Histamine and corticosteroids Flashcards by Nicholas Poovey

Q

Name all 5 first generation Histamine type 1 receptor blockers

A

Diphenhydramine 
Meclizine
Hydroxyzine
Promethazine
Chlorpheniramine

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Q

Name all three 2nd generation type 1 histamine receptor blockers

A

Loratidine
Ceterizine
Fexofenadine

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Q

Drug type

Diphenhydramine

A

Histamine type 1 receptor blocker first generation

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Q

Drug type

Meclizine

A

Histamine type 1 receptor blocker first generation

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Q

Drug type

Hydroxyzine

A

Histamine type 1 receptor blocker first generation

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Q

Drug type

Promethazine

A

Histamine type 1 receptor blocker first generation

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Q

Drug type

Chlorpheniramine

A

Histamine type 1 receptor blocker first generation

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Q

Drug type

Loratidine

A

Histamine type 1 receptor blocker second generation

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Q

Drug type

Ceterizine

A

Histamine type 1 receptor blocker second generation

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Q

Drug type

Fexofenadine

A

Histamine type 1 receptor blocker second generation

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Q

(Side) effects of 1st generation Histamine Type 1 receptor blockers

A

anti-hypersensitivity (allergy)
anti-emetic (motion sickness)
sedative effects (from crossing BBB)
anti-vertigo effects
reduced salivation

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Q

most common indication for Type 1 Histamine receptor blocker 2nd generation?

A

Day time allergies

also rhinitis; runny nose, combined with decongestants and acetaminophen

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Q

Main uses/indications for Histamine Type 2 antagonists

A

PUD peptic ulcer disease
GERD
Prophylaxis against stress ulcers in critically ill pts
(reduces gastrin and gastric acidity)

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Q

the 4 Histamine type 2 Receptor antagonists

A

Famotidine
Ranitidine
Nizatidine
Cimetidine

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Q

Adverse effects of Cimetidine

A

Gynecomastia

many drug-drug interactions

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Q

Adverse effects of all H2 receptor antagonists

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A

Dose adjustments in renal insufficiency
CNS side effects (confusion, dizziness)
Increase risk of pneumonia in hospitalized pts (cuz lower acidity in stomach so bacteria can survive easier)

Q

Overall physiological functions of corticosteroids

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A

Increase blood glucose (gluconeogenesis, counteracting with insulin)
Increase sodium and water retention
Down regulates the immune response

Q

2 major types of exogenous corticosteroids, function and an example of each

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A

Glucocorticoids; Anti-inflammatory- Dexamethasone

Mineralocorticoids; Sodium and water retention (increase BP)- Hydrocortisone

Q

Main function of Hydrocortisone

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A

Increase BP via Na and water retention

Q

Main function of Dexamethasone

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A

Anti-inflammatory

Q

Indications for Mineralocorticoids

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A

Critically ill pts with suppressed Hypothalamus Pituitary Adrenal axis
Hypotension and hemodynamic instability; septic shock

Q

How do glucocorticoids achieve their anti-inflammatory nature? (mechanisms)

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A

Inhibit T cell and B cell proliferation
Inhibit leukocyte production
Inhibition of capillary permeability to leukocytes
Inhibit prostaglandin production (key in inflammatory response)

Q

Methylprednisolone, Hydrocortisone, Prednisone, Dexamethasone. List in order from least to greatest in terms of anti-inflammatory activity.

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A

Hydrocortisone
Prednisone
Methylprednisolone
Dexamethasone

Q

Indications for Glucocorticoids?

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A

Autoimmune diseases
(rheumatoid arthritis, Sjogrens, post-transplantation, anaphylactic rxns, asthma, allergic rhinitis, traumatic injuries and inflammation, shock and critically ill pts)
Post dental treatment; i.e. removal of impacted 3rds (trismus)

Key points about Sjogrens Syndrome

Mostly appears ages 45-55 10x more common in women ~50% of pts have Rheumatoid arthritis or other autoimmune disorders

Management of dry mouth (categories and examples)

Salivary substitutions; Carboxymethylcellulose, Glycerin Muscarenic agonists; Pilocarpine, Cevimeline Steroids; Prednisone Salivary stimulation; sugar free gum or lozenges Drink water

``` Name the dosage and timing of each for surgery: submucosal injection of dexamethasone Intramuscular injection of dexamethasone oral/IV methylprednisolone pure oral methylprednisolone ```

SM dex= 4mg 1 hour before surgery IM dex = 4mg at time of surgery Oral/IV methyl= 16 mg PO 12 hours before and 20mg IV immediately before surgery pur Oral methyl= 32 mg + 400 mg ibuprofen 12 hours before and 12 hours post surgery

Steroid adverse effects; cardiovascular

``` Hypertension; water and Na retention inhibition of prostaglandin synthesis increase renal excretion of potassium (hypokalemia) (pt should be put on K supplement) short term effect reversible ```

Steroid adverse effects; infections

increase risk of infection because of impaired cell mediated immunity. Especially with prednisone 20-40mg/day Bacterial, fungal and viral infections

Steroid adverse effects; GI

GI perforations, fistulas; esp with prednisone Oropharyngeal and esophageal candidiasis (must rinse mouth after use) Peptic ulcer disease (due to inhibition of prostaglandin synthesis, cumulative prednisone dose of 1000mg and risk factors of concurrent NSAIDs

Mechanism for steroid induced osteoporosis

decrease Ca GI absorption Increase Ca renal excretion Decrease androgen and estrogen production Inhibition of osteoblast proliferation Inhibition of osteocytes proliferation and induction of apoptosis Stimulation of osteoclasts bone resorption (pt should take Ca and Vit D supplements) Greatest effects in first 6 months. When taking doses greater than 7.5 mg/day, including inhaled steroids

steroid adverse effects; Ophthalmic

Glaucoma: Most common; betamethasone, dexamethasone; moderate: prednisone; mild: hydrocortisone Cataract (long-term prednisone use)

steroid adverse effects; Dermatologial

Acne (usually disappears after discontinuation) Cutaneous and subcutaneous atrophy Delayed wound healing Mycosis (mucosal, skin, nail fungal infection)

Long term use of steroids can lead to what disease?

Cushing syndrome