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Flashcards in Pharm 4 Resp pt2 Deck (25)
1

TOPICAL Nasal Decongestants causes ___, resulting in (3)

Causes vasoconstriction, resulting in
Nasal mucosa shrinkage
Promotes drainage
Ultimately, improving breathing through the nasal passages

2

Topical nasal decongestants compared to oral preparations.

Topical has reduced effects compared to oral: achieving decongestion without extreme changes in BP, cardiac stimulation, or vascular redistribution

3

Prototypical SEDATING Oral Antihistamines
Example
Indications
Routes of administration (3)

Diphenhydramine HCl (Benadryl®)
Indications: upper respiratory allergies; rhinorrhea, sneezing 2o common cold
PO, IM, or IV

4

Sedating Oral Antihistamines Contraindications, Precautions, Side Effects

*Makes you drowsy. It's the active ingreident in any medication that makes you drowsy.
Contraindicated in neonates, nursing moms
Caution in asthma, lower respiratory tract infections, glaucoma, hyperthyroidism, hypertension, GI or urinary obstruction
Pregnancy not recommended (Cat. B in 3rd trimester)
Potentiates CNS depression with ETOH, potentiates anticholinergic effects with MAOIs

5

What would you give to kids with : seasonal allergic rhinitis, perennial allergic rhinitis, chronic episodic urticaria?

Cetirizine HCl
It’s purple and grape flavored. This is what you’d give to kids.

6

Prototypical Low-Moderate Sedating Oral Antihistamines
Example
Indications

Cetirizine HCl
Indications: seasonal allergic rhinitis, perennial allergic rhinitis, chronic episodic urticaria

7

Mod-Low Sedating Oral Antihistamines Contraindications, Precautions, Side Effects

Contraindicated in hydroxyzine sensitivity
Caution in hepatic or renal dysfunction, nursing mothers
Pregnancy Cat. B
Potentiates CNS depression w/ ETOH, large doses of theophyline may decrease cetirizine clearance
Somnolence, fatigue, dry mouth, dizziness

8

Prototypical Non-Sedating Oral Antihistamines
Example
Indications

Fexofenadine (Allegra®)
Indications: allergic rhinitis, chronic episodic urticaria

9

Prototypical Non-Sedating Oral Antihistamines-Decongestants
Example
Indications

Fexofenadine/Pseudophedrine HCl (Allegra-D®)
Indications: seasonal allergic rhinitis with nasal congestion

10

Non-Sedating Oral Antihistamine - Decongestants Contraindications, Precautions, Side Effects

Contraindicated in narrow-angle glaucoma, urinary retention, severe hypertension or CAD, during or within 24 hrs. of MAOIs
Pregnancy Cat. B
Nursing mothers: not recommended
Avoid use in hepatic insufficiency, DM, hypertension, ischemic heart disease, prostatic hypertrophy, GI or urinary obstruction, hyperthyroidism, increased intraoccular pressures, seizure disorders, elderly > 60 yoa

11

Antihistamines also have the following effects to a variable degree: (3)

Anticholinergic (drying)
Antipruritic
Sedative

12

What do I do in patients that need rly good control of poison ivy pruritis?

Hydroxyzine

13

Antihistamines Contraindications, Precautions, Side Effects

Asthma
Glaucoma
Hyperthyroidism
Hypertension
GI or urinary obstruction or retention
Pregnancy: not recommended (Cat. B in third trimester
Drowsiness
Dizziness
Anticholinergic effects
Gastritis
Paradoxical excitement
Potentiates CNS depression with alcohol

14

What is Paradoxical excitement

one side effect of Antihistamines.
can happen in kids. Asthmatics who also get beta-agonists. The kid is running around like a monster after getting benedryl.

15

Prototypical Intranasal Steroids
Example
Indication

Fluticasone propionate
Indications: seasonal and perennial allergic and non-allergic rhinitis

16

Intranasal Steroids Contraindications, Precautions, Side Effects

Headache
Nasal irritation and dryness or congestion
Epistaxis
Sneezing
Throat discomfort
GI upset
Pregnancy Cat. C

17

the primary ingredients in most antitussives (2).
What do they do to the body?

Codeine and dextromethorphan
both act on the cough center of the medulla to suppress cough by ELEVATING THE COUGH THRESHOLD

18

What is Dextramethorphan compared to codeine?

Dextromethorphan is the d-dimer isomer of codeine, but lacks the analgesic and addictive properties of codeine
Codeine works more effectively (5x) more effectively than dextromethorphan.
Robotripping: kids drink lots of Robotissum on the way to school, and hallucinate.

19

Prototypical Non-Narcotic Antitussives
Example
Indication

Benzonatate
Indications: cough

20

Non-Narcotic Antitussives Contraindications, Precautions, Side Effects

Contraindicated with or within 14 days of MAOIs
Nursing mothers
Pregnancy Cat. C
Sedation, headache, dizziness, GI disturbance, pruritis, skin eruptions, nasal congestion

21

Prototypical Narcotic Antitussives
Example (2)
Indication

Hydrocodone bitartrate, homatropine methylbromide
Indications: cough
This is now a Schedule 2 cough syrup antitussive. It’s kind of like Vicodin as a cough syrup.
These will stop your cough, and make you loopy. The dosing depends on what the patient needs for their job/lifestyle.

22

Narcotic Antitussives Contraindications, Precautions, Side Effects

Glaucoma
Head injury, increased ICP
Respiratory impairment
Elderly, debilitated
GI, urinary obstruction
Acute abdomen
Nursing mothers
Pregnancy Cat. C
Potentiates CNS depression w/ ETOH
Increased toxicity of TCAs, MAOIs
Respiratory depression
Sedation, drowsiness
GI disturbances
Orthostatic hypotension

23

Prototypical Oral Expectorants
Example
Indication

Guaifenesin (Robitussin®)
Indications: cough, bronchitis

24

A tsp contains how much fluid?

5 ml aka 5 cc

25

Expectorants Contraindications, Precautions, Side Effects

Precaution in ASTHMA**, Pregnancy not recommended, GI disturbance, headache, rash