Weak 12: resp, immuno, GI Flashcards
Contraindications/nursing considerations with 1st gen H1 antagonists
Sedation more prevalant in first generation, means they should not be used concurrently with other CNS depressants and alcohol. Educate to use only as directed, many ODs because people see as “safe” and are more lax about dosing
Uses of H1 antagonists
mild allergy
adjunt to severe allergy
Motion sickness (some have antagonizing pathways to vestibular apparatus in inner ear responsible for motion sickness)
Insomnia (1st gen)
Caution/contraindications of theophylline
Slow IV admin to avoid fatal CV events
highly variable metabolism (CYP450), requires plasma monitoring
Caffeine (also a methylxanthine) – increase AE, compete for metabolizing enzymes
tobacco/marijuana – induces CYP450
CYP450 induces – subtherapeutic lvls
CYP450 inhibitors – supratherapeutic (even toxic levels)
Monoclonal antibody types
IgE antibody antagonist: omalizumab
IL-5 receptor antagonists
IL-4 receptor alpha antagonist
How does omalizumab work?
forms complex with IgE that prevents it binding to Mast cells
AE of omalizumab
viral infection, injection site reaction, hypersensitivity
Considerations of omalizumab
Long half life, after stops, takes about a yr to get back to pre-treatment levels
How do IL-5 receptor antagonists work?
inhibit IL-5, causing decreased eosinophils
AE of IL-5 receptor antagonists
HA, pharyngitis, fatigue, hypersensitivity rxns,
How do IL-4 receptor alpha antagonists work?
decreased cytokine-induced inflammation
AE of IL-4 receptor alpha antagonists?
injexn site rxns, oral herpes, conjunctivitis, antibody development against the drug
Montelukast is the most commonly prescribed leukotriene receptor blocker. In comparing its adverse effects with the other two leukotriene receptor blockers, why do you think it’s more highly prescribed?
Minimal side effects, no CYP450 inhibition or liver injury, only rare neuropsych effects
What is the purpose and mechanism of action of drugs to treat allergic rhinitis
Intranasal glucocorticoids: suppress immune response to allergens, prevention and treatment (not PRN)
Antihistamines: block histamine, less effective than intranasal glucocorticoids, can relieve some symptoms, but not nasal congestion
Sympathomimetics: cause local vasoconstriction, so less fluid can leak out to become snot, a1 agonism, only to relieve congestion
List three drugs used for cough (antitussives). Which can cause CNS depression? Which have abuse potential?
Codeine – small abuse potential when with something to deter abuse, CNS depression
Hydrocodone – CNS depression, small abuse potential when formulated with other drugs to deter abuse
Dextromethorphan – CNS actions, high doses can cause euphoria, thus abuse potential exists
How do all glaucoma drugs except prostaglandin analogs work?
decreased production of aqueous humor
AE of Beta blockers for glaucoma
systemic beta blockade
AE of Prostaglandin analogs for glaucoma
A2 agonists: dry mouth, ocular hyperemia
ocular hyperemia (enlarged vessels)
AE of A2 agonists for glaucoma
dry mouth, ocular hyperemia
Pt education for antibiotic treatment of H. Pylori
important to take all types and complete entire 10-14 days course, they should be taken 2-3 times a day and combined with an antisecretory agent (H2RA, PPI)
For each class of antiemetics, describe a patient you would NOT administer the drug to
Serotonin receptor antagonists: pt w/ a prolonged QT or on SSRIs
SubP/NK receptor antagonists: pt on warfarin, or on oral BC not using another method of contraception
Haloperidol: prolonged QT
Cannabinoids: psychiatric disease
Scopolamine: an elderly person who is particularly prone to disorientation
Discuss opioid use in diarrhea: how do they work? What drug category are they? Why are they not schedule II like many of the other opioids?
Loperamide, and other similar drugs agonize Opioid receptors, which decreases bowel motility, they are either schedule IV or unscheduled because they are poorly absorbed (no euphoria) and they are formulated with drugs (atropine) which create unpleasant side effects if the dose is increased
How does sulfasalazine work?
Sulfasalazine is metabolized by intestinal bacteria, and converted into 2 substances, one of which (5-ASA) suppresses prostaglandin synthesis and local inflammation, the other is sulfapyridine and causes the AE associated with the drug
What is Alosteron used for
IBS-D in women
AE of alosteron
well-tolerated to severe, including death d/t ischemic colitis
What are the differences in H1 and H2 receptor agonism? What drugs do we use for each?
H1 receptor agonism causes:
Vasodilation, increased vascular permeability,
Hypotension, reflex tachy
Bronchoconstriction
itching/pain (stim of nerves)
CNS: cognition, memory, sleep/wake
Drugs: diphenhydramine (benadryl), promethazine (phenergan)
H2: gastric secretion
Drugs H2RAs: cimetidine, famotidine
Pt education for immunosuppressants
Toxic: nephrotoxicity, hepatotoxicity
AE: bone marrow suppression, infection, depression, flu-like symptoms, injection site reactions, decrease vaccine effectiveness
Don’t use with other immunosuppressants
Encourage family members to get vaccinated, avoid live vaccinations
Avoid with other nephrotoxic drugs, metabolized by CYP450 – be careful with inducers and inhibitors
mTOR inhibitors with high fat foods → increased absorption and possible toxicity
Indication of Calcineurin inhibitors
prevent transplant rejection
Considerations for Calcineurin inhibitors
Unpredictable PO: must monitor plasma levels
hepatic metabolism: avoid CYP450 inducers and inhibitors
avoid with other nephrotoxic drugs
Cyclosporine vs tacrolimus
tacrolimus is more effective but has a smaller TI
Indication for mTOR inhibitors
prevent renal transplant rejection
Cautions with mTOR inhibitors
avoid CYP450 inducers and inhibitors
high fat food cause increased absorption which can lead to toxicity
List a short, medium, and long acting glucocorticoids
Short: cortisone, hydrocortisone
Medium: prednisone
Long: dexamethasone
Uses of glucocorticoids
rheumatoid arthritis
SLE
IBD
asthma
bursistis/tenitis/synovitis/osteoarthritis
allergic rxns
neoplasms (for some types of cancers)
suppression of allograft rejection
Class of Cyclophosphamide
cytotoxic drug
What is similar about Azathioprine and
Methotrexate
they are both cytotoxic drugs that interfere with folate metabolism
What are two long acting B2 agonists
formoterol and Salmeterol
Indication for LABAs
preferred in COPD
fixed dose scheduling (not PRN)
when used alone in asthma increased mortality (USE W/ GLUCOCORTICOID)
Indication of PO terbutaline and albuterol
long term control, not first line, dosing is 3-4x/day
Indications for cromolyn
asthma, exercise induced asthma (neb), allergic rhinitis (intranasal)
Indications for roflumilast
severe bronchitis primary COPD (not first line)
CI roflumilast
pregnancy
psych rxns possible
Indication of glucocorticoid + LABA
Symbicort and advair are used for asthma
Indication B2 antagonist + anticholinergic
Combivent is used in COPD
AE of sympathomimetics for allergic rhinitis
CNS stim
CV effects in high doses
rebound congestion
Pseudoephedrine is associated with abuse bc can be turned into meth
AE of sympathomimetics for allergic rhinitis
CNS stim
CV effects in high doses
rebound congestion
Pseudoephedrine is associated with abuse bc can be turned into meth
Drugs for allergic conjunctivitis
H1 receptor blockers: azelastine (prevents mast cell activation)
ocular decongestants: phenylephrine
consideration with phenylephrine for ocular decongestion
use for max 2 weeks bc can cause rebound conjunctivitis
Consideration with oitments
highest medication absorption (of topicals)
good for thickened, inflamed skin (eczema)
not good for moist, weeping skin (burns)
AE of topical glucocorticoids
local reactions
thinning of skin with long term use
AE of Keratolytics
toxicity with long term high dose use (rare)
topical antibiotics:
-drug
-indication
-AE
benzoyl peroxide as first line for acne, AE peeling and drying
Retinoids
-drug
- mechanism of action
-AE
tretinoin, hyperproliferation of epithelial cells
AE: peeling, drying
Kerolytics
- drug
-mechanism of action
- AE
azelaic acid
supresses P. acnes (strain of bacteria causing acne)
AE: itching, burning, pigment reduction
Drugs for psoriasis
Methotrexate: systemic, caution: teratogenisis
Topical: Coal tar: supresses DNA synthesis, inhibits keratinocytes
Indication and AE for Topical tacrolimus
immunosuppressant, 2nd line for ezcema
AE: erythema, pruitis
Indication, possible mechanism of action, AE of topical minoxidil
alopecia/male pattern bladness, possibly works thru direct vasodilation, AE: local allergic rxns
Interactions of Cimetidine
H2RAs are CYP450 inhibitors (toxic doses of other meds metabolized by CYP450)
antacids can decrease the absorption of Cimetidine (give 1hr apart)
Drug interactions of PPIs
increased pH causing decreased absorption of some HIV drugs and antifungals
Who are antacids contraindicated for?
All antacids contain lots of Na+, so caution with HTN, HF, or renal d. (careful electrolyte balancing)
Compare and contrast the two drugs used to increase defensive factors in the treatment of PUD
Misoprostol and sucralfate have different mechanisms of action (see 31). Misoprostol cannot be given to pregnant women, can cause dose-related diarrhea, abdominal pain, and spotting/dysmenorrhea. Sucralfate, on the other hand, has minimal side effects (some experience constipation), but can increase the absorption of some other drugs, so it should be given at least 2 hrs apart from other meds.
How can Senna and Bisacodyl be give
PO or PR (per rectum faster)
What type of laxative are magnesium compounds
osmotic laxatives
AE of osmotic laxatives
dehydration, bloating, cramping, flatulance
Indication, drug class, mechansim of action for methylnaltrexone
constipation, selective mu antagonist, blocks mu receptors on GI tract –> increased peristalsis
Which med can be used in diarrhea caused by IBD
budesonide (for initiation of remission, not long term management)
AE of dexamethasone for nausea
transient blood sugar increase
Indication and potential MOA for Cannabinoids
likely antagonize canabinoid receptors in the CTZ, indicated for nausea and appetite stimulation in AIDs
AE of Cannabinoids
in theory same as marijuana (psych disorders)
tachy, hypotension, drowsiness
abuse potential (schedule 4 d/t slow onset
Class and MAO of meclizine
antihistamine, M and H block in neuronal pathway from inner ear to vomiting center
AE of metoclopramide
in high doses, sedation, diarrhea, long teem EPS
