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Opiod Antitussives
high abuse and addictive potential
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Opiod Antitussive
MOA
- suppress cough reflex by direct action on cough center in medulla in the brain
- Analgesic and drying effect on mucosa of respiratory effect
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Opiod Antitussive
indications
Nonproductive cough
Harmful cough
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Opiod Antitussive
contras
- drug allergy
- Alcohol use
- Hypercapnea
- Respiratory depression
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Opiod Antitussive
cautions
- Increased intracranial pressure
- Impaired renal function
- Liver disease
- BPH
- Addison’s
- COPD
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Opiod Antitussive
SE
- Sedation
- Nausea/vomiting
- Lightheadedness
- Constipation
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Opiod Antitussive
Interactions
- Opiods
- General anesthetics
- Tranquilizers
- Sedatives/hypnotics
- Trcyclic antidepressants
- Alcohol
- Other CNS depressants
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Benzonatate MOA
- suppresses cough reflex by numbing stretch receptor cells in respiratory tract which prevents reflex stimulation of medullary cough center
- Non opiod
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Benzonatate Indications
Harmful, nonproductive cough
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Benzonatate SE
- Dizziness
- Headache
- Sedation
- Nausea
- Constipation
- Pruritus
- Nasal congestion
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Dextromethorphan MOA
- non opiod
- suppress cough reflex through direct action on cough center in medulla, but has no analgesic or CNS depressant
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Dextromethorphan indications
nonproductive, harmful cough
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Dextromethorphan Contras
- Hyperthroidism
- Advanced cardiac and vessel disease
- Hypertension
- Glaucoma
- Used of MAOI’s within last 14 days
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Guaifenesin (Mucinex) MOA
- expectorant
- stimulates respiratory tract secretions by decreasing adhesiveness and viscosity of phlegm
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Guaifenesin (Mucinex) Indications
- Common cold
- Bronchitis
- Laryngitis
- Pharyngitis
- Pertussis
- Influenza
- measles
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Guaifenesin (Mucinex) SE
GI, very minimal
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Antihistamines (general) MOA
- block histamine receptors on mast and basophil cell surfaces, preventing release of histamine from these cells
- ÷Competes for only unoccupied receptors,so GIVE EARLY!!!
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Antihistamines (general) indications
Nasal allergies, hayfever, allergic reactions, symptoms of common cold, motion sickness, Parkingson’s disease, vertigo, and occasional sleep aid
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Antihistamines (general)
- Allergy to drug
- Narrow angle glaucoma
- Cardiac disease
- Kidney disease
- Hypertension
- Bronchial asthma
- COPD
- Peptic ulcer disease
- Seizures
- BPH
- Pregnancy
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Antihistamines (general) Cautions
- Liver impairment
- Renal insufficiency
- Lactating mothers
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Antihistamines (general)
- Drowsiness
- Anti cholinergic effects
- Dizziness
- Restless
- Headache
- Some cardiovascular effects
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Antihistamines (general) interactions
- Anticholinergics : increase these effects
- Apple Juice
- Orange Juice
- Grapefruit Juice
- St. John’s Wart
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Traditional Antihistamines
- Diphenhydramine (Benadryl)
- Brompheniramine
- Chlorpheniramine
- Gimenhydrinate
- Meclizine
- promethazine
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Benefits of Traditional Antihistamines
- Effect histamine receptors peripherally and centrally
- Monitor vital signs
- Best taken with meals
- Anticholinergic effects = more effective
- Used alone or in combination to treat many disorders
- Available OTC and prescription
- Consult MD when before use with other OTC medications
- Less expensive
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Diphenhydramine (Benadryl)
- traditional antihistamine
- Often used as hypnotic for sedating effects
- Can increase increase fall risk in children and elderly
- Most commonly used
- Pregnancy Category B
- Many different forms available, including combinations with other drugs
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Diphenhydramine (Benadryl) indications
- Prevention of allergies
- Motion sickness
- Parkinson’s disease
- Promotion of sleep
- Treatment of severe, acute allergic reaction
- Treatment of acute dystonic reaction
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Diphenhydramine (Benadryl)
- Know allergy
- Nursing mothers
- Neonates
- People with lower respiratory tract symptoms or pneumonia
- Acute asthma attack
- use of alcohol, MOAI's, or CNS depressants
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Non Sedating Antihistamines
- Loratadine (Claritin)
- Cetirizine
- Fexorfenadine (allergra)
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Non Sedating Antihistamines
- Do not cross blood brain barrier: only work peripherally
- Minimal adverse effects when taken correctly
- Longer duration of action – once a day dosing
- Should not be used in children younger than 6 years old
- Reduced doses foe elderly or decreased renal function
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Loratadine (Claritin)
- Available OTC
- Pregnancy B
- Drug allergy only contraincations
- Not recommended for children under 2
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Loratadine (Claritin) indications
- Hayfever
- Chronic urticaria
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Adrenergic Decongestants drugs
- naphazoline (Privine),
- Oxymetazoline
- tetrahyrdozoline
- xylometazoline
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Adrenergic Decongestants MOA
constrict blood vessels, especially nasal sinuses, which shrinks engorged mucous membranes and relieves stuffiness
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Adrenergic Decongestants Contras
- Narrow angle glaucoma
- Cardiovasular disease
- Hypertension
- Diabetes
- Hypertyroidsim
- Prostatitis
- Patient unable to close their eyes
- Hx of CVA or TIA
- Cerebral arteriolsclerosis
- Long standing asthma
- BPH
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Adrenergic Decongestants interaction
- MAOI
- Methyldopa
- Urinary acidifiers
- Alkalinizers
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Adrenergic Decongestants SE
- Generally well tolerated
- Nervousness
- Palpitations
- tremor
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decongestants indications
- Acute or chronic rhinitis
- Common cold
- Sinusitis
- Hayfever or other allergies
- Preoperatively for better visualization
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three groups of decongestants
- adrenergics
- anticholinergics
- corticosteriods
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general teaching tips
- increase fluids (3L)
- use humidifier
- avoid dry air, smoke filled enviroments, and allergens
- medications with food
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