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108 Cards in this Set

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bromocriptine and cabergoline
DA agonist- inhibit the release of prolactin.
used to prevent breast tenderness and lactation
cabergoline every other day & less side effects than bromocriptine.
SE= usu, orhtostatic hypo, and psych disturbances.
Somatropin and Somatrem
(native rhGH) and same with more methionine at amino terminus
GH agonist-
used for growth failure in kids (turner's) and cachexia in AIDS pts., GI function in those w/ short bowel syndrome
SE= edema (reduces with Tx time), myalgia, hyperglycemia & hypothyroidism.
Contra in DM and hypothyroidism or until 1 yr after leukemia Tx.
Mecasermin/ Mecasermin rinfabate
recombinant human IGF-1 (not as effective as GH Tx)
Use: those unresponsive to GH therapy (IGF-1 deletion or GHr mutation or antibodies)
inject 2xs/day
SE: hypoglycemia (less with rinfabate; its inactive/bound). other SE sim to GH.
rinfabate not FDA approved, but only need once daily instead of 2xs.
Octreotide
Octreotide

somatostatin analog (somatostatin inhibits hormone secretion) inhibits both pituitary and GI hormones. dec pancreatic and gastric acid and slows intestinal motility.
use: treat acromegaly and excessive diarrhea.
**can shrink tumor
SE: GI, but subside with time,
gallstone and sludge, bradycardia
contra: GB disease, DM, cardiac Dx & thyroid (somatostatin inhibs TSH)
Pegvisomant
Pegvisomant

GH receptor antagonist
Use: Tx of excess GH (acromegaly)= 97% normal IGF-1 levels acheived.
unlike octreotide it won't shrink tumor but actually can make it grow; lack of negative feedback.
inject 1x/day
Insulin- lispro
aspart
glulisine
rapid acting insulins.
can inject IV
clear, neutral pH, zinc to extend shelf life.
SE: usu. use regular insulin to treat ketoacidosis even though these can be given IV.
regular insulin
Fast acting
DOC for ketacidosis
clear at neutral pH
can be given IV
SE: hypoglycemia, lipodystrophy (alternate injection site), edema. interactions with other drugs, visual disturbances, local allergic Rx.
NPH or Isophane insulin
NPH insulin// Isophane insulin

intermediate-acting insulin
turbid suspension at neutral pH
not for IV use
insulin glargine
detemir
both are long acting insulin
glargine is pH4.0 that preciptates in body to last longer
detemir is myristoylated= bind to albumin=inc T1/2
gives a consistent baseline level of insulin
tolbutamide
1st gen sulfonylurea
stims insulin release from beta cells
reduce serum glucagon
safest in elderly-little hypoglycemia
can cause hypoglycemia
some GI effects
Weight gain
contra in renal and hepatic Dx and pts with sulfa allergies
Glyburide
Glimepiride
2nd gen sulfonyureas-more potent
last 24 h= 1x/day
less hypoglycemia than gen 1
Glimepiride most potent & cardioprotective
contra in renal and hepatic pts
Glipizide
2nd gen sulfonylurea
t 1/2 2-3 hrs-least hypoglycemia
ER version last 24 hr but more hypoglycemia
contra in liver and renal pts
Repaglinide
Repaglinide

meglitinide- not sulfa derivative like sulfonylureas= safe in sulfa allgeric pts
less effect on weight
rapid acting- rec on K+= mimics insulin better and increases insulin release
t 1/2= 1h
hypoglycemia
contra: pregnancy, renal pts and those prone to hypoglycemia
Metformin-DOC for type II DM
biguanide
inc insulin action at mus and fat
slows GI absorb of glucose
reduces glucagon and gluconeogenesis
dec macrovasc events
no weight gain
safe in children 10+
lactic acidosis and diarrhea
hypoglycemia when combo w/ sulfonylureas or insulin
contra: preg or breast feeding, lactic acid conditions (renal, hepatic, alcoholic or tissue hypoxia diseases:CHF and COPD)
Pioglitazone
Rosiglitazone
"insulin sensitizers"
PPAR gamma r ligands increase glucose trans into fat cells
can use with metformin but not insulin in type II
can dec LDL and prevent type II
oral 1-2 /day
weight gain and edema
black box on rosiglitazone for MI and angina
contra: CHF pts, hepatic pts and pregnant
Ascarbose
Miglitol
Ascarbose and Miglitol

Alpha-glucosidae inhibitors
reduce glucose absorption
dec postprandial glucose; not fasting
can use w/ metformin or sulfon's
or insulin
no weight gain
flatulence, diarrhea; GI
contra: preg, hep/ren/GI pts
Exenatide
Liraglutide
GLP-1 agonist resistant to DPP-IV degradation
postpran and fasting glucose better control
may inc beta cell #/function
weight loss-slows gastric empty=pt eats less
exan= SC inject b4 2 main meals
lira= 1 SC inject/day
Exenatide; acute pancreatitis and pancreatic and thyroid CA risk(Lira black box)
Sitagliptan
DPP-IV inhibitors
potentiates effects of incretin homones
dec postpran and fast glucose
no weight gain
oral 1/day
acute pancreatitis and risk panc CA
Contra: slow GI pts and preg/BF
Pramlintide
synthetic analog of amylin (amylin works w/ insulin to dec glucose)
slows gastric emptying
suppress glucagon postpran
modulates appetite in CNS
weight loss
SC inject 3/day- must use with insulin in type I and II
SE: GI and hypoglycemia
contra: slow GI pts, preg/BF
Bromocriptine
Bromocriptine
DA agonist- inhibits excessive symp tone=less hepatic glucose production
dec fast.postpran FA and TAGs
reduces cardiovascular end point problems by unknown mec
oral within 2 hr of wake
lower dose and faster peak than bromo used for other indications
usual effects
psych, hallucination & fibrotic complications at higher doses
Glucagon
inc blood glucose when glycogen is available
reg glucos, aa and FA
potent inotropic and chronotropic effects on heart-used in beta block o/d
IM.IV, SC no oral
not as effective in kids or starved, adrenal insufficient or chronic hypoglycemic pts
profound relax of intestines
onset is gradual
Diazoxide
Diazoxide

non-diuretic thiazide, vasodialtor and hyperglycemic
inhibits insulin secretion or dec peripheral glucose utiliaztion
use: pts with insulinoma
oral; duration 24-36 h
SE: hyperglycemia with poss ketoacidosis,Na/h2o retention-->hypotension, excess hair growth in kids
Gonadorelin
Short acting GnRH agonist
not available in US anymore
Use; treat infertility, delayed puberty
SC injection or pumps
SE: less likely to cause ovarian hyperstim then LH or FSH
Leuprolide
Goserelin
Leuprolide and Goserelin
long-acting GnRH agonist
contiunous administration causes intial surge then inhibition of gonadatropin release
Use: prostate CA to reduce androgen, treat precocious puberty
SE: menopausal symp in women, testicular atrophy. initial rise in testosterone in men with prostate CA may cause bone pain (give anti-androgen simultaneously).
contra: preg and BF
Cetrorelix
Cetrorelix
GnRH antagonist
Use: supress endogenous LH and FSH for ART
SC inject
4-5 days vs 3 wks w/ Leuprolide
SE: none, well tolerated
hMG (human menopausal gonadotropins)

Menotropins
FSH drug
Tx: to stim follicle production
contains both FSH and LH.
from urine of postmen women

stimulates the develop of ovarian follicles and spermatogenesis
hCG

from urine of pregnant women
Use: binds to the LH receptor
Longer T1/2 than LH.
rhCG subcut
hCG IM
Ethinyl estradiol
Mestranol
synthetic estrogens- only in OCs
very potent
Use: contraception, decrease uterine bleeding, supress ovulation or excess ovarian androgens or treat adrongen dependent CA (prostate)
SE: Migraines, thromboembolism and blood clots
Contra: estrogen dependent breast CA, thromobotic disorders , smoking.
conjugated equine estrogens
synthetic conjugated estrogens
esterified estrogens
horse
plant estrogens
Use: HRT
same as OC
Diethylstillbestrol
non-steroid with estrogenic activity
primary hypogonadism: pts 11-13 to stimulate puberty and growth
SE: developmental abnormalities to fetus when exposed in utero
Tamoxifen
SERM (selective estrogen receptor modulator)
agonist in uterus and bone
antagonist in breast
Use: Tx estrogen depend breast cancer
SE: inc risk of uterine CA
Raloxifene
Raloxifene

SERM- antagonist in breast and uterus
agonist in bone
Use: prevent postmen osteoporosis
lowers ttl and LDL chol
SE: hot flashes and DVT risk
Fulvestrant
Fulvestrant

full estrogen receptor antagonist
Use: in pts with Tamoxifen resistant tumors
SE: hot flashes
Anastrozole
Aromatase inhibitor
non-steroidal competitive inhib of aromatase
Use: Tx of advanced breast CA in postmen women; Tamox -resistant
SE: menopause sympt
Progesterone
Medroxyprogesterone
Pregane (progest derivaitve)
medroxy-doesn't require inject

Use: OC and prevent enodmetrial hyperplasia in HRT
SE: inc BP, depression and drowsiness,
Norethindrone
estrane- synthetic progest from testosterone
Use: OC and HRT
SE: inc BP and depression
*may reduce plasma HDL
Norgestrel
Gonanes- have selective progestin activity
Use: OC or HRT
SE: inc BP, depression, drowsy
Mifepristone (RU 486)
Progesterone receptor blocker
prevents progestin binding
Use: pregnancy termination, or implantation prevention
antagonizes glucocorticoid receptor
SE: GI and vag bleeding
Contra: pregnancy that want to keep or BF, anemics, pts on glucocorts or anticoags
Danozol
Danozol
Weak progestin,androgen &glucocorticoid that supresses ovarian function
Use: Tx of endometriosis
SE: weight gain, hirsiutism
Contra: liver pts, preg or BF
Drospirenone/ethinyl estradiol (Yaz)
Combo estrogen and spironolactone (progesterone agonist effect).
Use: contraception, water retention and PMDD
SE: drospirenone has some low andronergic effects
Testosterone
Methyltestosterone
anabolic and andronergic
Use: testicular deficiency; pre/post-pubertal hypogonadism
in women in combo with diethystilbestrol for female hypopituitarism
hypoproteinemia of nephrosis and negative nitrogen balance in post-op, burn and premature pts
SE: dec testosterone production/spermatogenesis in men
masculinization in women, psuedohermaphroditism in fetus, oily skin,acne, dec HDL and agression
Flutamide
Flutamide
androgen receptor antagonist
Use: prostate CA (w/leuprolide), topically for hirsuitism and male pattern baldness
SE: mild hepatotox, libido effects
Finasteride
Dutasteride
Finasteride and Dutasteride

Inhibits 5a-reductase (enzyme that converts testosterone to DHT)
Use: Tx of BPH, male pattern baldness
SE: reduces PSA; mask prostate CA?, teratogenic- male fetus abnormalities.
Oxytocin
Use: induce labor at term, prevent post partum hemorrhage
IV,IM or nasal
SE: water intox (ADH-like effects)
uterine rupture(large dose)
anaphylaxis
sinus bradycardia of fetus from extreme uterine contractions
Ergonivine maleate
Ergonivine maleate

activate serotonin and a-andrenergic receptors on smooth muscle
Use: contract uterus after delivery of placenta
action 30 sec after IV, 10 min after oral
Contra: never to induce labor--> fetal hypoxia, hep/ren failure
Dinoprostone
syntehtic prostaglandin E2
Use: induce expulsion of uterine contents(suppository) or cervical ripening prior to delivery(gel)
SE: GI, severe v/diarrhea
contra: fetal distress, Hx of difficult deliveries
MgSO4
relaxes uterine muscle; mech unknown
Use: preterm labor (notFDA) or preeclamptic pts to prevent convulsions
IV-slowly (hypotension or asystole if too fast)
SE: depressed reflexes and causes weakness, circulatory collapse and CNS/resp depression.
Nifedipine
Nifedipine
Ca++ channel blocker
Use: preterm labor (not FDA)
now a 1st line with B2 antagonists not availalbe.
SE: flushing, h/a, hypotension
Indomethicin
Indomethicin
NSAID
Use; preterm labor (not FDA) by reducing prostaglandin synthesis
SE: GI irritation, risk of partial closure of the fetal ductus arteriosus
Progesterone
Use: prophylactically weeks 16-37 to maintain pregnancy- only in high risk women
Nitroglycerin
emergency use only; uterine rupture
contra: in uncorrected hypovolemia, severe anemia, intracranial pressure and cardiac issues
Ethanol
direct relax of myometrium and inhibition of oxytocin
inject 7.5 ml/kg for 2 hrs then 1.5 for up to 10 hrs
Cortisone
Hydrocortisone
equal mineralcorticois and glucocorticoid properties
Use: in pts with adrenal insufficiency
Prednisone
Prednisolone
(prednisone converts to prednisolone in liver)
more glucocorticoid activity than mineral.
Use: anti-inflammatory with salt retaining effects
SE: with long term use: dec immunity, peptic ulcers, dec glucose tolerance, osteoporosis, glaucoma, cataracts, restlessness,CNS effects (occur rapidly after Tx onset), muscle wasting and Na adn water retention, truncal obesity, increase appetite, buffalo hump, adrenal insufficiency if stopped abruptly.
Contra: immune compromised, heart/ HTN pts, osteoporotic pts, first trimester of preg.
Triamcinolone
Methylprednisolone
Triamcinolone and Methylprednisolone

Glucocorticoids
almost no mineralcorticoid acitivity
Use: highest anti-inflamm effects with no Na retaining
SE: usual glucocorticoid effects
Dexamethasone
glucocorticoid
Use: cerebral edema; enters CNS
use when endogenous cortisol levels have to be measured ; no cross react
SE: usual glucocorticoid
Fluticasone
glucocorticoid
Use: inhaled for intranasal to Tx asthma and rhinitis
Aminoglutethimide
corticosteroid inhibitor
inhibits the conversion of cholesterol to pregnenolone= inhibits all steroid synthesis
Use: off market, used for Cushing's meta breast CA and prostate CA unresponsive to other treatments
can cause adrenal insufficiency. must give corticosteroids concomitantly

Inhibits estrogen synth, less effect on testosterone
Ketoconazole
Oral anti-fungal that inhibits steroidogenesis at higher doses (inhibits 17a-hydroxylase)= dec androgens then cortisol.
Use: Cushing's pts before surgery or radiation or long term mgnt.
SE: reversible heptox, gynecomastia, impotence and dec libido
Mitotane
Mitotane
Adrenocorticolytic; selective atrophy of zona fasciulata/reticularis of adrenal gland.
not in US
Use: primary adrenal carcinoma, instigate remission of Cushing's
SE: severe GI
Conra; inc met of phenytoin and warfarin
Metyrapone
Metyrapone

inhibits terminal enzyme in cortisol synth.
*request compassion use from Novartis
Use: short term symptomatic until Cushing's determined
*only one in class OK for pregnant
SE: GI, hirsuitism
less toxicity than mitotane
Mifepristone RU486
antagonist of progesterone receptor and at high doses glucocorticoids
Use: abortions and inoperable ectopic ACTH secretion and adrenal carcinoma
SE: gut pain, amenorrhea
Spironolactone
K+ sparing diuretic that at high doses has anti-andronergic effects.
Use: HTN, Hirsuitism and ascites
SE: hyperkalemia, gynecomastia and menstrual irregularities
Levothyroxine Na+
Liothyronoine Na+
Levo=Na+ salt of T4; DOC
Lio= Na+ salt of T3;works faster, but not for maintenance
Use: hypothyroidism, Hashimoto's, thyrotropin-dependent carcinoma
SE: hyperthyroidism, palpatations, tachycardia, weight loss, insominia, heat intolerance
Methimazole (DOC)
Propylthiouracil
inhibits synthesis of thyroid hormone
Use: DOC for Grave's; if used before radioactive iodine= less chance of thyroid storm.
PTU- black box for severe liver injury/failure.
SE: itching,rash,granulocytopenia and agranulocytosis, sore throat.
low dose in pregnancy to prevent goiter and cretinism
Iodide
decreases synthesis of T3 and T4. and rapid dec in thyroid hormone release.
used prior to surgery because dec vascularity of gland.
prevents uptake of radioactive iodine
SE: effects wear off after 6-8 weeks; not long term Tx.
Radioactive Iodine
becomes trapped in gland and beta rays destroy the gland.
Use: hyperthyroid in elderly and those w/heart Dx for thyroid ablation
low doses diagnostic
SE: hypothyroidism
Propranolol
B-blocker
Use: reduce s/s of hyperthyroidism and dec peripheral conversion of T4 to T3
not a monotherapy; given w/ thiomides
Contra: pts with COPD or asthma, caution in DM; can use Ca+ channel blockers if propranolol is contraindicated
Calcitonin
hormone that antagonizes action of PTH and inhibits bone reabsorb of Ca+ and phosphate by osteoclasts
Use: prevent vert compression fractures
Intranasal or inject
SE: allergic Rx, rhinitis and sinusitis w/ intranasal form, n/v
Teriparatide
Teriparatide

recombinant PTH (new Tx for ostoeporosis)
only anabolic osteoporisis Tx, but effects diminish w/time; use on ly 18-24 mos.
hypoparathyroidism
SE: osteosarcoma (black box), inc serum Ca= and dec serum phos
contra: open epiphysis , radiation therapy
Denosumab
Denosumab
human monoclonal antibody against RANK lligand (RANK-l needed for maturation of osteoclast)
inc bone mass and strength in cortical and trabecular bone
Use: severe osteoporisis,
SE: hypocalcemia, cellulitis
Contra: hypocalcemia; fix this 1st
Alendronate (Fosamax)
Bisphosphonate-oral binds Ca+ salts and substitutes phosphate molecule forming a complex that inhibits bone breakdown and resorption
SE:GI irritation, n/v (must take 2 hrs before b-fast,
osteonecrosis of jaw following dental work.
Contra: pts with esophageal Dx, pts who can't stay upright for hour.
Ca+ supplement that day will inhibits it's absorb
Zoledronic acid
Pamidronate (off label)
IV- Bisphosphonates
Use: DOC for osteoporosis
administer once every 3 mos or once/yr
may require coadmin of Ca+ and Vit D during therapy
SE: renal tox if administered too fast
Aluminum Hydroxide
Magnesium Hydroxide
(Maalox)
inorganic bases
neutralize gastric acid
often combined due to opposing actions of diarrhea(Mg) and constipation(Al).
SE: systemic absorption of Al, Mg and Ca if renal impaired.
* can interfere with absorb of sulfonamides, valproic acid and L-dopa, dec bioavail of phenytoin and digitalis.
increase renal clear of salicylates and phenobarbs
Sodium bicarbonate (tums)
acid neutralization
same as Mg/Al hyddroxides with drug interactions.
elderly take them as "candy"
Cimetidine
Ranitidine
Nizatidine
Cimetidine // Ranitidine // Nizatidine

H2 Histamine receptor antagonist
(g-protein linked= inc cAMP=stim H+/K+ATPase proton pump= H+)
Use: GERD, PUD and Zollinger-Ellison syndrome
SE: low incidence.
Cimetidine at high doses is antiandrogenic and use to treat hirsiutism in females.
drug interactions: warfarin, phenytoin, theophylline, phenobarb, some benzos, Propanolol, digoxin, qunidine, TCAs, nifedipine
Omeprazole
Esomeprazole
Rabeprazole
Proton pump inhibitor (irreversible)- final stage of Gastric acid production, by binding of the activated drug to the H+/K+ATPase in the parietal cell.
Use: DOC for GERD, and esophagitis. last 24-48 h
Long term Tx common. best on empty stomach.
SE: dec absorb of Ca+ = risk of osteoporosis.
Interact with phenytoin, diazepam and warfarin
Sucralfate
aluminum salt of sulfated sucrose.
polymerizes and forms a sticky protective barrier in stomach
Use: protects ulcer craters from acid as they heal
SE: constipation
DI: digitalis, tetracycline and phenytoin
Misoprostol
Misoprostol

prostaglandin E1 analogue
Use: prevent ulceration by NSAIDs
SE: usu
Contra: preg=induces uterine contractions and abortion
Metoclopramide
D2 receptor antagonist
(DA slows GI) inc GI motility and tone of smooth muscle; antiemetic
SE: extrapyramidal symptoms
Contra in parkinson's and pregnancy.
Bethanechol
Muscarinic agonist
Use: inc tone and motility of GI; post operative ileus or increase lower esophegeal tone
SE: usu muscarinic; diarrhea, sweating, sweating, urinary incontinence
Erythromycin
antibiotic
strong contractions of GI via stimulation of motilin; usu a side effect
Use: bowel dysmotility and rapid clearance of stomach contents
Glycopyrrolate
Dicyclomine
Glycopyrrolate// Dicyclomine

antimuscarinic agents
Use: gastrointestinal antispasmotics; dec intestinal overactivity, cramping and spasms
SE: sedation, dry mouth and constipation
Amitriptyline
TCA
Use: treatment of irritable bowel syndrome; anticholinergic effects dec spasticity and dec pain.
Ondansetron
Ondansetron
5HT3 receptor antagoinist; selective
Use: treat vomiting from chemo and vagal stimulation
SE: dizziness and constipation
Prochlorperazine (Compazine)
Promethazine (Phenergan)
block DA, muscarinic and histamine receptors
Use: post-op n/v,
SE: significant sedation due to block of Histamine and muscarinic
Dronabinol
(pot)
mech not well undrstood
Use: antiemetic and appetite stimulator.
Magnesium hydroxide
sodium salts (fleet)
Lactulose
Polyethylene glycol (colon prep)
Osmotic laxatives
Fleet orally or as enema
lactulose also used in pts with cirrhosis to dec ammonia buildup
all can be used as an intestinal prep for bowel surgery or colonoscopy
SE: intense shitting (I'm get tired, give me a break, however it is true).
Contra: sodium salts (fleet) in pts with CHF.
Docusate sodium (Colase)
emulsifying agent that allows water to penetrate the colonic contents and soften them by inc water absorption when taken orally.
Lubiprostone
Prostaglandin E derivative
inc intestinal fluid secretion via luminal Cl- channels.
Use: soften stools and reduce bloating and promote spontaneous BMs.
do not develop tolerance as in other laxatives.
SE: mild; the usu n, h/a and diarrhea
Loperamide (imodium)
opioid analogue
decreased peristalsis at low dose w/little abuse risk(no CNS effects)
SE: abdominal pain. distention, constipation, dry mouth and n/v
high doses- CNS effects and respiratory depression
Dipehnoxylate/atropine (Lomotil)
combo of opiod diphenoxylate and atropine (anticholinergic)
Use: antidiarrheal
SE: diphenoxylate has CNS and abuse potential therefore combined with atropine which has unpleasant effects; blurred vision and dry mouth, to reduce abuse potential.
SE: anorexia, pruritis and numbness in extremities
Contra: ulcerative colitis and pts with drug abuse Hx or to Tx diarrhea with organisms that penetrate the gut.
Simethicone (gas-Ex)
antiflatulent that coats and dissipates gas to make it pass with less of a noticeable effect.
Bismuth; pepto bismol
absorbs excess water and may absorb some microbial toxins
salicylate inhibits prostaglandins; antiinflammatory
Use: traveller's diarrhea
SE: black/darkened stools
contra: aspirin allergic pts and children; Reyes syndrome (use Bismuth citrate instead)
Isoproterenol
B-andrenergic agonist; non-selective.
Use: bronchodilation
SE: heart side effects (tachycardia, etc) = rarely used
Albuterol
Levalbuterol
Pirbuterol
selective B2 agonists. 1st line drug for asthmatics
Use: for fast aciting bronchodilation for acute asthma attack- without the B1 stimulation to the heart.
Albuterol has an oral form as well as inhaled
SE: levalbuterol few SE than albuterol.
Pirbuterol hard to use in acute attack because no spacer on inhaler.
Salmeterol
Salmeterol/Fluticasone (Advair)
Beta 2 bronchoselective dilators with long action.
Use: prophylactically to dec likelihood of bronchospasm and for nocturnal asthma.
salmeterol/fluticasone= Beta 2 agonist&corticosteroid.
SE: not for acute attacks, take 20 minutes to work.
need to be combined with a corticosteroid if not already(Advair).
does not replace fast-acting; need both
Ipratroprium(Atrovent)
Tiotropium (spiriva)
muscarinic antagonist- quaternary ammonium compound that stays in the lungs and slowly bronchodilates.
Use: COPD and emphysema
often with a B2 agonist, when beta isn't enough or tolerated
SE; cough, dry mouth and paradoxical bronchconstriction
Theophylline
CNS stimulant; elevates mood and decreases fatigue by blocking adenosine receptors. also a phophosdiesterase inhibitor and relaxes smooth muscle of bronchiles.increases diaphragm contraction. Oral
SE: cardiac stimulation and diuretic, insomnia and nervousness, low therapeutic index.
DI: phenytoin, smoking, Oral contraceptive inc clearance, Cimetidine dec clearance
Beclomethasone
Flunisolide
Fluticasone
Beclomethasone, Flunisolide and Fluticasone
corticosteroids
Use: severe asthma, dec inflammation, should always be used with a long-acting B agonist
SE: not with short term use
SE: oropharyengeal candidiasis, hoarseness and dec in bone density(use spacer to dec swallowed drug).
Zafirlukast
Montelukast
Pranlukast
block the leukotriene receptor.
oral, must take chronically.
Use: decrease need for inhaled oral steroids; still need a B2 agonist attack inhaler.
SE: few slight inc in URI, sore throat.
Zileuton
Zileuton

blocks 5-lipoxygenase= dec synthesis of leukotrienes.
Use: same as leukotriene inhibitors
may also dec asthmatic reaction to aspirin and NSAIDs.
SE: few same as leukotriene inhibitors
Cromolyn sodium
Cromolyn sodium
inhibits the release of histamine from mast cells
Use: treat allergic asthma esp in kids, inhaled several xs/day to be prophylactic. load for 2-3 months for full effect. DOC for inflammation in children
SE: bad taste
Omalizumab
Omalizumab

monoclonal ab targeted at IgE
Use: prevent allergic reactions in pt with mod-severe asthma and dec need for steroids.
food allergy treatment as well.
inject SC every 2-4 weeks
Diphenhydramine(benadryl)
Promethazine (phenergan)
Hydroxyzine
antihistamine- sedating
antiemtic and anaticholenergic activity
Use: allergies, antiemetic and motion sickness
SE: very sedating first generation antihistamines due to enter the CNS
Brompheniramine maleate
Cholorpheniramine maleate
moderately sedating first gen antihistamine; bulkier and don't cross the BBB as readily as sedating first gen H1 blockers.
SE: still sedating just not as much as other 1st gen.
dry mouth
Loratadine
Desloratidine
Levocetirizine
Certirizine
Fexofenadine
second generation non-sedating antihistamines H1 antagonists
are much bulkier and don't get into the CNS and cause sedation and they are not anticholenergic.
better at preventing than treating
SE: Cetirizine elimnated by kidney only; caution in renal pts.
liver tox poss in rest
2nd gen metabolized by CYp3A4= possibility of drug interactions.
all antihistamines may lower siezure threshold and are teratogenic; don't use in pregnancy.
Azelastine
Azelastine

Nasal H1 antihistamine
non-competitive H1 blocker and also decreases the release of histamine from mast cells
Use: allergic rhinitis
SE: