Pharmacology

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Author:
Asherbea
ID:
49149
Filename:
Pharmacology
Updated:
2010-11-19 10:17:02
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Pharmacology
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Description:
Drugs for Allergic Rhinitis, Cough, and Colds
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  1. What are the classes of drugs used for allergic rhinitis?
    Oral Antihistamines, Intranasal Glucocorticoids, Intranasal Cromolyn, and Sympathomimetics (oral/nasal)
  2. What is perennial (nonseasonal) caused from?
    Indoor Allergens such as: dust mites and pet dander.
  3. Seasonal Rhinitis is caused from what?
    Outdoor allergen, fungi, pollens
  4. Seasonal Rhinitis is also known as what?
    Hay Fever
  5. What is allergic Rhinitis? What are the symptoms?
    • Inflammatory disorder of the upper airway, lower airway, and eyes.
    • Symptoms include: Sneezing, Rhinorrhea, Pruitius, and Nasal Congestion.
  6. Tiotropium (Spiriva) - Pharmacokinetics
    • Long acting inhaltion only
    • Effects being 30 min - 24 hours
    • More effective than Ipotropium (Advent)
    • More convenient dosing schedule
  7. Ipotropium - caution use in patients with.. (2)
    • 1.) Glaucoma - increased intraocular pressure
    • 2.) Peanut or soy allergy
  8. Which one of the Leukotrine modifers is liver toxic?
    Zyflo

    (Singulair has no liver injury, Accolate is rare)
  9. Leukotrine modifiers - nursing implications
    Monitor LFT's for toxicity (Zyflo)
  10. Leukotrien modifiers - Adverse effects
    HA, fatigue, coughing, GI upset, dyspepsia, liver toxicity (rare), arthralgia (joint pain)

    Churg Strauss (severe asthma, not with Zyflo)
  11. Accolate - Pharmaco
    Leukotrien
    • PO
    • M: liver
    • E: feces
  12. Name one IgE Agonist
    Omalizumba (Xolair)
  13. Antihistamines
    • not for nasal congestions
    • for itching, sneezing, and runny nose

    AE: sedation & dry mouth, urinary retnetion, constipation

    Avoid CNS depressants
  14. Nasal decongestants - sympathomimetics
    Phenylephrine, Ephedrine, Seudophedrin

    reduces nasal congesting by stimulating alpha 1 receptors on nasal blood vessels

    • Topical - rapid response
    • PO- delayed, moderate and prolonged response
    • Does not reduce runny nose, sneezing, itching

    AE: rebound congetstion or rhinits due to overuse, CNS stimlation with PO: restlessness, insomnia, irritabilty; abuse; cardio wide spread vaso constriction
  15. Antitussive agents (2 types)
    Opioid - codiene & hydrocodone (most effective cough suppressant) suppress respirations, drowsiness, fatigue, euphoria

    Non-opiod - Dextromethaphran (most effective non opiodi), mind/body dissociation, enhance analgesic effects of opiods, Benadryl, Benzonitate

    Act in CNS to suppress cough (elevate threshold)
  16. Name drugs for COPD
    • Anticholergenics (Atrovent MDI & Spirivia DPI)
    • Gluco + Beta 2 combo
  17. Beta 2 agonists + Glucocorticoids - Name meds
    Advair diskus = flovent, long acting beta 2, & Serevent)

    Bronchodilaton + Anti inflamm

    Inhalation in AM & PM

    For asthma & COPD
  18. glucocorticoids- Nursing care
    Nursing: Calcium + Vit D. supplement (bone loss prevention)

    Rinse mouth after use

    Withdrawl use slowly
  19. Adverse Effects - Glucocorticoids
    • Adrenal impairment (high conc./long term)
    • Bone loss (long term use, esp if menopausal)

    Thrush, dysphonia, slowing growth in children, hyperglycemia, GI discomfort - PUD, Cushing's syndrome (moon face)

    Abrupt stopping can result in hypotension, hypoglycemia, and myalgia
  20. Pharmaco - Glucocorticoids
    • MDI or DPI inhalation (moderate to severe long term use)
    • PO (brief use only)
    • IV (high stress acute attack- dexamethasone & kellelog IV & IM)
  21. MoA- Gluco - Anti inflammatory
    • First line therapy - asthma prevention
    • Long term therapy, not PRN

    • 1.) Suppress inflammation
    • 2.) Reduce edema
    • 3.) Increase # of beta 2 receptors & responsivenss to beta 2 agonists
    • 4.) reduce hyper-reactivity & mucus production
  22. Name Glucocorticoids - anti inflammatory
    Prednisone, Flovent, Azmacort, Aerobid, Pulmicort
  23. Tilade - Nedocromil
    Mast Cell stabilizer
    • Not available in US
    • AE: bad taste

    Nursing: rinse mouth immediately after use
  24. Cromoylyn - Pharmaco
    MDI for mild-moderate asthma, prophylaxis, allergic rhinities

    • Especially for seasonal allergic attacks
    • Full effects take several weeks
    • No systemic side affects
    • E: urine

    Nursing: alternative to taking glucocorticoids
  25. MoA for Mast Cell Stabilizers
    Prevents release of histamine & other mast cell mediators
  26. Name 2 Mast Cell stabilizers:
    • Cromolyn (Intal)
    • Nedocromil (Tilade)
  27. IgE - Xolar - Adverse Effects
    • Pain @ injection site
    • viral infection
    • URI
    • sinusitis, HA

    RARE: cancer & anaphylaxis
  28. IgE modifier - Xolair - drug interactions
    cannot be paired with a glucocorticoid, ineffective
  29. IgE modifier - Xolair - pharmacokinetics
    • Sub Q injection
    • slow absorption - peak 7-8 days
    • M: liver
  30. IgE modifier - Use
    Xolair
    • 2nd line agent
    • allergen induced asthma
    • seasonal allergic rhinities
  31. MoA - IgE modifiers (Xolair) - Anti-inflammatory
    Reduces IgE (antibody) available to bind with receptors
  32. Zyflo - Pharmacokinetics
    Leukotrine modifiers
    • PO
    • with or without food
    • M: liver
    • E: urine
  33. Leukotriene Modifiers - Pharmacokinetics
    Singulair
    • PO only
    • M: liver
    • Exreted: bile, with or without food
    • not for quick relief
  34. Leukotriene: anti-inflammatory - USES
    • 1.) Asthma prophylaxis and maintenance (Zyflo)
    • 2.) Allergic rhinitis > age 1
    • 3.) Prevention of exercise-induced bronchospasm > 15

    • Singular - age 1 min (single)
    • Accolate - age 5 min (chronic asthma for adults and young children)
    • Zyflo - age 12 min
  35. Leukotriene: anti-inflammatory - MoA
    Blocks leukotrine receptors, improves lung function
  36. Name 3 Leukotrine modifiers
    Singulair, Zyflo, Accolate

    All generics have "luk"
  37. Ipotropium (Advent) & Tiotropium (Spiriva) - Adverse effects
    • Dry mouth
    • Urinary retention
    • min systemic effects (constipation, tachycardia)
    • Irritation of pharynx - hoarse voice
  38. Use for Anticholinergics
    • COPD
    • Bronchospasm

    Off-label for asthma
  39. Anticholinergic Pharmcokinetics
    Ipotropium
    • 1.) inhalation only - MDI
    • 2.) effects begin within 30 mins - 6 hours
    • 3.) less effective for allergen and exercised induced asthma
  40. MoA Anticholinergic
    Bronchodilator

    Blocks muscarinic cholinergic receptors in bronchi
  41. Name 2 Anticholergenics
    • Ipratropium (Atrovent)
    • Tiotropium (Spiriva)

    (I -pray, I'm TIRED)
  42. Aminophylline - Methylxanthine
    PO, IV (IV to be infused slowly due to high solubility, IV more common)
  43. Methylxanthine - Interactions
    • 1.) Caffeine - intensify effects on CNS & heart
    • 2.) Reduce theo: Phenobarbitol, Phenytoin, Rifampin
    • 3:) Increase theo: fluoquinolones, Cipro, cemetidine

    **Teach patient NOT to chew SR **
  44. Methylxanthine - Pharmacokinetcs
    • PO, IV(emergencies)
    • Plasma level important: 10-20 mcg max
    • Slow absorption (food can alter)
    • M: liver
    • more dangerous than beta 2 and glucocs, not as effective
  45. Methylxanthine - Use
    Chronic stable asthma treatment
  46. Methylxanthine MoA
    RELAXES smooth muscle of the bronchi = bronchodilation
  47. Name the Methylxanthines
    • Theophylline
    • Aminophylline
  48. Uses for beta 2 agonists
    short & long term asthma control

    Long acting beta 2 agonists need to be paired with glucocorticoids when asthma is controlled
  49. MoA beta 2 agonists
    1.) Selective activation of beta 2 receptors in the smooth muscle tissue of the lungs = bronchodilaton

    2.) Histamine suppression

    3.) Increased ciliary motility
  50. Name beta 2 short-acting inhalers
    Albuterol, Bitolterol, Levalbuterold, Pirbuterol

    ends in -buterol

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