Allergies plague many of our patients. There are many different medications used to treat this disease and its important to be able to tell the difference....
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In this third video, I cover respiratory medications for allergies, cough, asthma, and anaphylactic shock.
Antihistamines
We'll start with two antihistamine generations, 1st and 2nd. First generation causes drowsiness and is shorter acting, while second generation is non-sedating and longer acting. Recall we already learned a different set of antihistamines in the first video, the H2 receptor blockers for acid reflux. Stems are sometimes similar, -atadine vs. -tidine, so be careful.
Decongestants
Pseudoephedrine is only available behind the pharmacy counter (BTC) and often paired with a 2nd generation antihistamine as the "hyphen 'D'," on the end of a drug name. Phenylephrine is often marked as "P.E." and is available over the counter (OTC). Finally, oxymetazoline, brand Afrin is only meant for a few days of use to avoid rebound congestion.
Allergic rhinitis
Anti-inflammatories like triamcinolone produce fewer side effects with a nasal spray formulation. Full effects may take a few weeks, but steroid nasal sprays are hands down the best prophylaxis for seasonal allergies.
Expectorants / antitussives / oral steroids
Expectorants like guaifenesin help remove mucus and antitussives suppress the urge to cough. The choice of antitussive often depends on cough severity. Oral steroids like prednisone and methylprednisolone reduce severe inflammation sometimes from this cough.
Asthma
Asthma is straightforward, an inflammatory condition paired with bronchoconstriction. Our drugs then work as anti-inflammatories and bronchodilators. An inhaled steroid with long-acting beta-2 agonist is a common combination. While patients can safely use an inhaled steroid like fluticasone alone, in certain conditions beta-2 agonists like salmeterol must be paired with an inhaled steroid for safety.
Anticholinergics
Also relax bronchial smooth muscle for asthma and COPD and include short-acting ipratropium and long-acting tiotropium inhaled forms.There is also non-inhaler asthma therapy. Leukotriene inhibitors such as montelukast and the biologic omalizumab have their place in respiratory therapy.
Anaphylaxis
Epinephrine is part of the LEAN acronym, lidocaine, epinephrine, atropine, and naloxone for critical emergency medicines.
It's sometimes easier to see the divisions in outline rather than paragraph form of the major classes.
Antihistamines
1st Generation
Diphenhydramine
2nd Generation
Cetirizine
Loratadine
Loratadine-D
Decongestants
Pseudoephedrine- BTC
Phenylephrine - OTC
Oxymetazoline - nasal spray, rebound congestion, 3 days max
Allergic rhinitis
Triamcinolone - no proper stem
Cough
Guaifenesin / dextromethorphan (DM)
Guaifenesin / codeine (AC)
Oral Steroids
Methylprednisolone
Prednisone
Both use "pred" as prefix or infix
Asthma
Steroid and long acting beta-2 agonist
Budesonide / formoterol (Symbicort)
Fluticasone / salmeterol (Advair)
Nasal / oral steroid
Fluticasone comes as both nasal (Flonase) and oral (Flovent) form
In this third video, I cover respiratory medications for allergies, cough, asthma, and anaphylactic shock.
Antihistamines
We'll start with two antihistamine generations, 1st and 2nd. First generation causes drowsiness and is shorter acting, while second generation is non-sedating and longer acting. Recall we already learned a different set of antihistamines in the first video, the H2 receptor blockers for acid reflux. Stems are sometimes similar, -atadine vs. -tidine, so be careful.
Decongestants
Pseudoephedrine is only available behind the pharmacy counter (BTC) and often paired with a 2nd generation antihistamine as the "hyphen 'D'," on the end of a drug name. Phenylephrine is often marked as "P.E." and is available over the counter (OTC). Finally, oxymetazoline, brand Afrin is only meant for a few days of use to avoid rebound congestion.
Allergic rhinitis
Anti-inflammatories like triamcinolone produce fewer side effects with a nasal spray formulation. Full effects may take a few weeks, but steroid nasal sprays are hands down the best prophylaxis for seasonal allergies.
Expectorants / antitussives / oral steroids
Expectorants like guaifenesin help remove mucus and antitussives suppress the urge to cough. The choice of antitussive often depends on cough severity. Oral steroids like prednisone and methylprednisolone reduce severe inflammation sometimes from this cough.
Asthma
Asthma is straightforward, an inflammatory condition paired with bronchoconstriction. Our drugs then work as anti-inflammatories and bronchodilators. An inhaled steroid with long-acting beta-2 agonist is a common combination. While patients can safely use an inhaled steroid like fluticasone alone, in certain conditions beta-2 agonists like salmeterol must be paired with an inhaled steroid for safety.
Anticholinergics
Also relax bronchial smooth muscle for asthma and COPD and include short-acting ipratropium and long-acting tiotropium inhaled forms.There is also non-inhaler asthma therapy. Leukotriene inhibitors such as montelukast and the biologic omalizumab have their place in respiratory therapy.
Anaphylaxis
Epinephrine is part of the LEAN acronym, lidocaine, epinephrine, atropine, and naloxone for critical emergency medicines.
It's sometimes easier to see the divisions in outline rather than paragraph form of the major classes.
Antihistamines
1st Generation
2nd Generation
Decongestants
Allergic rhinitis
Cough
Oral Steroids
Asthma
Anti- IgE antibody
Anaphylaxis
About TonyPharmD
Tony Guerra, Pharm.D. / DesMoines Area Community College Pharmacology Professor
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