Pharm 2 - 3/3

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kbryant86
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237791
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Pharm 2 - 3/3
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2013-09-30 10:17:17
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Pharm
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Pharm 2- set 3 of 3
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  1. Migraine

    3 types to Tx
    • a neurovascular disorder
    • are debilitating
    • dilation and inflamm of intracranial bld vessels

    • types= S & Sx - pain releif (ASA, opioid)
    • = Pathophysiology - Anti-emetics (b/c pressure on hypothalamus causing n/v)
    • = Preventative
  2. Ergotamine, dihydroergotamine
    • -Abortive agents, stopping a headache in progress
    • -stops pain transmission when the pt. feels Migraine coming on

    SE= angina, tachycardia, GI, numbness, weakness, cold extrems, Dependence
  3. Sumatriptan / Imitrex
    • Serotonin receptor agonist (triptans)
    • 2ng gen of Ergotamine

    Can't use with MAO b/c plasma levels increase
  4. 5 things used to prevent migraines
    • Beta blockers
    • Ca++ channel blockers
    • Tri-cyclic Antidepressants
    • Antiepiletics
    • Estrogen-menstrual related migraines
  5. Asthma
    inflammtion and bronchospasms
  6. advantages and types of inhalation Tx
    Adv= enhanced local therapeutic effects, minimized systemic effects, rapid onset

    • Types= Nebulizers
    •  = Dry powder inhaler
    •  = Metered-dose inhaler
  7. nebulizer

    dry powder

    metered-dose
    N= convert drug to mist

    D= dry micronized powder directly to the lungs

    M= pressurized device synchronized with inhalation
  8. Why use a spacer?
    it increase the amount of medicine that acutally enters the lungs
  9. Glucocorticoids
    • ***Most effective anti-asthma (anti-inflamm) drugs available
    • Prophylaxis of chronic asthma
    • Beneficial effects develope OVER TIME (will not help in middle of attack)
    • Used on a regular schedule
  10. inhaled forms of glucocorticoids do these 3 things
    • dec. release of mediators
    • dec. activity of inflamm cells
    • dec. vascular permeability (edema)
  11. asthma management - IV therapy
    • for acute-short term use only
    • toxicity risk increases with long term
  12. Oral vs. inhalation use of Glucocorticoids
    • O= Adrenal suppression, bone loss
    •  = nl cortisol production stops by body
    •  = pts must be weaned off so adrenal glands pick up production

    • I= oropharyngeal candidiasis and dysphonia
    •  = little inhaled meds reaches systemic circulation
    •  = changing from oral to inhale must include weaning, even if using both
  13. leukotriene modifiers
    • used for asthma
    • supress the effects of leukotrienes which cause bronchoconstriction, eosinophil infiltration, mucous production, and edema
  14. Zileuton / Zyflo

    Zafirlukast / Accolate

    Montelukast / Singulair
    All Leukotriene Modifiers

    • Z= stops production of leukotris
    •    => Liver toxicity

    A= 2nd gen, block leukotri receptors (myalgia & P450)

    S= 3rd gen, blocks leukotri recept w/o SE
  15. Cromolyn / Intal
    • used for asthma
    • suppress bronchial inflammtion
    • inhibits inflamm cells
    • stabilizes mast cell membrane - decrease release of histamine
    • can be used for exercise asthma
  16. Omalizumab / Xolair  (Monoclonal Antibody)
    • NOT a DOC, a 2nd string drug
    • only for allergy related asthma
    • IgE antagonist
    •  =>blocks allergic response and binds free IgE in the blood
    • Inject SubQ weekly

    For Uncontrolled Asthma
  17. Asthma - Beta 2 agonists
    • bronchodilators
    • inhibit bronchospasm by relaxing smooth ms
    • suppress histamine release in the lungs
  18. Short vs. Long acting dilators when inhaled
    • Short= rescue drugs
    • exercise induced asthma
    • immediate, lasts 3-5 hours, q6h
    • Albuterol / Proventil

    • Long= 30 min, lasts 12hrs, q12h
    • Salmeterol / Serevent= DPI
    • mortality t/r excessive use during attacks
    • MUST be taken with a glucocorticoid
  19. oral asthma meds have more SE
    oral asthma meds have more SE
  20. Black Box warning
    • Med receives if:
    • linked to a certain severe risk
    • not bad enough to removed from market
    • education important
    • careful follow up
  21. Smart Trial
    • Salmeterol was black boxed
    • ran a trial vs placebo
    • people using only med, and not steroids that should accompany it, developed SE
  22. Anti-cholinergic for asthma
    block muscarinic recptors in lung, causeing bronchodilation
  23. Ipratropium / Atrovent
    • anti-cholinergic
    • inhaled atropine derivatie
    • fast acting
    • less effective that beta agonists
    • can be used with albuterol
    • NOT used if peanut allergy
  24. Tiotropuin / Spiriva
    long acting form of Atrovent
  25. Fluticasone / Salmeterol - Advair

    Budesonide / Formotorol - Symbacort
    • combo inhalers
    • long term Beta agonists and inflamm agents
    • Have good asthma control
  26. methylxanthines
    • asthma management
    • CNS stimulation
    • bronchodilation - relaxes smooth ms
  27. Theophylline - oral or IV
    • Asthma management
    • narrow therapeutic range

    • SE= N/V, cardiac stimulation, vasogdilation, diuresis, tremor, anxiety
    • = toxic levels >25ug/dl
  28. allergic rhinitis

    Hay Fever vs.
    Perennial
    • colds/coughs
    • allergic inflamm of upper airway, lower airway, and eyes

    • H= seasonal, outdoor allergins
    • P= non-seasonal, indoor allergins
  29. oral histamines
    • cold relief
    • help with Sx of sneezing rhinorrhea, nasal itching, BUT NOT congestion
  30. Diphenhydramine / Benadryl

    Fexofenadine / allegra

    Loratidine / Claritin
    all for Sx of cold relief, BUT NOT congestion
  31. Intranasal glucocorticoids
    • **Anti-inflamm prevent/suppress all major symptoms
    • ***Most safe and effective
    • 5-7 days before results are seen
    • not for acute onset
  32. Intranasal cromolyn
    • suppress release of histamine
    • safe and effective
    • Takes 1-2 weeks to work
    • not for acute onset
  33. sympathomimetics - oral/nasal
    • decongestants - vasoconstrict of membranes
    • Alpha1 of sinus membranes (use with caution for CAD and HTn b/c of A1 stimulation)
    • Relieves stuffiness, NOT sneezing/runny nose
    •  => rebound congestion if overused

    PO SE= restlessness, insomnia, anxiety, irritability

    - Phenylephrine, ephedrine, pseudoephedrine
  34. Dangers of Sudafed
    • S contains pseudoephedrine, which is used to make meth
    • Cobmat Meth Epidemic Act= limits the amount of ephedrine and pseudoephedrine purchased at one time
    • Phenylephrine is used instead, but is less effective
  35. Anti-tussives
    • drugs for cough
    • complex reflex involving CNS, PNS, and resp muscles
  36. codeine / hydrocodone
    • opioid used for cough
    • Schedule II controlled substance
    • Works the best, but is voided b/c of addictive properties
  37. Dextromethorphan
    • non-opioid used for cough
    • Analgesic action and can increase opioid actioves
  38. Expectorant
    • used for coughs
    • stimulate flow of resp secretions
    • - Terpin hydrate, Ammonium Cl, Iodide products (don't work well)
    • - Guaifenesin works well in high doses
  39. Acetylcysteine / Mucomyst
    • used for cough
    • Mucolytics
    • reacts with mucous to thin secretions
  40. common cold
    • acute upper airway infection of viral origin
    • self limiting and benign
  41. cold remedies:

    Acute upper resp viral infection

    Zinc
    • A= nasal decongestion
    • anti-tussive
    • analgesic
    • antihistamine (suppress mucous production)
    • caffeine (offset sedation of other drugs)

    • Z= prevents rhinovirus from adhering to epithelial cells
    • no evidence that it does anything else

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