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What is adrenergic? cholinergic? anticholinergic?
- Adrenergic: activity promotes bronchorelaxation.
- Cholinergic: Activity promotes bronchoconstriction.
- Anticholinergic: activity promotes bronchorelaxation.
What is allergic rhinitis? symptoms? types?
- Inflammatory disorder of the upper airways, lower airways, and eyes.
- Symptoms: sneezing, rhinorrhea (runny nose), Pruritus (itchiness), Nasal congestion, for some ppl: conjunctivitis, sinusitis, and asthma.
- Types: Seasonal and perennial, triggered by airborne allergens, allergens to IgE on mast cells. Inflammatory mediators released: Histamine, leukotrienes, and prostaglandins.
what are the classes of drugs used for allergic Rhinitis?
- Oral antihistamines.
- Intranasal glucocorticoids.
- Sympathomimetics (oral and intranasal)
Characteristics of Oral antihistamines?
- First-line drugs for allergic rhinitis.
- Do not reduce nasal congestion. Most effective if taken prophylactically.
- AE are mild- sedation with 1st gen, and much less with 2nd gen.
- Anticholinergic effects. (dry mouth, constipation, and urinary retention)
- Azelastine nasal spray: only intranasal antihistamine available, benefits equivalent to oral antihistamines, metered-spray device, leaves bitter taste.
What are the actions of antihistamines?
- Increased capillary permeability.
- Mucosal edema.
Histamien antagonists names? MOA? TU? AE? NI?
- Nonsedating (2nd gen): deloratadine (clarinex), fexofenadine (allegra), loratadine (claratin).
- Sedating (1st gen): Ceritizine (zyrtec), Brompheniramine (Dimetane), Diphenhrydramine (benadryl).
- MOA: Block H1 receptors, block action of histamine, More effective at preventing.
- TU: Upper respiratory tract acute allergic rxns. Reduce swelling and itching. relieve symptoms of cold. Relieve allergic rhinitis. Allergic symptoms. Sleeping aids/insomnia. Prevent nausea and vomiting/motion sickness. Prevent tremors/PD.
- AE: anticholinergic (dry mouth, constipation, uranary retention). Sedation/drowsiness-most common.
- NI: Avoid alcohol or using hazardous equipment, take w food to decrease GI distress, increase fluids, read OTC labels, contraindicated in narrow-angle glaucoma, BPH, pregnancy, bladder neck obstruction, and peptic ulcer disease, take 30-60 mins before traveling for motion sickness.
Intranasal glucocorticoids? names? MOA? TU? AE?
- They are the most effective for treatment and prevention of rhinitis.
- Names: Intranasal Cromolyn sodium, and symphathomimetics (decongestants).
- MOA: Anti-inflammatory actions, prevents or surpasses major symptoms: congestion, rhinorrhea, sneezing, nasal itching, and erythema.
- TU: Use for pts w mild to moderate rhinitis.
- AE: most common is drying of nasal mucosa or sore throat, burning or utching sensation, etc. Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)
Intranasal Cromolyn? trade name? group? MOA? TU?
- nasal Glucocorticoid.
- MOA: Surpasses release of Histamine from the mast cells.
- TU: rhinitis. Best used for phrophylaxis, not for treatment. Response may take 1-2 weeks to develop.
Sympathomimetics (oral/nasal) tradename? common names? MOA? AE? TU? Contraindications?
- Names:Phenylephrine, ephedrine, pseudoephedrine.
- MOA: Reduce nasal congestion by activation alpha1-adrenergic (bronco-relaxation)receptors on nasal blood vessels. However, it does not reduce rhinorrhea, sneezing, or itching)
- AE: rebound congestion, constipation, CNS stimulation, Cardiovascular effects (tachycardia) and stroke, abuse.
- TU: rhinitis.
- Contraindications: HTN and hyperlipidimia pts.
What are the combinations of antihistamines and sympathomimetics?
Usually the ones containing a D. Such as allegra D (fexofenadine/pseudoephedrine).
Drugs for cough? types? examples.
- they are called: antitussives.
- There are 2 types: Opiod and nonopiod antitussives.
- Opiod: Codeine and hydrocodone.
- Nonopiod: Dextromethorphan and Diphenhydramine.
The common cold? symptoms? viral or bacterial? What are OTC remedies?
- It is an acute upper respiratory viral infection.
- Symptoms: rhinorrhea, nasal congestion, cough, sneeze, sore throat, headache, horadeness, malise, myalgia.
- Fever is common in children not adults.
- Viral: yellow and green mucous in the morning.
- Bacterial: if it persist through the day.
- OTC remedies: nasal decongestant, antitussive, analgesic, antihistamine (for chlinergic actions), caffeine (to offset effect of antihistamine).
what is important abt OTC remedies in meds?
- Avoid OTC in children less than 2 yrs.
- Consult physician before administering.
- Meds are all abt weight.
What are the 2 main pharmacologic classes for the treatment of asthma? examples.
- Anti-inflammatory agents: glucocorticoids (prednisone)- long term use.
- Bronchodilators: Beta2 agonists (albuterol)-use for right now solution.
What are the most common drugs used for asthma?
- Inhalators ( dry-powder inhaler)
- anti-inflammatory (glucocorticoids)
- Bronchodilators (beta2-adrenergic agonists)
- Glucocorticoids/LABA combinations (budesonide/formoterol-symbicort)
Inhalation drug therapy? advantages? types? what does this therapy promotes?
- Advantages: therapeutic effects are enhanced, systemic effects are minimized, relief of acute attacks is rapid.
- Types: metered-dose inhalers (MDIs), Dry-powder inhalers (DPIs), Nebulizers.
- Promotes: Bronchodilation and pulmonary decongestion, Loosening of secretions, topical application of corticosteroids and other drugs, Moistening, cooling, or heating of inspired air.
Anti-inflammatory drugs? types?
- They are used for long-term therapy controlled.
- Types: Glucocorticoids (most common), Leukotriene modifiers, Cromolyn.
Glucocorticoids? classification? TU? MOA? AE? Examples?
- Considered the most effective anti asthma drug available.
- TU: Chonic controlled of asthma. Usually administer by inhalation, but IV and oral are also options.
- MOA:Suppress inflammation, decreased synthesis and release of inflammatory mediators, decreased infiltration and activity of inflammatory cells, decreased edema of the airway mucosa.
- AE: Minor when taken acutely, can be severe when log-term used (adrenal suppression, osteoporosis, hyperglycemia, and others), Oropharyngeal candidiasis and dysphonia- gargle after use and use of spacer.
- Examples: budesonide (pulmicort/symbicort) and fluticasone (flovent), triamcinolone (azmacort).
Keukotriene modifiers? MOA? examples?
- Less effective than inhaled glucocorticoids.
- MOA: Suppress effects of leukotrienes.
- Examples: zileuton (zyflo), Zafirlukast (accolate), Montelukast (singulair) most popular.
Cromolyn? MOA? TU? AE?
- MOA: Suppresses bronchial inflammation-Mast cell stabilizer. anti-inflammatory effects are less than the ones from glucocorticoids.
- TU: Chronic asthma-Used for phophylaxis, not quick relief. Common routes are: Nebulizer, MDI.
- AE: safest of all anti asthma medications, cough, bronchospasm.
Bronchodilators? types? characteristics?
- They provide symptomatic relief but do not alter the underlying disease process (inflammation). So used to rescue.
- Usually need to be accompanied by a glucocorticoid for long-term suppression of inflammation.
- Principal brochodilators are the beta2-adrenergic agonists.
Beta2-adrenergic agonist? examples? TU? MOA? AE?
- Most effective drug in relieving acute bronchospasms and prevention of exercise-induces bronchospasms.
- EX: -ROL suffix, albuterol (proventil/ventolin), Salmeterol (serevent), Terbutaline, etc.
- TU: Use for asthma: both quick and long-term control.
- MOA: Activate beta2 receptors in smooth muscle of lung, promoting bronchodilation and thereby relieving bronchospasm.
- Also suppress histamine release in lung and increase ciliary mobility.
- AE: Inhaled preparations- systemic effects=tachycardia, angina, and tremor.
- Oral preparations: excessive dosage-angina pectoris, tachydysrhythmias, tremor.
Methylxanthines? ex? MOA?
- EX: Theophylline.
- Narrow TI- low bronchospasm, high toxicity.
- MOA: brochodilatation.
- Not used as much, old drug.
What are glucocorticoids /LABA combinations? EX? TU?
- Combination b/t glucocorticoids (bronchodilators) and inhaled steroid (LABA-long acting beta agonist bronchodilators)
- EX: Fluticasone/salmeterol (advair), Budesonide/formoterol (symbicort).
- TU: indicated for long-term maintenance in adults and children. Not recommended for initial therapy.