WMiranda Pharm Exam 6 - Respiratory PDF

1st Generation Antihistamines Benadryl Indications: Flu, cold, & allergy symptoms, Insomnia, Anaphylaxis, Motion sickness, Parkinsonism, Pruritus, Anxiety MOA: Competes with histamine for receptor sites on effector cells. Block both histaminic & muscarinic receptors & passes the blood-brain barr...

1st Generation Antihistamines Benadryl Indications: Flu, cold, & allergy symptoms, Insomnia, Anaphylaxis, Motion sickness, Parkinsonism, Pruritus, Anxiety MOA: Competes with histamine for receptor sites on effector cells. Block both histaminic & muscarinic receptors & passes the blood-brain barrier Safety/Contraindications/D2D: « SEDATION: Caution when using in the elderly & children Do NOT use: Newborns, premature infants, nursing mothers Caution w/ narrow-angle glaucoma: can á intraocular pressure. Don’t use topical on eyes Cautious in pts with benign prostatic hypertrophy/hyperplasia: can â urine flow Anticholinergic effects (esp in elderly): Pt should avoid concurrent use of MAO inhibitors or CNS depressants. D2D: CYP2D6 inhibitor, weak, anticholinergic effects, CNS depression, â central histamine effects BBW: Promethazine in kids Special: < 2yrs old: serious Cr at baseline (peds) behavioral & other Young kids may have a paradoxical excitation effect. adverse effects Pt should avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause drowsiness. Instruct patient to avoid applying occlusive dressings, cosmetics, or other skin products over areas treated with topical formulation. Don’t drink alcohol while taking this drug.  2nd Generation Antihistamines cetirizine (Zyrtec) Sedating, CNS depression (Caution w/ other CNS depressant use), â central histamine effects Fexofenadine (Allegra) Prolonged Qt, OATP1A2 substrate, OATP2B1 substrate, P-gp substrate, binds to polyvalent cations may interact with antifungals, causing concentrations of this antihistamine to á. Indications: Allergic rhinitis, Sneezing, Itchy/watery eyes, Itchy nose/throat, Chronic idiopathic urticaria MOA: Acts as an antihistamine by competing with histamine for receptor sites on effector cells. Act peripherally, so these H1 receptor blockers are less sedating. « Large molecules, low lipid solubility, & can’t cross the blood-brain barrier. They have a low affinity for the histamine receptors in the brain. = No sedative effects Zyrtec: exception as it's the only 2nd gen with a long half-life & sedative effect. Special: Caution in patients >65 yo Cr at baseline, then in elderly pts consider periodically As a class, the onset is about 1-2.5 hours. To reach a steady-state it takes 1-3 days, but food can impair their absorption. Generally, well-tolerated, but a headache, dry mouth, dyspepsia, nausea, & fatigue may occur  Nasal Decongestants Oxymetazoline (Afrin) Indications: Nasal congestion, sinus congestion/pressure MOA: Stimulates smooth muscle alpha adrenergic receptors, producing vasoconstriction & reducing nasal congestion Safety/Contraindications/D2D: MAO inhibitor use within 14 days Adverse effects can include sneezing, nasal dryness, & rebound nasal congestion (aka rhinitis medicamentosa). Caution in pts with glaucoma, angle-closure, HTN, cardiovascular disease, diabetes, hyperthyroidism D2D: hypertensive effects, interferes with radiolabeled norepinephrine analog effect Special: Use for 3 days or less: pts may develop rhinitis medicamentosa or may have rebound or recurring congestion.  Oral Decongestants Sudafed Indications: Nasal congestion r/t common cold, hay fever, or upper respiratory allergies MOA: Enhance norepinephrine & epinephrine or adrenergic activity by stimulating the alpha1-adrenergic receptor which induces vasoconstriction. Safety/Contraindications/D2D: MAO inhibitor use within 14 days Caution: pregnancy Caution in individuals with glaucoma, angle-closure, HTN, cardiovascular disease, diabetes, hyperthyroidism D2D: (alpha-1 agonist; beta-2 agonist) hyperglycemic effects, hypertensive effects, interferes with radiolabeled norepinephrine analog effect, urine pH sensitivity Special: No routine tests recommended May cause anticholinergic effects. Elderly pts are more susceptible to these effects. Use in peds pts