Comprehensive Pharm Exam Notes – Respiratory, ENT, Eye, GI, & Related Drugs

Respiratory Medications

• Seven drugs covered: Albuterol, Ipratropium, Beclomethasone, Cromolyn, Montelukast, Omalizumab, Theophylline

Albuterol (short-acting β₂-agonist)

• Indications: bronchospasm (asthma, exercise-induced asthma, COPD); immediate relief of acute asthma exacerbation
• Adverse effects: palpitations, tachycardia, tremor, nervousness, hypertension, throat irritation, dry mouth, insomnia
• Patient tip: for post-dose dry mouth, simply drink water (do not need to rinse & spit)

Ipratropium (anticholinergic bronchodilator)

• Indications: bronchospasm in COPD, chronic bronchitis, emphysema, rhinorrhea
• Adverse effects follow the anticholinergic "DUCCT" mnemonic: Dry mouth, Urinary retention, Constipation, Confusion, Tachycardia (emphasize constipation & dry mouth)

Beclomethasone (inhaled corticosteroid)

• Indications: persistent asthma, allergic rhinitis (know both!)
• Mechanism: reduces airway swelling & irritation
• Adverse effects: hyperglycemia, growth delay, ↑ infection risk (especially URTI), oral candidiasis
• Teaching: rinse mouth with water and spit to avoid pushing fungus deeper (do not merely drink)

Cromolyn (mast-cell stabilizer)

• Indications: asthma (mild-to-moderate persistent), COPD, allergic rhinitis, conjunctivitis
• Mechanism: stabilizes mast cells → blocks histamine release
• Adverse effects: cough, throat irritation, paradoxical bronchospasm

Montelukast (leukotriene receptor antagonist)

• Indications: persistent/chronic asthma, COPD, allergic rhinitis
• Adverse effects: rhinitis, neuro-psychiatric events, suicidal ideation → instruct patient to report mood changes

Omalizumab (IgE monoclonal antibody)

• Drug class clue: ends in -mab
• Indications: moderate-to-severe persistent asthma, nasal polyps
• General monoclonal antibody principle: targets cells directly (no extra specifics needed for exam)

Theophylline (methylxanthine bronchodilator)

• Indications: bronchodilation, asthma prophylaxis, status asthmaticus, COPD
• Key safety: elevated serum levels → palpitations & restlessness (monitor levels, signs of toxicity)

Allergic Rhinitis & Common-Cold Medications

Drugs: Diphenhydramine, Fexofenadine, Fluticasone, Pseudoephedrine, Phenylephrine, Codeine, Dextromethorphan, Guaifenesin, Acetylcysteine, Honey (herbal)

Antihistamines

• Diphenhydramine (1st-gen): allergic rhinitis/reactions, insomnia, motion sickness, pruritus; adverse effects – sedation/drowsiness, dry mouth, paradoxical excitation in children (<2 y/o avoid)
• Fexofenadine (2nd-gen, with Loratadine & Cetirizine): allergic rhinitis, urticaria, itchy eczema; little-to-no sedation; adverse – dyspnea, dry mouth, headache

Intranasal Corticosteroid

• Fluticasone: allergic rhinitis, nasal polyps, sinusitis
• Adverse: epistaxis, nasal ulceration, cough

Decongestants / Adrenergic Agonists

• Pseudoephedrine & Phenylephrine are stimulants → avoid in HTN
• Pseudoephedrine: allergic rhinitis, sinus congestion, Eustachian-tube obstruction; adverse – rebound congestion, insomnia, restlessness, anxiety
• Phenylephrine (adrenergic agonist): adverse – hypertension, reflex bradycardia, excitability, rebound congestion → risk \text{HTN} + \text{HTN} = hypertensive crisis

Antitussives

• Codeine (opioid): chronic non-productive cough; adverse – respiratory depression, dizziness
• Dextromethorphan: cough suppressant; do not give to children (want to expectorate); adverse – sedation, dizziness, CNS toxicity

Expectorant

• Guaifenesin (Mucinex): loosens mucus; adverse – abdominal pain, dizziness

Mucolytic / Antidote

• Acetylcysteine: acetaminophen overdose, cystic fibrosis (breaks thick secretions), renal protection pre-contrast
• Adverse: rotten-egg odor, N/V

Herbal

• Honey: natural cough suppressant, more effective than OTC antitussives; contraindicated <1 year old

Eye-Disorder Pharmacology

Administration Basics

• Hand hygiene; check expiration; ensure dropper tip clean/undamaged
• Patient looks up, pull lower lid → form pocket; drop med; avoid blinking; never touch dropper to eye
• Store properly after use

Glaucoma / Ocular Pressure Drugs

Need-to-know summary:
• Timolol & Dorzolamide ↓ production
• Latanoprost & Brimonidine ↑ outflow
• Pilocarpine causes pupil constriction + bradycardia
• Monitor HR with Timolol
• Latanoprost → eye/eyelash hyper-pigmentation

Ear-Disorder Pharmacology

Otic Drop Technique

• Adults: pull auricle up & back
• Children: pull auricle down & back
• Keep head tilted so ear faces upward for a few minutes

Drugs

• Amoxicillin: otitis media & other bacterial infections; contraindicated if penicillin or severe cephalosporin allergy; adverse – allergy, GI upset, superinfection
• Ciprofloxacin + Dexamethasone (otic): otitis externa; Cipro kills bacteria, Dexa ↓ pain/edema/erythema

Gastrointestinal Pharmacology

Peptic Ulcer Disease (H. pylori – Triple Therapy)

• Omeprazole + Clarithromycin + Amoxicillin
• (Metronidazole used only in quadruple therapy or if PCN-allergic)

GERD / Heartburn / PUD Symptom Control

• Antacids – neutralize acid
– Aluminum hydroxide → constipation
– Magnesium hydroxide → diarrhea
• Acid-reducers
– Proton-pump inhibitor: Omeprazole blocks proton pump
– H₂-blocker: Famotidine blocks H₂ receptor
• Both ↓ acid; chronic use → \text{B}_{12} deficiency, osteoporosis, GI infection (e.g., gastroenteritis)

GI Protectants & Pro-Motility

• Sucralfate: sucrose-aluminum complex → viscous protective "syrup" over ulcers (barrier vs acid/pepsin)
• Misoprostol: prostaglandin analog ↑ protective mucus; prevention of NSAID-induced gastric ulcers
• Metoclopramide: dopamine antagonist ↑ gastric emptying; avoid in Parkinson’s or patients w/ EPS; adverse – dystonia, akathisia, tardive dyskinesia

Laxatives

Rule of thumb: increase fluid, fiber; avoid with bowel obstruction.
• Bulk-forming: Psyllium – absorbs water → bulky stool
• Stimulant: Senna – ↑ peristalsis; fast onset; adverse – abdominal pain; not for long-term
• Osmotic: Lactulose – draws water in; adverse – dehydration, hyperglycemia (caution diabetics)

Antidiarrheal & Bowel-Disease Agents

• Diphenoxylate + Atropine (mild opioid + anticholinergic)
– Indications: diarrhea, ↓ ileostomy output
– Contraindications: infectious diarrhea (Salmonella, C-diff) – must expel pathogen
– Adverse: fatigue, dizziness, dependence (opioid component)

• Sulfasalazine (5-ASA + sulfa): inflammatory bowel disease
– Contra: sulfa or aspirin allergy
– Adverse: GI upset, photosensitivity (sun precautions), Stevens–Johnson syndrome, bone-marrow suppression (↑ infection risk), possible hepatotoxicity

• Probiotics: restore normal flora in IBS & C-diff; avoid in immunosuppressed & premature infants (risk of sepsis)

Antiemetics

• Reminder: Ondansetron multi-dose vial/solution must be discarded after 28 days once opened

Pancreatic Enzyme Replacement

• Pancrelipase: provides lipase/amylase/protease for pancreatic insufficiency & cystic fibrosis
• Contra: pork allergy or cultural/religious objection (porcine origin)

Weight-Loss Agents (adjunct to diet & exercise)

• Orlistat: inhibits GI lipase → fat not absorbed → steatorrhea (oily stools)
• Phentermine: sympathomimetic stimulant; avoid in cardiac disease, hyper-thyroid, substance abuse; adverse – tachycardia, HTN, palpitations, GI upset
• Semaglutide (Ozempic): GLP-1 agonist originally for diabetes; now at higher or adjusted dose for obesity (FYI – not testable, nice-to-know)

Quick Reference Acronyms & Pearls

• DUCCT (anticholinergic adverse effects): Dry mouth, Urinary retention, Constipation, Confusion, Tachycardia
• Ear drops: Adult – Up & Back / Child – Down & Back
• Glaucoma cheat-sheet:
– "Tim & Dor ↓ make (production)"
– "Lata & Brimo let it leave (outflow)"
– "Pilo pupil small (miosis) & pulse slow (bradycardia)"
• Triple therapy for H.\,pylori: Omeprazole + Clarithromycin + Amoxicillin
• Discard multi-dose ondansetron after 28 days