone- Somatropin Side effects
Hyperglycemia
Myalgia (pain in a muscle or group of muscles.)
Hypercalciuria- kidney stones
Growth Hormones facts
Inadequate secretion during childhood – Short stature
Excessive secretion during adolescence – Gigantism
Excessive secretion during adulthood – Acromegaly
Somatostatin
Inhibits release of growth hormone by the pituitary.
ADH: Desmopressin (Synethic ADH)
Produced by hypothalamus and stored in posterior pituitary
-Produces effects on kidneys *Works on renal collecting tubules to increase reabsorption of water *
-Short half life, need to give 4-5x per day.
Formulated with peanut oil
-Increases reabsorption of water
-Decreases urine volume
ADH: Desmopressin Side effects
Admin: Spray latteraly
Side effects: drying/ irritation/ bloody nose
fluid retention- low NA+
Follow up: Labs: renal fx, UA, specific gravity, NA+ (135-145 me 2/L)
Contraindications: Peanut allergy
Diabetes insipidus
When body hypo-secretion
S&S: alor of pee/ excessive urnation
Anti-Diuretic Hormone (ADH)
In response to increased osmolarity (highly concentrated blood, dehydration) the pituitary releases ADH
ADH causes the kidney to retain water and decreases water excretion.
Once the concentration of the blood (hydration status) returns to normal the stimulus for release of ADH goes away and the pituitary stops releasing ADH.
Hypothyroidism (symptoms)
decreased T3/T4
- waxy/ faatigue/ wt gain/ cold intolerance/ hair + nail change/ decreased in hair/ Brady/ consitipation/ depressed
- *if severe can lead to myexedima coma**
Hyperthyroidism (symptoms) (increased TSH)
irritability/ heat intolerance/ anxiety/ tachy/ sweaty/ diarrhea/ Bugs eye(graves disease)/ increased HR
**if severe can lead to thyroid storm –> cardiac arress*
Levothyroxine - Synthroid
Thyroid replacement
-Synthetic T4 then converts to T3 in the body
-Can take 1-3 weeks for full benefit, usually increased at 4-6 week intervals.
Side effects: Hyperthyroidism (over treatment)
Follow up: Labs: TSH/ T3 + T4
- life long therapy/ take in AM on empty stomach before breakfast
Negative Feedback Loop of Thyroid Hormone Production
Hypothalamus produces -> TRH (Thyrotropin-releasing hormone)…this causes the Anterior Pituitary Gland to produce ->TSH (thyroid-stimulating hormone)….this cause the thyroid gland to produce-> T3 & T4
Propylthiouracil
-When there are too much Thyroid Hormone and this med will Interferes with synthesis of T3 and T4 in the thyroid gland as well as conversion of T4 to T3 in the peripheral tissues.
Can lead to hypothyroidism symptoms
-Given orally several times per day (one tablet q 8 hours) TID
Follow up: Labs; CBC/ TSH
Pregnancy Category D
during pregnacy hyper-thyroid can clear up and then come back
Adrenal Gland
Multiple Hormones including cortisol, aldosterone and androgen *Cortisol- Stress response: Increase blood sugar Increase breakdown of lipid and protein Suppress inflammation Increase sensitivity to the SNS Increase breakdown of bones Dilates bronchial smooth muscle
*Aldosterone- increase fluid retention & decrease K+ which increase BP
Cortisol: Hydrocortisone
Treatment of adrenal insufficiency
Many treatment targets (Inflammation, allergy, autoimmune disorders)
Excessive, prolonged use leads to Cushing’s like syndrome
Cannot stop suddenly **If stop cortisone suddenly: adrenal insufficiency, hypotension, lethargy, renal failure, nausea and vomiting.
Gradual withdrawal allows the adrenal gland to resume normal function. **
Anxiety, vertigo, insomnia, confusion, depression, HTN, peptic ulcer disease.
Low Aldosterone
Body excrete excessive water/ sodium and keeps K+
which contributes to dangerous fluid and electrolyte imbalances
High Aldosterone
too much fluid retention/ sodium and low K+
Aldosterone: Fludrocortisone
Replacement therapy for acute and chronic adrenocortical insufficiency (Addison’s disease, primary hypoaldosteronism, congenital adrenal hyperplasia) usually along with hydrocortisone
If Addison’s disease effects aldosterone production
Taken with hydrocortisone
PO every day, or three times per week
SE: too much fluid retention/ sodium and low K+
FU: Labs/ kidney check/ BMP + weight gain
Oral
Sulfonylurea: Glipizide
Stim pancreas to release insulin
*biggest worry= hypoglycemia
Persistent hypoglycemia, GI distress, hepatotoxicity
- decreased BS + take 30 min pre breakfast
ETOH= Disulfran- N/V + Flushing
Oral
Biguanide: Metformin
Increase insulin sensitivity / decrease absorption in intestine
SE: abd cramping dirrhea- but will go away
-Nausea, vomiting, diarrhea, anorexia, headache, dizziness, agitation, fatigue.
**Does not cause hypoglycemia **
** has to be help pre procedures (SX or Scans with IV dyes)-> poss. Lactic acidosis
- eats BID- do not take when you are sick / dehydrated
Oral
Melgitinides: Repaglinide
Stimulate the pancreas to release insulin.
3x per day 30 min or less pre meals. Skip if not eating, add if eating extra, no more than 4 per day.
SE: hypoglycemia/ Nausea/ diarrhea/ No grape fruit juice with increase toxicity
Oral
Thiazolidinediones: Pioglitazone
- Helps cells use insulin better
- Decreases insulin resistance at the tissues
- Taken every day with or without food
- Side effects:hepatotoxicity/ liver hurt/ increase chol
- Does not need to worry about hypoglycemia
Oral
Alpha-glycosidase Inhibitors: Arcabose
- works in intestine/ TAKE before eating up to 3X a day
- Stops the breakdown of carbohydrates in the intestine and decreases absorption of carbohydrates.
- Side effects: Stomach Pain/ liver dysfunction/ anemia
- Treatment of hypoglycemia: Dextrose tabs- can not give sugar because med will get rid of it and can not self correct hypoglycemia
Oral
Gliptin: Sitagliptin
Increase release of insulin and decreases available glucagon. **SLows gastric emptying*
Taken daily with or without food.
Side effects:HA/ symptoms of upper resp/ pancreatitis
hypoglycemia
Diabetes
Fasting blood sugar greater than 125 mg/dL on two separate occasions.
Hemoglobin A1C (greater than 6.5%)
Normal BS: 70-100
Hyperglycemia
Thirsty/ Dry/ increased urniation/ increased hunger and can lead to change in mental status
Hypoglycemia
lethargic/ dizzy/ altered mental status/ HA/ * SWEATY & SHAKY
DIAB TYPE 1
insulin Cannot give orally (does not absorb)
Only regular can be given IV
Most given subcutaneously
Hypoglycemia treatment
Treatment depends on stores of blood sugar and level of consciousness and ability to swallow.
- Awake: (need 15 gm of sugar) 4oz of OJ, 15 saltines, 1 tbsp. honey
- Unable to swallow but able to follow direction: Glucagon
SQ (need glucose storage, takes 30 minutes)
Altered LOC, very low sugar: D50 IV
if pt is anorexia they do not have storage and can not give them glucagon
Type I Diabetes, Uncontrolled Type II DiabetesInsulin
Maintain blood sugar
Usual side effects are hypoglycemia, hypokalemia, and Lipohypertrophy
Steroids, thyroid, and epinephrine antagonize effects
Furosemide and thiazide diuretics can increase glucose
hypoglycemia with beta blockers (hypoglycemia pt can not feel when they have Tachy so it is dangerous)
Insulin storage
Proper storage: out of heat/light. Opened lasts one month. ROOM TEMP
When to check blood sugar
Types of Insulin-MEMORIZE
Regular Insulin: Onset 30 minutes, peak in 2 hours, lasts 5 hours GIVE 30 MINUTES PRIOR TO MEAL.
NPH: Onset 1 hours, peak 4 hours, lasts 18 hours GIVE 30 MINUTES BEFORE FIRST MEAL OF DAY, SOMETIMES 30 MINUTES BEFORE SUPPER TOO.
Can mix in same syringe. R first than N
Glargine Lantus injection
Glargine: gradual onset, begins in 1 hour, no peak, lasts up to 24 hours. CANNOT BE MIXED WITH OTHER INSULINS
Lispro: Onset 5-10 minutes, peak 30 minutes to an hour, duration 3-4 hours. Given 5-10 minutes before a meal.
*Lispro give at the time of meal- give it with tray infront of them**
Amylin Mimetics: Pramlinitide injection
-give between meals-
Decreased gastric emptying, decrease glucagon, increased feelings of fullness- helps u eat less
Proper storage: store like insulin can be left out / SQ injection
Onset: 60 min prior to meals - start working in 60 min
Side effects: Nausea/ hypoglycemia/ pancreatitis located with RUQ + back
amylin mimetic, if used with insulin can cause severe hypoglycemia
Incretin Mimetics: Exenatide injection
**incretin mimetic, if used with insulin can cause severe hypoglycemia** Similar to glucagon Decreased gastric emptying Increase release of insulin SQ 60 minutes prior to meals Peaks in 2 hours
H receptor blockers: diphenhydramine
*loratadine - Non drowsy
Better at prevention then relief/reverse
Have anticholinergic effects as well: dry membranes
Can cause drowsiness esp older versions. CNS depressants add to this.
Other uses: Vertigo/Motion sickness
Parkinson’s Disease
Insomnia
Urticaria and other skin rashes
H receptor blockers: diphenhydramine Side effects
Dry mouth, headache, drowsy, bitter taste. (dizzy, urinary retention, thickening of secretions, nausea, vomiting, paradoxical excitation, EPS, agranulocytosis, respiratory depression-First generation)
ANTICHOLINERGIC Side effects
Intranasal CorticosteroidsFluticasone-steroid
FLONASE
-Glucocoricoid applied directly to the nasal mucosa
-Topical so no serious side effects, not systemic
-Decrease secretion of inflammatory mediators, reduce edema, and cause vasocontriction
*No immediate benefit (1-3 weeks)**
Side effects: Drying, burning, epistaxis
Common cold
Viral infections of the URT
No cure or effective prevention
Treatment is symptom management
Common Cold Symptom ReliefDecongestants
Relieve congestion, oral or intranasal Can be combined with antihistamines Sympathomimetic, alpha-adrenergic Oxymetazoline (Afrin)*, no systemic absorption so no side effects but rebound congestion. Should not used longer than 3-5 days.
Decongestants: Oxymetazoline, Pseudoephedrine
- DO not give to ppl with heart problems*
- Taken orally there is no rebound congestion but there is systemic absorption (insomnia, excitability, and HTN)
- Pseudoephedrine (Sudafed)-phenylephrine
- Can be made into methamphetamine so must register at pharmacy.
- Phenylephrine is an alternative decongestant but not as effective
Anti-Tussives
DO not give to a productive cough
-Can suppress cough if viral, dry and hacking
If cough is r/t removal of excess secretions and foreign material, aspiration or emphysema then cough suppression is not advised.
-Opioids raise the cough threshold at low doses but can lead to CNS/respiratory depression, bronchocontriction in ashtma
Anti-Tussives: Dextromethorphan
Dextromethorphan*(Rubutisin), non opioid but chemically similar. Work by raising the cough threshold.
There is some abuse potential
Side effects are drowsiness, Headache, GI upset, paradoxical excitation, tremors, euphoria, insomnia
if given with opioids it will make it more potent SYNERGISTIC
Expectorants: Guaifenesin
Increase mucus flow by reducing the thickness of secretions.
Guaifenesin (Mucinex) helps with dry and productive cough.
Should not be used with children under 6
take with a lot of water
Mucolytic: Mucomyst
Directly loosens thick viscous bronchial secretions. Break down chemical structure of mucus, makes thinner and easier to cough up.
Bad odor, rotten eggs
Inhalation
Can cause bronchospasm so should not be used with asthmatics.
Reverses acetaminophen (Tylenol) overdose
can not take if pt has asthma
Lower Respiratory System
Bronchial Smooth Muscle and Autonomic Nervous System
Treatment of Asthma: Open up airways and decrease inflammation
Beta Adrenergic Agonists
Activate sympathetic nervous system to relax bronchial smooth muscle.
Nonselective (beta 1 and 2) Selective (beta 2)
Acute Bronchoconstriction, bronchospasm but no anti-inflammation component
Short acting beta agonists
Albuterol
Rescue- fast acting
Last only 2-6 hours
Prn no more than 12 inhalations per day
Headache, dizziness, tremor, nervousness, throat irritation, tolerance
Tachycardia, dysrhythmia, hypokalemia, hyperglycemia, paradoxical bronchoconstriction, increased risk for asthma related death.
do not use with a Beta blocker
-wait 1 min between puffs & hold in puff for 5-10 sec
- can take 15-30 before exercise
Anticholinergics: Ipratropium
Alternative to bronchodilators
Slower and less intense
Block the parasympathetic nervous system
Can be used in asthma, copd more commonly
Ipratropium (Atrovent)*, Tiotropium (Spiriva)
Can combine atrovent and albuterol for longer bronchodilation
Spiriva has a longer duration of action and used as prophylaxis for bronchospasm in COPD
*Anticholinergic side effects = Anti sludge - dry mouth,Salivation, Lacrimation, Urination, Defecation, Gastrointestinal Distress and Emesis
**SOY PEANUT ALLERGY **
Inhaled Corticosteroids: Betamethasone (Qvar)
Hoarseness, dry mouth, cough, sore throat
Candida- fungal infection in mouth - pt must rinse and spit
Systemic absorption (risks
** IF TAKEN WITH Abuterol**
Abuterol goes first THEN THE SEROID**
Mast cell stabilizer: Cromolyn
Bitter after taste- Take 15-30 min prior exercise
Leukotriene Modifiers
(singular -montelukast)
only pill
Leukotrienes are mediators involved in allergic and asthmatic reactions.
Leukotrienes in the airway cause edema, inflammation and bronchoconstriction
Montelukast (Singulair)* blocks leukotriene receptors
Reduce inflammation, effect on bronchioles minimal
Headache, cough, nasal congestion, GI upset, increased infection in the elderly.
Contraindicated with alcohol use or hepatic dysfunction
liver dysfunction esp in elderly
Sympathetic Alpha receptors located
- Smooth muscles/ arteries
- Prostate
- Brain
Beta receptors
- Heart
- lungs
- kidney
- Pupil dilate/increase HR/ increase RR/ decrease urine formation/ prostate contract
