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71 Cards in this Set

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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
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
Antihistamines for Allergic Rhinitis: benadryl, claritin, zyrtec, allegra, astelin, patanase, ect pg 908
Oral/Nasal. Block H1 receptors, decrease itching, sneezing, and rhinorrhea, do not reduce congestion. Adverse: sedation with anticholinergic effects, (dry mouth, constipation) bitter taste
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
Intranasal Cromolyn

pg 909
Nasal. Prevents release of inflammaotyr mediators from mast cells, decrase all symptoms, benefits modest. Adverse: None
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
Anticholinergics
Nasal. Block nasal cholinergic receptors and reduce secretions. Adverse: nasal drying and irritation
Antileukotrienes in allergic rhinitis
Oral. block leukotriene receptors, reduce nasal congestions. Adverse: none
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)
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)
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
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.
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
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
Antibacterial Drugs for PUD:
Amoxicillin, Bismuth, Flagyl, Tetracycline, Tinidazole, Clarithromycin
pg 918
Action: Eradication of H. pylori
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.
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)
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
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
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
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)
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,
Antacids
4 Major Groups
Aluminum Compounds
Magnesium Compounds
Calcium Compounds
Sodium Compounds
Others
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
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
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.
Stimulant Laxatives: bisacodyl, senna, castor oil
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
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
Serotinine Antagonists
Ondasetron (Zofran)
Uses: chemotherapy, radiation, postoperative. Action: blocks serotonin receptors on vagal afferents and in the CTZ. Adverse: HA, diarrhea, dizziness
Glucocorticoids as an antiemtic: dexamethasone (decadron) & Solu-medrol
Use: chemotherapy. Action: unknown
Substance P/Neurokinin1 Antagonists: Aprepitant (Emend)
Use: Chemotherapy. Action: blocks receptors for substance P/neruokin1 in the brain. Adverse: fatigue, asthenia, hiccups, dizziness, liver injury
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
Benzodiazepines as antiemetics: lorazepam (ativan)
sedation, suppresion of anticipatory emesis, anterograde amnesia, conctrol EPS by phenothiazine antiemetics
Cannabinoids Dronabinol (Marinol)
Use: Chemotherapy. Action: unknown, probably activate cannabinoid receptors associated with the vomiting center. Adverse: dissociation, depersonalization, dyphoria, tachy, hypotension, drowsiness, abuse potential
Anticholinergics as antiemetics: scopolamine
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
Antihistamines as antiemetics: dimenhydrinate(dramamine)
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
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
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
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
NonSpecific Drugs for IBS
pg 943
*Antispasmodics (hyoscyamine, dicyclomine)
*Bulk-forming agents
*Antidiarrheals
*TCAs
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
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.
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
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.
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
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
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
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.
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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.
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.
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
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
Sugar & Fat Substitutes

pg 968
Sugar: Saccahrin, aspartame, sucralose, acesulfame, neotame, tagatose
Fat: Olestra (Olean), calorie free fat substitue
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!
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
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
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