Pharma Exam 2 Flashcards
Antihistamines
-relieve symptoms of allergies.
-Effective for allergic rhinitis.
-Anti-pruritic (decrease itching)
-Also use for motion sickness, insomnia, Parkinson’s
-Prototype drug: diphenhydramine (Benadryl)
Histamine Receptors
-H1-your brain, skin, bronchioles, lining of the blood vessels
-H2- parietal cells located in the stomach lining, heart, uterus and vascular smooth muscle cells, surface of neutrophils
-H3- central nervous system
-H4- thymus, small intestine, spleen, the colon, bone marrow and basophils
Diphenhydramine (Benadryl)
-First generation- More sedative effects
-blocks the effects of histamine at H1-receptor sites in the respiratory tract.
-SE: Thicken respiratory secretions, No apple, grapefruit, or orange juice (decrease its absorption).
-No pts with BPH, hyperthyroidism, Caution in asthma(trap secretions down there leading to pneumonia)
-Should be discontinued 4 days before skin testing
Cetirizine (Zyrtec), Loratadine (Claritin), Fexofenadine (Allegra)
Great for seasonal allergies and can take 24 hrs to work
-Take them a month before the season starts; once the receptors already hit by the allergens; the med has to wait
Fluticasone (Flonase)
- Intranasal Corticosteroids
-Treats seasonal allergic rhinitis by decreasing local inflammation in nasal passages, thus reducing nasal stuffiness.
-SE: nasal irritation, epistaxis - can mask signs of infection in patients with known bacterial, viral, fungal, or parasitic infections
-NC:How to use and clean the dispenser and as directed and Not to swallow large amounts can cause palpations
Phenylephrine (Neo-Synephrine)
-Relief of congestion in the nose and Nasal Decongestants
-No pts with HTN, Hyperthyroidism, heart disease, diabetes
-*2006 Methamphetamine Abuse Act
-Monitor for: systemic effect
-Can cause rebound congestion if used more than 3 days
*2006 Methamphetamine Abuse Act
-phenylephrine (Neo-Synephrine)
-Not on store shelves anymore
-Highly regulated
-Requires ID and registration to purchase
Antitussive Drugs
-suppress cough reflex bc many resp. disorder causes non-productive cough
- Non-prod cough is a protective mechanism to force irritants out of the resp. system
-Prototype drug: dextromethorphan (Robitussin, PediaCare, Vicks 44, Benylin Pediatric).
Dextromethorphan (Robitussin, PediaCare, Vicks 44, Benylin Pediatric)
-Relief of Chronic nonproductive cough by Directly affecting the cough center in the medulla.
- NO with pts that have chronic cough resulting from emphysema and asthma bc want to them to cough up secretions. If you suppress cough with this med it can lead to pneumonia.
-SE: Drowsiness, dizziness, irritability, and restlessness
-Abusive and avoid alchy or other CNS deppressants
Bronchodilators
-Facilitate respiration by dilating the airways
-Beta-agonists (sympathomimetics)-> causes beta stimulation in the SNS-> Dilation of the bronchi and Increased rate and depth of respiration.
-Prototype drug: albuterol (Proventil, Ventolin)
Albuterol (Proventil, Ventolin)
-Bronchodilator in managing Chronic Airway Limitation (CAL) and asthma.
-“Rescue Drug.”
-SE: Tremors, insomnia, GI symp
-Don’t take with Beta-Blockers(Propranolol) which blocks beta receptor sites
- Limit caffeine intake since it has similar sympathomimetic effects which increase the risk of adverse effects
Respiratory Anticholinergic Agents
-Considered first-line treatment for patients with CAL.
-Controls the bronchoconstriction long-term.
-Prototype drug: ipratropium bromide (Atrovent)
Ipratropium bromide (Atrovent).
-Used for maintenance treatment (prophylaxis) of bronchospasm. Blocks cholinergic receptors in the lungs.
- NO Peanuts or soybean allergy
-SE: Dysgeusia (bad taste in mouth),Paradoxical acute bronchospasm
-Explain the importance of taking ipratropium daily, despite the absence of symptoms. Rinse mouth after each use to avoid fungal infections (thrush).
Anti-Inflammatory Agents
-used to manage respiratory disorders, especially asthma.
- Prophylaxis and Inhibits the production of leukotrienes and prostaglandins
-Inhaled glucocorticoid steroids=have become first-line treatment for persistent asthma.
– Can be given orally, parenterally, or by inhalation.
-Prototype drug: beclomethasone (Qvar)
Beclomethasone (Qvar)
-anti-inflammatories (steroidal)
-Maintenance treatment of asthma as prophylactic therapy.
-SE: pharyngeal and laryngeal fungal infections, Rinse mouth after inhalation and spit, Use a spacer for MDI
- No pts with Active systemic fungal infection and Suppression of immune system
-Use a beta-2 agonist inhaler before flunisolide because it dilates the bronchial tree, allowing the steroid to get
deeper into the lungs.
-NC: Take flunisolide every day, regardless of how well the patient feels; Educate pt this NOT a rescue inhaler; Monitor for toxicity- systemic toxicity, hypertension; and Long term may stunt growth in children,
Leukotriene Receptor Antagonist
-Leukotrienes are inflammatory mediators that are powerful bronchoconstrictor and vasodilators.
-Prophylaxis or treatment of chronic asthma.
-Prototype drug: Montelukast (Singulair)
Montelukast (Singulair)
-Blocks leukotriene receptor sites on cells
-SE: Rare(hallucinations, depression, sucidial ideation report immediately)
-NO pts with liver impairment
NC: Monitor ALT and educate pt its not a rescue drug so take at least 2 hrs before exercise
Hyperlipidemia
-Total cholesterol: less than 200
-LDL: 100
-HDL: 40 to 59(Good cholesterol and it can be increased with avocados and exercise)
-Triglycerides less than 150 mg/dL(come from oils and saturated fats (baked goods, processed foods)
-Always try diet & exercise before prescribing statins
Statins
-Lowers LDL cholesterol by 20-60% when given at their maximum recommended dose.
-Raise HDL levels between 5 and 10%
-Lower triglycerides between 10 and 33%.
- Discovered in Fungus
- Prototype drug: Atorvastatin (Lipitor) “Statins”
Atorvastatin (Lipitor)
-Tx: Pt. at risk for CVD( (DM, HTN, smokers, etc). Decreases inflammation in the blood vessels(Ex: Pts undergoing heart cath get high dose statins bc the procedures irritates the lining of the blood vessels)
- High 1st pass effect(Liver tries to take out a lot of it before it gets there which is why we give large does(60 or 80 mg doses)).
- Inhibit HMG-CoA reductase(enzyme used by the liver to produce cholesterol)
- No pts with acute liver disease and pregnancy( bc suppresses cholesterol which makes up the lining of cell wall which inhibits growth of child)
- SE: myopathies, rhabdmoloyisis, photosensitivity
- Most cholesterol formed between 12-3am Should be taken in the evening(take at bedtime for most effect bc stops the liver from making cholesterol). Ppl that work night shift should take it before bed in the morning.
-NC: Dietary education before medical therapy(Exerices will be more effective than diet), Monitoring CPK and Liver enzymes 3 wks to a month for adverse effects, Baseline cholesterol panel should be done and periodically thereafter(6 months), Interacts with Grape juice due to the P450 metabolism pathway may cause toxic levels( if you shut down system wont metabolize drug), Report myopathies (big AE) and Rhabdomyolysis= breakdown of muscle clogs up kidneys
Fibric Acid Derivatives
-Reduce the synthesis of triglycerides in the liver
-Decrease VLDL and LDL; Increase HDL
-Prototype: gemfibrozil (Lopid)
- Most frequently they are used in combination with statins(The combined used of a fibrate and a moderate-dose statin carries a somewhat increased risk of myopathy)
-SE: Nausea, bloating, diarrhea, liver changes
Bile Acid Sequestrants
-Prototype: colesevelam* (Welchol)
Colesevelam* (Welchol)
-Used in patients who have not responded to other drug therapy.
- Not absorbed; binds to bile acids in the GI tract-> results in increased clearance of cholesterol
-Combine with bile acids to form insoluble complex which prevents reabsorption of bile acids from small intestine
- SE: Constipation, bloating, N/V
-NC: Don’t take with other meds, Caution with warfarin, Increase fluid intake
Niacin (Niaspan)
-mega high dose Vitamin B3 (6 grams/24 hrs)
-proven to not be very effective
-Causes severe skin flushing and “hot flashes”
-Taking ASA decreases this
Ezetimibe (Zetia)
-Works in the GI tract at the small intestine to stop absorption of lipids
-Same labs, adverse effects, and precautions as the statins.
-Drug of choice for children with hypercholesterolemia
Role of Adrenergic Receptors
-When alpha-1 receptors are stimulated, they cause peripheral constriction, and blood pressure increases as a result.
-Alpha-2 receptor sites are located within the brain.
-Beta-1 receptor sites are located primarily in the heart.
-Beta-2 receptor sites are located primarily in the bronchial and vascular musculature.
Classification of Hypertension
- Prehypertension: 120-139/80-89
- Stage 1: 140-159/90-99
- Stage 2: 160 and up/ 100 and up
- HTN Crisis: 210 and up/ 120 and up
Drug Therapy and Hypertension
-Drug therapy is now recommended to be started with every patient who has been diagnosed as having hypertension, whether it is stage 1 or stage 2.
-Drug therapy is also recommended in prehypertension if the patient has compelling indications or comorbidities.
Combination therapy is indicated for stage 2 hypertension.
Angiotensin-Converting Enzyme Inhibitors
-ACE inhibitors are used as first-line antihypertensive if the patient has comorbidities.
-Prototype drug: captopril (Capoten)
