Pharmacology

Oral Antihistamines, Intranasal Glucocorticoids, Intranasal Cromolyn, and Sympathomimetics (oral/nasal)

Indoor Allergens such as: dust mites and pet dander.

Outdoor allergen, fungi, pollens

Hay Fever

• Inflammatory disorder of the upper airway, lower airway, and eyes.
• Symptoms include: Sneezing, Rhinorrhea, Pruitius, and Nasal Congestion.

• Long acting inhaltion only
• Effects being 30 min - 24 hours
• More effective than Ipotropium (Advent)
• More convenient dosing schedule

• 1.) Glaucoma - increased intraocular pressure
• 2.) Peanut or soy allergy

Zyflo

(Singulair has no liver injury, Accolate is rare)

Monitor LFT's for toxicity (Zyflo)

HA, fatigue, coughing, GI upset, dyspepsia, liver toxicity (rare), arthralgia (joint pain)

Churg Strauss (severe asthma, not with Zyflo)

• PO
• M: liver
• E: feces

Omalizumba (Xolair)

• not for nasal congestions
• for itching, sneezing, and runny nose

AE: sedation & dry mouth, urinary retnetion, constipation

Avoid CNS depressants

Phenylephrine, Ephedrine, Seudophedrin

reduces nasal congesting by stimulating alpha 1 receptors on nasal blood vessels

• Topical - rapid response
• PO- delayed, moderate and prolonged response
• Does not reduce runny nose, sneezing, itching

AE: rebound congetstion or rhinits due to overuse, CNS stimlation with PO: restlessness, insomnia, irritabilty; abuse; cardio wide spread vaso constriction

Opioid - codiene & hydrocodone (most effective cough suppressant) suppress respirations, drowsiness, fatigue, euphoria

Non-opiod - Dextromethaphran (most effective non opiodi), mind/body dissociation, enhance analgesic effects of opiods, Benadryl, Benzonitate

Act in CNS to suppress cough (elevate threshold)

• Anticholergenics (Atrovent MDI & Spirivia DPI)
• Gluco + Beta 2 combo

Advair diskus = flovent, long acting beta 2, & Serevent)

Bronchodilaton + Anti inflamm

Inhalation in AM & PM

For asthma & COPD

Nursing: Calcium + Vit D. supplement (bone loss prevention)

Rinse mouth after use

Withdrawl use slowly

• Adrenal impairment (high conc./long term)
• Bone loss (long term use, esp if menopausal)

Thrush, dysphonia, slowing growth in children, hyperglycemia, GI discomfort - PUD, Cushing's syndrome (moon face)

Abrupt stopping can result in hypotension, hypoglycemia, and myalgia

• MDI or DPI inhalation (moderate to severe long term use)
• PO (brief use only)
• IV (high stress acute attack- dexamethasone & kellelog IV & IM)

• First line therapy - asthma prevention
• Long term therapy, not PRN

• 1.) Suppress inflammation
• 2.) Reduce edema
• 3.) Increase # of beta 2 receptors & responsivenss to beta 2 agonists
• 4.) reduce hyper-reactivity & mucus production

Prednisone, Flovent, Azmacort, Aerobid, Pulmicort

• Not available in US
• AE: bad taste

Nursing: rinse mouth immediately after use

MDI for mild-moderate asthma, prophylaxis, allergic rhinities

• Especially for seasonal allergic attacks
• Full effects take several weeks
• No systemic side affects
• E: urine

Nursing: alternative to taking glucocorticoids

Prevents release of histamine & other mast cell mediators

• Cromolyn (Intal)
• Nedocromil (Tilade)

• Pain @ injection site
• viral infection
• URI
• sinusitis, HA

RARE: cancer & anaphylaxis

cannot be paired with a glucocorticoid, ineffective

• Sub Q injection
• slow absorption - peak 7-8 days
• M: liver

• 2nd line agent
• allergen induced asthma
• seasonal allergic rhinities

Reduces IgE (antibody) available to bind with receptors

• PO
• with or without food
• M: liver
• E: urine

• PO only
• M: liver
• Exreted: bile, with or without food
• not for quick relief

• 1.) Asthma prophylaxis and maintenance (Zyflo)
• 2.) Allergic rhinitis > age 1
• 3.) Prevention of exercise-induced bronchospasm > 15

• Singular - age 1 min (single)
• Accolate - age 5 min (chronic asthma for adults and young children)
• Zyflo - age 12 min

Blocks leukotrine receptors, improves lung function

Singulair, Zyflo, Accolate

All generics have "luk"

• Dry mouth
• Urinary retention
• min systemic effects (constipation, tachycardia)
• Irritation of pharynx - hoarse voice

• COPD
• Bronchospasm

Off-label for asthma

• 1.) inhalation only - MDI
• 2.) effects begin within 30 mins - 6 hours
• 3.) less effective for allergen and exercised induced asthma

Bronchodilator

Blocks muscarinic cholinergic receptors in bronchi

• Ipratropium (Atrovent)
• Tiotropium (Spiriva)

(I -pray, I'm TIRED)

PO, IV (IV to be infused slowly due to high solubility, IV more common)

• 1.) Caffeine - intensify effects on CNS & heart
• 2.) Reduce theo: Phenobarbitol, Phenytoin, Rifampin
• 3:) Increase theo: fluoquinolones, Cipro, cemetidine

**Teach patient NOT to chew SR **

• PO, IV(emergencies)
• Plasma level important: 10-20 mcg max
• Slow absorption (food can alter)
• M: liver
• more dangerous than beta 2 and glucocs, not as effective

Chronic stable asthma treatment

RELAXES smooth muscle of the bronchi = bronchodilation

• Theophylline
• Aminophylline

short & long term asthma control

Long acting beta 2 agonists need to be paired with glucocorticoids when asthma is controlled

1.) Selective activation of beta 2 receptors in the smooth muscle tissue of the lungs = bronchodilaton

2.) Histamine suppression

3.) Increased ciliary motility

Albuterol, Bitolterol, Levalbuterold, Pirbuterol

ends in -buterol