-
Diphenhydramine HCL
- (Benadryl)
- -1st gen. antihistamine
- -for allergies, sedation
- -some anticholinergic effects
-
Deminhydrinate
- (Dramamine)
- -1st gen. antihistamine
-for motion sickness prevention, vestibular disturbances
-some anticholinergic effects
-
Hydroxyzine HCL
- (Atarax)
- -1st gen. antihistamine
-sedative and mild anxiolytic properties
-
Meclizine HCL
- (Antivert)
- -1st gen. antihistamine
-to treat vestibular disturbances
-
Promethazine HCL
- (Phenergan)
- -1st gen. antihistamine
- -used for antiemetic, sedating
- -prevention and treatment of N/V
- -PO, parenteral, transdermal
- -alpha blocking activity, dopamine blocking
-
Cyproheptadine
- (Periactin)
- -1st gen. antihistamine
- -may be used to enhance appetite
- -serotonin blocking actions
-
Doxepin
-1st gen. antihistamine
-very potent tricyclic antidpressant
-
Cetirizine
- (zyrtec)
- -2nd generation antihistamines
-
Fexofenadine
- (Allegra)
- -2nd generation antihistamines
-
Loratidine
- (Claritin)
- -2nd generation antihistamines
-
Desloratidine
- (Clarinex)
- -2nd generation antihistamines
-
Phenylephrine HCL
Short acting topical decongestant
-
Naphazoline HCL
Intermediate acting topical decongestant
-
Tetrahydrolozine HCL
Intermediate acting topical decongestant
-
Oxymetazoline HCL
Long acting topical decongestant
-
Xylometazoline HCL
Long acting topical decongestant
-
Pseudoephedrine
systemic decongestant
-alpha and beta agonist activity related to ephedrine
-often used in combination with 2nd gen. antihistamine for allergic rhinitis with nasal congestion (claritin, allegra, zyrtec)
-
Side effects of systemic decongestant (5)
- 1. mild CNS stimulation
- 2. high doses can increase pulse and blood pressure
- 3. caution in pts w/ HTN and BPH
- 4. caution in pregnancy
- 5. behind the counter due to abuse and use to make illicit drugs
-
Guaifenesin
- (Duratuss & Humibid)
- -helps loosen phlegm and bronchial secretion to make coughs more productive
-used for chronic bronchitis, common col and bronchitis
-robitussin OTC
-Pregnancy category C
-
Veramyst
-nasal spray for seasonal and perennial allergic rhinitis
-contains aqueous suspension of micronized fluticasone furoate
-
Xyzal
(levocetirizine dihidrochloride)
-oral h1 blocker for season and perennail allergic rhinitis and chronic urticaria
-
Loperamide
opiate which acts as antisecretory agent
-not for pts with high fever or bloody darrhea
-can be used for traveler's diarrhea
-AE: rare, includes dizziness and constipation
-
Diphenoxylate
- (Lomotil)
- -opiate used for acute and chronic diarrhea; not due to severe inflammatory infections
-combined w/ atropine to discourage abuse
-AE: dry mouth, blurred vision, urinary hesitancy
-
Polycarbophil
(Fibercon)
-only FDA recommended OTC adsorbent
-absorbs tons of water and used for constipation and diarrhea
-AE: bloating and farting
-
To treat traveler's diarrhea (3)
- 1. Rifaximin (Xifaxan) for non-invasive E.coli
- 2. Fluoroquinolon: ciprofloxacin, levofloxacin
- - for severe illness/dysentery
-
Bulk formers for constipation (3)
- 1. Psyllium (Metamucil)
- 2. Methylcellulose (Citrucel)
- 3. Polycarbophils (Fibercon)
-
Emollient laxatives (2)
- 1. Docusate salts (Colace)
- 2. Glycerin suppositories - safe and effective in children
-
Lactulose
-osmotic agent for constipation
-metabolized by colon bacteria and lower pH --> increases peristalsis
-also uses for chronic liver failure, hepatic encephalopathy
$$$
-
Sorbitol
Osmotic agent used for chronic constipation
AE: farting, cramps
-less expensive than lactulose and works just as well
-
Antraquinone derivatives (2)
MOA and AE
(Casanthranol and Senokot)
-metabolized by gut bacteria and irritate colon causing contractions and secretion of water
-not for daily use cus may lead to laxative dependence and abnormal function
AE: cramps, diarrhea, laxative dependence
-
Bisacodyl
Irritant to colon mucosa and should be used for short term relief of constipation ONLY
May cause abdominal cramping
-
Saline laxatives (2)
- 1. Magnesium salts
- 2. Sodium phosphate
-used for bowel cleansing prior to certain procedures
-
Polyethlene Glycol (PEG)
(Colyte, Golytely, Nulytely, Miralax)
-osmotic cathartic agents
-used for bowel cleansing prior to Ba enema or colonoscopy
AE: N/V, anal irritation, cramps
-Stool should be completely liquid and clear
-
Amitiza
(Lubiprostone)
-used for constipation
-MOA: activates chloride channels locally in small intestine to increase intestinal fluid secretion; 1st selective chloride channel activator
-AE: nausea
-
Hycoscyamine sulfate
- (Levsin, Levsin drops, Levbid)
- -antispasmotics
-anticholinergic agent for IBS
AE: drowsiness, anticholinergic effects
-
Librax
Antispasmotic for IBS
-anticholinergic
-
Dicyclomine hydrochloride
- (Bentyl)
- -antispasmotic for IBS
-decreases fecal urgency and pain
-
When are anticholinergic agents contraindicated?
GI or GU obstruction
-
Tegaserod
- (Zelnorm)
- -drug used for IBS in women
-recently withdrawn due to increased incidence of CV events
-
5-ASA compounds (5)
- -topical anti-inflmmatory for IBD (Crohn's and UC)
- ----------------For UC 1st Line----------------
- 1. sulfasalazine
- 2. balsalazide
- 3. olsalazine
- -----------------For Crohn's & UC-------
- 4. Mesalamine
-
AE of 5-ASA compounds (6)
- 1. N/GI upset -- diarrhea
- 2. HA
- 3. arthralgias
- 4. myalgias
- 5. bone marrow suppression
- 6. hypersensitivity rxns (sulfa containing)
-
Oral Prednisone
Used for severe exacerbations of IBD
- can also be used as enema, IV, or topical (newer)
-
Thioguanine derivatives (3)
- 1. 6-Mercaptopurine
- 2. Azathioprine
- 3. Methotrexate for steroid dependent Crohn's
Immunosuppressive agents for IBD
AE: bone marrow suppression
-
Infliximab
- (Remicade)
- -immuniglobulin that binds to TNF for severe Crohn's, esp. fistulizing and steroid dependent
-IV
-more frequent URI, delayed hypersensitivity, infections (TB, Hep B)
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