UPPER RESPIRATORY DRUGS Flashcards
– 1st Generation Antihistamine
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
a. Diphenhydramine, dimenhydrinate
– 2nd Generation Antihistamine
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
b. Loratadine, cetirizine, fexofenadine
Intranasal Antihistamines
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
c. Azelastine, Olopatadine
Decongestants
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
d. Pseudoephedrine, oxymetazoline, phenylephrine
– Cough Suppressants
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
e. Benzonatate, Codeine, dextromethorphan
– Expectorants
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
f. Guaifenesin
Mucolytic
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
g. Acetylcysteine
h. Hypertonic Saline
USED TO TREAT: – Allergies – Insomnia – Motion Sickness – Nausea a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
MECHANISM:
– Blocks histamine-1 receptors found centrally and
peripherally in the body
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
ADVERSE EFFECTS: Check – Paradoxical effect in children (rare) a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
• ADVERSE EFFECTS:
– CNS Sedation (dangerous w/ other drugs)
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
• ADVERSE EFFECTS: – Weight gain with longer term use a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
• ADVERSE EFFECTS
Blocking of histamine receptors in brain, also somewhat blocks acetylcholine receptors in the
brain
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
• ADVERSE EFFECTS Can’t see Can’t pee Can’t spit Can’t **** a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
Concerns with other diseases
• Geriatrics/Urinary Retention/Glaucoma/Constipation
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
Concerns with other drugs (avoid B drugs)
• Booze (alcohol/EtOH), Benzos (diazepam), Barbiturates
(phenobarbital), Back relaxers (baclofen, cyclobenzaprine),
Big Opioids (morphine),
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
USED TO TREAT: – Allergies a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
b. Loratadine, cetirizine, fexofenadine
MECHANISM:
• Blocks histamine receptors found peripherally
ONLY (limited action in the brain- less drowsy)
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
b. Loratadine, cetirizine, fexofenadine
ADVERSE EFFECTS: • Minimal at normal dose a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
b. Loratadine, cetirizine, fexofenadine
ADVERSE EFFECTS:
Non sedating!
– If you overdosed, it loses peripheral selectivity
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
b. Loratadine, cetirizine, fexofenadine
USED TO TREAT: – seasonal allergic rhinitis a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
c. Azelastine, Olopatadine
USED TO TREAT:
Intranasal sprays results in LOCAL effect, not
systemic (fewer side effects!)
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
c. Azelastine, Olopatadine
USED TO TREAT: Primarily for nasal congestion – Allergies – Common Cold (VIRUS!) – SYMPTOM MANAGEMENT ONLY – Is there a cure for the common cold? a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
Decongestants
pseudoephedrine
Oral
Nasal Spray
Oral
Decongestants
phenylephrine/ oxymetazoline
Oral
Nasal Spray
Nasal Spray
• USED TO TREAT – Common Cold (VIRUS!) a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
• USED TO TREAT – SYMPTOM MANAGEMENT ONLY a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
MECHANISM:
– Adrenergic agonists (primarily alpha-1)
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
MECHANISM
– Goal is constriction of nasal blood vessels
• Secretions can now drain better
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
• ADVERSE EFFECTS Increased HR, increased BP, dysrhythmias • Anxiety, insomnia, tremor a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
Rebound congestion with?
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
Sprays
phenylephrine, oxymetazoline
Can damage the nasal mucosa (thinning)
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
Sprays
phenylephrine, oxymetazoline
Do Not use more than 3 day
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
Sprays
phenylephrine, oxymetazoline
CONTRA-INDICATIONS – known hypertension, heart disease a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
CONTRA-INDICATIONS – Other medications that can increase BP a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
CONTRA-INDICATIONS glaucoma a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
– Screen patients for contra-indications • Heart disease/HTN • Glaucoma a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
DRUG-DRUG INTERACTIONS: You cannot mix sympathomimetics with an antidepressant drug class called MAO-I’s a. Diphenhydramine, dimenhydrinate b. Loratadine, cetirizine, fexofenadine c. Azelastine, Olopatadine d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
DRUG-DRUG INTERACTIONS:
• MonoAmine Oxidase Inhibitor= phenelzine
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
DRUG-DRUG INTERACTIONS:
• Pseudoephedrine+ phenelzine= INCREASE BP!!!!
a. Diphenhydramine, dimenhydrinate
b. Loratadine, cetirizine, fexofenadine
c. Azelastine, Olopatadine
d. Pseudoephedrine, oxymetazoline, phenylephrine
d. Pseudoephedrine, oxymetazoline, phenylephrine
Opioid- Antitussive
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
Codeine
Non opioid- Antitussive
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
Benzonatate,
Opioid-Derived-Antitussive
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
Dextromethorphan
USED TO TREAT: – Dry, nonproductive cough e. Benzonatate, Codeine, dextromethorphan f. Guaifenesin g. Acetylcysteine h. Hypertonic Saline
e. Benzonatate, Codeine, dextromethorphan
COUGH SUPRESSION/ Anti-tussive
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
e. Benzonatate, Codeine, dextromethorphan
ADVERSE EFFECTS • Don’t chew, can numb the mouth! • Can cause drowsiness e. Benzonatate, Codeine, dextromethorphan f. Guaifenesin g. Acetylcysteine h. Hypertonic Saline
Benzonatate
ADVERSE EFFECTS • Don’t chew, can numb the mouth! e. Benzonatate, Codeine, dextromethorphan f. Guaifenesin g. Acetylcysteine h. Hypertonic Saline
Benzonatate
ADVERSE EFFECTS
Known to be mis-used (can cause hallucinations)
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
Dextromethorphan
DRUG-DRUG INTERACTION:
MAO-I’s, a type of old antidepressant (prototype=phenelzine
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
Dextromethorphan
Do NOT GIVE TOGETHER = “Serotonin Syndrome”
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
Dextromethorphan
No more than 5 days (this means its time to be seen by a prescriber!) this is sold OTC
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
Dextromethorphan
Dextromethorphan
No more than ? days (this means its time to be seen by a prescriber!) this is sold ?
5
OTC
Oral medication that helps facilitate removal of
secretions commonly seen with colds/upper
respiratory tract infections
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
f. Guaifenesin
Essentially this helps break up thick mucus (productive
cough)
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
f. Guaifenesin
ADMINISTRATION
Take with full glass of water- Take gua with agua
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
f. Guaifenesin
Take gua with agua
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine
h. Hypertonic Saline
f. Guaifenesin
Guaifenesin Take with full glass of?
Water Agua
USED TO TREAT:
– Intended to be inhaled to help decrease viscosity
of mucus secretions
e. Benzonatate, Codeine, dextromethorphan
f. Guaifenesin
g. Acetylcysteine + Hypertonic Saline
g. Acetylcysteine + Hypertonic Saline
ADVERSE EFFECTS Smells like ROTTEN EGGS! e. Benzonatate, Codeine, dextromethorphan f. Guaifenesin g. Acetylcysteine + Hypertonic Saline
g. Acetylcysteine + Hypertonic Saline
ADMINISTRATION Inhaled is via nebulizer e. Benzonatate, Codeine, dextromethorphan f. Guaifenesin g. Acetylcysteine + Hypertonic Saline
g. Acetylcysteine + Hypertonic Saline
