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66 Cards in this Set
- Front
- Back
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____________ are drugs that antagonize the action of histamine
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Antihistamines
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________________ is the first chemical mediator to be released in immune and inflammatory responses. It is synthesized and stored in most body tissues with high concentrations in the tissues exposed to environmental substances. (ex. skin muscosal surfaces of the eye, nose, longs and GI tract.
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Histamine
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True or false
In the CNS Histamine is located mainly in secretory granules of mast cells (tissues cells surrounding capillaries) and basophils (circulating blood cells) |
True
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_________ are drugs that antagonize the action of histamine
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Anti - histamines
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__________ is the first chemical mediator to be released in immune and inflammatory responses.
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Histamine
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Histamine is discharged from _________
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Mast cells
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______ or allergic reactions are exaggerated responses by the immune system that produce tissue injury and may cause serious disease
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Hypersensitivity
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__________ receptors are located mainly on smooth muscle cells in blood vessels and the respiratory and GI tracts
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H1
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A second generation H1 antagonists
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Loratadine (clartin)
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The only antihistamine formulated as a nasal spray for topical use
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Azelastine (astelin)
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The prototype of first generation antihistamines
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Diphenhydramine ( benadryl)
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An active metabolite of loratadine
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Desloratadine (clarinex)
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What happens to the human body when H2 receptors are stimulated?
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Symptms of asthma vary in incidence and severity from occasional episodes of mild respiratory distress with normal functioning between attacks to persistent daily or continual respiratory distress if not adequately controlled. Inflammation and damaged airway muscosa are chronically present even when clients appear symptom free
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Define hypersensitivity or allergic reations
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Hyper - sensitivity or allergic reaction are exaggerated responses by the immune system that produce tissue injury and may cause serious disease. The mechanisms that eliminate pathogens in adaptive immune responses are essentially identical to those of natural immunity. Allergic reactions may result from specific antibodies, sensitized T lymphocytes, or both formed during exposure to an antigen.
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What is the cause of type I immune response (also called immediate hypersensitivity)?
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Type I immune response (also called immediate hypersensitivity because it occurs within minutes after exposure to the antigen) is an immunoglobulin E (IgE) induced response triggered by the interaction of the antigen with antigen specific IgE bound on mast cells causing mast cel lactivation. Histamine and other mediators are released immediately, and cytokines, chemokines and leukotrienes are synthesized after activation.
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Give an example of a type II immune response.
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Type II responses are mediated by IgG or IgM generation direct damage to the cell surface. These cytotoxic reactions include blood transfusion reactions, hemolytic disease of newborns, autoimmune hemolytic anemia and some drug reactions. Hemolytic anemia (caused by destruction of platelets), both type II hypersensitivity responses are adverse effects of certain durgs ( e.g., penicillin methyldopa, heparin).
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Mr. Pearson son Michael is diagnosed with an allergy to peanuts. It is important for his child's health and well being that Mr. Pearson do which of the following?
a. Provide his son with an emergency contact in case of exposure b. Provide those in contact with his son with an emergency plan. c. Avoid situations in which his son may be exposed to peanuts. d. Give all who are in contact with is son azelastine in case of exposure. |
b
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Patients with drug allergies should wear a ________ ______ bracelet identifying the drug.
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Medical alert
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Mr. Boudreau presents to the physicians office with allergy related symptoms that interfere with his job as a care salesman. He requests a nasal spray for topical use, you would expect the physician to order which of the following?
a. Azelastine (astelin) b. Loratadine (claritin) c. Cetirizine (zyrtec) d. Desloratadine (clarinex) |
a.
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Second generation H1 antagonists cause less CNS depression because they are selective for peripheral H1 receptors and because of which other property?
a. They are excreted by the renal system. b. They are metabolized by the liver. c. They cross the blood brain barrier d. They do not cross the blood brain barrier |
d
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Mrs. Kost is prescribed a first generation antihistamine for her allergies. You would expect her to experience which of the following adverse effects?
a. Diarrha b. Incontinence c. Dry mouth d. Slurred speech |
c
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Mrs. Lawson administers diphenhydramine to her child, who experiences seasonal allergies, before his first baseball game. Her child may experience which of the following?
a. Hyperactivity b. Exacerbation of allergic symptoms. c. Decreased metal alertness d. Poor reflexes |
c
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Some food allergens have a higher inherent risk for triggering anaphylaxis than others; these higher risk allergens include which of the following? (select all that apply)
a. Shellfish b. Egg c. Milk d. Butter |
a,b,c
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Allergic rhinitis is inflammation of nasal mucosa caused by which of the following?
a. Type III hypersensitivity reaction to inhaled allergens b. Type II hypersensitivity reaction to inhaled allergens c. Type IV hypersensitivity reaction to inhaled allergens d. Type I Hypersensitivity reaction to inhaled allergens. |
d
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Virtually any drug may induce an immunologic response in susceptible people and any body __________ may be affected.
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Tissue
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You are visiting Mrs. O'Connor in her home for treatment of a wound. She is concerned that her husband, a truck driver, is bothered by his diphenhydramine. Which of the following is your response?
a. The drug may cause drowsiness and make driving unsafe. b. the drug is safe in small doses c. The drug is safe if it is purchased over the counter. d. The drug may exacerbate the allergies if used routinely. |
a
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Mr. Cobb presents to the emergency department with symptoms of a gastrointestinal bleed the physican orders a blood transfusion. The client has a history of anaphylaxis. The physician orders the administration of which of the following drugs before the blood transfusion?
a. Cetirizine b. Desloratadine c. Azelastine d. Diphenhydramine |
d
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Mrs Cheshire is diagnosed with severe kidney failure. You would expect the physician to order diphenhydramine with which of the following dosing intervals?
a. 12 to 18hrs b. 2 to 4hrs c. 4 to 6hrs d. 24 to 48 hrs |
a
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Which of the flollowing is one of hte benefits related to second generation antihistamine administration in older adults?
a. They do not impair thinking b. They reduce the number of falls in clients diagnosed with osteoporosis. c. They increase the ability of clients with dementia to perform ADL's. d. They do not affect oxygenation. |
a
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Mr. Mitchell age 74 is diagnosed with hypertension hyperlipidemia angina and gout. He presents to the physicians office with complaints of seasonal allergies. His daughter has diphenhydramine at home, and he asks if it is safe for him to take it. You are concerned because first generation antihistamines may cause which of the following? (select all that apply)
a. Hypotension b. Hypertension c. Syncope d. Myocardial hypoxia |
a,c
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Mr. Armstrong presents to the emergency room with his 4yr old child. The child self administered diphenhydramine of an unknown quantity. In overdose of diphenhydramine children may experience which of the following?
(select all that apply) a. Hallucinations b. Hypotension c. Dizziness d. myocardial hypoxia |
a,d
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Mr. Ames asks you whether antihistamines will help him cope with the symptoms of the common cold. Which of the following is your response?
a. Antihistamines are recommended. b. Antihistamines do not relieve symptoms. c. Antihistamines should be taken only before bed d. Antihistamines should be taken only if you are not driving. |
b
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Mrs. Sheffield is concerned that the antihistamine ordered by the physician is not relieving her symptoms and she will not find a medication to meet her needs. Which of the following is our response?
a. Antihistamines may not be answer to your allergic symptoms b. A client who doesnt respond to one antihistamine is usually resistant to others c. A client may respond better to one antihistamine than another. d. I will ask the physician to order another type of drug. |
c
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For treatment of acute allergic reactions a rapid acting agent of _____________ duration is preferred.
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short
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An antihistamine is chosen based on the desired effect duration of action adverse effects and other characteristics of available drugs. For most people a ________ generation drug is the first drug of choice.
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Second
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Brompheniramine (LoHist)
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Used for Allergic rhinitis 1 - 2 tabs 6 to 12mg q12hrs
Childeren: 12yrs and older same as adults. Children 6 to 12yrs 1 tab (6mg) q12hrs |
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characterized by hypotension due to massive vasodilation and acute airway obstruction due to bronchoconstriction caused by release of histamine and other chemical mediators in response to a severe allergic reaction.
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Anaphylactic shock
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a type I immunoglobulin E-mediated allergic reaction to a foreign substance (antigen) that has entered the body; occurs on second or subsequent exposure to an antigen. Symptoms develop rapidly; typical symptom onset ranges from 30 minutes to 2 hours after exposure to the antigen.
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Anaphylaxis
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an inflammatory response characterized by a skin lesion called a wheal, a raised edematous area with a pale center and red border, which itches intensely; also known as hives.
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Urticaria
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What type of reaction is this?
These cytotoxic reactions include blood transfusion reactions, hemolytic disease of newborns, autoimmune hemolytic anemia, and some drug reactions. Hemolytic anemia (caused by destruction of erythrocytes) and thrombocytopenia (caused by destruction of platelets), both hypersensitivity responses, are adverse effects of certain drugs (e.g., penicillin, methyldopa, heparin). |
Type II responses are mediated by IgG or IgM generating direct damage to the cell surface.
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What type of reaction is this?
is an IgG- or IgM-mediated reaction characterized by formation of antigen-antibody complexes that induce an acute inflammatory reaction in the tissues. Serum sickness, the prototype of these reactions, occurs when excess antigen combines with antibodies to form immune complexes. |
Type III
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is a cell-mediated response in which sensitized T lymphocytes react with an antigen to cause inflammation mediated by release of lymphokines, direct cytotoxicity, or both. The classic type IV hypersensitivity reaction is the tuberculin test, but similar reactions occur with contact dermatitis and some graft rejection.
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Type IV hypersensitivity (also called delayed hypersensitivity)
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_____________ is inflammation of nasal mucosa caused by a type I hypersensitivity reaction to inhaled allergens. It is a very common disorder characterized by nasal congestion, itching, sneezing, and watery drainage. Itching of the throat, eyes, and ears often occurs as well.
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Allergic rhinitis
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_____________ is a delayed hypersensitivity reaction most often caused by drugs, such as antimicrobials. In addition, many drugs that produce anaphylaxis also produce this
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Serum sickness
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______________ is an autoimmune disorder that may be idiopathic from nondrug causes or induced by hydralazine, procainamide, isoniazid, and other drugs.
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Systemic lupus erythematosus (SLE)
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These reactions are like anaphylaxis in terms of immediate occurrence, symptoms, and life-threatening severity. The main difference is that they are not antigen-antibody reactions and therefore may occur on first exposure to the causative agent. The drugs bind directly to mast cells, activate the cells, and cause the release of histamine and other vasoactive chemical mediators. Contrast media for radiologic diagnostic tests are often implicated.
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Anaphylactoid
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This drug class includes brompheniramine and chlorpheniramine
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alkylamines
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This drug class includes carbinoxamine, clemastine, and etc.
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ethanolamines
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This drug class includes tripelennamine, pyrilamine
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ethylenediamines
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This drug class includes methdilazine, promethazine
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phenothiazines
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This drug class includes cyclizine, hydroxyzine
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piperazines
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This drug class includes azatadine, cyproheptadine
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piperidines
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Chlorpheniramine (Chlor-Trimeton)
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Allergic rhinitis maximal dose, 24 mg in 24 h
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Clemastine (Tavist)
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Allergic rhinitis maximum of 8.04 mg daily
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Cyproheptadine
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Hypersensitivity Maximal dose 0.5 mg/kg/d
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Dexchlorpheniramine
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Hypersensitivity
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Diphenhydramine (Benadryl)
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Hypersensitivity Motion sickness
Parkinsonism Insomnia Antitussive (syrup only) maximal daily dose of 400 mg |
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Hydroxyzine (Vistaril)
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Pruritus Sedation Antiemetic
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Phenindamine (Nolahist)
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Allergic rhinitis maximal dose 150 mg in 24 h
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Promethazine (Phenergan)
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Hypersensitivity reactions (allergic rhinitis, conjunctivitis, dermatitis)
Sedation Antiemetic Motion sickness |
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Triprolidine (Zymine)
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Allergic rhinitis not to exceed 40 mL/24 h
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Azelastine (Astelin)
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Allergic rhinitis
2nd Gen. Nasal inhalation, two sprays per nostrils q12h |
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Cetirizine (Zyrtec)
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Allergic rhinitis
Chronic idiopathic urticaria Renal or hepatic impairment, PO 5 mg once daily |
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Desloratadine (Clarinex)
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Allergic rhinitis
Chronic idiopathic urticaria 5 mg once daily |
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Fexofenadine (Allegra)
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Allergic rhinitis
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Loratadine (Claritin)
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Allergic rhinitis
Chronic idiopathic urticaria Renal or hepatic impairment, PO 10 mg every other day |
