H1 Receptor Antagonist (Antihistamine)
Diphenhydramine (Benadryl)
Treats minor symptoms of allergy and common cold
What are some Adverse effects for H1 Receptor Antagonists?
drowsiness: occasionally paradoxical CNS stimulation and excitability.
Dry mouth, tachycardia, mild hypotension
May cause photosensitivity
What should pts avoid when taking Antihistamines?
Alcohol
Who shouldn't take antihistamines?
Third trimester of pregnancy, nursing mothers, newborn infants,
Intranasal Glucocorticoids
Fluticasone (Flonase)
This is the 1st choice for prevention of rhinitis
it decreases local inflammation in nasal passages, thus reducing nasal stuffiness.
What are some adverse effects of fluticasone (Flonase)?
Drying of nasal mucosa or sore throat, Epistaxis (nosebleed), Headache,
Can a pregnant client take Mometasone and Triamcinolone?
No, this is a class C drug so the effects on pregnancy is unknown.
Oxymetazoline (Afrin)
causes arterioles in nasal passages to constrict, dries mucous membranes,
Only use for 3-5 days due to rebound congestion.
Antitussives
Dextromethorphan (Benylin)
Moa: acts in medulla to inhibit cough reflex
Adverse effects: Dizziness, drowsiness, GI upset
Inhaler Education
1. Remove cap and hold Inhaler upright, shake it, tilt your head back slightly and breath out slowly, press down on the inhaler to release medication as you start to breath in slowly for (3-5 seconds), Hold your breath for 10 seconds.
Wait 1 minute between puffs.
2 main classificationS of drug for Asthma and/or COPD
Bronchodilators and Anti-inflammatory agents
Bronchodilators
- Beta2-Adrenergic Agonists (Albuterol)
- Methylxanthines (Theophylline)
- Anticholinergics (Ipratropium)
Anti-inflammatory Agents
- Steroidal: Glucocorticoids (Prednisone)
- Non-steroidal: Cromolyn
- Leukotriene Modifiers
- Anti-IgE
Beta 2 adrenergic Agonists
Most effective drugs for relieving acute bronchospasm
What are some Short Acting "Rescue Inhalers"?
Albuterol, Salbutamol, Levalbuterol (Xopenex)
onset of action: 5min or less.
Duration: 4-6hrs
What is the off label use for Terbutaline?
Fetal distress, pre-term labor (Given SQ/IV)
What are some long acting bronchodilators?
These are commonly administered in conjunction with inhaled steroids.
Serevent (Salmeterol), Foradil (Formoterol),
Bronchodilators-Beta-Adrenergic Agonists
Albuterol (Proventil, Ventolin, Vospire)
Moa: Selectively binds to beta2-adrenergic receptors in bronchial smooth muscle to cause bronchodilation
Primary use: for the termination of acute bronchospasm/ It can also be used before exercise to prevent exercise induced asthma
Who can not get Beta-Adrenergic Agonsits?
Hx of Dysrhythmias or MI
Not rec. to women who are breastfeeding
Bronchodilators- Anticholinergic
Ipratropium (Atrovent), Combivent
Moa: Causes bronchodilation by blocking cholinergic receptors in bronchial smooth muscle
Primary use: Relief of acute bronchospasm
What are some Adverse effects when taking anticholinergics?
Cough, hoarseness, bitter taste
Methylxanthines
Theophylline, Aminophylline
They have a narrow margin of safety (5-15)
What are some side effects for Methyxanthines?
N/V, CNA Stimulation
They are primarily used for long-term prophylaxis of asthma that is unresponsive to beta agonists or corticosteroids
Who should not take Methylxanthine?
Pts with CAD, angina pectoris, severe renal or liver disorders, PUD, BPH, DM
Not rec. for women who are breastfeeding
Anti-inflammatory agents- Corticosteroids
Beclomethasone (Beclovent, Beconase, Vancenase, Vanceril)
Moa: Reduces inflammation
Primary use: to decrease the frequency of asthma attacks,
Adverse effects: Oropharyngeal, Candidiasis
Limit use to under 10 days
What should you teach the pt to do after taking a steroid inhaler?
Rinse mouth after using, closely monitor blood glucose levels
Omalizumab (Xolair)
Attach to receptor on Immunoglobin E (IgE)
Leukotriene Modifiers
Zafirlukast (Accolate)
Moa: Prevents airway edema and inflammation by blocking leukotriene receptors in airways
Primary use: for prophylaxis of persistent, chronic asthma
AE: Headache. nausea, diarrhea
Mast Cell Stabilizers
Are safe for Prophylaxis of asthma
Less effective than inhaled corticosteroid
Ineffective at relieving acute bronchospasm