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Antihistamines+more
Antihistamines, Decongestants, Antitussives, and Expectorants
| Question | Answer |
|---|---|
| Antihistamines | Block the histamine receptors - causes 3 effects: Vasoconstriction Decrease in cap. permeability Drying effects |
| Uses of Antihistamines | Allergies and allergic reactions Cold symptoms Motion sickness Parkinson's Vertigo Sleep aids |
| Contraindications of antihistamines | Asthma, COPD Cardiac disease Hypertension Renal disease Peptic ulcer disease Seizures Pregnancy BPH Glaucoma |
| Side effects of antihistamines | Sedative effects Drying effects GI + hepatitis |
| Non-sedating antihistamines | Loratadine Fexofenadine Cetirizine |
| Pharmacokinetics for diphenhydramine hydrochloride | O - 15-30min P - 2 Hrs D - 10 hrs 1/2 life - 7-12hrs |
| Decongestants | 3 types: Anticholinergics Adrenergics Intranasal steroids |
| Adrenergic decongestants | Vasoconstriction Shrink swollen tissue **can cause rebound congestion** |
| Anticholinergic decongestants | Block acetylcholine receptors |
| Corticosteroid decongestants | "turn off the inflammation response" |
| Difference between PO and Topical decongestants | PO - less potent, slower onset, no rebound congestion |
| Pseudoephedrine | PO adrenergic decongestant |
| Phenylephrine | Topical adrenergic decongestant |
| Beclomethasone | Corticosteroid decongestant |
| Flunisolide | Corticosteroid decongestant |
| Antitussives | Stop or reduce the NONPRODUCTIVE cough for when it is harmful |
| Opioid Antitussives | Acts on the medulla Analgesic effect - drying effect |
| Non-opioid Antitussives | Same effect as opioid on the medulla No drying effect |
| Codeine | Opioid Antitussive |
| Hydrocodone | Opioid Antitussive |
| Dextromethorphan | Non-opioid Antitussives |
| Bronchodilators | Dilation of the airways |
| Pharmacokinetics of short acting B-adrenergic agonists | O - Immediate P - 10-25 min D - 2-6 hrs |
| Pharmacokinetics of long acting B-adrenergic agonists | O - 30-50 min P - 4 hr D - 2-6 hrs |
| Pharmacokinetics of long acting B-adrenergic agonists in combo with glucocorticoid/steroid inhaler | O - 15 min P - 1-3hr D - 12hr |
| Salbutamol | Short acting B-adrenergic agonist - selective to only B2 receptors Can't use too frequently |
| Formoterol | Long-acting B-adrenergic agonist |
| Salmetrol | Long-acting B2-adrenergic agonist - must be used in combo with glucocorticoid steroid 1 puff 2x/day |
| Budesonide/formoterol fumarate dihydrate | Long-acting B-adrenergic agonist in combo |
| Terbutaline sulphate | Short acting B-adrenergic agonist |
| Isoproternol hydrochloride | Nonselective B-adrenergic |
| SA of a and b Adrenergic receptor agonists | Tachycardia Tremors Hyperglycemia Anorexia |
| SA of b1 & b2 adrenergic receoptors | Tachycardia Tremor Angina |
| SA of salbutamol | Hypotension or hypertension Tremors Headache |
| Anticholinergics | Bind to Ach receptors = no ACh binding = bronchoconstriction prevented Used for the prevention of bronchospasm NOT acute symptoms |
| SA of anticholinergics | Dry mouth Sore throat Tachycardia GI distress Urinary retention |
| What are the COPD anticholinergic drug choices | Ipratropium Bromide (Atrovent) Tiotropium bromide monohydrate (Spiriva) Aclidinium bromide (Tudorza Genuair) |
| Ipratropium bromide | "Atrovent" Anticholinergic bronchodilator - liquid & aerosol Used 2x daily |
| Tiotropium bromide monohydrate | Same as Ipratropium but one dose/day |
| Xanthine Derivatives | Derived from plants - caffeine, theophylline Synthetic form - aminophylline Causes bronchodilation from inhibiting cAMP NOT for emerg. asthma attacks, but moderate or mild acute asthma |
| Most commonly used xanthine derivative | Theophylline |
| What is aminophylline used for? | IV treatment of status asthmaticus - for pt.s who don't respond to epinephrine |
| Why are xanthines not used as frequently today? | Due to drug interactions and variable blood levels |
| What foods reduce xanthine serum levels? | Charcoal-broiled, high-protein, low-carb foods |
| Contraindications for xanthines | Peptic ulcers GI disorders Cardiac disease |
| What is the therapeutic range for xanthine derivatives? Canadian Asthma Consensus guideline? | 55-100mmol/L 28-55mmol/L |
| What are the 2 categories for nonbronchodilating respiratory drugs? | Leukotriene Receptor Antagonists & corticosteroids |
| Leukotrienes | Block leukotrienes = prevention of smooth m. contraction of the airways + decrease mucous production Montelukast Zafirlukast |
| Side effects of Montelukast & zafirlukast | Both = liver dysfunction Zafirlukast = headache, nausea, diarrhea |
| Indications for Leukotrienes | Long-term asthma control - not for asthma attacks Takes about 1 week for improvement |
| Corticosteroids/glucocorticoids | Anti-inflammatory - stabilize bronchoconstrictor-releasing cells Inhaled, PO, IV |
| What are Corticosteroids/glucocorticoids used for | Persistant asthma COPD exacerbations |
| Nursing teaching for Corticosteroids/glucocorticoids | Rinse mouth after inhalation Use bronchodilator first Use a spacer for better delivery Monitor with peak flow meter |
Created by:
ahgecas25