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36 Cards in this Set

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antitussives
demulcent
expectorants
What are used to treat coughs and mucus?
Narcotic antitussives
Nonnarcotic antitussives
What are the different types of antitussives?
prevent coughing

should NOT be used indiscriminately; only when cough is nonproductive and is exhausting patient or is very painful.
What are the therapeutic uses for antitussives?
Antitussives
Caution

COPD, asthma, chronic bronchititis, emphysema, bronchiectasis, cystic fibrosis (congenital disease with dysfunction of exocrine glands in lung causing overproduction of viscid mucus.
secondary
Use of antitussive is ___________ to treatment of source of cough. Example: in some asthmatics, cough is primary symptom - would use a bronchiodilator before an antitussive.
Narcotic antitussive
codeine etc

mech of action

depresses cough center in medulla of CNS
Narcotic antitussive
Side effects and cautions

potential for abuse

constipation
depresses respiration
cause drug dependency
Nonnarcotic antitussives
fewer GI symptoms (usually)

Mechanism of action

1. some are peripherally acting - reduces activity of lung stretch receptors, or benzocaine, a topical anesthetic whose usefulness has not been established.

2. may act centrally as do the narcotics, but do not have a narcotic side effects DEXTROMETHORPHAN - half as potent as codeine, no prescription necessary = an isomer of codeine that has no analgesic or additive properties
Nonnarcotic antitussives

lung
anesthetic
DEXTROMETHORPHAN
analgesic
fewer GI symptoms (usually)

Mechanism of action

1. some are peripherally acting - reduces activity of ____ stretch receptors, or benzocaine, a topical _________ whose usefulness has not been established.

2. may act centrally as do the narcotics, but do not have a narcotic side effects _____________- half as potent as codeine, no prescription necessary = an isomer of codeine that has no ___________ or additive properties
Demulcents
agents with a soothing effect (gargles, lozenges, syrups, even steam treatment)
agents with a soothing effect (gargles, lozenges, syrups, even steam treatment)
Define demulcents.
Drugs that increase secretion of mucus in bronchi or modify it to reduce viscosity.
Define Expectorants.
Antitussives
Demulcents
Expectorants

Other drugs effecting mucus:
Mucolytic
Mucomyst
Ethanols
Diluents
Dornase
What are ALL of the drugs that treat coughs and mucus?
adrenergic agents
Better than antihistamines for colds, useful for allergy stuffiness too
nasal vasoconstriction
What is the mechanism of action for adrenergic agents in treating nasal congestion?
habituation occurs
What is the caution for adrenergic agents in treating nasal congestion?
antihistaminics
Good for allergy, may help relieve cold symptoms
Intranasal steroids
For allergy. May increase risk of thrush and prevent healing of damaged nasal mucosa.
Adrenergic agents
Antihistaminics
Intranasal steroids
What are the names of the drugs groups that for nasal decongestion?
habituation occurs
What is the caution for adrenergic agents in treating nasal congestion?
antihistaminics
Good for allergy, may help relieve cold symptoms
Intranasal steroids
For allergy. May increase risk of thrush and prevent healing of damaged nasal mucosa.
Adrenergic agents
Antihistaminics
Intranasal steroids
What are the names of the drugs groups that for nasal decongestion?
all over the body
Where are H1 receptors found?
only found in the stomach
Where are the H2 receptors found?
histamine
1. Contraction of bronchial and intestinal smooth muscle H1 receptors.
2. Dilation of arterioles and capillaries and increases permeability - also mediaated by H1 receptors.
3. Increases gastric acid secretion - mediated by H2 receptors.
general approaches to therapy
1. produces opposite effects as histamine (epinephrine), i.e. good for counteracting symptoms of reaction that has occurred. Only minor effect on histamine release.

2. Histimine antagonists to prevent histamine reaction, i.e. compete with histamine for H1 or H2 receptor sites.
epinephrine
histamine
Histimine antagonists
1. produces opposite effects as histamine (___________), i.e. good for counteracting symptoms of reaction that has occurred. Only minor effect on ___________ release.

2. __________ ___________ to prevent histamine reaction, i.e. compete with histamine for H1 or H2 receptor sites.
H1 antagonists
these are the classical "antihistamines"

First generation types bind both centrally and peripherally. They are MORE sedating but also more useful as a sedative, for motion sickness, or in special cases for treating Parkinson's.

Second generation types caes less drowsiness. Note, however, that these newer agent can produce adverse cardiovacular effects.
H1 antagonists
Therapeutic uses

1. Antagonize allergic reactions (hives, watery eyes, stuffy nose -- but NOT asthma!) - prevent more symptoms from occuring, but less effective than epinephrine at counteracting reaction that has already occurred. Mechanism: Besides preventing action of histamine, acts as mild sedative so more able to ignore distressing symptoms.

2. Motion sickness - appear to depress CNS and decrease sensivity of inner ear. Not very effective at contolling nausea of other origins.
asthma
less
histamine
decrease
Therapeutic uses

1. Antagonize allergic reactions (hives, watery eyes, stuffy nose -- but NOT _______!) - prevent more symptoms from occuring, but _____ effective than epinephrine at counteracting reaction that has already occurred. Mechanism: Besides preventing action of ________, acts as mild sedative so more able to ignore distressing symptoms.

2. Motion sickness - appear to depress CNS and ________ sensivity of inner ear. Not very effective at contolling nausea of other origins.
Side effects

H1 antagonists
due to chemical similarity to some antipsychotics and to atropine

1. Antipsychotic-like - drowsiness, sedation, dizziness. In others may cause agitation and hallucinations. Higher therapeutic doses are usually sedating.

2. Antimuscarinic (atropine-like - dryness of mouth, blurred vision
Cautions

H1 antagonists
1. Potentiate other sedative-hypnotics, tranquilizers, and alchol
2. Avoid use in asthmatics (drying of bronchiole secretions) - recall from respiration notes that the asthma prophylactic CROMOLYN prevent the release of histamine by blocking degreanulation of mast cells. A similar agent lodoxamide is marketed in eye solutions for eye allergies. Neither agent is an antihistaminic that competes for H1 receptor sites.

3. Do periodic blood tests (check for blood dyscrasias)
H2 antagonists
block a second type of histamine receptor

These are not antihistamines as we know them.

nothing to do with allergy, has to do with stomach acid.
H2 antagonists
Therapeutic uses

1. decrease gastric secretion (ulcer patients)
2. unapproved use - to treat heartburn
H2 antagonists
Side effects

sedation
diarrhea
muscle pain
rash
dizziness
inhibits p450 enzymes, so decreases metabolism of other drugs in liver.
breast enlargement in men
mental confusion