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Pharm2 Mod 3: pulmonary > chronic rhinitis, cough and cold medications > Flashcards

chronic rhinitis, cough and cold medications Flashcards

1
Q

what is an antitussive

A

substance that suppresses cough

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2
Q

what are centrally acting antitussive

A

dextromethophran
opiates

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3
Q

what are locally acting anti-tussives

A

benzonatate

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4
Q

what is the MOA for dextromethophan

A

crosses the BBB and activates sigma opioid receptors on the cough center in the CNS (Medulla), thereby suppressing the cough reflex
does not affect ciliary activity (in the bronchial tree)

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5
Q

what are the indications for dextromethorphan

A

short-term relief of cough

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6
Q

what are the interactions with dextromethophan

A

avoid co-use with MAOIs and in SSRI/SNRI - can cause serotonin syndrome

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7
Q

what are the adverse drug effects with dextromethophan

A

mild and infrequent dizziness and drowsiness
at very high doses (when used recreationally) can cause hallucinogenic state
serotonergic effects

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8
Q

what are the contraindications for dextromethorphan

A

avoid in chronic cough
avoid in hepatic disease
avoid when operating machinery

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9
Q

what is the MOA for codeine

A

supress cough reflex centrally (though evidence does not necessarily suppport this)
dries bronchial secretions
often co-administed with guaifensesin (expectorant)

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10
Q

what are the indications for codeine use

A

short term relief of cough

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11
Q

what are the interactions with codeine

A

conver to morphine in liver via cytochrome P450
concomitant use of opiates leads to sedation and respiratory depression

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12
Q

what are the adverse effects of codeine

A

tolerance
respiratory depression
sedation
n/v
potential for abuse
pruritus

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13
Q

what are the contraindications for codeine

A

illeus
respiratory depression
head injury
seizures
hepatic failure

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14
Q

what is the MOA for benzonatate

A

anesthetizes the stretch receptors of vagal afferent fibers in the lungs, reducing the urge to cough after deep inhalation; periphally-acting

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15
Q

what are the interactions with benzonatate

A

can be additive to other local anesthetics

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16
Q

what are the indications for benzonatate

A

mostly for relief of chronic cough, but sometimes used for acute cough (with variable success)

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17
Q

what are the adverse effects of benzonatate

A

well tolerated, GI upset, local anesthesia from chewing
overdoses - cardiac arrhythmias, seizure, bronchospasm

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18
Q

when are benzonatate contraindicated

A

avoid in allergy to ester anesthetics

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19
Q

what is the MOA of guaifenesin

A

loosens secretions to allow for more productive cough - increases volume and reduces viscosity of phlegm in trachea/bronchi
cilia can then more easily propel/mobilize secretions upward

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20
Q

what are the indications for guaifenesin

A

treatment of acute cough

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21
Q

what are the contraindications for guaifenesin

A

should not be used for chronic cough
avoid in pediatrics; can lead to seizures in this population

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22
Q

what are the adverse effects of guafenesin

A

rare at recommended doses
excessive use can result in nephrolithiasis

23
Q

what are histamines

A

produced by mast cells and basophils
released by an immunologic trigger or following a mechanical or chemical stimulus

24
Q

how many receptors do histamines have

A

4 different types but only two are pharmacologically important

25
Q

where are H1 receptors located

A

smooth muscle cells. endothelium and brain

26
Q

where are H2 receptors located

A

gastric mucosa mast cells, immune cells and brain

27
Q

what are the general effects of histamine

A

local vasodilation
transudation of fluid through endothelial cells
stimulates nerve endings, producing pain and itching

28
Q

what are organ-specific effects of histamine

A

lung - bronchoconstriction
GI tract: contraction of smooth muscle, potent secretagogue for gastric acid secretion, pepsin and intrinsic factor
brain - neurotransmitter

29
Q

what are first generation antihistamines

A

diphenhydramine (Benadryl) and hydroxyzine (vistaril or atarax)

30
Q

what are the second generation antihistamines

A

cetirizine, loratadine and fexofenadine

31
Q

when should first generation antihistamines be avoided

A

elderly - it may cause delirium, dizziness, urinary retention

32
Q

what is the use for cetirizine

A

crosses BBB a little, little drowsiness but better for itching, hives

33
Q

what are the pharmacokinetics of first generation antihistamines

A

act quickQ6h
sedating
hydroxyzine can be used as an anxiolytic agent

34
Q

what are the pharmacokinetics of second generation antihistamines

A

24 hour non-drowsy formulation

35
Q

what is the MOA for pseudoephedrine

A

sympathomimetics, alpha and beta 2 adrenergic receptor agonist
- direct stimulation of alpha-adrenergic receptors of respiratory mucosa causes vasoconstriction and of beta-adrenergic receptors causes bronchial relaxation
reduces tissue hyperemia and edema
reduces nasal congestion and opens blocked eustachian tubes

36
Q

what is pseudoephedrine indicated for

A

decongestant: acute nasal congestion, sinusitis, otitis media

37
Q

what are the adverse effects of pseudoephedrine

A

increases HR and contractility
contraindicated in patients with heart disease, severe HTN or uncontrolled DM

38
Q

what is the chemical precursor to the manufacture of methamphetamine

A

pseudoephedrine

39
Q

what is the MOA for phenylephrine

A

binds primarily to alpha1 receptors, causing vasoconstriction

40
Q

what are the indications for phenylephrine

A

decongestant: nasal decongestant
less effective for treatment of rhinitis symptoms than pseudoephedrine

41
Q

what are the pharmacokinetics of phenylephrine

A

oral or intranasal

42
Q

what are the AE of phenylephrine

A

increases systolic and diastolic pressure - induces reflex bradycardia

43
Q

what are the interactions with phenylephrine

A

ACE inhibitors, CCBS can increase clearance, making less effective
interaction with MAOIs, TCAs can increase concentration

44
Q

what are the common oral decongestatns

A

pseudoephedrine
phenylephrine

45
Q

what is oxymetazoline

A

afrin - topical decongestant
appropriate for treating acute rhinitis

46
Q

what are the pharmacokinetics of oxymetazoline

A

long acting form (~12 hours per spray)
dosed twice daily for max of 3 days

47
Q

what are the AE of oxymetazoline

A

longer duration of use can lead to rebound congestion

48
Q

what is the MOA for inhaled nasal fluticasone

A

glucocorticoid receptor agonist - causes vasoconstriction and inhibitory effects of cells and mediators of inflammation

49
Q

what are the indication for inhaled nasal fluticasone

A

treatment and prevention of allergic rhinitis; treatment of chronic nasal polyps
not indicated for treatment of acute upper respiraotry infections

50
Q

what are the adverse effects of inhaled nasal fluticasone

A

epistaxis
pharyngitis
systemic absorption of steroid is possible

51
Q

what are the available inhaled antihistamines

A

azelastine and olopatadine - intranasal administration

52
Q

what are the indications for inhaled antihistamines

A

indicated for allergic rhinitis in adults and children > 12

53
Q

what are side effects of inhaled antihistamines

A

nose bleeds, headaches are possible side effect
somnolence, poor taste

Pharm2 Mod 3: pulmonary (2 decks)

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