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Antihistamines, decongestants, antitussives, bla bla bla lilk8tob

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.

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  


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Created by: lilk8tob