189: Antihistamines Flashcards
(137 cards)
1
Q
What are the four different roles of histamine in embryonic development?
A
- Cellular growth and proliferation
- Hematopoiesis and immunity
- Inflammation
- Wound healing
2
Q
What are the two major pathways for histamine metabolism?
A
- Diamine oxidase
- Histamine methyl transferase
3
Q
What are the main differences between first-generation and second-generation H1 antihistamines?
A
Feature | First-Generation H1 Antihistamines | Second-Generation H1 Antihistamines |
|———|———————————–|————————————|
| CNS Penetration | More capable of accumulating in the CNS, leading to sedation | Less capable of accumulating in the CNS, thus less sedating |
| Half-Life | Shorter half-lives, requiring more frequent dosing | Longer half-lives, requiring less frequent dosing |
4
Q
What are the common uses of H1 antihistamines?
A
H1 antihistamines are used for the treatment of:
- Allergic reactions
- Urticaria
- Pruritus
- Nausea
- Vertigo
- Sleep issues
- Anxiety
5
Q
What is the mechanism of action of H1 antihistamines in relation to the blood-brain barrier?
A
First-generation H1 antihistamines are lipophilic, which enhances their penetration of the blood-brain barrier, leading to sedation. In contrast, second-generation H1 antihistamines are less lipophilic and have a lower ability to penetrate the blood-brain barrier, resulting in less sedation.
6
Q
What neurotransmitter is produced in the tuberomammillary nucleus and what functions does it regulate?
A
Histamine is the neurotransmitter produced in the tuberomammillary nucleus, regulating the sleep-wake cycle, endocrine homeostasis, cognition, and memory.
7
Q
What are the six groups of H1 antihistamines based on chemical structure?
A
- Ethylenediamines
- Ethanolamines
- Alkylamines
- Phenothiazines
- Piperazines
- Piperidines
8
Q
What is the clinical significance of the lipophilicity of H1 antihistamines?
A
The lipophilicity of H1 antihistamines allows them to penetrate the blood-brain barrier, which can lead to sedation as a side effect.
9
Q
What is the mechanism of action of H1 antihistamines in relation to G proteins?
A
H1 antihistamines act as antagonists that bind to H1 receptors, which are heptahelical transmembrane molecules that transmit signals to intracellular second messengers via G proteins.
10
Q
What is the role of H2 receptors in the body?
A
H2 receptors are primarily located on gastric mucosal parietal cells and are involved in the regulation of gastric acid secretion.
11
Q
Where are H3 receptors primarily found and what is their significance?
A
H3 receptors are primarily found on histaminergic neurons and immune cells, playing a role in the modulation of neurotransmitter release and immune responses.
12
Q
What is the significance of the longer half-lives of second-generation H1 antihistamines?
A
The longer half-lives of second-generation H1 antihistamines allow for less frequent dosing, improving patient compliance and convenience.
13
Q
What are the potential effects of histamine on the sleep-wake cycle?
A
Histamine plays a role in regulating the sleep-wake cycle, promoting wakefulness and alertness.
14
Q
How do H1 antihistamines affect the treatment of pruritus?
A
H1 antihistamines are effective in treating pruritus by blocking the action of histamine, which is a key mediator in the sensation of itch.
15
Q
What are the implications of histamine’s role as an important neurotransmitter in the brain?
A
As an important neurotransmitter, histamine influences various brain functions, including cognition, memory, and the regulation of sleep, highlighting its significance in neurological health.
16
Q
What is the relationship between histamine and inflammation?
A
Histamine is involved in the inflammatory response, contributing to symptoms such as redness, swelling, and itching by acting on various immune cells and blood vessels.
17
Q
What are the clinical implications of the presence of multiple aromatic or heterocyclic rings in H1 antihistamines?
A
The presence of multiple aromatic or heterocyclic rings enhances the lipophilicity of H1 antihistamines, facilitating their penetration of the blood-brain barrier and increasing the likelihood of sedation.
18
Q
What are the potential side effects of first-generation H1 antihistamines due to their ability to cross the blood-brain barrier?
A
First-generation H1 antihistamines can cause sedation, drowsiness, and cognitive impairment due to their ability to cross the blood-brain barrier and affect central nervous system activity.
19
Q
What is the significance of H4 receptors in the immune system?
A
H4 receptors, which are highly expressed in the bone marrow and peripheral hematopoietic cells, play a role in immune cell regulation and inflammatory responses.
20
Q
What are the differences in the pharmacokinetics of first-generation versus second-generation H1 antihistamines?
A
First-generation H1 antihistamines are more lipophilic, leading to greater CNS penetration and sedation, while second-generation H1 antihistamines have longer half-lives and are less sedating due to reduced CNS accumulation.
21
Q
How does histamine contribute to wound healing?
A
Histamine plays a role in wound healing by promoting inflammation and the recruitment of immune cells to the site of injury, facilitating tissue repair.
22
Q
What are the implications of histamine’s anticonvulsant effects?
A
Histamine’s anticonvulsant effects suggest its potential role in modulating neuronal excitability and could have therapeutic implications for seizure disorders.
23
Q
What is the role of histamine in regulating gastric acid secretion?
A
Histamine stimulates gastric acid secretion by binding to H2 receptors on parietal cells in the stomach, which is crucial for digestion.
24
Q
How do H1 antihistamines alleviate symptoms of allergic reactions?
A
H1 antihistamines alleviate allergic reaction symptoms by blocking the action of histamine at H1 receptors, reducing symptoms like itching, swelling, and redness.
25
What is the significance of the blood-brain barrier in the context of H1 antihistamines?
The blood-brain barrier's significance lies in its role in determining the sedative effects of H1 antihistamines, as those that can cross it may cause sedation, while those that cannot are less sedating.
26
What are the potential drug interactions associated with first-generation H1 antihistamines?
First-generation H1 antihistamines may interact with other drugs metabolized by the hepatic cytochrome P450 system, leading to drug-drug interactions and increased side effects.
27
How does the structure of H1 antihistamines influence their pharmacological properties?
The structure of H1 antihistamines, including the presence of aromatic rings and alkyl substituents, influences their lipophilicity, ability to cross the blood-brain barrier, and overall pharmacological effects.
28
What are the clinical uses of H1 antihistamines in treating nausea and vertigo?
H1 antihistamines are used to treat nausea and vertigo by blocking histamine's action in the vestibular system, which can help alleviate motion sickness and related symptoms.
29
What is the role of histamine in the immune response?
Histamine plays a crucial role in the immune response by promoting vasodilation, increasing vascular permeability, and facilitating the recruitment of immune cells to sites of infection or injury.
30
How do H1 antihistamines affect sleep patterns?
H1 antihistamines can affect sleep patterns by inducing sedation, which may help individuals with sleep disturbances but can also lead to next-day drowsiness.
31
What are the implications of the widespread expression of H1 and H2 receptors in various tissues?
The widespread expression of H1 and H2 receptors in various tissues indicates their involvement in multiple physiological processes, including allergic responses, gastric acid secretion, and neurotransmission.
32
What are the potential benefits of using second-generation H1 antihistamines over first-generation agents?
The potential benefits of using second-generation H1 antihistamines include reduced sedation, longer half-lives allowing for less frequent dosing, and a lower risk of drug interactions.
33
What are the primary effects of H1 antihistamines on proinflammatory cytokines and immune cell chemotaxis?
H1 antihistamines decrease the production of proinflammatory cytokines and the chemotaxis of eosinophils and other immune cells.
34
What are the significant side effects associated with first-generation H1 antihistamines?
Significant side effects include urinary retention, hypotension, and cardiac arrhythmias, which are mediated through non-histamine receptors.
35
How do second-generation H1 antihistamines differ from first-generation in terms of sedation and side effects?
Second-generation H1 antihistamines are less likely to cause sedation and have fewer side effects compared to first-generation antihistamines due to reduced lipophilicity.
36
What is the typical pharmacokinetic profile of first-generation H1 antihistamines after oral administration?
Sedating effects can be observed within 30 minutes to 1 hour, generally persisting for 4 to 6 hours, with some effects lasting up to 24 hours. They are metabolized by hepatic cytochrome P450 (CYP) enzyme 3A4.
37
What is the duration of action for second-generation H1 antihistamines in suppressing wheal-and-flare reactions?
A single dose can suppress the wheal-and-flare reaction for 1 to 24 hours, and regular use can prolong this effect, such as 6 days of daily cetirizine use resulting in 7 days of suppression.
38
How are second-generation H1 antihistamines metabolized and what is their impact on drug interactions?
Second-generation H1 antihistamines are metabolized in the liver via the hepatic enzyme CYP 3A4, and those like cetirizine and levocetirizine undergo minimal hepatic metabolism, reducing the likelihood of interactions with other drugs.
39
A patient with renal insufficiency is prescribed cetirizine. What adjustment should be made?
Dosages of cetirizine need to be adjusted for patients with renal insufficiency as it is excreted in the urine.
40
A patient with hepatic disease is prescribed loratadine. What adjustment should be made?
Loratadine’s half-life ranges from 8 to 24 hours depending on hepatic function, so dosage adjustments may be necessary for patients with hepatic disease.
41
A patient with CIU is prescribed a second-generation H1 antihistamine. What is the advantage of these drugs over first-generation agents?
Second-generation H1 antihistamines are less sedating, have longer half-lives, and are less likely to cause side effects compared to first-generation agents.
42
A patient with CIU is prescribed cetirizine. How long does its wheal-and-flare suppression last after discontinuation?
Cetirizine’s wheal-and-flare suppression may persist for up to 7 days after discontinuation.
43
A patient with CIU is prescribed fexofenadine. How does its metabolism differ from other second-generation H1 antihistamines?
Fexofenadine undergoes minimal hepatic metabolism, reducing the likelihood of interactions with other drugs.
44
A patient with CIU is prescribed loratadine. How does its half-life vary?
Loratadine’s half-life ranges from 8 to 24 hours depending on hepatic function.
45
A patient with CIU is prescribed cetirizine. How does its peak concentration time compare to fexofenadine?
Cetirizine reaches peak concentrations approximately 1 hour after administration, while fexofenadine reaches peak concentration at 2 to 3 hours.
46
What are the mechanisms by which H1 antihistamines decrease the production of proinflammatory cytokines?
H1 antihistamines decrease the production of proinflammatory cytokines by:
1. Binding to the H1 receptor, which inhibits the expression of cell-adhesion molecules.
2. Reducing chemotaxis of eosinophils and other immune cells.
3. Decreasing mediator release from mast cells and basophils through inhibition of calcium ion channels.
47
What significant side effects are associated with first-generation H1 antihistamines and how are they mediated?
Significant side effects associated with first-generation H1 antihistamines include:
- Urinary retention
- Hypotension
- Cardiac arrhythmias
These side effects are mediated through non-histamine receptors such as muscarinic, alpha-adrenergic, and serotonin receptors.
48
How do second-generation H1 antihistamines differ in their binding to the H1 receptor compared to first-generation agents?
Second-generation H1 antihistamines bind noncompetitively to the H1 receptor, making them less likely to be displaced by histamine. They also dissociate slowly, resulting in a longer duration of action compared to first-generation H1 antihistamines.
49
What pharmacokinetic properties are characteristic of first-generation H1 antihistamines?
First-generation H1 antihistamines are characterized by:
- Sedating effects observed within 30 minutes to 1 hour after administration.
- Sedation lasting for 4 to 6 hours, potentially up to 24 hours for some agents.
- Metabolism by hepatic cytochrome P450 (CYP) enzyme 3A4, forming glucuronides before excretion in urine.
- Typically administered in divided doses at intervals of 4 to 8 hours, although some may be dosed once daily.
50
What is the clinical significance of the longer half-lives of second-generation H1 antihistamines?
The longer half-lives of second-generation H1 antihistamines, which range from 6.5 to 14 hours, allow for:
- Once or twice daily dosing, improving patient compliance.
- Sustained suppression of allergic reactions, as regular use can prolong the effect of wheal-and-flare suppression for several days after discontinuation.
51
What factors contribute to the reduced side effects of second-generation H1 antihistamines compared to first-generation agents?
The reduced side effects of second-generation H1 antihistamines compared to first-generation agents are attributed to:
- Reduced lipophilicity, leading to less central nervous system penetration.
- Less likelihood of causing sedation due to their selective binding to peripheral H1 receptors.
- Fewer interactions with non-histamine receptors, minimizing adverse effects.
52
How does the metabolism of second-generation H1 antihistamines affect their drug interactions?
Second-generation H1 antihistamines undergo minimal hepatic metabolism, which reduces the likelihood of interactions with other drugs. For example:
- Cetirizine and levocetirizine undergo minimal hepatic metabolism, making them safer in terms of drug interactions.
- Loratadine and other second-generation agents are metabolized by the hepatic enzyme CYP 3A4.
53
What is the benefit of second-generation H1 antihistamines regarding receptor binding?
They selectively bind to peripheral H1 receptors, resulting in fewer interactions with non-histamine receptors, which minimizes adverse effects.
54
How does the metabolism of second-generation H1 antihistamines affect drug interactions?
Second-generation H1 antihistamines undergo minimal hepatic metabolism, reducing the likelihood of interactions with other drugs.
## Footnote
For example, cetirizine and levocetirizine are safer in terms of drug interactions.
55
What is the duration of action for second-generation H1 antihistamines?
They have a longer duration of action compared to first-generation agents, suppressing the wheal-and-flare reaction for 1 to 24 hours, depending on the specific antihistamine. Regular use can extend this effect.
56
What are the implications of fexofenadine's pharmacokinetics in patients with renal insufficiency?
Fexofenadine is primarily excreted in urine, and while dosage adjustments are recommended for decreased creatinine clearance, it is usually unnecessary for patients with hepatic disease.
57
What role do H1 antihistamines play in modulating cellular adhesion molecules?
They may modulate the expression of cellular adhesion molecules, influencing the release of inflammatory mediators from leukocytes, potentially reducing inflammation and allergic responses.
58
What are the indications for treatment with H1 antihistamines?
They are effective in treating up to 50% of patients with chronic idiopathic urticaria (CIU), angioedema, and dermatographism, but not effective for physical urticarias or pruritus unrelated to histamine.
59
What dosing regimens are recommended for H1 antihistamines?
The lowest effective dosage is preferred to minimize side effects, with possible increases if symptom control is inadequate.
## Footnote
Doses up to 4 times the normal recommendation may be necessary for some CIU patients.
60
What are the risks associated with first-generation H1 antihistamines?
They have a pronounced sedative effect, and monitoring for adverse effects is generally not required beyond usual surveillance.
61
What alternative treatment strategy could be considered for a patient with CIU not responding to a first-generation H1 antihistamine?
An agent from another antihistamine group or a second-generation H1 antihistamine should be considered.
62
What dosing strategy might be necessary for H1 antihistamines in patients with mastocytosis?
Higher doses than normally employed for allergic disorders may be necessary, such as fexofenadine 360 mg in the morning and cetirizine 40 mg at night.
63
What is the potential issue with taking fexofenadine with antacids?
Patients should avoid taking fexofenadine with antacids as this can interfere with drug absorption.
64
What is the next step for a CIU patient not responding to standard doses of second-generation H1 antihistamines?
Doses up to 4 times that normally recommended may be necessary.
65
How does the potency of cetirizine compare to fexofenadine and loratadine?
Cetirizine is more potent than fexofenadine, which is more effective than loratadine in suppressing histamine reactions.
66
How does the potency of desloratadine compare to levocetirizine and fexofenadine?
Levocetirizine and fexofenadine are more potent than desloratadine in suppressing histamine’s effects in the skin.
67
What is the effectiveness of H1 antihistamines in treating chronic idiopathic urticaria (CIU)?
They are effective in treating up to 50% of patients with CIU, angioedema, and dermatographism.
68
What should be considered if an agent from one class of H1 antihistamines proves ineffective?
An agent from another antihistamine group should be considered.
69
How do second-generation antihistamines compare to placebo in treating urticaria and angioedema?
They are superior to placebo in the treatment of urticaria and angioedema.
70
What is the recommended approach for dosing H1 antihistamines in patients with mastocytosis?
Higher doses than normally employed for allergic disorders may be necessary for symptom control.
71
What should patients be advised regarding the intake of fexofenadine?
Patients should avoid taking fexofenadine with antacids as it can interfere with drug absorption.
72
What is the significance of adjusting dosages for special patient populations when prescribing H1 antihistamines?
Certain populations may require dosage adjustments due to varying metabolism and excretion rates.
73
What are the therapeutic endpoints for H1 antihistamine therapy?
They are dictated by improvement in histamine-related signs and symptoms.
74
What is the clinical implication of the sedative effects of first-generation H1 antihistamines?
The sedative effect can impact patient safety and daily functioning.
75
What should be done if symptom control is inadequate with H1 antihistamines?
Dosage may be increased if symptom control is inadequate.
76
What factors may necessitate lower dosages of H1 antihistamines in certain patients?
Individuals with hepatic or renal disease may require lower dosages due to impaired metabolism or excretion.
77
What is the role of H1 antihistamines in the treatment of mastocytosis?
They are commonly used to treat symptomatic mastocytosis patients, often requiring higher doses for symptom control.
78
What should be monitored in patients taking cyproheptadine due to hepatotoxicity concerns?
Periodic liver transaminase evaluation may be recommended.
79
What is the impact of food on the absorption of antihistamines?
Taking the medication with food may alleviate gastrointestinal discomfort.
80
What is the general recommendation for the use of H1 antihistamines in patients with chronic urticaria?
These agents appear to have equal efficacy in treating chronic idiopathic urticaria (CIU).
81
What is the significance of the findings regarding the potency of cetirizine, fexofenadine, and loratadine?
Cetirizine is more potent than fexofenadine, which is more effective than loratadine in suppressing histamine reactions.
82
What should be considered when prescribing H1 antihistamines to elderly patients?
Elderly patients may require dosage adjustments due to altered pharmacokinetics.
83
What is the recommended dosage adjustment for patients with renal impairment taking H1 antihistamines?
Lower dosages may be necessary due to impaired metabolism or excretion.
84
What are the common CNS effects associated with first-generation H1 antihistamines?
Common effects include dizziness, tinnitus, disturbed coordination, and others.
85
How do second-generation H1 antihistamines compare to first-generation in terms of sedation?
Most second-generation agents are low sedating and better tolerated, except for cetirizine and levocetirizine.
86
What are the considerations for using H1 antihistamines in children?
Children may be more susceptible to side effects, and acute poisoning is rare but can occur.
87
What are the considerations for using H1 antihistamines in children?
Many sedating and low-sedating H1 antihistamines can be safely used with appropriate dosing. Children may be more susceptible to side effects like excitation and insomnia, especially with first-generation agents. Acute poisoning is rare but can occur with first-generation agents, leading to hallucinations, ataxia, incoordination, athetosis, and convulsions.
88
What precautions should be taken when prescribing H1 antihistamines to elderly patients?
Caution in those with renal insufficiency, cardiac disease, chronic hepatic disease, and CNS or balance comorbidities. Older individuals may be more susceptible to anticholinergic effects, such as urinary retention, hesitancy, constipation, and postural hypotension.
89
What is the classification of most H1 antihistamines in terms of pregnancy safety?
Most H1 antihistamines are classified as pregnancy category B or category C. Earlier reports linked H1 antihistamines to fetal malformations, particularly cleft palate defects, leading to their avoidance in the first trimester. However, newer studies did not demonstrate an increased risk of congenital malformations with first-trimester exposure to first-generation antihistamines.
90
What are the potential drug interactions with H1 antihistamines?
H1 antihistamines may interact with other drugs metabolized by the hepatic CYP system, such as imidazole antifungals, cimetidine, and macrolide antibiotics. First-generation H1 antihistamines inhibit the hepatic enzyme CYP 2D6 in vitro and are contraindicated for patients receiving monoamine oxidase inhibitors due to potential interference with metabolism.
91
What are the central nervous system effects associated with first-generation H1 antihistamines?
The central nervous system effects of first-generation H1 antihistamines include dizziness, tinnitus, disturbed coordination, inability to concentrate, blurred vision, diplopia, nervousness, irritability, insomnia, and tremor.
92
How do second-generation H1 antihistamines differ in sedation compared to first-generation agents?
Most second-generation H1 antihistamines, except for cetirizine and levocetirizine, are low sedating and better tolerated than first-generation agents. Cetirizine, at doses of 10 mg and 20 mg, occupies 12% and 25% of H1 receptors in the human brain, respectively, indicating some sedation potential.
93
What are the anticholinergic side effects associated with first-generation H1 antihistamines?
Anticholinergic side effects of first-generation H1 antihistamines include dry mucous membranes, urinary retention and hesitancy, postural hypotension, dizziness, erectile dysfunction, and constipation.
94
What are the major features of acute poisoning with first-generation H1 antihistamines in children?
Acute poisoning with first-generation H1 antihistamines in children may present with hallucinations, ataxia, incoordination, athetosis, and convulsions.
95
What is the clinical significance of QT interval prolongation associated with H1 antihistamines?
QT interval prolongation and torsades de pointes are serious but rare cardiac side effects associated with H1 antihistamines. These effects are mediated through blockade of potassium channels unrelated to the H1 histamine receptor, and transient hypotension may develop after rapid intravenous administration.
96
What should be monitored in patients taking H1 antihistamines with prostatic hypertrophy?
Patients with prostatic hypertrophy require close monitoring when taking H1 antihistamines due to the anticholinergic effects that can exacerbate urinary retention and hesitancy.
97
What are the pharmacokinetics of H2 antihistamines?
H2 antihistamines are rapidly absorbed from the GI tract with peak levels occurring between 1 and 2 hours after administration. They are primarily eliminated unchanged through renal excretion, with only 10% to 35% undergoing hepatic metabolism.
98
What are the indications for H2 antihistamines in dermatology?
H2 antihistamines have a limited role in treating dermatologic conditions. They are often used in combination with H1 agents in refractory cases of chronic idiopathic urticaria (CIU) and angioedema.
99
What precautions should be taken when initiating therapy with H2 antihistamines?
When initiating therapy with H2 antihistamines, consider hepatic CYP system inhibition, preferred agents like ranitidine, dosage adjustments for decreased creatinine clearance, and contraindications for cimetidine in patients taking dofetilide.
100
What is the mechanism of action of H2 antihistamines?
H2 antihistamines act as inverse agonists that bind to H2 receptors located throughout the body, including epithelial cells, endothelial cells, and chondrocytes. They also play a role in gastric acid secretion, antigen presentation, cellular recruitment, cutaneous vascular permeability, and the local release of inflammatory mediators.
101
What are the common side effects associated with H2 antihistamines?
Common side effects include drowsiness, malaise, muscular pain, diarrhea, and constipation. Rare reports of granulocytopenia have also been noted.
102
How do cimetidine and ranitidine affect alcohol metabolism?
Cimetidine and ranitidine inhibit alcohol dehydrogenase activity, which can lead to increased blood alcohol levels.
103
What are the potential risks of using H2 antihistamines in immunocompromised individuals?
H2 antihistamines may increase the risk of pneumonia and facilitate oral infections in immunocompromised individuals due to their suppression of gastric acid secretion.
104
What unique adverse effect is associated with cimetidine in men?
Cimetidine can cause gynecomastia and may lead to elevated prolactin levels in men, resulting in loss of libido, impotence, and reduction of sperm counts.
105
What is the FDA pregnancy category for H2 antihistamines?
H2 antihistamines are classified as FDA pregnancy category B drugs, indicating they are generally considered safe for use during pregnancy.
106
What is the potential interaction between cimetidine and warfarin?
Cimetidine increases the serum levels of warfarin, potentially leading to an increased risk of bleeding.
107
What precautions should be taken for elderly patients using H2 antihistamines?
Elderly patients may require a reduction in dosage to accommodate decreased renal function and should have their medication lists carefully reviewed to avoid adverse effects, including increased susceptibility to CNS disturbances such as confusion and dizziness.
108
What are the implications of cimetidine's interaction with warfarin?
Cimetidine increases the serum levels of warfarin, potentially leading to an increased risk of bleeding due to its inhibition of the CYP system.
109
What precautions should be taken when prescribing H2 antihistamines to elderly patients?
Elderly patients may require a reduction in dosage to accommodate decreased renal function and should have their medication lists carefully reviewed to avoid adverse effects, including increased susceptibility to CNS disturbances such as confusion and dizziness.
110
What is the FDA pregnancy category for H2 antihistamines, and what does this imply?
H2 antihistamines are classified as FDA pregnancy category B drugs, indicating that they are generally considered safe for use during pregnancy based on available studies.
111
What are the significant drug interactions associated with ranitidine?
Ranitidine interacts with medications less frequently than cimetidine but can significantly interact with fentanyl, metoprolol, midazolam, nifedipine, theophylline, and warfarin, potentially affecting their efficacy and safety.
112
What is the risk of necrotizing enterocolitis in neonates associated with H2 antihistamines?
Cimetidine and nizatidine are not recommended for children except for reducing gastric acidity, as there is a wide risk of necrotizing enterocolitis in neonates when using these medications.
113
How do famotidine and nizatidine compare to cimetidine in terms of side effects and drug interactions?
Famotidine and nizatidine are associated with fewer side effects and less inhibition of the CYP system compared to cimetidine, leading to fewer reported drug interactions.
114
What are the common adverse effects associated with doxepin?
The most common adverse effect associated with doxepin is sedation. Additionally, tolerance may develop with regular use.
115
What is the pregnancy category of oral doxepin?
Oral doxepin is classified as a pregnancy category C drug.
116
What is the pregnancy category of topical doxepin cream?
Topical doxepin cream is classified as a pregnancy category B drug.
117
What precautions should be taken when prescribing doxepin to elderly patients?
Elderly patients should be cautioned as they may be more susceptible to anticholinergic effects, including urinary retention and blurred vision.
118
What is the primary use of ketotifen in dermatology?
Ketotifen is primarily used in the treatment of chronic idiopathic urticaria (CIU), physical urticaria, and symptoms associated with mastocytosis.
119
What are the side effects reported with ketotifen?
The side effects reported with ketotifen include sedation and atropine-like effects.
120
What is a significant contraindication for the use of doxepin?
The use of both oral and topical forms of doxepin is contraindicated during breastfeeding.
121
What should be monitored in patients taking doxepin who have underlying depression?
Patients with underlying depression should be closely monitored for signs of suicidal ideation when initiating therapy with doxepin.
122
What is the availability of ketotifen in the United States?
Ketotifen is available in the United States only as an ophthalmic solution.
123
What is the effect of doxepin on intraocular pressure?
Doxepin can cause a sudden increase in intraocular pressure and should not be used in patients with glaucoma.
124
A patient with depression is prescribed doxepin. What precautions should be taken?
Patients with underlying depression should be closely monitored for signs of suicidal ideation when initiating doxepin therapy.
125
A patient with glaucoma is prescribed doxepin. Why is this contraindicated?
Doxepin can cause a sudden increase in intraocular pressure and should not be used in patients with glaucoma.
126
A patient with depression is prescribed a monoamine oxidase inhibitor (MAOI) and doxepin. Why is this contraindicated?
Doxepin should not be used concurrently with monoamine oxidase inhibitors as it may interfere with their metabolism.
127
A patient with systemic pruritus is prescribed doxepin. What is the most common adverse effect?
Sedation is the most common adverse effect of both oral and topical doxepin.
128
A patient with mastocytosis is prescribed ketotifen. What additional properties does this drug have?
Ketotifen is an H1 antihistamine with additional mast cell- and basophil-stabilizing properties.
129
What are the common adverse effects associated with both oral and topical doxepin?
The most common adverse effect is sedation. Additionally, tolerance may develop with regular use.
130
What is the pregnancy category of oral doxepin and its clinical significance?
Oral doxepin is classified as a pregnancy category C drug, indicating that risk cannot be ruled out and it should be used only if the potential benefit justifies the potential risk to the fetus.
131
What precautions should be taken when prescribing doxepin to elderly patients?
Elderly patients may be more susceptible to anticholinergic effects, including urinary retention and blurred vision, and should be monitored closely.
132
What is the significance of doxepin's potency compared to diphenhydramine?
Doxepin is 800 times more potent than diphenhydramine, making it a preferred choice in dermatological treatments for conditions like CIU and physical urticaria.
133
What are the contraindications for using doxepin during breastfeeding?
The use of both oral and topical forms of doxepin is contraindicated during breastfeeding due to potential risks to the nursing infant.
134
What are the potential side effects of ketotifen?
Common side effects of ketotifen include sedation and atropine-like effects. There are no studies on its safety in pregnant or breastfeeding women.
135
What is the primary use of ketotifen in clinical practice?
Ketotifen is used successfully in the treatment of CIU, physical urticaria, and symptoms associated with mastocytosis.
136
What is the classification of doxepin cream in terms of pregnancy category?
Topical doxepin cream is classified as a pregnancy category B drug, indicating that it is generally considered safe for use during pregnancy.
137
What is the clinical significance of H2 receptors in relation to cimetidine?
Cimetidine is known to be more inhibitory of the CYP system, which can lead to significant drug interactions; therefore, alternatives may be preferred in certain situations.
