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What is adrenergic? cholinergic? anticholinergic?
- Adrenergic: activity promotes bronchorelaxation.
- Cholinergic: Activity promotes bronchoconstriction.
- Anticholinergic: activity promotes bronchorelaxation.
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What is allergic rhinitis? symptoms? types?
- Inflammatory disorder of the upper airways, lower airways, and eyes.
- Symptoms: sneezing, rhinorrhea (runny nose), Pruritus (itchiness), Nasal congestion, for some ppl: conjunctivitis, sinusitis, and asthma.
- Types: Seasonal and perennial, triggered by airborne allergens, allergens to IgE on mast cells. Inflammatory mediators released: Histamine, leukotrienes, and prostaglandins.
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what are the classes of drugs used for allergic Rhinitis?
- Oral antihistamines.
- Intranasal glucocorticoids.
- Sympathomimetics (oral and intranasal)
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Characteristics of Oral antihistamines?
- First-line drugs for allergic rhinitis.
- Do not reduce nasal congestion. Most effective if taken prophylactically.
- AE are mild- sedation with 1st gen, and much less with 2nd gen.
- Anticholinergic effects. (dry mouth, constipation, and urinary retention)
- Azelastine nasal spray: only intranasal antihistamine available, benefits equivalent to oral antihistamines, metered-spray device, leaves bitter taste.
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What are the actions of antihistamines?
- Bronchodilation.
- Vasoconstriction.
- Increased capillary permeability.
- Mucosal edema.
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Histamien antagonists names? MOA? TU? AE? NI?
- Nonsedating (2nd gen): deloratadine (clarinex), fexofenadine (allegra), loratadine (claratin).
- Sedating (1st gen): Ceritizine (zyrtec), Brompheniramine (Dimetane), Diphenhrydramine (benadryl).
- MOA: Block H1 receptors, block action of histamine, More effective at preventing.
- TU: Upper respiratory tract acute allergic rxns. Reduce swelling and itching. relieve symptoms of cold. Relieve allergic rhinitis. Allergic symptoms. Sleeping aids/insomnia. Prevent nausea and vomiting/motion sickness. Prevent tremors/PD.
- AE: anticholinergic (dry mouth, constipation, uranary retention). Sedation/drowsiness-most common.
- NI: Avoid alcohol or using hazardous equipment, take w food to decrease GI distress, increase fluids, read OTC labels, contraindicated in narrow-angle glaucoma, BPH, pregnancy, bladder neck obstruction, and peptic ulcer disease, take 30-60 mins before traveling for motion sickness.
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Intranasal glucocorticoids? names? MOA? TU? AE?
- They are the most effective for treatment and prevention of rhinitis.
- Names: Intranasal Cromolyn sodium, and symphathomimetics (decongestants).
- MOA: Anti-inflammatory actions, prevents or surpasses major symptoms: congestion, rhinorrhea, sneezing, nasal itching, and erythema.
- TU: Use for pts w mild to moderate rhinitis.
- AE: most common is drying of nasal mucosa or sore throat, burning or utching sensation, etc. Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)
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Intranasal Cromolyn? trade name? group? MOA? TU?
- NasalCrom.
- nasal Glucocorticoid.
- MOA: Surpasses release of Histamine from the mast cells.
- TU: rhinitis. Best used for phrophylaxis, not for treatment. Response may take 1-2 weeks to develop.
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Sympathomimetics (oral/nasal) tradename? common names? MOA? AE? TU? Contraindications?
- Decongesstants.
- Names:Phenylephrine, ephedrine, pseudoephedrine.
- MOA: Reduce nasal congestion by activation alpha1-adrenergic (bronco-relaxation)receptors on nasal blood vessels. However, it does not reduce rhinorrhea, sneezing, or itching)
- AE: rebound congestion, constipation, CNS stimulation, Cardiovascular effects (tachycardia) and stroke, abuse.
- TU: rhinitis.
- Contraindications: HTN and hyperlipidimia pts.
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What are the combinations of antihistamines and sympathomimetics?
Usually the ones containing a D. Such as allegra D (fexofenadine/pseudoephedrine).
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Drugs for cough? types? examples.
- they are called: antitussives.
- There are 2 types: Opiod and nonopiod antitussives.
- Opiod: Codeine and hydrocodone.
- Nonopiod: Dextromethorphan and Diphenhydramine.
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The common cold? symptoms? viral or bacterial? What are OTC remedies?
- It is an acute upper respiratory viral infection.
- Symptoms: rhinorrhea, nasal congestion, cough, sneeze, sore throat, headache, horadeness, malise, myalgia.
- Fever is common in children not adults.
- Viral: yellow and green mucous in the morning.
- Bacterial: if it persist through the day.
- OTC remedies: nasal decongestant, antitussive, analgesic, antihistamine (for chlinergic actions), caffeine (to offset effect of antihistamine).
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what is important abt OTC remedies in meds?
- Avoid OTC in children less than 2 yrs.
- Consult physician before administering.
- Meds are all abt weight.
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What are the 2 main pharmacologic classes for the treatment of asthma? examples.
- Anti-inflammatory agents: glucocorticoids (prednisone)- long term use.
- Bronchodilators: Beta2 agonists (albuterol)-use for right now solution.
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What are the most common drugs used for asthma?
- Inhalators ( dry-powder inhaler)
- anti-inflammatory (glucocorticoids)
- Bronchodilators (beta2-adrenergic agonists)
- Glucocorticoids/LABA combinations (budesonide/formoterol-symbicort)
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Inhalation drug therapy? advantages? types? what does this therapy promotes?
- Advantages: therapeutic effects are enhanced, systemic effects are minimized, relief of acute attacks is rapid.
- Types: metered-dose inhalers (MDIs), Dry-powder inhalers (DPIs), Nebulizers.
- Promotes: Bronchodilation and pulmonary decongestion, Loosening of secretions, topical application of corticosteroids and other drugs, Moistening, cooling, or heating of inspired air.
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Anti-inflammatory drugs? types?
- They are used for long-term therapy controlled.
- Types: Glucocorticoids (most common), Leukotriene modifiers, Cromolyn.
- TU:
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Glucocorticoids? classification? TU? MOA? AE? Examples?
- Considered the most effective anti asthma drug available.
- TU: Chonic controlled of asthma. Usually administer by inhalation, but IV and oral are also options.
- MOA:Suppress inflammation, decreased synthesis and release of inflammatory mediators, decreased infiltration and activity of inflammatory cells, decreased edema of the airway mucosa.
- AE: Minor when taken acutely, can be severe when log-term used (adrenal suppression, osteoporosis, hyperglycemia, and others), Oropharyngeal candidiasis and dysphonia- gargle after use and use of spacer.
- Examples: budesonide (pulmicort/symbicort) and fluticasone (flovent), triamcinolone (azmacort).
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Keukotriene modifiers? MOA? examples?
- Less effective than inhaled glucocorticoids.
- MOA: Suppress effects of leukotrienes.
- Examples: zileuton (zyflo), Zafirlukast (accolate), Montelukast (singulair) most popular.
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Cromolyn? MOA? TU? AE?
- MOA: Suppresses bronchial inflammation-Mast cell stabilizer. anti-inflammatory effects are less than the ones from glucocorticoids.
- TU: Chronic asthma-Used for phophylaxis, not quick relief. Common routes are: Nebulizer, MDI.
- AE: safest of all anti asthma medications, cough, bronchospasm.
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Bronchodilators? types? characteristics?
- They provide symptomatic relief but do not alter the underlying disease process (inflammation). So used to rescue.
- Usually need to be accompanied by a glucocorticoid for long-term suppression of inflammation.
- Principal brochodilators are the beta2-adrenergic agonists.
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Beta2-adrenergic agonist? examples? TU? MOA? AE?
- Bronchodilator.
- Most effective drug in relieving acute bronchospasms and prevention of exercise-induces bronchospasms.
- EX: -ROL suffix, albuterol (proventil/ventolin), Salmeterol (serevent), Terbutaline, etc.
- TU: Use for asthma: both quick and long-term control.
- MOA: Activate beta2 receptors in smooth muscle of lung, promoting bronchodilation and thereby relieving bronchospasm.
- Also suppress histamine release in lung and increase ciliary mobility.
- AE: Inhaled preparations- systemic effects=tachycardia, angina, and tremor.
- Oral preparations: excessive dosage-angina pectoris, tachydysrhythmias, tremor.
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Methylxanthines? ex? MOA?
- Bronchodilator.
- EX: Theophylline.
- Narrow TI- low bronchospasm, high toxicity.
- MOA: brochodilatation.
- Not used as much, old drug.
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What are glucocorticoids /LABA combinations? EX? TU?
- Combination b/t glucocorticoids (bronchodilators) and inhaled steroid (LABA-long acting beta agonist bronchodilators)
- EX: Fluticasone/salmeterol (advair), Budesonide/formoterol (symbicort).
- TU: indicated for long-term maintenance in adults and children. Not recommended for initial therapy.
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