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Drugs that Treat Allergic Rhinitis & the Common Cold Ch.45
Drug: Mechanism Of Action: Treatment Of: Adverse Effects: Notes:
Fexofenadine (Allegra) 1) Competes with histamine for binding Allergic Rhinitis Infrequent and usually minor: Do not cause drowsiness
H1 Receptor Antagonist to histamine receptor sites (H) Headache because it does not readily cross
(2nd generation) Nausea the BBB
Antihistamine Dyspepsia Most effective when taken
Dysmenorrhea before symptoms develop
p.758 Absorption when taken with
grapefruit & orange/apple juice
Fluticasone (Flonase) 1) Acts to decrease local inflammation Allergic Rhinitis When administered by the Use with caution with black
Inhaled Corticosteroid in the nasal passages through intranasal route adverse effects licorice
vasoconstriction and anti-inflammatory Reduces bronchial are uncommon:
p.762 mechanisms hyperreactivity Headache
2) Inhibits mast cells, macrophages, and Decreases airway mucus Cough
inflammatory mediators such as Decreases Nasal ulceration
prostaglandins, histamine, kinins, and infiltration/activity of Epitaxis
eukotrienes. inflammatory cells Local burning
Decreases edema of the
airway mucosa
Pseudoephedrine 1) Activate Alpha adrenergic receptors Allergic Rhinitis CNS stimulation (insomnia, No rebound congestion of
(Sudafed) vasoconstriction in nasal mucosa = Sinus Congestion restlessness, anxiety) given PO - not intranasal
Decongestant decreases mucosal swelling Common Cold Symptoms High doses=seizures,
2) Stimulates beta adrenergic psychosis
p.763 receptors in the lungs Dysrhythmias, HTN,
bronchodialation palpitations, tachycardia, dry
mouth
Dextromethorphan 1) Acts directly on the cough center in Cough suppressant Almost no effects at Carries no risk of dependence
(Delsym, Robitussin) the medulla of the brain to elevate cough Allergic Rhinitis (cough) therapeutic doses.
Antitussive threshold Common Cold (cough) Higher doses may cause:
Sedation
p.766 Dizziness
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Pharm Exam 8 Cyanne Distel
Pharmacological Treatment of Asthma & COPD
Chapter 44 p.730
Asthma p.732 COPD: Chronic Obstructive Pulmonary Disease
Chronic inflammatory disorder of the airway Chronic & recurrent obstruction of airflow
50% caused by allergens Chronic bronchitis-excessive mucus
50% unknown etiology Emphysema-loss of elasticity & destruction of alveoli
Allergen induced asthma:
Mediators of the immune system/inflammatory response
are released by mast cells
Airway becomes swollen and edematous
Spasms of the bronchial passages
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Pharm Exam 8 Cyanne Distel
Nebulizers
Small machine used to convert a drug solution into a fine mist
Face mask or mouthpiece
Several minutes to deliver the equivalent drug contained in one puff of an MDI
More effective delivery since the drug gains deeper access as the airways slowly dilate
Corticosteroids - Teaching
Gargle with water after each administration
S/S of oral candidiasis
Use a spacer
Participate in weight-bearing exercise to minimize bone loss
Supplemental calcium + vitamin D
NSAIDs with caution
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Pharm Exam 8 Cyanne Distel
Drugs that Treat Asthma and COPD Chapter 44
Drug: Mechanism Of Action: Treatment Of: Adverse Effects: Notes:
Albuterol (Proventil, 1) Acts by selectively binding to beta- Drug of choice for relieving Inhaled-uncommon Can give PO or inhaled but if you
Ventolin) adrenergic receptors in the bronchial bronchospasm PO: Palpitations, give it PO you can have more
Beta-Adrenergic smooth muscle to cause bronchodilation Facilitates mucus drainage headaches, tremors, systemic effects in the sympathetic
Agonists Inhibits release of nervousness, restlessness, nervous system
inflammatory chemicals from tachycardia, insomnia, dry
p.736 mast cells mouth Drug interactions: Betablockers:
PO, Inhaled bronchospasm
MAOIs: hypertensive crisis
Thyroid hormone: stimulatory
effects
Ipratropium (Atrovent) 1) Causes bronchodilation by blocking Bronchospasm from asthma Dry mouth Contraindications
Anticholinergic cholinergic receptors in bronchial and COPD Nausea Patients sensitive to soy, soybean, &
smooth muscle GI distress peanut
p.739 Bitter taste
Inhaled, intranasal
Beclomethasone 1) Decreases inflammation of the Asthma & Allergic Rhinitis Corticosteroid toxicity NOT a bronchiodialator and should
(Beconase) airways and immune responses (inhibits Decreases mucus & Local effects= hoarseness, not be used to terminate asthma
Corticosteroid synthesis & release of histamine, edema dry mouth, change in taste, attacks in progress
leukotrienes, cytokines, prostaglandins) development of cataracts
p.740 decreases frequency of asthma **Review contraindications for
attacks corticosteroids on main paper
Inhaled, intranasal
Cromolyn 1) Prevent degranulation of the mast Asthma & COPD Bronchospasm
Mast Cell Stabilizer cell-prevent release of histamine prophylactically Cough
(inflammatory response) Not used to treat acute Pharyngeal irritation
p.742 asthma or COPD attacks
Inhaled-MDI, nebulizer used for long term
Zafirlukast (Accolate); 1) Prevents airway edema and Prophylaxis of persistent, Headache Delayed onset of action
Montelukast (Singulair) inflammation by blocking leukotriene chronic, asthma Less effective to than inhaled
receptors in airways corticosteroids
Leukotriene Modifier
Given PO Drug interactions
p.743 Warfarin-increased prothrombin
time (PT)
Theophylline (Theo- 1) Relaxes bronchial smooth muscle Was the principal N/V Headache Narrow therapeutic range- toxicity
Dur) bronchodilation methylxanthine used for Irritability Insomnia not really used anymore
Methylxanthin 2) Suppresses airway responsiveness to asthma Dysrhythmias Older drug
stimuli that may cause bronchospasm Hypotension A lot of drug interactions
p.744 Seizures Safer drugs than methylxanthines
available now
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Pharm Exam 8 Cyanne Distel
Pharmocotherapy for Peptic Ulcer Disease
Chapter 59 p.1005
Objectives
Explain the pathogenesis of GERD, PUD, constipation, and diarrhea.
Introduce the treatment for GERD, PUD
Compare the mechanisms of different laxatives
Identify the prototype drug and explain the mechanism, indications, contraindications, drug interactions for drugs acting on the gastrointestinal system
Describe the effect of medications on absorption
GERD p.1008
Results when acidic stomach contents enter the esophagus
In adults, the cause of GERD is usually transient weakening or relaxation of the lower esophageal sphincter (LES), a specialized muscle segment at the end of the
esophagus. The sphincter may no longer close tightly, allowing movement of gastric contents upward into the esophagus when the stomach contracts.
Acid gastric contents cause heartburn and in some causes injury to the esophagus.
Pathogenesis of GERD also involves decreased salivary secretions and diminished esophageal motility.
TX: Remove acid-causing food and drugs, administer proton pump inhibitors, administer H receptor antagonists.
Peptic Ulcer Disease (PUD) p.1008
Peptic Ulcer: A lesion or erosion located in either the stomach (gastric) or the small intestine (duodenal) mucosa that is usually associated with acute inflammation.
PUD occurs when there is an imbalance of protective factors versus aggravating factors. The levels of protective mucus and bicarbonate ion secretions are unable
to protect against the aggravating factors of pepsin and gastric acid.
Complications: Bleeding, perforation, penetration, and GI obstruction due to scarring.
NSAIDS are likely responsible for almost half of peptic ulcer cases NSAIDS promote ulcer formation and inflammation both topically and systemically.
NSAIDS interfere with prostaglandin synthesis via the enzyme COX in the stomach, which normally aids in the production of mucus and bicarbonate.
NSAIDS decrease gastric blow flow and slow cellular repaid.
TX: Aggressive acid suppression with drugs. Eradicate H. Pylori (a bacterium associated with PUD) and discontinue NSAIDS when possible.
Proton Pump Inhibitors p.1010
Act by blocking H+, K+, ATPase, the enzyme that is responsible for secreting hydrochloric acid in the stomach (prevent acid from being released or produced)
PPIs reduce acid secretion to a greater extent than the H receptor antagonists and have a longer duration of action
About 95% of the acid production is blocked, making the PPIs the most efficient drugs available for treating acid-related disease.
Omeprazole (Prilosec)
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Pharm Exam 8 Cyanne Distel
Pharmacology for Diarrhea and Constipation
Chapter 60 p.1024
Laxatives
Bulk Forming Laxatives p.1026 Stimulant/irritant Laxatives p.1026
Absorb water, thus adding size to the fecal mass. Promote peristalsis by irritating the bowel
Must be taken with plenty of water. Rapid and more likely to cause diarrhea and cramping than bulk-
Psyllium (Metamucil) (Onset: 12-24 hours) forming laxatives
bisacodyl (Dulcolax) (Onset: 8-12 PO/15 min. suppository/rectal)
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Pharm Exam 8 Cyanne Distel
Diarrhea Anticholinergic
Increase in the frequency and fluidity of bowel movements Parasympatholytic = anticholinergic = anti-acetylcholine
Type of body defense to rapidly and completely eliminate the boy of toxins Effect on GI motility = slows the GI and allows for more water to be
and pathogens absorbed into the stool.
Causes of Diarrhea: Can increase absorption of drugs due to slowing GI motility
Medications: Antibiotics, laxatives, magnesium antacids, digoxin, Also reduces acid production; stop pancreatic secretions
orlistat, and NSAIDS. Atropine - reduces oral secretions, reduces spasms
Disease processes: Viral and bacteria infections. Adverse effects: Drowsiness, blurred vision, tachycardia
Foods - intolerance, spicy foods
Risk for fluid deficit
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Pharm Exam 8 Cyanne Distel
Bisacodyl (Dulcolax) 1) Irritates the mucosa in the colon Most frequently used Abdominal Pain Onset of action 8-12 hours PO;
Bulk-Type Laxative and alters intestinal and electrolyte stimulant-type laxative Cramping or 15-60 minutes PR (rectal)
absorption F&E imbalance Should not be taken with dairy
p.1027 products because these can
dissolve the enteric coating and
cause dyspepsia
Only 15% of the drug is absorbed Enteric-coated should not be
after oral administration crushed or chewed
Magnesium Hydroxide 1) Neutralizes gastric hydrocholic PO: Antacid effect N/V Can bind to other drugs
(Milk of Magnesia) acid to form magnesium chloride Laxative Abdominal cramping delays their absorption (take 2
Bulk-Type Laxative 2) Exerts a laxative effect in the hours apart from other meds)
colon by drawing water and
p.1027 electrolytes to form a larger and
softer fecal mass
Diphenoxylate w/ 1) Acts on smooth muscle of the Diarrhea Well tolerated at normal Acts with 5-60 minutes
Atropine (Lomotil) intestine to slow peristalsis doses. Some experience: Do not drive or operate
Opiod/Antidiarrheal Dizziness machinery until effects of the
Controlled substance (atropine Lethargy drug are known
p.1029 reduces abuse) Drowsiness
Ondansetron (Zofran) 1) Blocks serotonin receptors in the Taken before chemotherapy Headache Monitor for dehydration
Antiemetic chemoreceptor trigger zone, an area sessions to prevent nausea Constipation OR diarrhea Patient should take this
Serotonin 5-HT receptor of the brain responsible for nausea and vomiting Dizziness BEFORE they come for their
anatagonist and vomititng chemotheraphy session
p.1040
Atropine Reduces oral secretions Drowsiness
Reduces spasms Blurred vision
Tachycardia
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