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NS 119 > Test 2 Pharmacology Part 2 > Flashcards

Test 2 Pharmacology Part 2 Flashcards

1
Q

Antihistamines

A

Drugs that directly compete with histamine for specific receptor sites

Two histamine receptors

  • H1 histamine - 1
  • H2 histamine - 2
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2
Q

H1 receptor antagonists

A
  • ex: benadryl
  • inhibit smooth muscle constriction in blood vessels and respiratory and GI tracts
  • decrease capillary permeability
  • decrease salivation and tear formation
  • used for a variety of allergic disorders to prevent or reverse target organ inflammation
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3
Q

First-generation H1 Receptor Antagonists

A
  • non-selective/sedating
  • bind to both central and peripheral H1 receptors
  • usually cause CNS depression (drowsiness, sedation) but may cause CNS stimulation (anxiety, agitiation), especially in children and elderly
  • also have substantial anticholinergic effects
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4
Q

Examples of 1st generation H1 receptor antagonists

A
  • chorpheniramine: elixir and expectorant
  • hydroxyzine (Visterel)
  • diphenhydramine (Benadryl)
  • promethazine
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5
Q

First-Generation Side Effects

A
  • sedation
  • dry mouth
  • blurred vision
  • GI disturbances
  • headache
  • urinary retention
  • hydroxyzine is not recommended for pregnancy and breast feeding
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6
Q

Second-Generation H1 receptor antagonists

A
  • selective/non-sedating
  • cause less CNS depression b/c they are selective for peripheral H1 receptors and do not cross BBB
  • longer-acting compared to 1st generation
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7
Q

Examples of Second-generation H1 receptor antagonists

A
  • cetirizine (Zyrtec)
  • loratadine (Claritin)
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8
Q

Second-generation side effects

A
  • may cause slight sedation
  • some antihistamines may interact with antifungal, e.g. ketoconazole; antibiotics, e.g. erythromycin; prokinetic drug–cisapride or grapefruit juice, leading to potentially serious ECG changes e.g. Terfenadine
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9
Q

Nursing Implication: Antihistamines

A
  • gather data about the condition or allergic reaction that required treatment; also, assess for drug allergies
  • contraindicated in the presence of acute asthma attacks and lower respiratory disease
  • use w/ caution in increase intraocular pressure, cardiac or renal disease, hypertension, asthma, COPD, peptic ulcer disease, BPH, or pregnancy
  • instruct patients to report excessive sedation, confusion, or HTN
  • avoid driving/operating heavy machinery and do no consume alcohol or other CNS depressants
  • don’t take with other prescribed or OTC meds w/o checking w/ prescriber
  • best tolerated when taken w/ meals, less GI upset
  • if drymouth occurs, teach patient to perform frequent mouth care, chew gum, or suck on hard candy
  • monitor intended therapeutic effects
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10
Q

Decongestans: 2 main types

A
  • adrenergics (largest group)
  • corticosteroids
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11
Q

Oral decongestants

A
  • prolonged decongestant effects, but delayed onset
  • effect less potent that topical
  • no rebound congestion
  • exclusively adrenergics
  • examples: phenylephrine and pseudoephedrine (Sudafed)
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12
Q

Topical Nasal Decongestants

A
  • both adrenergics and steroids
  • prompt onset
  • potent
  • sustained use over several days cuases rebound congestion, making the condition worse
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13
Q

2 categories of Topical Nasal Decongestants

A
  • adrenergics
    • ephedrine (Vicks)
    • oxymetazoline (Afrin)
    • naphazoline (Privine)
    • phenylephrine (Neo Synephrine)
  • Intranasal Steroids
    • beclomethasone dipropionate (Beconase, Vancenase)
    • flunisolide (Nasalide)
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14
Q

Nasal Decongestants: Side Effects

A
  • adrenergics
    • nervousness, insomnia, palpitations, tremors, (systemic effects due to adrenergic stimulation of the heart, blood vessels, and CNS)
  • steroids
    • local mucosal dryness and irritation
  • rebound congestions develops with topical agents when used more than a few days
  • CNS stimulation occurs with oral sympathomimetics
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15
Q

Decongestants: Nursing Implications

A
  • pts should avoid caffeine
  • report a fever, cough, or other symptoms lasting longer than a week
  • monitor for intended therapeutic effects
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16
Q

3 classes of cough preparations

A
  • antitussives
  • expectorants
  • mucolytics
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17
Q

Antitussives

A
  • drugs used to stop or reduce coughing
  • opiod and nonopioid (narcotic and non-narcotic)
  • Use only for nonproductive coughs!
    • some act w/in the CNS, some act peripherally
    • indicated in dry, hacking, nonproductive cough that interfere with rest and sleep
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18
Q

Antitussives: Examples

A
  • codeine phosphate
  • pholcodine
  • dextromethorphan
  • diphenhydramine
19
Q

Antitussives: side effects

A
  • Benzonatate
    • dizziness, headache, sedation
  • Dextromethorphan
    • dizziness, drowsiness, nausea
  • Opioids
    • sedation, nausea, vomiting, lightheadedness, constiptation
20
Q

Antitussives: Nursing Implications

A
  • perform respiratory and cough assessment, and assess for allergies
  • instruct patients to avoid driving or operating heavy equipment due to possible sedation, drowsiness, or dizziness
  • if takin chewable tables or lozenges, don’t drink for 30 to 35 minues afterward
  • report any of the following to caregiver
    • cough lasting more than a week, persistant headache, fever, rash
  • antitussives are for NONPRODUCTIVE coughs
  • monitor for intended therapeutic effects
21
Q

Expectorants

A
  • aid in the removal of mucus
  • reduce viscosity of secretions
  • disintegrate and thin secretions
  • Guafenesin is most commonly used
  • Ammonia & Ipecacuaha Mixture is another one
  • stimulate flow of respiratory tract secretions
22
Q

Expectorants: Side effects

A
  • guafenesin
    • nausea, vomiting, gastric irritation
  • terpin hydrate
    • gastric upset
    • elixir has high alcohol content
23
Q

Expectorants: Nursing Implications

A
  • should be used w/ caution in the elderly or those with asthma or respiratory insufficiency
  • should receive more fluids, if permitted, to help loosen and liquefy secretions
  • report a fever, cough, or other symptoms lasting longer than a week
  • monitor for intended therapeutic effects
24
Q

Mucolytics

A
  • reacts directly with mucus to make it more watery. This should help make the cough more productive
  • acetylcysteine
  • bromhexine
  • carbocisteine
25
Q

TB: 1st line drugs

A
  • high efficacy, low toxicity
    • Isoniazid (INH)
    • Pyrazinamide
    • Ethambutol
    • Streptomycin
26
Q

TB: 2nd line drugs

A
  • low efficacy, high toxicity, or both
    • ethionamide
    • para aminosalicylic acid
    • cycloserine
    • amikacin/capreomycin
    • fluoroquinolones
    • rifabutin
27
Q

Isoniazid (isonicotinic acid hydrazide, H)

A

Antitubercular Agent

  • essential component of all anti TB regiemn (except intolerance to H or resistance)
  • is is tuberculocidal: kills fast multiplying organism and inhibit slow acting organism
  • acts on both intracellular (present in macrophages) and extracellular bacilli
  • is the cheapes AT agent
28
Q

Rifampin (Rifampicin, R)

A
  • semisythetic derivative of Rifamycin B from Steptomyces mediterranei
  • bactericidal to M. Tuberculosis and others
    • S. aureus
    • N. Meniingitidis
    • H. influenzae
    • E. coli
    • Klebsiella
    • Proteus
    • Legionella
29
Q

Pyrazinamide (Z)

A
  • Chemically similar to INH
  • weak tuberculocidal, more active in acidic medium
  • more lethal to intracellular bacilli and to those at sites showing inflammatory response (Therefore effective in first 2 months of therapy where inflammatory changes are present)
30
Q

Ethambutaol (E)

A
  • tuberculostatic, clinically active as Streptomycin
  • fast multiplying bacteria are more sensititve
  • also acts against atypical mycobacteria
  • if added in triple regimen (RZH) it is found to hasten the rate of sputum conversion and to prevent development of resistance
31
Q

Streptomycin (S)

A
  • it was 1st clinically usefull antibiotic drug
  • it is protein synthesis inhibitor by combining with 30S ribosome
  • it is tuberculocidal, but less effective than INH/Rifampicin
  • acts on extracellular bacilli only (poor penetration in the cells)
32
Q

Antivirals

A
  • key characteristics
    • able to enter the cells infected with virus
    • interfere with viral nucleic acid synthesis and/or regulation
    • some drugs interfere with ability of virus to bind to cells
    • some drugs stimulate the body’s immune system
    • best responsed to antiviral drugs are in patients with competent immune systems
    • a healthy immune system works synergistically with the drug to eliminate or suprress viral activity
33
Q

Amantadine (Symmetrel)

A
  • Antiviral - nonretroviral
  • narrow antiviral spectrum-active only against influenza A
  • used prophylactically when vaccine is not available or cannot be given
  • therapeutic use can reduce recovery time
  • CNS effects: insomnia, nervousness, lightheadedness
  • GI effects: anorexia, nausea, others
34
Q

Remantadine (Flumadine)

A
  • same spectrum of activity, mechanism of action and indications as amantadine
  • fewer CNS effects
  • causes less GI upset
35
Q

Ribaviring

A
  • Antiviral - nonretroviral
  • synthetic nucleoside analog
  • given orally, or oral or nasal inhalation
  • inhalation form (Virazole) used for hospitalzied infants with RSV (respiratory syncytialvirus) infections
36
Q

Amphotericin B and Nystatin

A
  • fungal meningitis
  • bind to the funcal cell membrante component ergosterol, leading to increased fungal cell membrane permeability and the loss of intracellular constitutents
  • Amphotericin B has activity agains Candida spp., Cryptococcus neoformans, Blastomyces dermatitidis, histoplasma capsulatum, sporothrix schenckii, coccidioides immitis, peracoccidioides braziliensis, aspergillus spp., Penicillium marneffei, etc.
37
Q

Major acute reaction to IV Amphotericin B

A
  • fever and chills
  • tachypnea and respiratory stirdor
  • modest hypotension
  • patients with preexisting cardiac or pulmonary disease may develop hypoxia or hypotension
  • although the reaction ends spontaneously in 30 to 45 minutes
38
Q

Nystatin

A
  • a polyene antifungal drug with a ring structure and a mechanism of action similar to that of amphotericin B
  • too toxic for systemic use, nystatin is limited to the topical treatment of superficial infections caused by C. albicans
  • infections commonly treated by this drug include oral candidiasis (thrush), mild esophageal candidiasis, and vaginitis
39
Q

Fluconazole

A
  • anti-fungal
  • doesn’t require an acidic environment, as does ketoconazole, for GI absorption
  • about 80 to 90% of an orally administered dose is absorbed, yielding high serum drug levels
  • penetrates widely into most body tissues
  • cerebrospinal fluid levels are 60 to 80% of serum levels permitting effective treatment for fungal meningitis
  • about 80% of the drug is excreted unchanged in the urine
  • dosage reducetions are required in the presence of renal insufficiencty
  • well tolerated
40
Q

Fluconazole side effects

A
  • asymptomatic liver inzyme elevation
  • drug associated hepatic necrosis has been reported
  • alopeica has been reported as a commong adverse event
  • coadministration of enzyme inhibitor fluconazole with phenytoin results in increased serum phenytoin levels
41
Q

dornase alfa (Pulmozyme)

A
  • CF drug
  • hydrolyzes the DNA in sputum of CF patients and reduces sputum viscosity and viscoelasticity
  • contraindications: allergic
  • side effects:
    • serious side effects are: an allergic reaction (difficulty breathing, closing of the throat, swellin of the lips, tongue, or face, or hives), increased difficulty breathing, chest pain, fever
    • less serious side effects: voice alteration, sore throat, rash, laryngitis, eye redness, irritation, inflammation, nasal stuffiness or discharge
  • Drug interraction
    • Afrezza (insulin inhalation, rapid acting)
    • insulin inhalation, rapid acting
    • Exubera (insulin inhalation, rapid acting)
42
Q

Nicotine Replacment Oral Agents

A
  • nicotine gum
  • nicotine inhaler
  • nicotine lozenge
  • nicotine nasal spray
  • nicotine patch
  • buppropion SR
  • Varenicline
43
Q

Buproprion SR (Wellbutrin)

A
  • Advantages
    • oral formulation given BID that is easy to use
    • may be beneficial for patients with coexisting depression
    • initiated before quit date
    • no risk of nicotine toxicity if patient continues to smoke
  • Disadvantages
    • increased seizure risk
    • several contraindications and precautions that may preclude use
    • side effects of insomnia and dry mouth
44
Q

varenicline (Chantix)

A
  • advantages
    • oral formulatin given BID that is easy to use
    • intiate before quit date
    • new mechanism of action for persons who previously failed using other medications
  • disadvantages
    • may induce nausea in up to 1/3 of patients (need to titrate)
    • post-marketing surveillance data stimulated FDA warning

NS 119 (9 decks)

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