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pathopharm exam 3
chapter 70
| Question | Answer |
|---|---|
| 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. |
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Seka_nurse
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