Pharm 2

Front 1

common cold aka

Back 1

Rhinovirus

Front 2

Acute rhinitis

Back 2

Acute inflammation of the nasal mucosa

Etiology -Pollen or foreign substance ie seasonal allergies.

Front 3

Sinusitis

Back 3

inflammation of 1 or more of the sinus tracts.

Front 4

Acute pharyngitis

Back 4

sore throat

Front 5

4 Classifications of medications used to treat the symptoms associated with the common cold, allergic rhinitis, or sinusitis:

Back 5

• Antihistamines
• Nasal and systemic decongestants
• Antitussives
• Expectorants

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histamine 1 which is responsible

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for smooth muscle contraction

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histamine 2- which is responsible

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for increasing gastric acid secretions

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First-generation antihistamines Side effects:

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drowsiness, dry mouth, etc.

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Second-generation antihistamines are

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Nonsedating antihistamines; little to no effect on sedation

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Action of antihistamines:

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Decrease nasopharyngeal secretions, nasal itching, and tickling that cause sneezing

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anticholinergics are

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bronchodilators

Front 12

Nasal and Systemic Decongestants action

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Stimulates the alpha-adrenergic receptors, causing vascular constriction of capillaries

Shrinks nasal mucous membranes and decreases nasal fluid secretions

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antihistamines CAUSES WHAT KIND OF EFFECTS

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anticholinergic

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Systemic decongestants Examples:

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ephedrine, phenylephrine, and pseudoephedrine

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Intranasal Glucocorticoids Used to treat

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allergic rhinitis

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Antitussives Purpose:

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act on cough center in the medulla

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Expectorants Purpose:

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To loosen bronchial secretions

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Restrictive lung disease

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decreased lung compliance.

Air is not able to get into the lungs due to some reason

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Chronic bronchitis, bronchiectasis, emphysema caused from

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Cigarette smoking, chronic lung infections, etc.

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Bronchial asthma is from

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genetic, allergies to mites, dust, etc.

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Chronic asthmatic attack treated with

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beta-adrenergic agonists

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Anticholinergics

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New anticholinergic drug: Ipratropium bromide (Atrovent)
Action: dilates bronchioles
Administration: aerosol inhaler

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Methylxanthines (Xanthine Derivatives) are

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bronchodilators “too keep a person stable

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Theophylline Action:

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relaxes smooth muscles of the bronchi, bronchioles, and pulmonary blood vessels

inhibits the enzyme phosphodiesterase, thus increasing cyclic AMP, promoting bronchodilation

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Leukotriene Receptor Antagonists/Inhibitors is

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bronchodilator “keeps stable”

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Glucocorticoids (steroids) Action:

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antiinflammatory effect

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Cromolyn and Nedocromil use

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Prophylactic treatment of bronchial asthma ONLY!

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MUCOLYTICS Action

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liquefies and loosens thick mucus secretions

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Dornase alfa (Pulmozyme) for clients with

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cystic fibrosis to break up the DNA causing thick tenacious secretions.

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Bronchial asthma Characteristic symptoms:

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dyspnea
bronchoconstiction/spasms
increased mucous secretions
wheezing

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Bronchial asthma Pathophysiology

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 Allergens attach themselves to mast cells and basophils

 Resulting in antigen-antibody reaction—stimulating

 Chemical mediators, i.e., histamines, leukotrienes, etc.

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 Factors contributing to bronchoconstriction:

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cyclic adinosene monophosphate {cAMP} which normally promotes bronchodilation in the lung tissues, is now impaired, so constriction occurs.

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MUCOLYTICS Method of administration:

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administer 5 minutes after a bronchodilator

Acetylcysteine (Mucomyst) nebulizer

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MUCOLYTICS Also used as an

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antidote for acetaminophen overdose but is given po in this scenario.

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 Dornase alfa (Pulmozyme)

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for clients with cystic fibrosis to break up the DNA causing thick tenacious secretions.

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# of common colds per year for adults & children

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Adults 2-4/year.
children-up to a dozen/year

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Symptoms of common cold

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Nasal congestion,
nasal discharge (Rhinorrhea)
cough
increased mucosal secretions

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Sinusitis treatment

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Treatment- treat symptoms- over the counter pain relievers, extra fluids

Antibiotics if lasts > 1 week or with other symptoms such as T > 101, or yellow/green secretions.

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Treatment Acute pharyngitis

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Treatment: saline gargles, antibiotics with bacterial infection

Take to dr. if T> 101, or cannot swallow saliva. Need to be checked for poss. Strep infection.

Front 41

Chlorpheniramine maleate; diphenhydramine (Benadryl) have same side effects as

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first generation histamines

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diphenhydramine aka

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diphenhydramine (Benadryl)

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Second-generation antihistamines examples

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Cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin), azelastine (Astelin)

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New anticholinergic drug:

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Ipratropium bromide (Atrovent)

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anticholinergic Action:

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dilates bronchioles and dries up *causes CANTS*

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anticholinergic Administration:

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aerosol inhaler

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Systemic decongestants Side effects and drug interactions

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- can cause systemic reaction and affect BP and HR- watch client closely if has existing problem.

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Don’t overuse as this can cause a rebound effect and worsen the symptom.

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Systemic decongestants

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Will cause nosebleeds and have possibility of increasing glucose levels if used long-term.

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Intranasal Glucocorticoids

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Intranasal Glucocorticoids Examples:

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Beclomethasone, fluticasone (Flonase), triamcinolone (Nasacort)

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causes body to slow production of cortisol to slow so a person needs to be tapered off of this steroid to keep blood sugar regulated

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Intranasal Glucocorticoids

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Only use on dry, “tickly” cough, not on productive cough.

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Antitussives

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Expectorants Active ingredient:

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Guaifenesin products

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Expectorants Nursing implications-

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don’t give at night; encourage extra fluids po to thin secretions.

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Chronic bronchitis, bronchiectasis, emphysema Characteristic symptoms:

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Dyspnea (trouble breathing), bronchoconstriction, and increased mucus secretions

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Acute asthmatic attack Treated with

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Sympathomimetic-first line of defense-These drugs mimic the sympathetic nervous system-will excite everything.

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Sympathomimetic for Acute asthmatic attack increases

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cyclic AMP; bronchodilation results

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emergency treatment for acute asthmatic attack

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Epinephrine (adrenaline), for emergency- given SQ (such as epi-pen) or IV **ACTS FAST**

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Epinephrine (adrenaline) Restores

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circulation and increases airway patency

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Epinephrine (adrenaline) Side effects:

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heart palpitations, hypertension

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Nonselective adrenergic agonist:

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Isoproterenol (Isuprel), 1941, beta1- and beta2-agonist

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Nonselective adrenergic agonist Effects:

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increased heart rate and bronchodilation

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Selective beta-adrenergic agonist:

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Metaproterenol (Alupent), 1961; see Drug Chart 41-1, beta2-agonist (some beta1)

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Selective beta-adrenergic agonist Effects:

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bronchodilation; some increase in heart rate but will get better as body adjusts to med.

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Other common selective beta-adrenergic agonists are

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albuterol (Proventil), pirbuterol acetate (Maxair), terbutaline (Brethine)

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Methods of administration for albuterol (Proventil), pirbuterol acetate (Maxair), terbutaline (Brethine)

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usually either nebulizer or MDI (metered dose inhaler)

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Methylxanthines (Xanthine Derivatives)- Action:

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stimulates the CNS and respiration, dilates coronary and pulmonary vessels, causes diuresis

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Theophylline therapeutic index

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Has narrow therapeutic index.

Therapeutic serum level: 10 to 20 µg/mL; toxic level: >20 µg/mL (Know symptoms of toxicity!)

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Theophylline side effects & aversion

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GI disturbances, nervousness, irritability, cardiac dysrhythmias, tachycardia, palpitations, hyperglycemia

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Leukotriene is

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a chemical mediator that normally causes an inflammatory response; the inhibitor will limit the response, stoping the inflam. process

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Leukotriene Action:

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reduce inflammatory process and decrease bronchoconstriction

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Leukotriene Drugs:

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zafirlukast (Accolate), zileuton (Zyflo), Singulair

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Methods of administration Glucocorticoids (steroids)

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beclomethasone Aerosol inhaler
triamcinolone (Aristocort) Tablet
dexamethasone (Decadron) injection

*Watch glucose levels

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Cromolyn and Nedocromil Action:

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Antiinflammatory effect and suppresses the release of histamine (prevents inflammation )

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the chemoreceptor trigger zone is influenced by

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dopamine and responds mostly due to inner ear problems, drugs, or toxins put into the body.

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The Vomiting Center is influenced by

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acetylcholine

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The Vomiting Center usually triggered by

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smells, tastes, and GI “bugs”.

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Nonpharmacologic measures for treating vomiting include

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first letting the GI tract rest.

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if non-pharmacologic measures don’t work for vomiting use

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Nonprescription antiemetics

OTC (over the counter) meds:

Phosphorylated carbohydrate solution aka Emetrol. ***don't use in diabetics high sugar **

Bismuth subsalicylate- PeptoBismol

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Prescription Antiemetics include the following: used if not responding to OTC meds.

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Anticholinergic
Prescriptive antihistamines
Dopamine antagonists-
Serotonin receptor antagonist
Glucocorticoids
Cannabinoids

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Dopamine antagonists High doses=

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antipsychotic

Causes extrapyramidal symptoms in high doses (mimic Parkinsons disease; will discuss more in Unit 5) or if client has underlying problem that allows medication to remain in body and “stack”

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Emetics- will induce

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forceful vomiting! Always check with Poison Control FIRST!!

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Don’t’ induce vomiting if

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ingesting a caustic substance such as gasoline, kerosene, bleach- can cause more harm “on way up”

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Causes of diarrhea may include

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spicy/spoiled food, fecal impaction, bacteria, virus, malabsorption problems, lax. abuse, irritable bowel syndromes, or tumors.

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diarrhea treatment Nonpharmacologic measures

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such as letting stomach rest; BRAT diet when food reintroduced (Bananas, Rice, Applesauce, Tea/Toast).

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Purpose of antidiarrheals

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to add bulk to the stool.

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Types of antidiarrheals

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Opiates and opiate
Immodium-Lomotil

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Somatostatin analog- octreotide (Sandostatin) for

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severe diarrhea

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Adsorbents- Kaopectate, - will

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will coat GI tract and decrease diarrhea

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Antidiarrheal combinations- such as lactobacillus helps to

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restore natural floura & slows peristalsis

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Laxatives- 4 types

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osmotics, bulk forming, stimulants, and emollients.

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Osmotic (saline) laxatives do

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- pulls water into colon.

watch pt. if has hx. of cardiac or renal disorders because of the heavy electrolyte base in them

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Stimulant (contact) laxatives- work by

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irritating intestinal walls.

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Bulk-forming- work by

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absorbing water into intestine and increasing peristalsis.

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Emollient (stool softeners) laxatives- promotes

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softening of the stool-

Don’t use in children or anyone at risk of aspiration as can cause lipid pneumonia

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CONTRAINDICATIONS for laxatives:

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Inflammatory disorders of the GI tract, Appendicitis, Diverticulitis, Ulcerative colitis, Spastic colon, Bowel obstruction, Pregnancy (can induce labor)

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ANTIULCER DRUGS

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 Tranquilizers & Anticholinergic- drugs not used often.
 Antacids- neutralize pH- made of 3 diff bases Al, Ca, and Mg
 Systemic antacids- calcium- watch levels- can build and cause Milk-Alkali syndrome (elevated Ca+, crystalluria, and renal failure; sodium bicarb (baking soda)- can cause heart irreg.
 Nonsystemic antacids-
1. Aluminum and Calcium based can cause CONSTIPATION.
2. Magensium based can cause DIARRHEA (remember milk of magnesia also used as laxative)
 Aluminum hydroxide (Amphojel)- used on renal pts. to help decrease phosphate level.
 Calcium carbonate (Tums)
 Dihydroxyaluminum sodium (Rolaids)
 Magaldrate (Riopan)
 Magnesium hydroxide- (don’t use Mg+ on renal pts. they can’t break it down) and aluminum hydroxide (Maalox, Mylanta)

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ANTIULCER DRUGS Nursing Implications

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- take on empty stomach with 2-4 oz. water (enough to reach stomach but not alter absorption); don’t give with other meds: 1 hr. before or 2 hrs. after meds

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Histamine2-Blockers- block the

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increase in acid secretion

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Histamine2 ex:

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 Cimetidine (Tagame), Rantidine (Zantac), Famotidine (Pepcid) More potent than cimetidine, and rantidine Nizatidine (Axid)

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Histamine2 Lab effects:

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Tagamet increases BUN, creatinine, and alkaline phosphatase (ALP)

Front 102

Histamine2 Drug interactions –

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theophylline, calcium channel blockers for HTN, dilantin

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Proton Pump Inhibitors (PPIs)- suppress

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gastric acid production. “little purple pill”

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 Types of PPIs

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 Omeprazole (Prilosec)
 Lansoprazole (Prevacid)
 Rabeprazole (Aciphex)
 Pantoprazole (Protonix)
 Esomeprazole (Nexium)

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Prostaglandin Analogue- suppresses

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gastric acid production and increases cytoprotective action.

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Misoprostol (Cytotec) – Causes

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Labor *will abort fetus DON’T use if pregnant!!

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Miotics: used to

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lower intraocular pressure of open-angle glaucoma .

Will constrict pupil. SE h’ache, brow pain- apply pressure to inner canthus to prevent systemic reaction. Antidote for systemic rx. Is Atropine EX- Pilocarpine

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Carbonic Anhydrase Inhibitors is a

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miotic

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Mannitol (Osmitrol) osmotics

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emergency treatment to rapidly decrease intraocular pressure.

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Prostaglandin Analogs – will increase

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brown pigment

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MyDriatices do & se

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dilate the pupils-

SE are brow pain, h’aches- Treat overdoses with Physostigmine

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 Cycloplegics: paralyze

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the muscles of accommodation

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 Drugs for Disorders of the Ear

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 Antibacterials- for ear infections
 Antihistamine/decongestants- added to help drain fluid
 Ceruminolytics- removal of ear wax.

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 Administration of ear medications

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 Adult- pull ear back and up
 Children- pull ear back and down

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Antiacne drug preparations are

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–very harsh on liver

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Antiacne drug type & se

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Topical: tretinoin (Retin-A)-sun sensitivity

Systemic: isotretinoin (Accutane) don’t get pregnant-severe fetal anomalies, tetracycline (no dairy products; sun sensitivity; don’t take < 8 yrs old or if pregnant as will cause permanent staining of teeth as they are forming; discard when expired)

Side effects: skin irritation (tretinoin), thrombocytopenia, hematuria (isotretinoin)

Front 117

Psoriasis Drug preparations

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Topical: anthralin, coal tar, tazarotene – can stain clothing
Systemic: biologic agents, methoxsalen, etretinate

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Biologic agents also used to boost individual’s own immune system.

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 Alefacept (Amevive)
 Efalizumab (Raptiva)
 Etanercept (Enbrel)
 Infliximab (Remicade)
 Adalimumab (Humira)

Front 119

Verruca Vulgaris (Warts)-

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horny nodules most commonly on hands and feet. Is virus. Contagious though!

Front 120

wart removal

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burning, freezing, duct tape!, topical removers (salicylic acid products)

Front 121

Stevens-Johnson syndrome

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(severe blisters all over body)

Front 122

 Penicillins most common cause of drug induced

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dermatitis.

Front 123

Contact/exogenous Dermatitis

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chemical or plant poison ivy/oak/sumac

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Drug induced Dermatitis

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–allergic reaction; can be mild rash or severe anaphylactic reaction.

Front 125

 Drug therapy for dermatitis

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 Topical- hydrocortisone
 Systemic- EX- antihistamines such as Benadryl; steroids as last resort

Front 126

 Drugs for hair loss- are

Back 126

vasodilators- Watch BP closely (for hypotension)!
 minoxidil (Rogaine)
 finasteride (Propecia)
 SE are headaches, hypotension

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 Degrees of burns-

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1st degree- epidermis
 2nd degree- epidermis and lower dermis
 3rd degree- epidermis, dermis, and underlying nerves and tissue damage.

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burn tx

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 Cool compresses to 1st degree and some 2nd.
 Pain meds will be needed for 2nd & 3rd degrees
 Watch electrolytes with severe burns. Will learn more about them in 4th term.

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 Topical drugs for burns –

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Sulfamylon and Silvadene