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Allergy/Immunology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Treatment options

A
  • Avoidance of triggers
  • Medications
  • Allergy injections
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2
Q

1st Gen Antihistamines

A
  • Diphenhydramine (Benadryl)
  • Hydroxyzine (Atarax)
  • Chlorpheniramine (Chor-Trimenton)
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3
Q

1st Gen mechanism, onset

A

Mech: Blocking the actions of histamine at the receptor (H1) sites. Do not block histamine release.
Onset: 15-30 mins

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4
Q

1st Gen Effect, SE

A

Effect: Reduce sneezing, itching, rhinorrhea, but NOT congestion.
SE: Sedation, anticholinergenic effects

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5
Q

1st Gen CI

A

Lactating mothers
Glaucoma
BPH
Children, Elderly

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6
Q

2nd Gen Antihistamines

A

Loratadine (Claritin)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)

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7
Q

Where is histamine stored?

A

Mast cells and basophils

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8
Q

Where does IgE bind?

A

Mast cells

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9
Q

2nd Gen Mech. and Onset

A

Mech: Inhibits H1 receptors
Onset: Rapid, maximum effect 1-2.5 hrs

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10
Q

2nd Gen Effect, SI

A

Effect: Reduced sneezing, itching, rhinorrhea but NOT congestion. Less sedating and long-acting
SE: anticholinergenic effects, but less than 1st gen. so OK for BPH, elderly etc.

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11
Q

Anticholinergic effects

A

No shit
No spit
NO see = blurry vision
NO pee = NO men w/ prostate problems

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12
Q

Decongestants

A

Pseudoephedrine (Sudafed): Oral

Pseudoephedrine (Afrin): Intranasal

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13
Q

Decongestant Mechanism

A

Alpha-andrenergic agonist

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14
Q

Decongestant Effect, SI

A

Effect: Vasoconstriction restricts blood flow to nasal mucosa that has been dilated by histamine.
SI: HA, nervousness, irritability, tachy, palpitations, insomnia

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15
Q

Decongestant CI

A
  • HTN, cardiovascular disease
  • Hyperthyroidism
  • Glaucoma
  • Co-use w/ MAOI’s
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16
Q

MAOI’s

A
  • Monoamine Oxidase Inhibitors
  • Depression
  • Interact w/ everything
  • Causes malignant HTN
17
Q

Rhinitis Medicamentosa (RM)

A
  • Prolonged use of topical decongestant induce rebound congestion upon withdrawl.
  • Leads to hypertrophy is nasal mucosa, termed RM
  • Wean oral over 7-10 days
  • Nasal: do NOT use for over 3 days
18
Q

Combo Antihistamine/Decongestants (3)

A

Fexofenadine / Pseudo: Allegra D
Laratadine/ Pseudo: Claratin D
Cetirizine/ Pseudo: Zyrtec D

19
Q

Cromolyn Sodium (IN)

A

Nasalcrom

20
Q

Nasalcrom Mech

A

Mast cell stabilizing agent, reduces release of histamine and other mediators.

21
Q

Nasalcrom Effects, SE

A
  • Reduces nasal pruritis, sneezing, rhinorrhea, congestion.
  • Prophylactic use, start 4 weeks before.
  • Frequent dosing, non rx.
  • *No serious SE
22
Q

Intranasal Glucocorticoids (INGC’s)

A
  • Flonase
  • Nasonex
  • Beconase
  • Others*
23
Q

INGC mechanism

A
  • Disabling APC’s
  • Reduce stimulus for mast cell degredation
  • Reduce last-phase inflammation
  • supress neutrophil chemotaxis
  • mildly vasoconstrictive
  • reduce edema
24
Q

INGC Effect, SE

A

Reduce nasal blockage, pruritis, sneezing and rhinorrhea.
Single most effective agent used correctly
-Therapeutic effect within 1-3 days, max effect takes up to 3 weeks.
SE: nasal irritation, bleeding

25
Q

Anticholinergic nasal spray

A

Ipaptroprium Bromide (Atrovent)

  • good for runny nose
  • reduces release of substance P
26
Q

Leukotriene Inhibitors

A

Montelukast (Singulair)

  • Helpful for runny nose, congestion
  • Not first-line therapy
  • Only for asthma but approved for AR
27
Q

Saline (IN)

A

NaSal, SeaMist, Ocean, Ayr

Relief from crusting and can be soothing

28
Q

For eye allergies

A
  1. Normal Saline
  2. Azelastine (Optivar): inhibits histamine release
  3. Olopatadine (Patanol): inhibits histamine release
    4: Naphazoline (OPcon-A): antihistamine, decongestant. OTC
29
Q

Allergy Injections

A

When meds and avoidance dont work.
Effective for dust mites, cats, pollens.
“Immunotherapy”

30
Q

Mild AR Tx Plan

A

Non-sedating antihistamine and/or decongestants PRN

31
Q

Persistant mild to moderate AR Tx

A
  • IN steroid starting 1-2 weeks prior to season.
  • Non-sedating antihistamine/decongestant
  • Topical (eye) antihistamine
32
Q

Severe AR Tx

A
  • Topical nasal INGC’s
  • Non-sedating antihistamine/decon
  • Short-term oral steroids
  • Consider immunologist refferal
33
Q

Anaphylaxis

A

Acute systemic allergic rxn.

Type I hypersensitivity, IgE.

34
Q

Anaphylaxis S/S

A

Tachy, Hypotensive, Wheezing, urticatria, facial swelling

35
Q

Use of Epi Pen

A
  • Immediate Tx imperative
  • No contraindications
  • IM is best route
  • Opens airway, raises BP
  • Can be re-administered every 5 minutes
36
Q

Tx for anaphylaxis (acute)

A

SImple BLS, O2, shock position
Epi 1:1000, .3-.5cc IM
Benadryl IV (25-50mg), H2 blocker
Corticosteroids (decadron, medrol)

37
Q

Tx for anaphylaxis (continued)

A 
Tx hypotension: IV fluids, Epi drip
Albuterol
Observe for 24 hrs
Benadryl for 24 hrs
Can repeat epi and antihistamine if rxn reoccurs

Allergy/Immunology (10 decks)

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