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71 Cards in this Set
- Front
- Back
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Management of asthma
pg 899 |
*Measuring lung function (FEV, FCV, PEF)
*Classification of Severity *Treatment Goals: reducing impairment & reducing risk *Chronic drug therapy *Acute drug therapy & EIB *Reduce exposure to allergens and triggers |
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Allerigic Rhinitis
pg 907 |
S/S: sneezing, runny nose, itching, nasal congestion, conjunctivitis, sinusitis, asthma. Triggered by airborne allergens, IgE antibodies releasing inflammatory mediators. Seasonal or perennial. Drug therapy: oral antihistamines, intranasal glucocorticoids, and sympathomimetics
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Antihistamines for Allergic Rhinitis: benadryl, claritin, zyrtec, allegra, astelin, patanase, ect pg 908
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Oral/Nasal. Block H1 receptors, decrease itching, sneezing, and rhinorrhea, do not reduce congestion. Adverse: sedation with anticholinergic effects, (dry mouth, constipation) bitter taste
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Intranasal Glucocorticoids:
Flonase, Nasonex, beclomethasone, flunisolide, ciclesonide pg 908 |
Nasal. Prevent inflammatory response to allergens and reduce all symptoms. Adverse: nasal irritation, possible slowing of linear growth in children
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Intranasal Cromolyn
pg 909 |
Nasal. Prevents release of inflammaotyr mediators from mast cells, decrase all symptoms, benefits modest. Adverse: None
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Sympathomimetics (Decongestants): phenylephrine, Sudafed, Naphazoline, Afrin, Tyzine
pg 909 |
Oral/Nasal. Activate vascular alpha 1 receptors and cause vasoconstriction, reduces nasal congestion, do not decrease sneezing, itching, or runny nose. Adverse: restlnessness, insomnia, increased BP, rebound nasal congestion, hemorrahgic stroke, abuse
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Anticholinergics
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Nasal. Block nasal cholinergic receptors and reduce secretions. Adverse: nasal drying and irritation
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Antileukotrienes in allergic rhinitis
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Oral. block leukotriene receptors, reduce nasal congestions. Adverse: none
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Opioid Antitussives
pg 912 |
Supressive cough. Most used codeine and hydrocodone, act in the CNS to elevate cough threshold. Can suppress respiration, significant potential for abuse (antitussive mixture lower potential)
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Nonopioid Antitussives
pg 912 |
Dextromethorphan: most effective nonopioid cough medicine. Acts in the CNS, can cause euphroia, abuse, does not depress respiration, can reduce pain. Others: diphenhydramine, benzonatate (tessalon)
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Expectorants & Mucolytics
pg 912 |
Expectorants: renders cough more prodcutive by stimulating the flow of respiratory tract secretions, ex: guafenesin (mucinex)
Mucolytics: reacts directly with mucous to make it more watery, ex: mucomyst and hypertonic saline |
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Cold Remedies
pg 912 |
Common Cold = acute URI of viral origin. Symptomatic treatment, combination drugs based on symptoms present. Not proven that Vit C or zinc can prevent or cure colds.Caution with OTC in young children.
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Peptic Ulcer Disease
pg 915 |
Imbalance of defensive & aggressive factors.
Defensive factors: mucus, bicarbonate, blood flow, prostaglandins. Aggressive factors: helicobacter pylori, NSAIDs, Gastric acid, pepsin, smoking |
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PUD Therapy
pg 916 |
Drugs: Antibiotics, Antisecretory agents, mucosal protectants, antisecretory agents that enhance mucosal defenses, antacids
Nondrug therapy: diet, stop smoking, NSAIDS, ETOH, stress |
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Antibacterial Drugs for PUD:
Amoxicillin, Bismuth, Flagyl, Tetracycline, Tinidazole, Clarithromycin pg 918 |
Action: Eradication of H. pylori
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Cimetidine (Tagament)
Histamine2 Receptor Antagonist pg 919 |
Action: blocks H2 receptors in stomach, reduces volume and hydrogen ion concentration in gastric juice, suppresses basal acid secretion. PO, IM or IV. Therapeutic: Gastric & Duodenal ulcers, GERD, Zollinger-Ellison Syndrome, Aspiration pneumonitis, Heartburn, indigestion, sour stomach. Adverse: antiandrogenic effects, CNS, pneumonia, hypotension, dyrhythmia, candida. Give one hour apart from antiacids. Can elevate theophylline, lidocaine, wargarin, and phenytoin levels.
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Ranitidine (Zantac)
H2 Receptor Antagonist pg 920 |
Action: suppresses secretion of gastric acid by blocking H2 receptors. Adverse: less than tagament, rare CNS, no antiandrogenic effects, increase rx pneumonia, few drug interactions. Uses: same as tagament. Others:famotidine (pepcid) & nizatidine (Axid)
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Omeprazole (Prilosec)
Proton Pump Inhibitor pg 921 |
Action: prodrug, active drug causes irreversible inhibition of H+ and K+ ATPase, the enzyme that generates gastric acid, inhibit basal and stimulated gastric release. Uses: short term therapy of duodenal ulcers, gastric ulcers, erosive esophagitis, GERD, limited to 4-8 wks.
Adverse: HA, diarrhea, N/V, gastric CA, Hip Fracture |
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Other Proton Pump Inhibitors
pg 922-923 |
Esomeprazole (Nexium): adverse: nausea, flatulence, abd pain, dry mouth, fracture, pneumonia
Lansoprazole (prevacid): same Rabeprazole (Aciphex): also has antibacterial activity Pantoprazole (Protonix): same |
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Sucralfate (Carafate)
pg 923 |
ACtion: sticky gel that adheres to ulcer crater, creating a barrier to back diffusino of hydrogen ions, pepsin and bile salts. Use: acute and maintenance therapy of duodenal ulcers. Adverse: no known serious, constipation, no systemic effects
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Misoprostol (Cytotec)
pg 923 |
Action: prevents NSAID induced ulcers by serving as a replacement for endogenous prostaglandins
Use: prevention of gastric ulcers caused by long-term therapy with NSAIDs. Adverse: diarrhea, abd pain, spotting, contraindicated during pregnancy (X) |
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Antacids
Amphojel, MOM, Mylanta, ect pg 924 |
Action: react with gastric acid to produce neutral salts or salts of low acidity, decrease destructino of gut wall, can reduce pepsin activity, stimulate productino of prostaglandins
Uses: PUD, prior to anesthesia to prevent aspiration pneumonitis, GERD symptomatic relief Adverse: Constipation, diarrhea, sodium loading, |
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Antacids
4 Major Groups |
Aluminum Compounds
Magnesium Compounds Calcium Compounds Sodium Compounds Others |
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Bulk-forming laxatives:
Methylcellulose, psyllium, polycarbophil pg 931 |
Action: Absorb water, softening and enlarging fecal mass, fecall swelling promotes perstalsis, act on small intestine and colon, safe effect as dietary fiber. Indication: temporary tx of constipation, IBS, diverticulosis, ileostomy/colostomy. Adverse: esophageal obstruction, intestinal obstruction/impaction, drink full glass of water/juice
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Surfactant Laxatives:
Docusate sodium, docusate calcium |
Action: softens stool by facilitating penetration of water, secretion of water and electrolytes into intestine, acts on small intestine and colon. Produce soft stool several days after tx, give with full glas of water
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Osmotic Laxatives:
magnesium hyroxide/sulfate/citrate, sodium phosphate, polyethylene glycol |
Action: osmotic action retains water, softens feces, fecal swelling promotes peristalsis, act on small intestine and colon. Produce soft or semifluid stool in 6-12 hours, high doses 2-6 hours. Adverse: loss of water, dehydration, increased mag levels, fluid retention, renal failure.
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Stimulant Laxatives: bisacodyl, senna, castor oil
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Action: stimulates peristalsis, softens feces by increasing secretion of water and electrolytes into the intestine and decreasing water and electrolyte absorption. Bisacodyl and Senna act on colon, castor oil acts on small intestine. Produce semifluid stool within 6-12 hours. Uses: tx of opioid induced constipation, tx of constipation resulting from slow intestinal transit
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Misc. Laxatives
pg 930 |
Lubiprostone: acts on small intestine & colon; opens chlorid channels in the intestinal epithelium, increases intestinal motility and secretion of fluid into the lumen, IBS, Preg Cat C
Mineral Oil: colon; lubricates and reduces water absorption Glycerin suppository: colon; lubricates, reflex recal contraction Lactulose: colon, similar to osmotic laxatives Polyethylene glycol electrolyte solution (Go-Lytely): small intestine/colon; similar to osmotic diuretics |
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Serotinine Antagonists
Ondasetron (Zofran) |
Uses: chemotherapy, radiation, postoperative. Action: blocks serotonin receptors on vagal afferents and in the CTZ. Adverse: HA, diarrhea, dizziness
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Glucocorticoids as an antiemtic: dexamethasone (decadron) & Solu-medrol
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Use: chemotherapy. Action: unknown
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Substance P/Neurokinin1 Antagonists: Aprepitant (Emend)
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Use: Chemotherapy. Action: blocks receptors for substance P/neruokin1 in the brain. Adverse: fatigue, asthenia, hiccups, dizziness, liver injury
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Dopamine Antagonists:
Prochlorperazine (compazine) |
Use: chemotherapy, post-operative, general antiemetic
Action: blocks dopamine receptors in the CTZ Adverse: EPS, anticholinergic, hypotension, sedation. Haldol: adverse: prolonged QT. Reglan: prokinetic agent |
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Benzodiazepines as antiemetics: lorazepam (ativan)
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sedation, suppresion of anticipatory emesis, anterograde amnesia, conctrol EPS by phenothiazine antiemetics
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Cannabinoids Dronabinol (Marinol)
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Use: Chemotherapy. Action: unknown, probably activate cannabinoid receptors associated with the vomiting center. Adverse: dissociation, depersonalization, dyphoria, tachy, hypotension, drowsiness, abuse potential
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Anticholinergics as antiemetics: scopolamine
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use: motion sickness. Action: blocks muscarinic receptors in the pathway from the inner ear to the vomiting center. Adverse: dry mouth, blurred vision, drowsiness, urinary retention, constipation, disorientation
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Antihistamines as antiemetics: dimenhydrinate(dramamine)
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Use: motion sickness. Action: blocks H1 receptors and muscarinic receptors in the pathway from the inner ear to the vomiting center. Adverse: sedation, dry mouth, blurred vision, urinary retention, constipation
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Nonspecific Antidiarrheal Agents: Opioids
pg 941 |
Most effective antidiarrheal agents, decrease intestinal motility, slow intestinal transit, decreases secretinos of fluid into the small intestine and increases absorption of fluid and salt, fluidity and volume of stools are reduced. Diphenoxylate: used only for diarrhea, given in combo with atropine (Lamotil), low abuse potential. Loperamide (Immodium): structual analong of meperidine, little to no abuse potential
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Other Nonspecific Antidiarrheals
pg 942 |
Pepto-Bismol: prevention and tx of mild diarrhea, may blacken stools or tongue
Bulk forming agents: give stool more firm, less watery consistency Anticholinergic Antispasmodics: atropine, relieve cramping but undesirable S.E. of bluured vision, dry mouth, tachy ect |
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Management of Infectious Diarrhea
pg 942 |
usually caused by e.Coli, self limiting, for severe symptoms may give antibiotics :cipro, levoflxacin, azithromycin. Mild symptoms: loperamide, however may prolong infection. Avoid local drinking water and wash local foods
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NonSpecific Drugs for IBS
pg 943 |
*Antispasmodics (hyoscyamine, dicyclomine)
*Bulk-forming agents *Antidiarrheals *TCAs |
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Alosetron (Lotronex)
pg 943 |
SEVERE IBS-D in Women only. Action: selective blockade of serotonin receptors, decreases abdominal pain, increase colonic transit time, reduce intestinal secretions, increase absorption of water and sodium, incrase stool firmness, decrease fecal urgency and frequency. Adverse: constipation (obstruction, impaction, perforation), ischemic colitis, NOT for pt's with constipation, potentially fatal GI toxicity, patient physician agreement required
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Lubiprostone (Amitiza)
pg 944 |
Uses: IBS- C in women only. Benefits modes, can reduce abdominal pain and discomfort, chronic idiopathic constipation in women and men. Action: promotes secretions of chlorid-rich fluid into intesetinal lumen, enhances motility of small intestine and colon. Adverse: take with food and water to avoid nausea.
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Tegaserod (Zelnorm)
pg 944 |
Action: partial agonist of type 4 serotonin receptors, decrease visceral sensation, increase GI motility and secretions, reduce bloating, constipation, abd pain, benefits take one month to develop. Use: short term therapy of IBS-C and CIC in women, restricted by manufacturer to emergency situations. Adverse: severe diarrhea, cardiovascular events, stroke, MI, ischemic colitis. Contraindicated for women with cardiovascular disease, renal impairment, hepatic impairment, bowel obstruction, gallbladder disease ect
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5-Aminosalicylates:
sulfasalazine, mesalamine, olsalazine, and balsalazide pg 945 |
Used to treat mild or moderate ulcerative colitis and Crohn's disease, and to maintain remission after symptoms have subsided. reducing inflammation, suppression of prostaglandin synthesis and suppresion of inflammatory cells. Adverse: nausea, fever, rash, arthralfia, hematologic disorders, monitor CBC.
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Glucocorticoid for IBD:
(dexamethason, budesonide) pg 945 |
Relieve symptoms of ulcerative colitis and Crohn's disease, anti-inflammatory actions, induction of remission not long-term maintenance. Adverse from prolonged: adrenal suppresion, osteoporosis, infection, cushingoid syndrome. Budesonide: less systemic effects, extensive first pass metabolism
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Immunosuppressants in IBD:
(Azathiprine, Mercaptopurine, Cyclosporine) pg 946 |
Long-term therapy of selected pt's with ulcerative colitis and Crohn's disease. Induce and maintain remission, not for acute monotherapy. Sever S.E. pancreatitis and neutropenia, bone marrow suppression. Cyclosporine: acts faster, acute/severe disease, can rapidly induce remission, Adverse: renal impairment, neurotoxicity, immune system suppression
Methotrexate: short term remission |
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Immunomodulators in IBD:
Infliximab, Certolizumab, adalimumab, natalizumab pg 947 |
monoclonal antibody products that modulate immune responses, 2nd line agents for IBD, now recommended earlier in tx to induce remission quickly and maintain remission longer. all have serious side effects
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Antibiotics for IBD:
Metronidazole (Flagyl) Ciproflxacin (Cipro) pg 947 |
Can help control symptoms in patients with mild or moderate Crohn's disease, not effective against ulcerative colitis. Long-term therapy required with flagyl.
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Metoclopramide (Reglan)
Prokinetic Agent pg 947 |
Action: supresses emesis by blocking receptors for dopamin and serotinin in the CTZ, increases GI motility by enhancing the actions of acetylcholine.
Uses: supress postoperative N/V, emesis associated with chemotherapy, radiation therapy, toxins, and opioids, diabetic gastroparesis, suppresion of GERD. Adverse: sedation and diarrhea, tardive dyskinesia, prolonged use should be avoided. contraindicated with obstruction, hemorrhage, GI perf. Cisapride: fatal cardiac dysrhytmias |
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Palifermin (Kepivance)
pg 948 |
first drug approved for decreasing oral mucositis, currently indicated only for patient with hematologic malignancies. Action: acts through KGF receptors, stimulates proliferation, differentiation and migration of epithelial cells in buccal mucosa. Adverse: rash, erythema, edema, taste changes, discoloration of tongue, vision changes. Interaction: heparin. Given IV bolus, 6 doses = $10,000
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Pancreatic enzymes
pg 949 |
Given in deficiency: pancreatectomy, CF, pancreatitis, obstruction of pancreatic duct. Pancreatin and Pancrelipase. Given with every meal and snack. Adverse: diarrhea, nausea, cramping
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Drugs used to dissolve gallstones
pg 949 |
Chenodiol (Chenix): reduces hepatic production of cholesterol, lower cholesterol content in bile, gradual dissolution of gallstones, only radiolucent stones, not radiopaque (high calcium content). Adverse: diarrhea, liver injury, monitor liver function, preg cat X.
Ursodiol (Actigall): analong of Chenodiol, adverse effects rare, Preg cat B |
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Vitamin A (retinol)
pg 952 |
Actions: adaptation to dim light, embryogenesis, spermatogenesis, immunity, growth, maintaining structural/functional integrity of the skin and muscous membranes. Deficiency: night blindness, xerophthalmia, skin lesions. Toxicity: teratogenic, hypervitaminosis A, liver injury, increased ICP, jaundice, bone damge. Uses: prevention or correction of deficiency
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Vitamin E (Alpha-Tocopherol)
pg 953 |
Actions: kno known role in metabolism, antioxidant actions, protects against peroxidation of lipids, high doses lead to increased mortality. Deficiency: rare, inborn deficiency of alpha TTP, malabsorption syndromes, S/S ataxia, areflexia, muscle hypertrophy. Benefits: may reduce risk of colds in elderly, may dealy progression of age related macular degeneration. Risks: bleeding, high doses = death
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Vitamin D
pg 953 |
Regulating metabolism of calcium and phosphorus. Deficiency: rickets in children and osteomalacia in adults, increase rx of breast CA, colorectal CA, type 1 DM, falls, overall mortality
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Vitamin K
pg 953 |
Action: required for synthesis of prothrombin and three other clotting factors: VII, IX , and X, neede for coagulation of blood. Deficiency: bleeding tendencies, spontaneous hemorrhage, common with malabsortion syndromes (CF, celiac disease), given to newborns immediately after delivery, anticoagulant to warfarin. Adverse: hypersensitivity rxns, hyperbirubinemia.
Uses: correction of hypoprothrombinemia/bleeding caused by vitamin K deficiency, control of hemmorrhage caused by overdose with warfarin |
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Vitamin C (Ascorbic Acid)
pg 957 |
Actions: synthesis of adrenal steroids, conversino of folic acid to folinic acid, regulation of the respiratory cycle of mitochondria, production of collagen, antioxidant, absorption of dietary iron. Deficiency: scurvy, rare in U.S. S/S: faulty bone and tooth development, gingivitis, bleeding gums, poor wound healing, ecchymoses. Adverse: nausea, abdominal cramps, diarrhea. Use: prevention and treatment of scurvy, intensity or duration of common cold maybe slightly reduced, does not promote healing of wounds
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Niacin (Nicotinic Acid)
pg 958 |
Actions: lowers cholesterol levels, essential for cellular respiration. Deficiency: pellagra, rough skin/dermatitis. Adverse: low toxicity, flushing, dizziness, nausea. Uses: prevention or treatment of niacin def, high doses can lower cholesterol levels
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Riboflavin (Vitamin B2)
pg 958 |
Actions: coenzyme for multiple oxidative reactions. Toxicity: devoid of toxicity to humans. Use: only for prevention and correction of def, migraine headaches. Deficiency: sore throat and angular stomatitis, glossitis, dematitis.
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Thiamin (Vitamin B1)
pg 959 |
Action: essential coenzyme for carbohydrate metabolism, requirements increase during preg/lact. Def: beriberi, wet vs dry, Wernicke-Korsakoff syndrome in alcoholics. Adverse: none. Use: treatment and prevention of def
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Pyridoxine (Vitamin B6)
pg 959 |
Action: coenzyme in metabolism of amino acids and proteins. Deficiency: seborrheic dematitis, anemia, neuritis, convulsions, depression, confusion, rare except amg alcoholics, isoniazid may induce def, inborn def. Adverse: large doses neurologic injury, numbness, ataxia
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Cyanocobalmin (Vitamin B12) and Folic Acid
pg 959 |
Esssential factors in the synthesis of DNA. Deficiency of either manifests as megaloblastic anemia. B12 def produces neurlogic damage. Def of folic acid during pregnancy can impair development of CNS resulting in neural tube defects, anecephaly and spina bifida. ALL women who may become pregnant should consume folate. Folic acid protects against colorectal CA
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Sibutramine (Meridia)
pg 965 |
Use: promoting and maintaining weight loss in combo with reduced-calorie diet, BMI>30. Action: suppressing appetite, blockade of serotonin and norephinephrine reuptake, antidepressant actions. Adverse: HA, dry mouth, constipation, CNS, insomnia, nervousness, anxiety, low potential for abuse, can elevate BP, increase HR. Interactions: serotonergic agents, MAOIs, Sympathomimetics, Cyt P450. Need to show weight loss of 4 lbs in first month.
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Orlistat (Xenica, Alli)
Lipase Inhibitor pg 966 |
Acts in the GI tract to reduce absorption of fat, absorption of dietary fat reduced by 30%, reduced calorie diet with 30% calories from fat, modest but sustained benefits, reduced LDL, increased HDL, lowered BP. Adverse: GI- oily spotting, flatulence, fecal urgency, fatty stools, fecal incontinence, can dose with metamucil, take multivitamin 2 hrs before or after taking drug. Contraindicated in malabsorption syndrome or cholestasis.
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MISC Appetite Suppressants
pg 967 |
*Sympathomimetic Amines (diethylpropion, phentermine, phenylpropanolamine, amphetatmines)
*Bupropion (Wellbutrin) *Fluoxetine (Prozac) *Topiramate & Zonisamide: antisezure drugs *Dexfenflurarmine (Redux) & Fenfluramine (Pondimin)- damage heart valves |
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Investigational Weight-Loss Drugs
pg 969 |
*Rimonabant (Acomplia), effective weight loss, high risk of depression
*Leptin: only in individuals that can't make leptin themselves |
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Sugar & Fat Substitutes
pg 968 |
Sugar: Saccahrin, aspartame, sucralose, acesulfame, neotame, tagatose
Fat: Olestra (Olean), calorie free fat substitue |
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Histamine
pg 821 |
*Synthesized and stored in mast cells and basophils
*Released from mastcells and basophils by allergic mechanisms *H1 Stimulation: vasodialtion, increased capillary permeability, bronchoconstriction, CNS effects, itching, pain, secretions of mucus. *H2 Stimulation: secretion of gastric acid *Mild allergy response at H1 receptors, NOT involved in anaphylaxis response! |
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H1 Antagonists
Classic Antihistamines 1st & 2nd gen pg 822 |
Action: block actions of histamine1, can also block muscarininc receptors. Pharm effects: reduces itching and pain, suppresses secretion of mucus, CNS depression, anticholinergic effects.
Uses: Mild Allergy, seasonal allergic rhinitis, motion sickness, insomnia, common cold, severe allergy (limited). Adverse: sedation (1st gen), dizziness, confusion, fatigue, paradoxical excitation occurs, GI, anticholinergic (dry mouth, urinary hesitancy, constipation, palpitations). Interactions: CNS depressants. Avoid in preg/lact. Toxicity: like atropine poisoining, tx= drug removal and symptom management |
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H1 Antagonists Drugs
First Generation pg 825 |
*Aklylamines-- Brompheniramine
*Ethanolamines-- diphenhydramine (benadryl) *Phenothiazines-- promethazine (phenergan) *Piperazines--hydroxyzine (vistaril) *Piperidines-- cyproheptadine *Sedation can be a significant problem, significant anticholinergic properties |
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H1 Antagonists Drugs
Second Generation pg 825 |
Drugs: Azelastine (astelin), Cetirizine (Zyrtec), Levocetirizine (Xyzal), Fexofenadine (Allegra), Lratidine (Claritin), Desloratadine (Clarinex).
*Non-sedating *devoid of anticholinergic actions |
