Pharm V

• H1
• H2

}H1 receptors mediate smooth muscle contraction (allergic symptoms) }Dilation of capillaries

• Accelerate HR
• Accelerate gastric acid secretion

can lead to allergic reaction and even anaphylaxis

Both H1 and H2 dilate vessels

inflammitory response

There can be an in crease in body secretions

There can be dilation of the vessels causing fluid to move OU OF the vessels and into the tissue causing a drop in the Bp and excessive

“antagonists”

}Those that compete with histamine for the H2 receptors are “ H2 antagonists” or H2 BLOCKERS

}Think about cimetadine and rantadine- they act on the GI system

compete with histamine for the H1 receptors

help out with environmental allergies

will block histamines attempting to bind to receptor sites- that is why early treatment is needed!

the H1 blockers can’t help

Allergies due to- molds, mold spores, dust, etc…

can cause hay fever, ithy eyes, uticaria, sneezing, cough, etc…

• an anticholinergic effect- so they DRY secretions
• (Think about the opposite of SLUDGE

Histamines bind to nerve endings causing pruritis

Binds and activates specific receptors in the eyes, nose, skin, resp. tract

Histamines and other substances are released by mast cells, basophils b/c they are reacting to the circulating antingens( foreign substances) in the blood.

• 1) FEXOFENADINE-
• 2) Claritin

Allegra and Seldane*

Seldane has serious interactions- off market.

EES- antibiotic and Ketokonozole (antifungal)- can lead to Seldane build-up in the blood- can cause cardiac dysrythmias and can be life-threatening }

the relief of symptoms of seasonal allergic rhinitis-

OTC

children 12 and older

non-sedating antihistamine

those with lower resp-tract diseases

• those with an acute asthma attack
• Why

• Also now available OTC
• Fairly inexpensive

• 1) Diphenhydramine-
• 2) Meclizine
• 3) Promethazine- Phenergan
• 4) Astelin-
• 5) Zyrtec-
• 6) Chlor-trimeton-
• 7) Dramamine-
• 8) Unisom-
• 9) Atarax/Vistaril
• 10) Antivert-

Benadryl

• Used for allergies
• motion sickness
• a sleep aid (think safety ed.)

Commonly used for allergies and pruritis

Very safe (few s/e’s)

• Anticholinergic properties
• dries secretions so educate

These still act on CNS so educate about safety

• in nursing mothers
• neonates

PO (tabs, elixir and topical)

• alone
• in combo with other drugs- calamine, camphor

antihistamine

• vertigo
• dizziness
• motion sickness

• May cause sleepiness
• Safety if sleepiness

EducateRx.

Phenergan

Antihistamine, used basically for antiemetic

• Rx only-
• may be po, IV, IM, and rectal formula

Uusually ordered q4-6 hours prn for nausea

if Demerol is the drug of choice for pain

How does this work as an antiemetic?

for nausea Will dry secretions- educate and assess

Will dry secretions- educate and assess

Only nasal spray antihistamine

for adults and children over age 12

May have rebound effect-

educate

for year round allergy sufferers

for chronic uticaria also

Available OTC in tab form

Used for motion sickness

Can be used starting at age 6 and greater

Causes sleepiness

OTC for sleep aid

Take with a full glass of water

Has sedative and mild antianxiety properties

the treatment of vertigo

• dysrythmias/palpitations
• Hypotension, syncope
• Dizziness, blurred vision
• Sedation
• Paradoxical excitement,
• insomnia
• Nervousness,
• headache
• Seizure
• N/V/D/anorexia

• Rarely-
• Leukopenia,
• pancytopenia

to decrease the nasal mucosa inflammation

• a) Adrenergics
• b) Anticholinergics
• c) Corticosteroids-

• orally,
• inhaled,
• topical

• Neo-synephrine
• Sudafed

These give the longest effect because they are distributed systemically

Onset is delayed

Caution in handing out sudafed- why?

ID

• Vicks inhaler,
• Benzedrex

• Adrenergics
• intranasal steroids

Prompt onset

“rebound congestion”

adverse effects on nasal mucosa are more likely to occur with excessive or long term use

can produce rebound effect w/ long term use (usually longer than 3 days) or in excess

use only meds labeled for intranasal use

• Ephedrine- Vicks
• Afrin
• Neo-senephrine

cardiac stimulation

• cardiac tachdysrhythmias
• w/ severe CAD

• Beconase
• Decadron Phosphate Turbinase

They relieve nasal stuffiness (vasocinstrict)

Shrink engorged nasal mucous membranes

• they can cause
• Hypertension
• Palpitations
• HA,
• dizziness

specifically constrict the small blood vessels that supply the UR tract- especially those around the sinus cavity

bronchodilate

• nervousness,
• tremors,
• palpitations,
• insomnia

reduce inflammation

• mucosal irritation
• dryness

• Nasonex,
• Flonase,
• Nascort

stimulated when the receptors in the bronchi, alveoli, and the lining of the lungs (pleura) are stretched due to excessive secretions of foreign substance invasion

in the medulla

• after surgery
• after hernia repair,
• if there is IOP or ICP

• Opioid
• Non-opioid

Non-opioid

Dextramethrephan / Benzonatate

no analgesic effect

• does not have addictive properties
• or cause CNS depression

Fairly safe to use short term

non-opioid antitussive

but it anesthetizes the cough reflex by causing numbing of the stretch receptors

directly suppress the cough reflex

• Most of these drugs can cause dizziness,
• drowsiness,
• sedation

• Cause dry mouth,
• nausea,
• constipation

Tesselon

Tesselon Perle’s

-Non-opioid -Numbs cough receptors

• -Rx only
• -100 mg capsules only,
• orally-

Looks like a small vitamin E

antitussive- opioid

Addictive properties

Usually in combo with a cough med- Robitussin AC

Can depress RR and CNS

Controlled substance- Rx only

• severe respiratory disorders,
• seizures,
• ICP

• Vicks 44,
• Robitussin DM

• Non-opioid
• Safe
• Non-addicting*

• with persistent head aches (why?)
• with asthma,
• emphysema

Cough up and out by thinning secretions

Reduces viscosity of secretions

• Commonly- Robitussin,
• Guifenesen,
• Guiatuss

Help suppress cough b/c secretions thin

hyperkalemia with K+ sparing diuretics = cardiac dysrhythmias

• ICP,
• IOP,
• Asthma,
• Emphysema,
• Cardiac problems,
• HTN

• s/s,
• allergic reactions,
• allergies

• Get a really good hx.
• drug hx

use caution

• If patient has URI symptoms- many safe
• If Lower RI- not so much! Assess and get a Dx.

antibiotics like EES, ketokonozole

discuss with Dr. or dentist

call Dr

caffine

Histamine blockers reduce acid like in GERD

Allows for healing to begin

These all decrease stomach secretions = decrease in stomach acid = decrease in esophogeal irritation

• Tagamet,
• Pepcid,
• Zantac

Used for URI’s and LRI’s

common cold, rhinitis, hay fever

asthma, emphysema, chronic bronchitis-So your COPD’s (LR)-

obstruction in airflow through the airway

-Cystic Fibrosis will also affect the LR tract as well! (FYI)

Wheezing and SOB is the main complaint

• Asthma attacks are sudden-
• (status asthmaticus)*- can last days to weeks
• Both can be deadly!

Recurrent/reversible, bronchi and brochioles narrow, bronchospasm, inflame causing viscous mucous

Continuous inflammation of the brochi or bronchioles

• Chemicals
• Smoke
• Pet dander
• Air irritants

Enlarged air spaces in the lungs

Results in destroyed alveolar walls

O2 and CO2 exchange becomes impaired

respirations

• Smoke
• irritants

• Lungs become less elastic
• SOB ensues, especially on exertion

Xanthine derivitives,

Beta-agonists

Plant alkaloids-

• caffeine,
• theophylline,
• theobromine

Only theophylline

aminophylline (less potent & shorter acting than theophylline)

asthma attacks

status epilepticus*

• increase cardiac contractility
• ncreasing HR

increased blood flow to kidneys

diuretic effects (from increased blood flow to kidneys)

Educate

100% bioavailability

• Oral contraceptives
• EES
• Allipurinol
• Flu vaccine
• Cimetadine

Often a drug-drug interaction so the drugs become less effective or ineffective

• N/V/ anorexia
• GI reflux during sleep
• Tachy,
• palpitations,
• V dysrhythmias
• Increased urination
• Hyperglycemia
• Nervousness/tremors

• Slo-bid,
• theodur,
• Uniphyl

chronic respiratory disorders

• Oral,
• rectal,
• IV,
• topical

theo levels

WNL = 10.0-20.0 mcg/ml

on an empty stomach

about 70%

• Increased restlessness,
• irritability,
• N/V,
• tremors

• may be due to hypoxia
• ASSESS!!!

Never omit doses or double-up on doses

Elderly and pedi can have increased s/e’s

Smooth muscle relaxants

an acute asthma attack to quickly reduce airway constriction

They stimulate the SNS receptors (beta and alpha adrenergic receptors)

They imitate effects of epi and norepi in receptors

Dilate smooth muscle and airway

vasoconstrict- reduces swelling in mucus membranes and limits secretions

stimulates beta 1’s and 2’s

• terbutaline
• (Brethine)

on the uterus

relaxes the uterus

preterm labor

• 1) Albuterol
• 2) Epinephrine, ephedrine

• proventil,
• Servent*- longer acting

Beta 2 specific bronchodilators

short acting

Relieves bronchospasms

acute asthma attacks

• with tachy
• cardiac disease

• increase HR
• cause tremor

• Primatene,
• Adrenalin,
• Bronchaid

• ronchodilation
• Can also easily cause tachy

• •Ephedrine no longer OTC
• Rx only

primarily as a first line drug- code

Atrovent

Como drug- Albuterol and atrovent

bronchodilation

mainly for COPD management

Not for acute attacks

• anticholinergic s/e's
• Dries everything
• Cough
• HA
• Anxiety

with a hypersensitivity to atropine

• Substance in the body that causes
• inflammation,
• bronchial constriction
• mucous

• wheeze,
• cough,
• SOB

Newer class of asthma medication

primarily the lungs

block the effect of leukotreine

• 1) Singulair
• 2) Accolate
• 3) Zyflo

Fairly safe with few side effects

FDA ok for children 2 +

• Fairly safe with few side effects
• FDA ok for children 2 +

• asthma prophylaxis,
• for 12 +
• PO tabs

• ASA,
• EES,
• Dilantin,
• coumadin

can cause liver dysfunction

12 +

PO tabs

not with liver disease

• inderal,
• coumadin,
• theophylline

• All can cause N/V,
• dyspepsia,
• insomnia,
• dizziness

• Support the systems-
• Educate to report any side effects

do not stop abruptly

used for chronic asthma

Potent antiinflammatories

Not for acute asthma attacks

Prophylaxis for asthma prevention

decreases systemic effects

- reduces immunities,

can cause F&E imbalances, nervous system effects, dermatological effects

I & O's

• immunosuppressed
• patients with candida already,

patient with any systemic fungal/yeast infections

Can exacerbate psychosis! FYI

• Can cause pharyngeal irritation,
• cough,
• dry mouth,
• moon face (Cushingoid symptoms*)

• Baseline VS and lung sounds
• Skin color and cap refill (RR <12 or > 24 = uh oh)
• Cough, dyspnea, SOB, orthopnea, distress?
• Cardiac symptoms?
• Restlessness? O2 sats…
• Use of accessory muscles
• Allergies?
• Cough- color, viscosity of sputum
• Other meds?

• Stop smoking
• Avoid known allergens
• Review MDI (metered dose inhaler) use (Timby)
• OTC’s? Check with Dr. first
• have Id card or bracelet
• Clean mouth piece frequently
• Wean most drugs over 1-2 weeks

• No doubling doses if missed
• Never share
• Do not run out of Rx.

• Store upright, activate into air first…
• Store as directed

Weight gain > 3-5 lbs per week

may mean trouble

• 1)Prednisone
• 2) Hydrocortisone
• 3) Bexamethasone
• 4) Dexamethasone

an immunosuppressant

• many diseases
• Inflammatory diseases-Lupus-Arthritis-Chron’s disease-

To prevent organ rejection-

Can cause cushingoid symptoms

an immunosuppresant,

can also treat many skin conditions

- topical,

many skin conditions

antihistamine, antiinflammatory, immunosuppresant *

Can be given with antibiotics for those with bacterial meningitis

• Chromolyn
• Tilade

Suppress the release of mast cells

Cells in the body rich in histamines,

allergens can bind to them causing an allergic reaction!-

They also release vasocontrictor’s = SOB

Most meds here go directly to the lung and have little systemic effect

• used for COPD management
• used solely for prohylaxis

What does this mean then?•

• can be used for allergic rhinitis
• allergic eye disorders•Used to prevent….

•Also used for those with Chron’s and Ulcerative colitis

•Why?

Less potent then Tilade

If patient is lactose intolerant- chromolyn can exhibit similar GI symptoms

• Oral
• Opthalmic drops (Alomast, Alocril)
• Nasal spray
• No longer available in oral inhalation formula!

May take up to 4 weeks to start working…

}One spray per nostril, no more than 6 doses/24 h

• Educate parents about the meds
• Review inhaler/nebulizer education
• Any capsules- not chewed

Many meds can take several weeks for results

• }
• Can clean tubing and mouth pieces with H2O and vinegar solution

Many are antihistamines and anticholinergics

By relieveing n/v by blocking Ach receptors so nauseous stimuli is not transmitted

1)Scopolamine

2) meclazine/Antivert (antihistanmines)•

3)Compazine-

4)Zofran-

5) THC/Marinol

- has anticholinergic properties

Works on inner ear for balance

for glaucoma patients…

• 72 h patch- behind the ear
• Rotate patch
• 4 hours to start working
• Wash hands after administration

• those already on anticholinergics
• with antidepressants

H1 blockers •

Very safe antiemetic

Inhibits Ach by binding to histamine1 receptors

• motion sickness
• vertigo

Dopamine blocking agent “neuroleptic agent’ }

Dopamine blocking agent “neuroleptic agent’

• those with bone marrow supression
• seizure patients or those with encephalopathy}

Levadopa effects are decreased if given with Compazine

Seratonin Blocker (blocks in GI tract

• Very safe for adults
• No contraindications unless allergic to it specifically}

Increases chemo tolerance

Not good for kids or elderly or pregnancy}

HA

Take and OTC analgesic

• marijuana
• This alters mood and releives n/v
• Especially in those cancer patients with chemo

• Can cause hypotensive effects
• Better head to Cali for this one legally!

n/v- cause & length

• w/ oral meds-
• monitor I & O & edu b/c They can all dry
• Daily weights,
• baseline vs,
• electrolytes

• have effect CNS receptors -safety very important
• lower anxiety

SLOOOOW… the irritate the vein especially phenergan

low & slow

Peppermint and ginger can reduce n/v

• NSAIDS,
• ASA,
• antiplatelet drugs
• Digoxin

If only taking for impending travel- take the med 30-60 hours prior

NO DRIVING

tissue respiration

a O2 carrier in Hgb & myoglobin

many enzyme reations in the body

• liver,
• spleen
• bone marrow

anemia

women

found in meat certain veggies grains

must be converted by gastric juices before they can be absorbed

• OJ,
• veal
• fish

• eggs,
• corn
• beans
• cereal

• Nausea
• stomach upset
• vomiting
• diarrhea abd
• cramping constipation
• black or red tarry stools
• can discolor tooth enamel & eyes
• causes pain upon injection

z-trackit is thick

emer equip

water soluble B compelx vit

• neural tube defects
• such as spina bifida, encephaly & enecphalocele

at least one month before pregnanay

megaloblastic anemia-resulting from folic acid deficiency

oral

• dried beans,
• peas,
• oranges
• green veggies

• calc
• iron sulf
• vit b complex
• vit c in same solution

help raise blood cells

often given to CA pt

• gi stuff
• constipation

• vit b12
• erythropoieten (procrit, epogen)

• through straw
• no teeth discolor

• diet high in b12
• fish
• oysters
• egg yolk
• organ meet
• dairy
• clams

fights off the foreign invaders that are constantly attacking the body

Also fights against its own cells that can become cancerous

The system can also attack itself and cause autoimmune diseases or immune-mediated diseases

Agents that decrease or prevent an immune response and suppresses the immune system

They suppress certain lymphocyte (T-cells) cell lines

• Used for rejection therapy after an organ transplant**
• Used for the treatment of rheumatoid arthritis

• }Has a profound interaction with many drugs and GRAPEFRUIT JUICE
• Increases serum levels

May be given together to achieve therapeutic levels

the prevention of organ rejection

• for arthritis,
• psoriasis,
• IBD

Used for prophylaxis for organ rejection

May be given in combo with cyclosporine and corticosteroids

Side effects can be numerous

As with any in this class, they suppress the immune system making the patient prone to infection

ECHINACEA- commonly taken OTC to prevent colds, can interfere with immunosuppressant therapy

• Leukopenia
• Thrombocytopenia
• Hepatotoxicity

• Moderate hypertension
• Neurotoxicity including tremors
• Hepatotoxicity with cholelithiasis and hyperbilirubiemia
• Nephrotoxicity
• Gingival hyperplasia

take with CHOCOLATE MILK or with MEALS!!

Check labs before, during and after therapy

• Check renal function and urinary function
• Liver function,- is there jaundice, edema or ascites
• Check cardiofunction,- any history of dysrythmias, hypertension
• CNS baseline, seizure history
• Respiratory assessment

stop medication

to treat oral candidiasis which is common

Oral before IM-

to decrease risk of infection that is common with IM injections

Avoid crowds

Any early signs of cold or flu- call your Dr

Women on immunosupressants- use birth control for up to 12 weeks after therapy is completed

considered a cancer med,

Used for solid tumors in the breast, head, neck, lungs, and for lymphocytic leukemia

Also has immunosuppressant activity- can be used for rheumatoid arthritis, SLE

Drugs that accelerate urine formation-

resulting in removal of sodium water

• decrease extracellualar fluid volu
• reduce plasma volu
• reduce cardiac output

thus decrease bp

• 1)Carbonic Anhydrase Inhibitors
• 2)loop diuretics
• 3)Osmotic duiretic (manitol)
• 4) Potassium sparing diuretic
• 5) Thiazides & Thiazide like diuretics

derivatives of sulfonamide antibiotics

• primarily for open angle glaucoma
• helful in CHF

• acidosis
• hematuria
• uticaria
• photosensitivity
• melena
• hypokalemia => dig toxicity

w/ quinidine & oral hypoglycemic agents => can raise toxi

kids

Diamox

w/ allergies to sulfonamides