Study Guide 9 Flashcards
Antihistamines (or H1 receptor antagonists) block most, but not all, of the effects of histamine. They do this by competing at the histamine receptor sites throughout the body, thereby preventing histamine from entering these receptor sites and producing an effect on body tissues
Actions of Antihistamines
First-generation antihistamines bind nonselectively to central and peripheral H1 receptors and may result in central nervous system (CNS) stimulation or depression
usually occurs with higher doses and explains why some of these agents are used for sedation.
CNS depression
less sedating antihistamines
Topical antihistamines
Drowsiness or sedation
Disturbed coordination
CNS adverse reactions to antihistamines
affect the respiratory system and include the following:
Dryness of the mouth, nose, and throat
Thickening of bronchial secretions
Anticholinergic actions of antihistamines
Antihistamines are used cautiously in clients with
bronchial asthma, cardiovascular disease, narrow-angle glaucoma, hypertension, impaired kidney function, urinary retention, pyloroduodenal obstruction, and hyperthyroidism
drug that works directly on blood vessels to reduce swelling of the nasal passages, which, in turn, opens clogged nasal passages and enhances drainage of the sinuses
Decongestant
drug is used to relieve coughing. With a productive cough, secretions are made in the respiratory tract.
antitussive drug
Most antitussives depress the cough center located in the medulla
centrally acting drugs.
Codeine and dextromethorphan are examples of
centrally acting antitussives
increase the production of respiratory secretions, which in turn appear to decrease the viscosity of the mucus
Expectorants
Give me an example with mucolytic activity
mucolytic activity reduce the viscosity (thickness) of respiratory secretions by direct action on the mucus. An example of a mucolytic drug is acetylcysteine. One other mucolytic drug is on the market, dornase alfa (Pulmozyme). This agent is used for the treatment of cystic fibrosis.
What herb can be used as a decongestant and expectorant?
Eucalyptus
Describe Mucomyst
Acute o’verdosage may be treated with administration of the drug acetylcysteine (Mucomyst) to prevent liver damage
related to pooling of or thick secretions
Ineffective airway clearance
is to discontinue the drug therapy gradually by initially discontinuing the medication in one nostril, followed by withdrawal from the other nostril
rebound nasal congestion
Dryness of the mouth, nose, and throat may occur when antihistamines are taken. Offer the client frequent sips of water or ice chips to relieve these symptoms. Sugarless gum or sugarless hard candy may also relieve these symptoms.,
Impaired Oral mucus membranes
When congestion produces secretions in either the respiratory passages or the lungs, expectorants or mucolytics are used, respectively
therapeutic response
‘Allergic symptoms; hypersensitivity reactions, including anaphylaxis and transfusion reactions; motion sickness; sleep aid; antitussive and Parkinson-like effects
Diphenhydramine
What to use for allergic rhinitis
Claritin
What to use for none gestation
Epinephrine
Two things codeine does
Suppression of nonproductive cough
Relief mild to moderate pain
What to use to Relief of cough associated with respiratory tract infection
Guaifenesin
Asthma medications are categorized into what two groups
long-term control medications
* quick-relief medications used to treat acute air flow obstruction
What are the most effective long term control meds
are those that reduce inflammation, with inhaled corticosteroids (ICSs) being the first-line intervention
are the mainstay of treatment for many chronic pulmonary disorders. SABA bronchodilators are drugs used to relieve bronchospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema
Bronchodilators
Bronchodilator. Used if the asthma attack is life-threatening. Self-administered, and injected into the thigh. Side effects may be serious.
Epinephrine
Acts on pulmonary beta2 receptors with little effect on heart rate. Administered by inhalation or orally. Brand names CANNOT be interchanged due to insurance. Tremor and nervousness
Albuterol (Proventil HFA, Ventolin HFA, ProAir HFA)
Blocks the action of acetylcholine in bronchial smooth muscle. Used for prevention, not for acute management. Make sure the patient is not allergic to peanuts.
Ipratropium (Atrovent)
Indicated for maintenance therapy of asthma. Beta1 agonist with a long duration of action. Taken twice a day. Reserved for patients with more serious asthma. Available as a dry powder inhaler.
Salmeterol (Serevent)
Increase accumulation of mucus and fluid in the spaces between cells; they also increase vascular permeability permitting substances to pass through blood vessels. They are 100 to 1,000 more potent than histamine.
Leukotriene Inhibitor
Leukotriene Inhibitor. Indicated for the prophylaxis and chronic treatment of asthma. Has been approved for use in children over the age of 12 months. Once-daily dosage. Headache.
Montelukast (Singulair)
Corticosteroid. Comes in three strenths. Lowest is for mild asthma, and the highest is used to wean patients off oral corticosteroids. Should be used twice daily. Flonase is the nasal spray.
Fluticasone (Flovent)
Bronchodilator used to treat COPD. Similar to Ipratropium (Atrovent) but is doesd only once daily. works for 36 hours. Indicated only for long-term maintenance therapy. Dry mouth is very common.
Tiotropium (Spiriva)
to monitor breathing status and the effectiveness of the drug regimen
Peak flowmeter
Classes of Upper GI agents
- Antacids
- H2 blockers
- Proton Pump Inhibitors
- Mucosal protective agents
- Prostaglandin analogues
- Sodium bicarbonate
- Calcium carbonate
- Magnesium hydroxide
- Aluminum hydroxide
Antacids
- Cause a rebound release of gastrin and more acid secretion
- Inappropriate for chronic symptoms (SX relief only)
- Not for long term use, many may be systemically absorbed.
- Overuse can lead to metabolic alkalosis, electrolyte issues: hypo Phos, hypo K, hyper Cal (if Calcium based)
Antacids: cautions
H2 Receptor Antagonists
End in “-tidine”:
- Cimetidine
- Ranitidine
- Famotidine
TN: Tagamet
MOA: 1st gen H2 blocker
- Essentially obsolete: potent cytochrome P450 inhibitor
- Specific isoenzymes inhibited (see next flash card)
- Short acting
- Side effects: HA, dizziness, diarrhea, myalgia, anti-androgen (gynecomastia, ED, males: <libido)
cimetidine
TN: Zantac
MOA: H2 blocker
* Longer acting, more potent and much less P450 metabolism than cimetidine (mostly renally excreted)
* Thus very little drug interactions
* Little side effects
ranitidine
TN: Pepcid
MOA: H2 receptor blocker
* Longer acting and more potent than cimetidine
* Does not effect P450!
* Thus very little drug interactions
* Little side effects
famotidine
Proton Pump Inhibitors
- end in “-prazole”
1. Omeprazole (Prilosec)
2. Lansoprazole (Prevacid)
3. Esomeprazole (Nexium)
4. Pantoprazole (Protonix)
Others:
5. Rabeprazole (AcipHex)
6. Omeprazole w/ NaCO3 (Zegerid)
TN: Prilosec
MOA: PPI, prototype
* Know this drug for this exam, know the others later!
* Some P450 involvement and more drug interactions (Plavix) than the newer PPI’s but otherwise well-tolerated and few side effects
omeprazole
TN: Cytotec
MOA: Prostaglandin E1 analogue
* Supports production and secretion of gastric mucus barrier via E1
* Stimulates bicarbonate mucus production
* Decreases acid secretion
Misoprostol
TN: Carafate
* Complex of Al OH and sulfated sucrose
*Particularly useful as protectant in the duodenum and inhibits pepsin activity
* SE: Constipation, nausea
sucralfate
- Syrup of Ipecac
- Side effects of many drugs, especially:
-Chemotherapy agents
Emetics
Induces vomiting by stimulating the chemoreceptor trigger zone. Leads to vomiting within 20 min.
Risk: cardiotoxicity, also caustics “burn on the way out”. Therefore not recommended.
Syrup of Ipecac
TN: Benadryl
Mech: H1-receptor antagonist (1st gen antihistamine)
Role: Motion sickness, antiemetic adjunct especially in migraine.
Bonus: Strong anticholinergic side effects including sedation are important.
Diphenhydramine
TN: Antivert
Mech: Antihistamine
Indication: Vestibular system, treats benign paroxysmal vertigo (BPV).
meclizine
TN: Dramamine
Mech: Antihistamine/Anticholinergic
Indication: Vestibular systems, treats motion sickness (vertigo)
SE: Anticholinergic
dimenhydrinate
TN: Phenergan
Mech: D2 antagonist/H1-receptor antagonist
Indications: Nausea and vomiting, moderate proemetic chemotherapy agents
Side effects: D2 effects (aka Extra-Pyr SE, dystonic reactions), anticholinergic (sedation, dry mouth, etc)
promethazine
TN: Reglan
Mech: D2 antagonist, 5HT blocker, and muscarinic agonist. Prokinetic and increases LES tone.
Indications: Nausea, vomiting, gastroparesis, dyspepsia
Side effects: D2 blockade effects: Extra-Pyr SE, etc. Other: Restlessness, not sedating. Diarrhea. Depression.
metoclopramide
TN: Compazine
Mech: D2 antagonist. Phenothiazine antipsychotic like thorazine.
Indications: Nausea, vomiting, moderate proemetic chemotherapy agents. Psychosis & schizophrenia.
SE: Extra-pyr SE, dystonia, etc. Sedation.
prochlorperazine
TN: Zofran
Mech: 5HT-3 receptor antagonist. Central acting at chemoreceptor trigger zone. Also via vagal afferents
Indications: Vomiting. Severe proemetic chemotherapeutic agents (FDA approved). Actually terrible at treating nausea alone, or motion sickness.
SE: Well tolerated, less sedating. Headaches. Concern about QTc prolongation. Constipation.
ondansetron
Do antacids coat the stomach?
do not “coat” the stomach lining, although they may increase the sphincter tone of the lower esophagus.
What is CTZ?
the chemoreceptor trigger zone (CTZ), is a group of nerve fibers that sends signals to the vomiting center in the medulla when the metabolism is unbalanced
Where does scopolamine go on the body?
Skin
