Term
|
Definition
| Vascular system: dilates small bl vessels & increase capillary permeability-warm, flush,swelling, hypotension. bronchi: constriction of smooth muscle, promote secretion of mucus.CNS: neurotransmitters modulation, cognition, memory, sleep/wake cycle, seizure suppression. Sensory:itch & pain |
|
|
Term
|
Definition
| secretion of gastric acid |
|
|
Term
| Histamine in allergic response |
|
Definition
mild allergies-rhinitis, itching, local edema
only a minor role in severe allergic reactions |
|
|
Term
H1 antagonists-Antihistamines
classifications |
|
Definition
first generation:highly sedating
second generation |
|
|
Term
|
Definition
| selective block of H1 receptors, do not block release of histamine from mast cells/basophils. Some also bind to muscarinic recpetors |
|
|
Term
Antihistamine
pharmacologic effect |
|
Definition
Periphery:reduce flushing, swelling, itching, pain, and mucus production
CNS:Excitation (overdose) & depression (therapeutic). Anticholinergic in some |
|
|
Term
|
Definition
| mild allergies, seasonal allerigic rhinitis, acute urticaria, allergic conjunctivitis, mild transfusion reactions, adjunct in severe allergy, motion sickness, insomnia, reduce rhinorrhea & anticholinergic affects in colds. (not congestion) |
|
|
Term
Antihistamine
side effects |
|
Definition
| (FG)sedation (impairment can occur without feeling tired), dizzy, confusion fatigue, paradoxical excitation:insomnia, nervous, tremors, convulsions. N/V/D or constipation, loss of appetite. Anticholinergic (dry mouth,nasal passage, and throat. urinary ret. constipation, palpitations, thickening of mucus), photosensitivity |
|
|
Term
| Major concern with phenergan |
|
Definition
respiratory depression-can not use <2y/o
extravasation w/IV |
|
|
Term
Antihistamines
drug interactions |
|
Definition
| CNS depressants, MAOI, phenytoin, anticholinergics, cholinergics |
|
|
Term
Antihistamines
pregnancy/breast feeding |
|
Definition
Unknown, some fetal malformations. Avoid in 3rd trimester.
Is excreted in breast milk |
|
|
Term
Antihistamines
Acute toxicity |
|
Definition
| Dilated pupils, flushed face, hyperpyrexia, tachycardia, dry mouth, urinary retention. IN kids-hallucinations, incoordination, ataxia, convulsions, coma, CV collapse, death |
|
|
Term
First generation
sedation(worst/least) |
|
Definition
worst:benedryl, phenergan
least: chlorpheniramine |
|
|
Term
Second generation
lack these side effects |
|
Definition
| sedation & anticholinergic |
|
|
Term
|
Definition
| Do not drink fruit juices 4hours before, 2 hrs after administration |
|
|
Term
|
Definition
| drowsiness, fatigue, dry mouth, nose and throat. More sedation than other SG but less than FG. |
|
|
Term
Levocetirizine
contraindications |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| isomer of claritin, longer 1/2 life |
|
|
Term
| Classes of antihistamines |
|
Definition
| Alklamines, Ethylenediamines, Ethanolamines |
|
|
Term
| Antihistamines contraindications & cautions |
|
Definition
| hypersensitive, newborn/premies,nursing moms, narrow-angle glaucoma, MAOI use, lower respiratory infection (dry secrete/suppress cough), decreased mental alterness |
|
|
Term
|
Definition
| ketoconazole, erythromycin, cimetidine |
|
|
Term
|
Definition
| Inflammatory disorder affecting URT, LRT, & eyes |
|
|
Term
| Forms of allergic rhinitis |
|
Definition
Seasonal/hay fever:cyclic-outdoor
perennial:chronic-indoor |
|
|
Term
|
Definition
| sneezing, nasal pruritus, congestion, clear rhinorrhea, itching palate, red/itchey eyes, ear pressure/popping |
|
|
Term
|
Definition
| IgE reaction>mast cells release inflammatory mediators>histamine, leukotrienes, prostaglandins |
|
|
Term
|
Definition
| oral antihistamines, intranasal glucocorticoids, sympathomimetics (oral/nasal) |
|
|
Term
Astelin
class, use,side effect |
|
Definition
| second gen antihistamine,>12y/o 2 nasal sprays BID, Bitter taste & drowsiness |
|
|
Term
Pantanase
class, use, side effect |
|
Definition
| second gen antihistamine, 2 sprays ech nare BID, nose bleeds & HA |
|
|
Term
Intranasal Glucocorticoids
indications |
|
Definition
| prevent/supress:congestion, rhinorrhea, sneezing, itching, erythema |
|
|
Term
Intranasal Glucocorticoids
side effects |
|
Definition
| sore throat, epistaxis, HA, dry/burn sensation, adrenal suppression, slow linear growth (least w/flonase) |
|
|
Term
Intranasal Glucocorticoids
dosing |
|
Definition
| start with full dose and decrease to lowest effective, take up to one week for efficacy |
|
|
Term
Intranasal cromolyn
dosing |
|
Definition
| seasonal allergies-start 2 wks before allergy season, QID schedule |
|
|
Term
Nasal Decongestants
side effects |
|
Definition
| rebound congestion. Min systemic effects:CNS stimulation, CV effects, stroke, abuse |
|
|
Term
Decongestants
oral vs nasal |
|
Definition
| nasal-works faster, oral-works longer |
|
|
Term
| Most common symptom for requested medical care |
|
Definition
|
|
Term
|
Definition
Acute <3wks
subacute
chronic >8wks |
|
|
Term
|
Definition
| viral, URI, pneumonia, acute LV failure, asthma, foreign, body aspiration |
|
|
Term
|
Definition
| postinfection cough, bacterial sinusitis, asthma |
|
|
Term
|
Definition
| postnasal drip, asthma, GERD, COPD, ACE, brochogenic carcinoma, carcinomatosis, sarcoidosis, LV failure, aspiration |
|
|
Term
|
Definition
Productive-effective vs ineffective
Nonproductive-no purpose,virus, bacteria, GERD, CD,drugs |
|
|
Term
Sympathomimetics (decongestants)
action & use |
|
Definition
| Decrease nasal congestion by activating alpha1 on nasal bl vessels |
|
|
Term
Sympathomimetics (decongestants)
side effects |
|
Definition
| restless, irritable, anxiety, insomnia, widespread vasoconstriction |
|
|
Term
Sympathomimetics (decongestants)
abuse |
|
Definition
| pseudoephederine & ephedrine are similar to meth, all behind counter and need ID and sign a log. Some city/states require Rx. Limits Dose limits Sudafed adults 240mg/day child >6 120mg/day |
|
|
Term
| How to manage/avoid rebound congestion from nasal decongestants |
|
Definition
| Do not use more than a few days (3-5). D/c one nostril at a time or use nasal glucocorticoid x1 week before withdrawl |
|
|
Term
| Administering Sympathomimetics (decongestants) drops |
|
Definition
Head lateral low
dose more precise-better choice for kids |
|
|
Term
|
Definition
topical better-extensive 1st pass
adult max dose 60mg/day, child max 30mg/day |
|
|
Term
| Benefits of using combo antihistamine/sympathomimetic |
|
Definition
| relief of nasal congestion and histamine reaction |
|
|
Term
Atrovent nasal spray
effects |
|
Definition
| Decreases rhinorrhea only |
|
|
Term
| Benefits of Singulair in allergic rhinitis |
|
Definition
| Decrease nasal congestion |
|
|
Term
|
Definition
| reflex involving CNS, PNS, & muscles of respiration started by irritation to bronchial mucosa as well as by stilmuli arising at sites distant from resp tract |
|
|
Term
|
Definition
|
|
Term
| Most effective cough suppressant |
|
Definition
|
|
Term
Codeine antitussive
effects |
|
Definition
| decreases frequency and intensity of cough |
|
|
Term
Codeine antitussive
side effects |
|
Definition
| respiratory depression, N/V, sedation, dizzy, dry mouth, confusion, rash/pruritis, constipation |
|
|
Term
Codeine antitussive
cautions |
|
Definition
| Pts w/ reduced resp reserve, hypersensitivity, addiction hx, concurrent depressive meds, pregnancy C |
|
|
Term
Codeine antitussive
toxicity tx |
|
Definition
|
|
Term
Codeine antitussive
prescriber considerations |
|
Definition
federaly schedule V, MO schedule IV
must be combined w/2nd ingredient |
|
|
Term
|
Definition
| Acts in brain to increase cough threshold |
|
|
Term
Codeine antitussive
kinetics |
|
Definition
Onset-quick, duration 4-6h, lethal dose 0.5-1g (keep out of children's reach)
Adult max-120mg/day Child 60mg/day |
|
|
Term
Dextromethorphan (Robitussin DM)
MOA |
|
Definition
| Acts in brain to increase cough threshold, analog to codeine |
|
|
Term
Dextromethorphan (Robitussin DM)
indications |
|
Definition
| Cough suppressant for nonproductive cough in cold or allergy >4y/o |
|
|
Term
Dextromethorphan (Robitussin DM)
kinectics |
|
Definition
| quick onset, duration 3-6h (longer in renal pts). Adult max 120mg/day, child max 60mg. mg:mg equipotent to codeine |
|
|
Term
Dextromethorphan (Robitussin DM)
side effects |
|
Definition
| Rare at therapeutic doses:drowsy, dizzy, fatigue, stomach upset, constipation, N/V. Pregnancy C |
|
|
Term
Dextromethorphan (Robitussin DM)
overdose |
|
Definition
| confusion, excitation, nervous, irritable, restless, N/V, resp depression (PCP like), brain damage, seizure, loss of consciousness, irregular HR, death |
|
|
Term
Dextromethorphan (Robitussin DM)
abuse potential |
|
Definition
May precipitate psychosis and mania
must be 18 to purchase |
|
|
Term
Dextromethorphan (Robitussin DM)
drug interactions |
|
Definition
| MAOIs, SSRIs, Effexor, Cymbalta, 2D6 inhibitors/inducers |
|
|
Term
Dextromethorphan (Robitussin DM)
prescriber notices |
|
Definition
| Being used in adolescent parties to get high, always combined with guafinesen. Available in multiple formulations |
|
|
Term
Benedryl as an antitussive
MOA |
|
Definition
| Increase cough threshold in brain. Anticholinergic activity NOT histamine |
|
|
Term
Benedryl as an antitussive
indications |
|
Definition
| Supression of nonproductive cough caused by chemical or mechanical resp tract irritation, postnasal drip cough (to dry up) |
|
|
Term
Benedryl as an antitussive
side effects |
|
Definition
| drowsy, blurred vision, resp depression, disturbed coordination, urinary retention, dry mouth, dry resp. secretions, paradoxical CNS stimulation. Pregnancy B |
|
|
Term
Benedryl as an antitussive
interactions |
|
Definition
| CNS depressants, anticholinergics, MAOIs, cholinergics |
|
|
Term
Benedryl as an antitussive
Prescriber info |
|
Definition
| Available in multi formulas, antitussive doses produce prominent sedation.Adult:25mg q4-6h,Child>6 12.5mg q6h |
|
|
Term
|
Definition
| structrual analog of tertracaine (local anesthetic) |
|
|
Term
|
Definition
| Decreases sensitivity of respiratory tract stretch receptors |
|
|
Term
|
Definition
| sedation, dizzy, constipation, death in children <2. when chewed/broken-laryngospasm, bronchospasm, circulatory collapse |
|
|
Term
|
Definition
| stimulate sensory nerves causing local anesthesia and sense of improved airflow, questionable efficacy |
|
|
Term
Topical antitussives
indications |
|
Definition
|
|
Term
Topical antitussive
methods |
|
Definition
| ointments(TID), lozenges (hourly), cool mist vapor (w/med TID), patch(12h) |
|
|
Term
Topical antitussive
side effects |
|
Definition
toxic when ingested, burning in mouth, N/V, epigastric distress, restless, excitation, delirium, seizures, death
4tsp camphor=child death |
|
|
Term
|
Definition
| loosens and thins lower respiratory tract secretions, promote productive cough. protussive/expectorant |
|
|
Term
|
Definition
| Adult max 2.4gm/day, child >6 max 1.2gm/day |
|
|
Term
|
Definition
| N/V/D, stomach pain, HA, drowsy, rash, dizzy |
|
|
Term
Combo product labels
PM
Cough
Daytime
Allergy
AM
cold/flu |
|
Definition
benedryl
decongestant and/or analgesic
dextromethorphan
decongestant w/o antitussive
antihistamine
decongestant(stimulant, not after 6pm)
decongestant + antihistamine |
|
|
Term
| Most expensive illness & transmission |
|
Definition
| colds/virus, selfinoculation and aerosol |
|
|
Term
| Increased susceptability to colds |
|
Definition
| smoking, poor nutrition, increased population, chronic psychological stress,sedentary lifestyle, less diverse social networks |
|
|
Term
|
Definition
|
|
Term
|
Definition
| sore throat (1st), rhinorrhea, sneezing, cough, chills, HA, malaise, myalgia, fever |
|
|
Term
Viral infections
onset & duration |
|
Definition
| 1-3 days after exposure, self-limiting ends once enough netralizing atb in mucosa to end viral infection ~7 days |
|
|
Term
| When to seek medical care for virus |
|
Definition
| Fever >101.5, chest pain, SOB, worsening/development of symptoms during tx, COPD, chronic immunosupression, frail pts/advanced age |
|
|
Term
| Complications of colds/virus |
|
Definition
| sinusitis, eustachian tube obstruction, middle ear effusion, bronchitis, bacterial pneumonia or other bacterial infection, asthma/COPD exacerbation |
|
|
Term
Cold/viral infection
differential dx |
|
Definition
| Allergic rhinitis, asthma, Bacterial throat infection, croup, Flu, otitis media, pneumonia/bronchitis, sinusitis, pertusis |
|
|
Term
|
Definition
| Increase fluids, adequate rest, nutritious diet (chicken soup), vaporizer/humidifier, saline gargle & nasal sprays, hand hygiene, lysol/kleenex |
|
|
Term
|
Definition
| Decongestants, analgesia/antipyretic, antitussive, antihistamine, lozenges, gargles, anesthetics |
|
|
Term
|
Definition
MAO and COMT in GI, liver, tissues
pseudophedrine(sudafed)-dosed less frequently than phenylephrine(sudafed PE) |
|
|
Term
Decongestants
contraindications/cautions |
|
Definition
| hypersensitive, MAOIs last 14 days, children, HTN, hyperthyroid, DM, CHD, breast feeding |
|
|
Term
Decongestants
drug interactions |
|
Definition
| drugs that increase BP, TCAs decrease decongestion, Urinary acidifiers will increase elimination alkalizers will decrease elimination |
|
|
Term
Public Health Warnings on
cough, cold, allergy meds |
|
Definition
| not to be used in children <2, most say <4. Check ingredients. Watch for max doses on acetamenophen, ibuprophen, benedryl, DXM, and other |
|
|
Term
| When not to self treat a cough |
|
Definition
| thick yellow/green sputum, fever >101.5, unintended wt. loss, night sweats, hemoptysis, foreign body aspiration, Hx disease assoc w/cough, drug-induced, new or worsening symptoms, cough >7days |
|
|
Term
|
Definition
| WATER, cool-mist vapor, humidifier, hard candy/lozenges |
|
|
Term
|
Definition
| drugs that react directly with mucus to make more watery, making cough more productive |
|
|
Term
Hypertonic saline & acetylcysteine
use/side effects |
|
Definition
inhaled mucolytic
acetylcysteine-smells like rotten eggs(sulfur)
both- bronchospasm |
|
|
