Exam 3 Drugs

what are used as upper respiratory drugs?

primarily OTC cough and cold meds

often antitussives, expectorants, and antihistimines are used in combo not as monotherapy

what does the DFA recommend for children <2 years?

advices against using OTC cough and cold meds

manufactorers have voluntarily labeled products “no not use under 4 yrs”

what does histamine do?

4 diff histamine receptors (H1, H2, H3)

H1 receptors impact most of the upper airway symps:

nasal congestion

sneezing

pruritus

rhinorrhea

increased vascular perm (bronchoconstriction)

what do antihistamine drugs do?

competitive antagonists at H1 receptors

occupy open receptors

when is it recommended to start taking antihistamine drugs?

2-6 weeks prior to allergy season

what are antihistamine drugs indicated for?

first line drugs for allergic rhinitis, urticaria, and allergic conjunctivitis

can be used for insomnia (short term)

anaphylaxis (may be given with epi to blunt severity)

what do first gen antihistimine drugs do?

cross the BBB

sedation and anticholinergic effects

can inhibit norepi repuptake and enhance catecholamine release which can lead to HTN crisis if combined with MAOIs

what do second gen antihistimine drugs do?

reduced CNS penetration

what are contraindications for first gen antihistimine drugs?

nursing mothers (second gen usually better)

angle close glaucoma (dilation, increase pressure)

symp BPH (anticholingergic effects, relax detrusor)

arrhythmias

what are AE for first gen antihistimine drugs?

sedation

cognitive impairment

anticholinergic effects

what are nursing considerations for antihistimine drugs?

avoid with CNS depressants

assess baseline mental status

caution with elderly

what drug class is diphenhydramine?

benedryl

what is the MOA for diphenhydramine?

It is an H1 receptor antagonist that blocks the action of histamine, reducing symptoms of allergic reactions.

what are first gen H1 antagonists indicated for?

allergies

motion sickness

insomnia

what are second and third gen antihistimines indicated for?

allergic rhinitis

urticaria

what are examples of first gen antihistimine drugs?

diphenhydramine (benedryl)

what are examples of second and third gen anthistimines?

cetirizine (Zyrtec)

loratadine (Claritin)

fexofenadine (Allegra)

what are AE for second and third gen antihistimines?

HA (common)

sedation (low)

dry mouth

fatigue

what is important patient education for antihistimines?

may thicken resp tract secretions (careful with asthma, bronchitis, pneumonia)

some may cause increased photosensitivity and should be taken with caution if driving or operating machinery.

what do decongestants do?

A1 agonists cause vasoconstriction of nasal mucosal blood vessels (lessen blood flow and leakage out of vessels)

how long should you use decongestants for?

<5 days due to risk of rebound congestion

who should avoid decongestants?

children <12 yrs

pregnant women (esp first trimester)

elderly

what are examples of oral decongestants?

pseudophedrine (sudafed)

what are examples of topical decongestants?

oxymetazoline (afrin)

what are AE of decongestants?

nervousness

heart palpitations

insomnia

tremors

what drug class is pseudophedrine?

sudafed

what is the MOA for pseudophedrine?

what drug class is oxymetazoline?

afrin

what is the MOA for oxymetazoline?

what is do centrally acting antitussive meds do?

suppress cough reflex in medulla

what are opioid antitussive meds indicated for?

dry cough (not for productive cough or asthma)

what are AE for opioid antitussive meds?

resp despression

children <12 yrs

severe asthma

OUD

what are AE of opioid antitussive meds?

resp and CNS depression

dependence

what is dextromehorphan?

non opioid antitussive

what does dextromethorphan do?

inhibits NMDA receptors, inhibits the cough center

what are CA of dextromethorpan?

MAOIs

pregnancy (class C)

what are AE for dextromethorphan?

can produce dissociative or hallucinogenic effects at high doses

has serotonin and norepi reuptake inhibition properties

watch for serotonin syndrome

what does benzonatate do?

peripheral acting, nonopioid drug

works peripherally by numbing the cough (stretch) receptors in the resp tract

dampens the nerve signals that trigger the cough reflex

what is important patient education for benzonatate?

capsule myst be swallowed whole, NEVER chew, crush, or dissolve —> rapid, temp local anesthesia

accidental OD in children can be fatal

what are symps of benzonatate toxicity?

restlessness

tremors

seizures

within 15-20 min of ingestion

what are AE of benzonatate?

dizziness

HA

nausea

cardiovascular collapse

what is the MOA of OTC expectorants?

increases resp tract fluid to reduce mucus viscosity

stimulates secretory cells in teh resp tract to increase fluid vol and decrease mucus tenacity

what is an example of an expectorant?

guiafenesin (mucinex)

what is the drug class of guiafenesin?

what is the MOA for guiafenesin?

what are CA for expectorants?

children <12

pregnancy (only if benefits outweight risks) —> avoid during first trimester

what are AE of expectorants?

dizziness

HA

GI upset

what is important patient education for expectorants?

hydration (needs water to work)

what are topical corticosteroids indicated for?

first line for inflammation, dermatitis, psoriasis, contact derm

what do tps do?

suppress the immune sys, reduce inflammation

what drug class is isotretinoin?

what are AE of isotretinoin?

elevated triglycerides

hepatotoxitity

mood chanages

extreme teratogenic risk (pregnancy class x)

what are antimicrobial drugs indicated for?

confirmed or strongly suspected bacterial, fungal, viral, or parasitic infections

what is empiric therapy?

tx of an infection before culture info has been reported or obtained

what is definitive therapy?

antibiotic therapy tailored to tx organisms identified with cultures

what is prophylactic therapy?

tx with antibiotics to prevent in infection such as before surgery or after trauma

what does bactericidal mean?

kill bacteria

what does bacteriostatic mean?

inhibit bacterial activity or susceptible bacteria (inhibit growth)

what is the general antibiotic MOA?

bactericidal

bacteriostatic

interference with cell wall synthesis

interference with protein synthesis

interference with DNA replication

disrupt critical metabolic rxns inside cell

what are special considerations for antibiotics?

nausea and vomiting

pregnancy

genetic abnormalities lilke G6PD (glucose-6-phosphate dehydrogenase)

what are the antibiotic classes?

sulfonamides

beta-lactams (pencillins, cephalasporins, carbapenems)

macrolides

tetracyclines

aminoglycosides

quinolones

what are sulfonamides (sulfa drugs)?

broad spectrum

bacteriostatic —> prevent synthesis of folic acid required for DNA

what are sulfonamides indicated for?

UTI

what are AE of sulfonmides?

photosensitivity rash

what are examples of sulfa drugs?

trimethoprim-sulfamethoxazole (TMP-SMX) (bactrim, septra)

what are interactions for sulfa drugs?

sulfanylureas —> hypoglycemia

phenytoin —> toxicity

oral contraceptives —> pregnancy

warfarin —> increased bleeding

what are CA for TMP-SMX?

anemia

severe hepatic or renal impairment

what are beta lactams?

share a common structure and MOA

generally considered bactericidal

what are examples of beta lactams?

penicillin

cephalosporins

carbapenems

monobactams

what are examples of beta-lactamase inhibitors?

clavulanic acid

tazobactam

sulbactam

avibactam

what are examples of combo drugs for beta-lactams (include beta-lactamase inhibitors)?

unasyn (ampicillin/sulbactam)

augmentin (amoxicillin/clavulanic acid)

timentin (ticarcillin/clavulanate)

zosyn piperacillin/tazobactam) —> gram positive and negative anaerobes, used for empirically for serious infections

what are penicillins (PCN)?

more gram positive

bactericidal (inhibit bacterial cell wall synthesis)

what are penicillins indicated for?

pneumonia

intra-abd sepsis

what are AE for PCN?

urticaria

pruritus

angioedema

maculopapular rash

SJS

anaphylaxis

what are drug interactions for PCN?

NSAIDs —> enhance PCN effects

warfarin —> increased bleeding

oral contraceptives —> inhibit

what are the examples of PCN?

natural PCN

aminopenicillins

penicillinase resistance

extended spectrum

what are cephalopsorins?

broad spectrum (increase gram negative and less gram positive with each gen)

bactericidal (inhibit cell wall synthesis)

what are AE of cephalosporins?

diarrhea

cramps

colitis

SJS

what are important nursing considerations for cephalosporins?

may cause cross reactivity with PCN allergy

what are examples of first gen cephalosporins?

cefazolin (ancef)

cephalexin (keflex)

what are examples of second gen cephalosporins?

cefaclor

cefoxitin

what are examples of third gen cephalosporins?

cefotazime

ceftazidime

ceftriaxone

gets to CNS

what are examples of fourth gen cephalosporins?

cefepime

what are examples of fifth gen cephalosporins?

ceftaroline

what are carbapenems?

broadest spectrum

bactericidal

what are carbapenems indicated for?

used for tx of infections resistant to other antibiotics

bones and joints

polymicrobial infections

septicemia

endocarditis

what are AE of carbapenems?

seizures

GI

risk for cross sensitivity

what are important considerations for carbapenems? ?

infuse over 1 hr

IM formulations have lidocaine

what are examples of carbapenems?

imipenem-cilastatin (primaxin)

what are monobactam drugs?

gram negative

bactericidal

what are monobactam drugs indicated for?

UTI

skin

lungs

intra abd

gynecologic

gram negative septicemia

what are AE of monobactam drugs?

rash

diarrhea

nausea and vomiting

hepatotoxicity

what are important considerations for monobactam drugs?

monitor LFTs

inhalation formula used for pts with cystic fibrosis with gram neg resp infections

what are examples of monobactam drugs?

aztreonam (acactam)

what are macrolides?

broad spectrum

bacteriostatic or bactericidal (with high concentrations in tissue)

tx bacteria that reproduce in the host cell (listeria, chlamydria, legionella, campylobacter)

what are macrolides indicated for?

wide range:

resp

skin

soft tissue

strep

erythromycin sometimes used to stimulate GI motility because of effects on GI tract

what are AE of macrolides?

hepatotoxicity

allergic rxns

nausea and vomiting

reversible hearing loss

what are examples of macrolides?

THINK “MYCIN”

erythromycin

azithromycin (zithromax)

clarithromycin (baixin)

what is important pt education for erythromycin?

take round the clock Q6 hrs

don’t take with grapefruit juice

don’t take within 2 hrs of dairy products of antacids

reduces effects of oral contraceptives

can affect emotions (crying, laughing, abnormal thinking)

what are tetracryclines?

broad spectrum

bacteriostatic