Respiratory Pharm

  1. Anticholinergic Side Effects
    • Hot as a hare
    • Dry as a bone
    • Blind as a bat
    • Red as a beet
    • Mad as a hatter
  2. First Generation: diphenhydramine (Benadryl)
    H1 receptor antagonist
    • Therapeutic class:Antihistamine, centrally acting anticholinergic 
    • Preg cat: C
    • MOA: Blocks histamine
    • Indications: rhinorrhea, hay fever-nasal congestion, water eyes, sneezing,
    • Contraindications: prostatic hypertrophy, narrow-angle glaucoma, GI obstruction. Caution with hyperthyroidism. 
    • Adverse: sedation, Dizziness, Xerostomia, rarely paradoxical stimulation-mainly in children, urinary retention. possible for anticholinergic side effects
    • Interactions: CNS depressants/sedatives, MAOI may cause HTN crisis. 
    • Lab Tests: drug should be discontinued at least 4 days prior to skin allergy test-false positives will result if not D/C
  3. Second Generation: fexofenadine (Allegra)
    H1 receptor antagonist
    other class drugs-Zyrtec, Claritin
    • Therapeutic class: Antihistamine
    • Preg cat: C
    • MOA: blocks histamine from receptors
    • Indication: rhinorrhea, hay fever-nasal congestion, water eyes, sneezing,
    • Contraindications: Hypersensitivity 
    • Adverse: rarely sedation, dizziness, xerostomia, urinary retention. 
    • Interactions: absorption will be decreased with grape fruit juice/ citrus juices.
  4. *oxymetazoline (Afrin)
    • Therapeutic class: Nasal decongestant
    • Preg cat: C
    • MOA: Alpha-adrenergic receptor agonist causes SNS stimulation-causes arterioles to constrict in nasal passages. 
    • Indication: Nasal congestion, rhinorrhea
    • Contraindications: thyroid disorders, HTN, diabetes or heart disease must use caution.
    • Adverse: rebound congestion is common when med used for 3-5 days/ minor stinging and dryness in nasal mucosa. Headache, dizziness.
    • Interactions: unk
    • Lab tests: unk
  5. dextromethorphan (Robitussin)/Guaifenesin
    • Therapeutic class: nonopioid antitussive
    • Preg Cat: C
    • MOA: acts in medulla to inhibit cough reflex.
    • Indications: URI Cough
    • Contraindications: MAOI use or within 14 days of MAOI use.
    • Alerts: High dose/ abuse can cause hallucinations, loss of motor control, CNS complications, HTN, hyperthermia or death.
    • Adverse: rarely  dizziness, GI upset, drowsiness.
    • Interactions: MAOI, CNS depressants.
  6. fluticasone (Flonase)
    • Therapeutic class:Intranasal glucocorticoids
    • Preg cat: C
    • MOA: reduces secretion of inflammatory mediators
    • Indications: sneezing, rhinorrhea, periennial allergic rhinitis.
    • Contraindication: Severe hypersensitivity to milk proteins
    • Adverse: nasal irritation, epistaxis
    • Interactions: avoid with ritonvir (HIV med)
  7. Theophylline (Theo-Dur)
    • Therapeutic class: Bronchodilator
    • Preg cat: C
    • Moa:relaxes smooth muscle causing dilation of bronchioles and increases the contraction of the diaphragm through calcium uptake.
    • Indications: COPD, Chronic asthma in particular not normally used for acute exacerbation. Prophylaxis for long term asthma that has been unresponsive to other treatments.
    • Contraindication: A-fib,
    • Alert: Narrow therapeutic index and has many drug interactions.
    • Adverse: Nausea, cns stimulation, tachycardia, dizziness.
  8. leukotriene
    Cause inflammation, edema, and Bronchoconstriction
  9. mast cell stabilizers
    cromolyn (Intal)
    • MOA: prevents mast cells from releasing histamine
    • Indications:  prophylaxis for asthma
    • Contraindications: Acute phase of bronchospasms.
  10. omalizumab (Xolair)
    monoclonal antibodies
    • Therapeutic class: anti-inflammatory
    • Preg cat: B
    • MOA: Recombinant humanized monclonal antibody directed against IgE. inhibits binding of IgE to the receptor of mast cells and basophils. Results in a reduction of an allergic response.
    • Indication: Alergic asthma, urticaria
    • Contraindications: hypersensitivity
    • Adverse: allergic asthma, urticaria, headache, pharyngitis, Anaphylaxis can occur on first dose or on any dose.
  11. Albuterol
    Short acting bronchodilator
    • Therapeutic class: Beta-adrenergic agonist
    • Preg Cat: C
    • MOA: Activates beta 2 receptors in bronchial smooth muscle causing dilation.
    • Indications: acute bronchospasm
    • Contraindications: Hypersensitivity or to milk proteins.
    • Adverse effects: tremors, tachycardia, headaches
    • Interactions: any stimulants, MAOI, beta blockers block the effects of albuterol causing bronchospasms.
  12. ipratropium bromide (Atrovent)
    anticholinergic bronchodilator
    • Therapeutic class: Bronchodilator
    • Preg cat: C
    • MOA: Bronchodilation due to cholinergic receptors being blocked in bronchial smooth muscle. Often combined with other beta-agonists (Albuterol) 
    • Indications: Acute exacerbation of asthma
    • Contraindications: hypersensitive
    • Adverse: Cough, drying of mucosal membranes, hoarseness.
    • Interactions: none significant
  13. *bechlomethasone (Beconase AQ)
    Inhaled glucocorticoid
    • Therapeutic class: anti-inflammatory 
    • Preg Cat: C
    • MOA: Inhibits both inflammatory cells and release of inflammatory mediators.
    • Indications: chronic inflammation of airways
    • Contraindications: hypersensitivity
    • Alerts: decreases frequency of attacks in asthma not for acute symptoms. must be taken regularly for effects.
    • Inhaled glucocorticoids are preferred method due to fewer adverse effects. 
  14. *zarfirlukast (Accolate)
    leuokotreine inhibitor/ antagonist
    • Therapeutic class: Leuokotreine modifer 
    • Preg cat: B
    • MOA: Prevent leuokotreines from binding to receptors on the cells. should be started before symptoms begin-prophylaxis.
    • Indications:prophylaxis of chronic asthma
    • Contraindications: hepatic impairment(cirrhosis), hypersensitivity
    • Adverse: headache, but very few overall adverse effects.
    • interactions: may increase prothrombin time if administered with warfarin. Must be taken on empty stomach to increase bioavailability. 
  15. *Salmeterol (Serevent)
    Long acting bronchodilator
    • Therapeutic class: Beta-adrenergic agonist
    • Preg cat: C
    • MOA: selectively binds to beta 2 receptors found in bronchioles, causing dilation-longer acting and longer onset.
    • Indications: Chronic bronchospasm, asthma, COPD
    • Contraindications: hypersensitivity
    • Adverse: cough, drying of mucosal membranes, 
    • Interactions: MAOI, Beta blockers.
  16. *glucocorticoids (Prednisone)
    • Therapeutic class: Antiinflammatory
    • Preg Cat: D
    • MOA: adrenocortical steroids with salt retaining properties, synthetic analog mainly used for anti-inflammatory effects. modifies immune system. 
    • Indications: short term therapy of of acute asthma, limit therapy to 10 days
    • Contraindications: Fungal infections, hypersensitvity.
    • Adverse: HTN, fluid retention, weight gain, osteoporosis, disturbance in mood. many other SE that can be more serious.
  17. Corticoid/Glucocorticoid
    • treatment for many disorders
    • anti-inflammatory, anti-immune, anti-allergic effects.
    • indications: head trauma, autoimmune disorders, inflammation shock, asthma, drug interactions, anaphylaxis.
    • IM and SC are not reccommended routes.
    • Adverse effects: Increased BG, abnormal fat deposits, muscle atrophy, water retention, HTN, Euphoria or psychosis, thinned skin with purpura, peptic ulcers, growth retardation, adrenal atrophy, bone thinning.
  18. Mineralcorticoids
    help to control salt and water balance primarily through the kidneys.
  19. Corticotropins
    help to control secretion of hormones by the pituitary gland
  20. Glucocorticoid
    have multiple effects; glucose utilization, fat metabolism, bone development-they're potent anti-inflammatory agents. Can be used as a replacement for hypopituitarism (Addisons disease). Plus a longer list unneeded for this exam.
  21. Corticoids
    Broad term for glucocorticoids, corticotropins, mineralcorticoids. natural and synthetic analogues of the hormones secreted by the pituitary gland
    Due to an increase in PNS caused by Organophosphate pesticides (ie malathion, diazinon)Carbamates (ie physostigmine, carbaryl)Mushrooms (certain types)Sarin (warfare agent).

    • S - Salivation
    • L - Lacrimation
    • U - Urination
    • D - Diarrhoea
    • G - Gastrointestinal distress
    • E - Emesis

    • B-Bronchorrhea
    • B-Bronchospasm
    • B-Bradycardia
Card Set
Respiratory Pharm
Nursing107 resp. pharm