| Drug |
 |
|
| Info |
|
|
| Most common colds result from a : |
viral infection (rhinovirus or influenza virus) |
| Functions of histamine: |
dilation of capillaries & increased permeability -> lower BP, contraction of smooth muscles, acceleration of HR |
| H1 receptors |
mediate smooth muscle contraction & dilation of capillaries |
| H2 receptors |
mediate the acceleration of the HR and gastric acid secretion |
| Antihistamines: |
compete w/ histamine for unoccupied receptors- can't knock histamine off receptors, so it is best to take med early in histamine-mediated rxn |
| adverse consequences of histamine binding: |
vasodilation, increased cap. permeability w/ resultant edema |
| Antihistamines- therapeutic uses |
anticholinergic effects- reduce nasal, salivary, and lacrimal gland hypersecretion; in skin: reduce cap. permeablilty, and itching |
| nonsedating vs sedating- nonsedating work |
peripherally to block the actions of histamine & therefore do not have CNS effect (don't cross BBB) |
| Loratidine (Claritin) drug class: |
antihistamines |
| Cetirzine (Zyrtec) drug class: |
antihistamines |
| diphenhydramine (Benadryl) drug class |
antihistamines |
| Loratidine (Claritin) sedating? |
nonsedating, take 1x/day, for seasonal allergic rhinitis |
| Cetirzine (Zyrtec) sedating? |
nonsedating (unless at high doses), take 1x/day, for seasonal allergic rhinitis |
| diphenhydramine (Benadryl) sedating? |
is sedating, works peripherally and centrally; potent anticholinergic effects |
| Diphenhydramine (Benadryl) uses: |
hives, motion sickness, PD, sleep aid |
| Which group of nasal decongestants is rarely used? |
anti-cholinergic because you get systemic absorption- urinary retention, dry mouth.. |
| advantage of oral nasal decongestants |
prolonged effects, no rebound congestion; BUT: delayed onset & effects less potent |
| Pro/Con topical nasal decongestants |
prompt onset, BUT: rebound congestion after prolonged use |
| inhaled intranasal steroids & anticholinergic nasal decongestants |
not much rebound congestion, often used prophylactically |
| MOA: decongestants (adrenergic) |
shrink engorged nasal mucous membranes by constricting the small arterioles that supply the structures of the upp. resp tract |
| SNS stimulation produces: |
increased HR, vasoconstriction, low GI/GU, bronchodilation |
| Decongestant SE |
nervousness, insomnia, palpitations, tremor |
| Antitussives- purpose |
suppress cough |
| Antitussives- opiates & dextromethorphan work by: |
suppressing the cough reflex through a direct action on the cough center (medulla) |
| Nonopioid antitussives work by: |
suppressing cough reflex by anesthetizing (numbing) the stretch receptor cells in the respiratory tract |
| Dextromethorphan (Vicks formula 44, Delysm) drug class: |
antitussives |
| Dextromethorphan (Vicks) info: |
nonopioid, nonaddicting, no CNS depression, works directly on medulla cough center |
| Expectorants - purpose |
aid in coughing up & spitting out mucus (yummy) |
| Guaifenesin (Robitussin, Humabid) drug class: |
expectorants |
| Guaifenesin (Robitussin, Humabid) drug facts: |
thins difficult to cough up mucus in the resp. tract. 1/2life=1 hour, SE: N/V, GI irritation |
| When on expectorants, you should: |
drink more fluid to loosen and liquefy secretions |
| H1 blockers: review |
prevent harmful effects of histamine & are used to treat seasonal allergic rhinitis, anaphylaxis, reaction to insect bites... |
| H2 blockers: review |
used to treat gastric acid disorders |
| Nonsedating antihistamines cause: |
dry mouth |
| define chronic bronchitis |
continuous inflammation of the bronchi |
| define emphysema |
air spaces enlarge as a result of the destruction of the alveolar walls (surface where O2 and CO2 exchange takes place is reduced) |
| The two classes of bronchodilators: |
xanthine derivatives, beta-agonists |
| xanthine derivatives- used for |
prevention of asthmatic symptoms (have slow onset of action, so not used for acute attack) |
| xanthine derivatives- drug effects |
cause bronchodilation by increasing CAMP levels |
| xanthine derivatives- "trophic effects" |
positive inotrope and positive chronotrope - increases blood flow to the kidneys -> diuretic effect |
| SE of xanthines |
N/V, GE reflux during sleep, sinus tachycardia, palpitations, dysrhythmias, increased urinatino, hyperglycemia |
| Therapeutic ranges of xanthines - where metabolized? |
10 to 20 mcg/ml - liver |
| Theophylline (Theo-Dur, Slo-Bid) drug class |
xanthines |
| Theophylline (Theo-Dur, Slo-Bid) used for; |
treatment of chronic resp. disorders |
| Beta-2 adrenergic agonists- used when? |
during the acute phase of an asthma attack |
| when a beta-2 adrenergic receptor is stimulated, _______ (enzyme needed to make cAMP) is activated |
adenylate cyclase |
| Increased levels of cAMP made available by beta-2 adrenergics cause: |
bronchial smooth muscles to relax, which results in increased airflow |
| beta-2 specific drug effects: |
dilating effect on the peripheral vasculature- decreases BP, temporary decrease in serum K+ |
| beta-1 receptor stimulation causes: |
increased HR & force of contraction |
| When on Beta-2 adrenergics, do not also take: |
MAOI's or other sympathomimetics |
| Albuterol (Proventil, Ventolin) drug class: |
beta-adrenergic; beta2 specific |
| Albuterol used most for: |
treatment of acute attacks of asthma, can also be used to prevent attacks |
| Albuterol side effects: |
Nausea, anxiety, palpitations, increased HR, tremors |
| Epinephrine (Adrenaline) drug class: |
beta-adrenergic (alpha-beta agonist) |
| Epinephrine's beta2 stimulating effect: |
bronchodilation |
| Epinephrine (adrenaline)'s alpha 1 effect |
constriction of mucous membranes = nasal decongestant |
| Ipratropium bromide - drug class: |
anticholinergics |
| ipratropium bromide- uses |
actions slow & prolonged, so not for acute asthma, but for COPD |
| ipratropium bromide SE: |
dry mouth, GI distress, headache, coughing, anxiety |
| What are leukotrienes (LTs) |
produced in response to an allergen- in asthma, cause inflammation, bronchoconstriction, and mucus production |
| What do antileukotriene agents do? |
Prevent LT's from attaching to receptors located on circulating cells & cells w/in lungs (blocks inflammation) |
| antileukotriene drug effects |
prevent smooth muscle contraction of the bronchial airways, decrease mucus |
| antileukotriene therapeutic uses |
prophylaxis & chronic treatment of asthma (not for acute attacks) |
| antileukotriene agents- improvement in: |
1 week |
| antileukotriene SE: |
HA, nausea, dizziness, insomnia, diarrhea |
| antileukotriene- should monitor what? |
liver enzymes |
| Montelukast (Singulair) drug class: |
antileukotrienes |
| Corticosteroids- used for |
antiinflammatory effects, which lead to decreased airway obstruction |
| advantage of inhaled corticosteroids |
action is limited to the topical site of action- lungs; prevents systemic effects |
| Mechanism of action- corticosteroids |
reduce inflammation, enhance activity of beta-agonists |
| Corticosteroids- SE: |
pharyngeal irritation, coughing, dry mouth, oral fungal infections |
| Beclomethasone diproprionate (Beclovent, Vanceril) drug class: |
Corticosteroids |
| Beclomethasone dipropionate (Beclovent, Vanceril) drug facts: |
oral inhalation, long term control, topical activity |
| Mast cell stabilizers are used: |
as adjuncts to the overall management of patients w/ asthma- for prophylaxis only |
| Mast cell stabilizers are ____acting because |
indirect- prevent the release of the intracellular chem. mediators that cause bronchospasm (don't block receptors) |
| Do mast cell stabilizers have bronchodilator activity? |
Nope, so are only used prophylactically |
| Mast cell stabilizers are more effective in preventing asthma caused by: |
extrinsic factors such as allergens |
| Mast cell stabilizers SE: |
coughing, sore throat, rhinitis, bronchospasm, taste change, HA |
| Long or short term control: anticholinergics (ipratropium bromide) |
Long term |
| Long or short term control: antileukotriene (Montelukast- Singulair) |
long term |
| Long or short term control: corticosteroids (Beclovent) |
long term |
| Long or short term control: Mast cell stabilizers |
long term |
| Long or short term control: systemic steroids |
quick relief |
| beta2 adrenergic (Albuterol) |
quick relief |
