Antihistamines, decongestants, antitussives, bla bla bla lilk8tob
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| Most common colds result from a : | viral infection (rhinovirus or influenza virus)
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| Functions of histamine: | dilation of capillaries & increased permeability -> lower BP, contraction of smooth muscles, acceleration of HR
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| H1 receptors | mediate smooth muscle contraction & dilation of capillaries
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| H2 receptors | mediate the acceleration of the HR and gastric acid secretion
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| 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
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| adverse consequences of histamine binding: | vasodilation, increased cap. permeability w/ resultant edema
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| Antihistamines- therapeutic uses | anticholinergic effects- reduce nasal, salivary, and lacrimal gland hypersecretion; in skin: reduce cap. permeablilty, and itching
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| nonsedating vs sedating- nonsedating work | peripherally to block the actions of histamine & therefore do not have CNS effect (don't cross BBB)
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| Loratidine (Claritin) drug class: | antihistamines
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| Cetirzine (Zyrtec) drug class: | antihistamines
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| diphenhydramine (Benadryl) drug class | antihistamines
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| Loratidine (Claritin) sedating? | nonsedating, take 1x/day, for seasonal allergic rhinitis
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| Cetirzine (Zyrtec) sedating? | nonsedating (unless at high doses), take 1x/day, for seasonal allergic rhinitis
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| diphenhydramine (Benadryl) sedating? | is sedating, works peripherally and centrally; potent anticholinergic effects
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| Diphenhydramine (Benadryl) uses: | hives, motion sickness, PD, sleep aid
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| Which group of nasal decongestants is rarely used? | anti-cholinergic because you get systemic absorption- urinary retention, dry mouth..
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| advantage of oral nasal decongestants | prolonged effects, no rebound congestion; BUT: delayed onset & effects less potent
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| Pro/Con topical nasal decongestants | prompt onset, BUT: rebound congestion after prolonged use
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| inhaled intranasal steroids & anticholinergic nasal decongestants | not much rebound congestion, often used prophylactically
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| MOA: decongestants (adrenergic) | shrink engorged nasal mucous membranes by constricting the small arterioles that supply the structures of the upp. resp tract
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| SNS stimulation produces: | increased HR, vasoconstriction, low GI/GU, bronchodilation
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| Decongestant SE | nervousness, insomnia, palpitations, tremor
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| Antitussives- purpose | suppress cough
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| Antitussives- opiates & dextromethorphan work by: | suppressing the cough reflex through a direct action on the cough center (medulla)
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| Nonopioid antitussives work by: | suppressing cough reflex by anesthetizing (numbing) the stretch receptor cells in the respiratory tract
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| Dextromethorphan (Vicks formula 44, Delysm) drug class: | antitussives
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| Dextromethorphan (Vicks) info: | nonopioid, nonaddicting, no CNS depression, works directly on medulla cough center
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| Expectorants - purpose | aid in coughing up & spitting out mucus (yummy)
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| Guaifenesin (Robitussin, Humabid) drug class: | expectorants
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| Guaifenesin (Robitussin, Humabid) drug facts: | thins difficult to cough up mucus in the resp. tract. 1/2life=1 hour, SE: N/V, GI irritation
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| When on expectorants, you should: | drink more fluid to loosen and liquefy secretions
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| H1 blockers: review | prevent harmful effects of histamine & are used to treat seasonal allergic rhinitis, anaphylaxis, reaction to insect bites...
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| H2 blockers: review | used to treat gastric acid disorders
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| Nonsedating antihistamines cause: | dry mouth
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| define chronic bronchitis | continuous inflammation of the bronchi
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| 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)
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| The two classes of bronchodilators: | xanthine derivatives, beta-agonists
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| xanthine derivatives- used for | prevention of asthmatic symptoms (have slow onset of action, so not used for acute attack)
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| xanthine derivatives- drug effects | cause bronchodilation by increasing CAMP levels
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| xanthine derivatives- "trophic effects" | positive inotrope and positive chronotrope - increases blood flow to the kidneys -> diuretic effect
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| SE of xanthines | N/V, GE reflux during sleep, sinus tachycardia, palpitations, dysrhythmias, increased urinatino, hyperglycemia
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| Therapeutic ranges of xanthines - where metabolized? | 10 to 20 mcg/ml - liver
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| Theophylline (Theo-Dur, Slo-Bid) drug class | xanthines
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| Theophylline (Theo-Dur, Slo-Bid) used for; | treatment of chronic resp. disorders
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| Beta-2 adrenergic agonists- used when? | during the acute phase of an asthma attack
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| when a beta-2 adrenergic receptor is stimulated, _______ (enzyme needed to make cAMP) is activated | adenylate cyclase
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| Increased levels of cAMP made available by beta-2 adrenergics cause: | bronchial smooth muscles to relax, which results in increased airflow
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| beta-2 specific drug effects: | dilating effect on the peripheral vasculature- decreases BP, temporary decrease in serum K+
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| beta-1 receptor stimulation causes: | increased HR & force of contraction
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| When on Beta-2 adrenergics, do not also take: | MAOI's or other sympathomimetics
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| Albuterol (Proventil, Ventolin) drug class: | beta-adrenergic; beta2 specific
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| Albuterol used most for: | treatment of acute attacks of asthma, can also be used to prevent attacks
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| Albuterol side effects: | Nausea, anxiety, palpitations, increased HR, tremors
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| Epinephrine (Adrenaline) drug class: | beta-adrenergic (alpha-beta agonist)
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| Epinephrine's beta2 stimulating effect: | bronchodilation
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| Epinephrine (adrenaline)'s alpha 1 effect | constriction of mucous membranes = nasal decongestant
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| Ipratropium bromide - drug class: | anticholinergics
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| ipratropium bromide- uses | actions slow & prolonged, so not for acute asthma, but for COPD
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| ipratropium bromide SE: | dry mouth, GI distress, headache, coughing, anxiety
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| What are leukotrienes (LTs) | produced in response to an allergen- in asthma, cause inflammation, bronchoconstriction, and mucus production
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| What do antileukotriene agents do? | Prevent LT's from attaching to receptors located on circulating cells & cells w/in lungs (blocks inflammation)
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| antileukotriene drug effects | prevent smooth muscle contraction of the bronchial airways, decrease mucus
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| antileukotriene therapeutic uses | prophylaxis & chronic treatment of asthma (not for acute attacks)
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| antileukotriene agents- improvement in: | 1 week
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| antileukotriene SE: | HA, nausea, dizziness, insomnia, diarrhea
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| antileukotriene- should monitor what? | liver enzymes
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| Montelukast (Singulair) drug class: | antileukotrienes
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| Corticosteroids- used for | antiinflammatory effects, which lead to decreased airway obstruction
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| advantage of inhaled corticosteroids | action is limited to the topical site of action- lungs; prevents systemic effects
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| Mechanism of action- corticosteroids | reduce inflammation, enhance activity of beta-agonists
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| Corticosteroids- SE: | pharyngeal irritation, coughing, dry mouth, oral fungal infections
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| Beclomethasone diproprionate (Beclovent, Vanceril) drug class: | Corticosteroids
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| Beclomethasone dipropionate (Beclovent, Vanceril) drug facts: | oral inhalation, long term control, topical activity
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| Mast cell stabilizers are used: | as adjuncts to the overall management of patients w/ asthma- for prophylaxis only
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| Mast cell stabilizers are ____acting because | indirect- prevent the release of the intracellular chem. mediators that cause bronchospasm (don't block receptors)
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| Do mast cell stabilizers have bronchodilator activity? | Nope, so are only used prophylactically
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| Mast cell stabilizers are more effective in preventing asthma caused by: | extrinsic factors such as allergens
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| Mast cell stabilizers SE: | coughing, sore throat, rhinitis, bronchospasm, taste change, HA
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| Long or short term control: anticholinergics (ipratropium bromide) | Long term
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| Long or short term control: antileukotriene (Montelukast- Singulair) | long term
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| Long or short term control: corticosteroids (Beclovent) | long term
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| Long or short term control: Mast cell stabilizers | long term
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| Long or short term control: systemic steroids | quick relief
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| beta2 adrenergic (Albuterol) | quick relief
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