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pathopharm exam 3

chapter 70

QuestionAnswer
what is histamines? Synthesized and stored in mast cells (IN SOFT TISSUE AND SKIN) and basophils(BLOOD) Released through allergic and non-allergic mechanisms Acts on H1 and H2 receptors produce by neuron IN CNS W/ CELLS BODIES IN POSTERIOR HYPOTHALAMUS=SEIZURES
how is it stimulate? stimulate through allergic and non-allergic reaction regulate gastric acid secretion used in diagnostic procedure
where is it present? in all tissue, skin, lungs and GI tracts Low content in plasma dilate small blood vessels -increase capillary permeability constriction of smooth muscle in bronchi neurotransmitter in CNS
it is release? By allergic pathway, RELEASE OF IE ANTIBODIES= ATTACH TO MAST CELLS AND BASOPHILS AFTER exposure to allergen(IPOLLEN) the second exposure=histamine release from mast cells
what are some non-allergic responses? radiocontrast media, plasma expander, can act directly on mast cells to trigger histamine release. cell injuries certain drugs
what are the histamines receptors? like a lock, waiting for the right key. histamine attaching to receptor=receptor activation
receptor h1? itchy, pain, SWEELING and secretion of mucus vasodilation=capillaries in lungs, fingers and toes increase in size. =skin of the face and upper body=hypotension stretch =permeable =edema bronchoconstriction=bronchiole constrict CNS as well=Role in cognition, memory, and sleep-waking cycles
receptor h2? secretion of gastric acid=act directly in parietal cells=RELEASE ACID BLOCK ACETYLCHOLINE AND GASTRIN UNABLE TO ELICITACID SECRETION
what are some mild allergic? rhinitis , RHINORRHEA, Clear running nose), itching, local edema that activated H1 receptor SEVERE=Anaphylactic reaction=life-threatening, anaphylactic shock= bronchoconstriction, hypotension and edema glotis, histamine play is minor role in this
what are the principals mediators? leukotrienes, antidote= epinephrine (at risk of anaphylactic reaction)
Common antihistamines ? H1 = treat mid allergy disorders by blocking the receptor of h1 H2=treat gastric and duodenal ulcer , not used for allergy treatment
the two generations of antihistamines are? First-generation H1 antagonists (highly sedating) Some bind to muscarinic receptors Second-generation H1 antagonists I.E-zyrtec, claritin, allegra
FUNCTIONS OF h1 ANTAGONIST (BENADRYL) ARE? Reduce localized flushing•Reduce itching and pain. Make patient sleepy AN EDEMA EXITATION AND CNS DEPRESSION prefer second-generation due to not causing CNS DEPRESSION
OVERDOSES CAUSE? CNS stimulation WITH h1 Convulsions Very young children especially sensitive to CNS stimulation =BBB
WHAT ARE THE THERAPEUTIC USE? treat acute urticaria=reduce redness, itching, edema FOR MILD ALLERGY-HAY FEVER OR ROSE FEVER FOR SEVERE ALLERGY=USE AS ADJUVANT=BUT OTHER MEDICATION NEEDS TO BE GIVEN WITH IT. motion sickness= Promethazine, dimenhydrinate Treat insomnia decrease running nose, due to anticholinergic properties
ADVERSES AFFETCS ARE? severe local injury (w/IV) + respiratory depression PARADOXICAL OCCURS IN SOME PT Sedation(les with 2&3 generation ) Non-sedatives CNS effects Dizziness, fatigues, confusion, coordination problem GI NAUSEA, VOMITING, LOST OF APPETITE, CONSTIPATION(TAKEN W/ FOOD) ANTICHOLENERGIC EFFECT dry mouth, eyes, stool
what are dugs interactions? ACUTE TOXICITY availability increase risk of overdose Anticholinergic REACTIONS: DILATE PUPIL, FLUSHED FACE, HYPERPYREXIA, TACHYCARDIA, URINARY RETENTION, DRY MOUTH, CHILD CNS EXCITATION, CARDIOVASCULAR , COMA=DEATH
TREATMENTS? NO ANTIDOTE, NG TUBE-SUCTION OUT STOMACH, SOAK UP EXCESS MEDICATION FROM THERE ACTIVATED CHARCOAL-CATHARTIC Convulsions=IV and midazolam, lorazepam Hyperthermia= icse packs, cool sponge bath
CONTRAINDICATIONS? LATE 3RD TRIMESTERS-OR EARLY DELIVERY NURSING MOTHERS NEWBORNS NO ALCOHOL(ANTIDEPRESSANT)
Antihistamines used with caution ? caution in young children and older adults patients THAT HAVE CONDITION THAT CAN BE WORSEN with muscarinic blockade, (URINARY RETENTION,, HYPERTENSION, BENIGH PROSTATIC HYPERPLASIA ) Benadryl use careful in elderly
SECOND ANTI-HISTAMINE GENERATION Less sedation=cross BBB poorly Less CNS EFFECT low infinity with H1 RECEPTORS OF CNS ANTICHOLONERGIC=DRY MOUTH, EYES AND CONSTIPATION
2ND generation OTC? CLARITIN-LORATADIN ALLEGRA=FEXOFENADINE ZYRTEC-CETIREZINE
ALLEGRA=FEXOFENADINE TREAT SESONAL RHINITIS-chronic idiopathic urticaria(ITCHING, HIVES) COMBINATION-EFFECTIVE AND SAFE(LESS ADR) CAUTION WITH RENAL IMPAIRMENT, NOT WITH FRUIT JUICE=REDUCE THERAPEUTIC EFFECT H-LIFE=14.4
ZYRTEC-CETIRIZINE Uses: Allergic rhinitis and chronic idiopathic urticaria food delays absorption-TAKE @NIGHT MORE SEDATIVE THAN 2ND GENERATION, BUT LESS THAN 1ST GENERATION ANTIHISTAMINE
CLARITIN-LORATADIN Use: Seasonal allergic rhinitis Generally well tolerated Food delays absorption Use with caution in patients with significant hepatic and renal impairment
LEVOCETIRIZINE- XYZAL Uses: Allergic rhinitis and chronic idiopathic urticaria MORE SEDATIVE THAN 2ND GENERATION, BUT LESS THAN 1ST GENERATION ANTIHISTAMINE DROWSINESS, FATIGUE, MUSCLE WEAKNESS, DRY MOUTH ALCOHOL+ CNS DEPRESSANT
Desloratadine -Clarinex Uses: Seasonal allergic rhinitis, perennial allergic rhinitis, and chronic idiopathic urticaria
CNS DEPRESSION COMMON IN? ETHABOLAMINES (DIPHENHYDRAMINES) AND PHENOTHIAZINES(PROMETHIAZINE) LESS COMMON IN-ALKYLAMINES-(CHLORPHENIRAMINE)
PREADMISSION ASSESSMENT? -TE GOAL-RELIEF RHINITIS, RHINOHREA, ALLERGIC CONJUNCCTIVITIS, UTICARIA, EDEMA, FLUSHING, -HEALTH HX-ALLERGIES-ADR-IDENTIFY HIGH-RISK PATIENT(PREGNANT, NURSING, NEWBORN) CAUTION IN YOUNG CHILDREN -HEALTH CONDITION=URINARY RETENTION, ASTHMA,HBP-
IMPLEMENTATION:ADMINISTRATION CONSIDERATION GET VITALS -SYSTEMIC THERAPY PO SOME IV, IM OR RECTAL TAKE W/ FOOD TACH ADMINISTRATION NO CRUSHING=ENTERIC COATED REPORT INJURY / BURN
MINIMIZING ADVERSE EFFECTS? USE ALKYLAMINE =LESS DEPRESSION -TRY 2ND GENERATION=LESS SEEDATION-NO ACTIVITIES FATAL DEPRESSION W/ PROMTHIAZINE IN <2 YRS OLD SEVERE TISSUE INJURY W/ IV PHENERGAN IM PREFERRABLE IV-25 mg/mL or less at a rate of 25 mg/min or less.
MINIMIZING ADVERSE REACTIONS? NO ALCOHOL BENZODIAZEPINE,BARBITURATES, OPIOIDS NO FRUIT JUICE=DECREASE ABSORPTION=LESS EFFECTIVE 4 HRS B4 DRUG OR 1-2 HOURSE AFTER DRUGS
MANAGE TOXICITY NO ANTIDOTE- MINIMIZE ABSORPTION GIVE CHARCOL-CATHERTIC-SUCTIONING, NG TUBE-HYPERTHERMIA-SPONGE W/ ICEPACK MANAGE SYMPTOMS CONTROL CONVULSIONS W/ IV BENZODIAZEPINES
A patient who takes over-the counter diphenhydramine [Benadryl] for seasonal allergy symptoms complains of drowsiness. What should the nurse do? Second-generation antihistamines, such as cetirizine, cross the blood-brain barrier poorly and hence produce much less sedation than first-generation antihistamines.
A patient has chronic idiopathic urticaria. Which medication would be appropriate for the nurse to administer for this condition? Fexofenadine [Allegra] +ZYRTEC+XYZAL approved for chronic idiopathic urticaria. Diphenhydramine is approved for acute urticaria.
Which statement regarding antihistamine administration to older adults does the nurse identify as true? When used in older adults, antihistamines can cause sedation; smaller doses should be used initially and titrated up if needed. Also, these medications can worsen glaucoma or benign prostatic hyperplasia.
Created by: Seka_nurse
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