Pharmacology Review Exam 3 Module 5 and 6

Module 5: Drugs for Allergic Rhinitis and the Common Cold

• Allergic rhinitis and common cold treatments:
  • Short-acting: Albuterol
  • Long-lasting: Steroids (e.g., Beclomethasone)
  • H1 Receptor Antagonists (e.g., Diphenhydramine)
  • Mast Cell Receptor Stabilizers
  • Intranasal Corticosteroids (e.g., Fluticasone)
  • Decongestants (e.g., Oxymetazoline)
  • Antitussives (e.g., Opioids, Codeine)
  • Expectorants and Mucolytics

H1 Receptor Antagonists (Antihistamine)

• Actions and use: Treat minor symptoms of allergy and common cold (e.g., sneezing, runny nose, tearing of eyes)
• Adverse effects: Drowsiness, paradoxical CNS stimulation, anticholinergic effects (e.g., dry mouth, tachycardia, mild hypotension)
• Contraindications: Hypersensitivity, BPH, narrow-angle glaucoma, gastrointestinal obstruction, asthma, hyperthyroidism
• Education: Avoid activities requiring alertness, change positions slowly, avoid alcohol and CNS depressants

Mast Cell Receptor Stabilizers

• Actions and use: Anti-inflammatory, alternative to mild, persistent asthma or exercise-induced asthma
• Example: Cromolyn

Intranasal Corticosteroids

• Actions and use: Treat seasonal allergic rhinitis
• Adverse effects: Nasal irritation, epistaxis, systemic corticosteroid effects
• Contraindications: Prior hypersensitivity
• Education: Avoid concomitant use with intranasal decongestants, ritonavir, and licorice

Decongestants

• Actions and use: Activate alpha-adrenergic receptors, relieve nasal congestion
• Adverse effects: Rebound congestion, minor stinging, dryness in nasal mucosa
• Contraindications: Thyroid disorders, hypertension, diabetes, heart disease
• Education: Use with caution with herbal supplements, St. John's Wort, and MAOIs

Antitussives

• Actions and use: Raise cough threshold in CNS
• Adverse effects: GI distress, respiratory depression
• Education: Avoid activities requiring alertness, change positions slowly, avoid alcohol and CNS depressants

Beta Adrenergic Agonists

• Actions and use: Relieve bronchospasm, facilitate mucus drainage, inhibit inflammatory chemical release
• Adverse effects: Palpitations, headaches, throat irritation, tremor, nervousness, restlessness, tachycardia
• Education: Observe for chest, jaw, or arm pain, palpitations, and notify provider if they occur

Anticholinergics

• Actions and use: Cause bronchodilation by blocking parasympathetic nervous system
• Adverse effects: Dry mouth, tachycardia, angina
• Education: Sip fluids, suck on sugar-free hard candies to control dry mouth

Corticosteroids

• Actions and use: Reduce inflammation, decrease frequency of asthma attacks
• Adverse effects: Increased appetite, weight gain
• Education: Monitor blood glucose, may need insulin dosage increase, taper slowly

Leukotriene Modifiers

• Actions and use: Prevent airway edema, inflammation by blocking leukotriene receptors
• Adverse effects: Headache
• Education: Take before bed, 2 hours before exercise, avoid taking with food

Module 6: Fluid Balance, Electrolyte, and Acid-Base

Tonicity

• Definition: Ability of a solution to cause a change in water movement across a membrane due to osmotic forces
• Types: Hypertonic, isotonic, hypotonic

Osmosis

• Definition: Water moves from areas of low solute concentration to areas of high solute concentration

Hemostasis

• Definition: Balance, back to normal

Potassium and Magnesium

• Importance: Good for the heart

Crystalloids and Colloids

• Definition: Types of fluids used for IV infusion
• Examples: 0.45 NaCl (hypertonic), 0.9 NaCl (isotonic)

Module 5: Drugs for Allergic Rhinitis and the Common Cold

Short-acting and Long-acting Drugs

• Albuterol: short-acting
• Steroids: long-acting (e.g. Beclomethasone)
• Importance of education: wash mouth out to avoid thrush

H1 Receptor Antagonists (Antihistamine)

• Actions: treat minor symptoms of allergy and the common cold (e.g. sneezing, runny nose, tearing of the eyes)
• Use: often combined with an analgesic, decongestant, or expectorant in OTC cold and flu products
• Adverse effects: significant drowsiness, paradoxical CNS stimulation and excitability, anticholinergic effects (e.g. dry mouth, tachycardia, mild hypotension)
• Contraindications: hypersensitivity to the drug, BPH, narrow-angle glaucoma, gastrointestinal (GI) obstruction, asthma, hyperthyroidism
• Education:
  • Drug-Drug interactions: use with CNS depressants, such as alcohol or opioids, increases sedation
  • Lab tests: discontinue 4 days prior to skin allergy tests to avoid false-negative results
  • Herbal/Food interactions: Henbane increases anticholinergic effects

Mast Cell Receptor Stabilizers

• Actions: anti-inflammatory, alternative to control mild, persistent asthma or exercise-induced asthma
• Examples: Cromolyn

Intranasal Corticosteroids

• Actions: decrease local inflammation in nasal passages, reducing nasal stuffiness
• Examples: Fluticasone (Flonase)
• Adverse effects: nasal irritation, epistaxis, systemic corticosteroid adverse effects (e.g. hypertension, diabetes)
• Contraindications: prior hypersensitivity to the drug
• Education:
  • Drug-Drug interactions: concomitant use with intranasal decongestants increases risk of nasal irritation or bleeding
  • Use with caution with licorice, which may potentiate effects of corticosteroids

Decongestants

• Actions: activate alpha-adrenergic receptors, causing arterioles to constrict and relieve nasal congestion
• Examples: Oxymetazoline (Visine L.R.)
• Adverse effects: rebound congestion, minor stinging and dryness in nasal mucosa, systemic adverse effects (e.g. hypertension, diabetes)
• Contraindications: thyroid disorders, hypertension, diabetes, heart disease
• Education:
  • Use with caution with herbal supplements that have MAOI properties (e.g. St. John's Wort)
  • Avoid overdose, as there is no specific treatment

Antitussives

• Most effective: opioids (e.g. Codeine, Hydrocodone)
• Actions: raise the cough threshold in the CNS
• Adverse effects: GI distress, respiratory depression
• Education:
  • Avoid activities that require alertness while taking Codeine
  • Change positions slowly and lie down if feeling dizzy
  • Avoid alcohol and other CNS depressants while taking Codeine

Expectorants and Mucolytics

• Actions: loosen and clear mucus from the lungs
• Examples: Guaifenesin
• Education:
  • Take with food and increase fluids and dietary fiber to avoid GI distress
  • Be careful with taking multiple medications at once, as overdose may cause respiratory depression

Beta Adrenergic Agonists

• Actions: relieve bronchospasm, facilitate mucus drainage, and inhibit release of inflammatory chemicals
• Examples: Albuterol
• Adverse effects: serious adverse effects are uncommon, but may include palpitations, headaches, throat irritation, tremor, nervousness, restlessness, and tachycardia
• Education:
  • Observe for chest, jaw, or arm pain or palpitations and notify provider if they occur
  • Check pulse and report an increase of greater than 20 to 30 minutes
  • Avoid caffeine and take with food to reduce adverse effects

Anticholinergics

• Actions: block the parasympathetic nervous system, causing bronchodilation
• Examples: Ipratropium
• Education:
  • Sip fluids and suck on sugar-free hard candies to control dry mouth
  • Use with caution with herbal supplements that have MAOI properties (e.g. St. John's Wort)

Methylxanthines

• Actions: bronchodilation, diuretic, and cardiac effects
• Examples: Theophylline

Corticosteroids

• Actions: reduce inflammation, decrease frequency of asthma attacks
• Examples: Beclomethasone
• Education:
  • Do not stop abruptly, taper slowly
  • Monitor blood glucose levels and adjust insulin dosage as needed
  • Report increased appetite and weight gain

Leukotriene Modifiers

• Actions: prevent airway edema and inflammation by blocking leukotriene receptors
• Examples: Montelukast
• Adverse effects: headache
• Education:
  • Take before bed and 2 hours before exercise
  • Avoid taking with food

Mast Cell Stabilizers

• Actions: prevent release of histamine and other mediators from mast cells
• Examples: Cromolyn

Monoclonal Antibodies

• Actions: attach to a specific receptor on a target cell or molecule
• Examples: used for treating asthma and COPD

Anti-tubercular Drugs

• Categories: primary (first-line) and secondary (second-line) drugs
• Chemoprophylaxis: initiated for close contacts of patients recently infected with TB or for those who are susceptible to infections due to immunosuppression

Module 6: Fluid Balance, Electrolyte, and Acid-Base

Tonicity and Osmolality

• Tonicity: the ability of a solution to cause a change in water movement across a membrane due to osmotic forces
• Osmolality: the concentration of solutes in a solution
• Hemostasis: balance, returning to normal

Crystalloids and Colloids

• Crystalloids: solutions containing electrolytes (e.g. sodium, potassium, chloride)
• Colloids: solutions containing larger molecules (e.g. proteins, starches)

Fluid Therapy

• Hypertonic solutions: increase water movement into the bloodstream
• Isotonic solutions: maintain normal fluid balance
• Hypotonic solutions: decrease water movement into the bloodstream
• Examples: 0.45% NaCl (hypertonic), 0.9% NaCl (isotonic)

Electrolyte Balance

• Importance of potassium and magnesium for the heart
• Hypernatremia: >145, treated with hypotonic fluids
• Hyponatremia: <135, treated with isotonic or hypertonic fluids

This quiz reviews pharmacology for allergic rhinitis and the common cold, covering short-acting and long-lasting drugs, including steroids and H1 receptor antagonists.