Define the three parts of the lewis reaction
Flush
Flare
Wheel
What are Histamine’s effects? (7)
flush: vasodilation local capillaries
flare: vasodilation arterioles
wheel: local edema from increase in capillary permiability
Cardio: BP decrease, pos iontropic/chemotropic, vasodilation cutaneous vessels, headache
PLUS: bronchiole constriction, stimulate secretions,activate sensory nerves
Anti-Histamine First Gen
Name 4
Name 4 Reactions
2 most important factors?
Diphenhydromine, Meclizine (nausea), Promethazine, Olopatadine (mast cell stabilize)
CNS impairment, sedation, anticholinergic, adrenoreceptor blocker, local anesthetic
SEDATING & penetrate BBB
Anti-Histamine Second Gen
Name 4
Name 3 major factors
Fexofenadine, Loratadine, Cetrizine (sedating), Azelostine (nasal, faster)
non-sedating (mostly), no penetration BBB, longer duration action
Decongestants
Name 3
What does it do?
AE?
Phenylephrine / Pseudophedrine (oral)
Oxymetazoline (nasal)
alpha stim, vasoconstriciton, shrink mucosa
AE: insomnia, HTN, tolerance
Cough Supression
Name 2; what does second do?
AE
Expectorant
Name and what does
Opiate
Benzonatate - local anesthetic to stretch receptors
Numbness oral cavity, dizziness
Guaifenesin – increase volume and decrease viscosity of secretions
Bronchodilators
B2 agonist
does what?
SABA are:
Work as?
Cause?
LABA are:
Work as?
Cause?
stimulate adenyl cyclase increasing cAMP
saba: Albuterol / Levalbuterol
resuce inhalor
Tremor, tachycardia, hyperclycemia, tolerance
LABA: Formoterol / Aformoterol / Salmeterol
Slow acting / long lastig
increased risk hospitalization
Formoterol is the fastest of these
Bronchodilator
Muscarinic Antagonists
Do what?
Sama:
Lama:
cause what?
block vagally mediated airway tone
Ipratropium
Tiotropium, glycopyrrolate, Umeclidinium
Dry mouth, pharyngeal irritation
Bronchodilator
Theophylline
what does?
AE?
Smoking status?
inhibit phosphodiesterase, adenosine receptor antagonist
biotransformed by CYP450
arrythmias,seizures
DO NOT change smoking status
Inhaled Corticosteroids (ICS)
drug of choice for:
name 3
moa:
AE low:
AE high:
persistant asthma
budesonide
flunisolide
mometasone furoate
inhibition arachidonic acid via inhibition phospholipase A2
low: oral candidiasis, growth reduction
high: HPA axis suppression – for status asthmaticus
Leukotriene Modifiers
Name 3
Reason for use
Montelukast / Zafirlukast (slow)
Zafirlukast / Zileuton (hepatotoxic)
alterative to ICS, used in aspirin allergy
DO NOT use with confirmed neuropsych events
Immunotherapies
Name 3
AE
What are the “Big Four”?
Mepolizumab, Benralizumab Reslizumab (IL-5 antagonist)
Omalizumab (anti-IgE)
Anaphylaxis or injection site rxn
Big 4: Heart Failure, Cancer, Hypersensitivity, Increased risk infection
Mast Cell Stabilizer
What drug?
What AE?
Cromolyn
cough, wheezing/bronchospasm, laryngeal spasm
Roflumilast
inhibits what?
For what?
AE?
PDE4 (decrease inflammation)
for severe COPD with bronchitis
Depression/angioedema
Asthma treatment mild/mild-mod/ mod/severe
COPD treatment mild/mild-mod/mod/severe
Saba/Saba-ICS/Saba-ICS-Laba/Saba-ICS-Laba-Lama
One of S/L ; Either Laba/Lama; Lama or combo lama; Laba and lama w/ or w/o ICS
