1. First generation antihistamines? prototype?
    • Don't bring drowsy cough here.
    • Diphenhydramine (Benadryl), bromphenimarine (LoHist), dexchlorpheniramine, Chlorphenamarine (Chlor-Trimeton), hydroxyzine (Vistaril),
  2. 2nd Generation Antihistamines? Prototype?
    • Feel less drowsy!
    • fexofenadine (Allegra), loratadine (Claritin), dosloratadine (Clarinex)
  3. Sympathomimnetics (decongestants)? Prototype?
    • Only play Easy E (adrenaline=dance=Easy E). What?
    • oxymetazoline (Afrin), pseudoephedrine (Sudafed), epinephrine (Adrenaline), ephedrine
  4. Antitussives (differentiate between narcotic formulations and non).
    • Creeping drowsy high.
    • codeine, dextromethorphan, hydrocodone.
    • Differentiate:Narcs: codeine, hydrocodone
    • Non: dextromethorphan: locally acting agents are throat lozenges and cough drops that increase saliva flow and contain demulcents or local anesthetics.
  5. Expectorant
    • guaf sounds like cough
    • guafenesin
  6. Mucolytic
    • I see tell Sis teen's snotty
    • acetylcysteine (Mucomyst)
  7. Bronchidolators: Short Acting? Long Acting?
    • Prototype: Albuterol, levalbuterol (Xopenex), metaprotenol (Alupent), pirbuterol (Maxair)
    • Prototype: Salmeterol (Serevent), formoterol (Foradil), terbutaline (Brethine)
    • come back to
  8. Anticholergenic bronchodilators
    • Iced Tea (think anti-chol sounds like anti-cold=iced tea).
    • Ipratropium bromide (Atrovent), tiotropium (Spiriva)
  9. Xanthine Bronchodilators
    • Think tripping acid=high, narrow safety range
    • theophylline (Theo-dur), aminophylline
  10. Glucocorticoids: Systemic
    • Systemic: Prednisone, methylprednisone
    • Intranasal and/or inhaled: All end in ide or one. beclomethasone, bedesonide (Pulmicort), flunisolide (AeroBid), fluticasone (Flovent/Flonase), mometasone (Nasonex), triamcinolone (Azmacort/Nasocort)
  11. Leukotriene Modifier
    • Think, luk is in name because it's leukotriene modifier, and it's the singular one we are learning.
    • Montelukast (Singular)
  12. Mast Cell Stabilizer
    • "Cell number," calms them down, makes them stable.
    • cromolyn (Intal), nedocromil (Tilade)
  13. TB Meds
    • Isolation really puts everything right (and) stays fixed.
    • isoniazid (INH)
    • Rifampin (RIF)
    • Pyrazinamide
    • Ethambutol
    • Rifapentine
    • Aminoglycosides used in tx: Streptomycin
    • Flouroquinalones used: Erythromycin(?)
  14. H1 Blockers First Generation: MOA
    H1 Blockers Second Generation: MOA
    • 1-reduces inflammation by blocking H1 receptors. Nonselective sedating agents bind to central and peripheral H1 receptors.
    • 2-Reduces inflammation by blocking H1 receptors. Cause less CNS depression bc they're selective for peripheral H1 receptors and bind minimally to central H1 receptors. Don't cross blood brain barrier.
  15. H1 Blockers First Generation: Indications
    H1 Blockers Second Generation: Indications
    • 1-prophy and tx for allergy sx, allergic reactions, rashes, Parkinson's motion sickness (pormethazine-Pherergan), insomnia
    • 2-prophy for allergy sx
  16. H1 Blockers First Generation: Administration route + addtl considerations
    H1 Blockers Second Generation: Administration route + addtl considerations
    • 1-Most avail PO. IV admin may cause lightheadedness. Intranasal: azelastine (Astelin). Diphenhydramine- topical po IM IV.
    • 1-Diphenhydramine (Benadryl), hydroxyzine, and promethazine (Phenergan) strong CNS depressants.
    • 2-most avail only in oral prep. Dosing usually QD.
    • 2-Loratadine (Claritin) 1st to go OTC in many preparations.
  17. 1st Generation H1 blockers: side effects
    2nd Generation H1 blockers: side effects
    • 1-CNS depression. Drowsiness or CNS stim (excitability and restlessness-esp in kids).
    • 2- Mild drowsiness can still occur. GI upset.
  18. All H1 blockers: contra, caution
    • contra-Narrow angle glaucoma (inc. intra-ocular pressure/photosensitivity), hyperthyroidism, BPH r/t anticholergenic effects.
    • caution-Cardiac hist of tachycardia, hypotension, chronic lung disease (risk bronchospasms), renal impairment (urinary rtnt), seizures (dec. seizure threshold), diabetes (hypoglycemia), peptic ulcers (blocks H1 receptors in stomach), liver disease (metab in liver)
    • Don't take w/ ETOH, MAO inhibs and CNS depressants.
  19. Anticholergic SEs
    dry mouth, tachycardia, palpitations, urinary retention, constipation, and blurred vision, mild hypotension/dizziness.
  20. Sympathomimetics: MOA
    Stimulation of alpha-adrenergic receptors causing arteriole constriction.
  21. Sympathomimetics: Indications for use
    • Nasal congestion. Parenteral epinephrine- used for anaphylaxis, cardiac arrest, asthma.
    • Total/opthamalic epinephrine-glaucoma
  22. Simpathomimetics:
    side effects (oral, intranasal).
    • Intranasal for symptoms shouldn't be used more than 3-5 days. Rebound congestion. No HTN, Cardiac disrhythmias, thyroid disorders, diabetes.
    • SEs-
    • Intranasal-rebound congestion, stinging on contact, nasal mucosal dryness, decreased risk systemic effects with admin intranasally.
    • Oral/systemic-HTN, CNS stim leading to restlessness, anxiety, and insomnia
  23. Antitussives: MOA
    Ind for use
    SEs (narcs)
    • Suppresses cough receptors of throat, trach, or lungs. Decreases cough center in medulla oblongata.
    • Ind for: dry cough
    • SEs: CNS depression, bradypnea, bradycardia, hypotension, constipation
  24. Expectorants: MOA
    Ind for use
    • MOA: Works on cough receptors.
    • Ind: Lower resp, thick ropey secretions, leads to enhanced cough and liquified mucus.
    • SEsProductive cough, copious thick secretions/sputum
    • Admin: oral liquid
  25. Mucolytics
    • MOA: liquifies mucus
    • Admin by inhalation
    • oral prep also
  26. Intranasal/Inhaled/Systemic glucocorticoids
    • fluticasone (Flonase), Prototype Intranasal: beclomethasone
    • (Beclovent/Beconase)
    • PO: prednisone.
    • Intranasal formatulation: memetasone (Nasonex)
    • Avail in intranasal and inhaled form:
    • budesonide (Pulmicort/Rhinocort, flunisolide (AeroBid), triamcinolone
    • (Azmacort/Nasocort)- also in topical/IM/suncut/ID and oral.
    • Systemic formulations: methyplprednisone (Medrol)
  27. Glucocorticoids:
    • MOA: Dec inflammatory response by suppressing actns of WBCs
    • (neutrophils, eosinophils, lymphocytes), histamine, prostaglandins,
    • leukotrienes, interleukins. Keeps IgE from getting involved.Inds: tx chronic allergic rhinitis
    • SES: burining sens on contact, nasal mucosal dryness, possible bleeding.
    • Admin: must be taken routinely on sched to prev sx, take 1-2 weeks for
    • full effect.
  28. Glucocorticoids:
    • MOA: Dec inflammatory response by suppressing actns of WBCs
    • (neutrophils, eosinophils, lymphocytes), histamine, prostaglandins,
    • leukotrienes, interleukins. Keeps IgE from getting involved.
    • Ind: tx local inflammation of bronchiloes-chronic asthma, COPD. Used as prev of acute. Not effective at time of acute episode in progress. Initial tx asthma, COPD exac should include a bronchodilator (helps open
    • up bronchioles so corticos can get in deeper). Given in combo w bronchiodilator (long acting beta2) &/or anticholinergic) and possibly a a mast cell stabilizer or leuk modifier.
    • SEs: Candidiasis (opportunistic fungal infection). hoarseness, masking infection, monitor for systemic (potential) effects.
    • Admin: must be taken routinely on sched to prev sx, take 1-2 weeks for full effect.
  29. Glucocorticoids: Systemic
    Nursing considerations
    • MOA: Dec inflammatory response by suppressing actns of WBCs (neutrophils, eosinophils, lymphocytes), histamine, prostaglandins, leukotrienes, interleukins. Keeps IgE from getting involved.
    • Inds: tx significant inflammatory response. Acute, severe COPD exacerbation. Systemic for cancers, hodgekins, leukemia, lymphoma, adrenocortical insufficiencies).
    • Contra: Active infection
    • SEs: short term-hyperglycemia. long term- adrenal insuff, hyperglycemia, mood cnges, cataracts, peptic ulcers, elyte imbal, osteoporosis, masking s/sx infection creating potential for rapid growth. Cushing's synd-bruising, fat deposits in the cheeks (moon face), shoulders (buffalo hump), and abdomen, frail bones.
    • Nursing considerations: must be tapered to avoid lack of adrenal function and or rebound of symptoms.
  30. Beta 2 Adrenergic agonist bronchodilators: MOA
    Short acting Beta 2s: Inds
    Long acting Beta 2*s: Inds
    *Admin prior to corticosteroid.
    • Act of beta2 adrenergic receptors in smooth muscle of bronchi and bronchioles resulting in enzyme stimulation=>bronchodilation.
    • SAB2s-
    • PRN for acute bronchospasm + constriction
    • prev of exercise induced asthma
    • initial tx acute asthma
    • init tx COPD exac
    • (may dev tol over time, dec effect)
    • LAB2s-
    • Propy only
    • prevent exc induced asthma
    • prevent acute asthma (esp at night)
    • prevent COPD exacerbation
    • (most last up to 12 h).
  31. SAbeta2
    N considerations
    LAbeta2 admin
    N considerations
    • SA Admin: nebs, MDI (home)
    • SA NCs: Epinepherine & Terbutaline SC (not rec unless airway obstruction occurs d/t inflammation-more sig stim of beta1-adrenergic receptors causing cardiac SEs)
    • Monitor closely for tox w substantial use
    • LA admin: MDI, BEB, INhalation powder, PO, SC depending on drug.
    • Mosto often by inhalation.
    • LA NCs: Scheduled ATC admin required (most drugs Q12H)
    • Admin prior to corticosteroid.
  32. Beta2 Adrenergics: Contra, caution, SEs
    • Contra: tachydysrythmias, severe CAD. Caution: HTN, hyperthyroidism, DM, seizure disorders
    • SEs: cardiac-stims b1-adrenergic receptors in cardiac tissue causing tachycardia, palpitations
    • CNS- agitation, anxiety
    • OD- sig risk during acute asthma or COPD exac w SUBSTANTIAL use of SAB).
    • Cardiac sx: tachycardia, palpitations, angina, serious dysrhythmias, cardiac arrest. CNS- agitation, anxiety, insomnia, seizures, tremors. Labs hypokalemia (racing heart exhausts K+), hyperglycemia
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