NR566 Final Exam Study Guide Spring 2025 Chamberlain College

NR566 Final Exam Study Guide
Week 5

Chapter 56
 H1 antagonists  diphenhydramine, promethazine
o Adverse Effects
 Sedation
 Nonsedative CNS effects: Dizziness, incoordination, confusional
states, fatigue
 GI effects: N/V/D or constipation, loss of appetite
 Anticholinergic effects: Drying of mucous membranes, urinary
hesitancy, constipation, and palpitations
o Indication: Drug Selection
 All of the H1 antagonists are useful in treating allergic disorders
 Some are also indicated for other conditions (motion sickness,
insomnia)
 Mild allergy
 Motion sickness: Promethazine, dimenhydrinate
 Insomnia: Diphenhydramine, pyrilamine
o Sleep aids
 Practically all OTC sleep aids contain an H1 antagonist
(diphenhydramine or pyrilamine) as its active ingredient
o Lifespan Considerations
 Infants: Can cause sedation
 May be used in children older than 6 months with caution
 Children/adolescents: Can be used safely in smaller doses
 Pregnancy: Many antihistamines should be avoided unless
necessary
 Breastfeeding: Occasional, small doses of antihistamines do not
appear to cause sedations in infants. Use caution
 Older adults: Many should be avoided in older adults
 Can make glaucoma or BPH worse
o 1st Generation Vs. 2nd Generation
 2nd-gens produce much less sedation than first-gens because:
 2nd-gen agents cross the blood-brain barrier poorly
 They have a low affinity for H1 receptors of the CNS
 Fexofenadine- Food Drug Interactions (Antihistamine)
o Certain fruit juices (apple, orange, grapefruit) can reduce fexofenadine
absorption, possibly reducing therapeutic effects
o Do not drink fruit juices within 4 hours before dosing or 1-2 hours after
dosing

,Chapter 58
 Glucocorticoids
o MOA
 These drugs differ from most drugs in two ways:
 Glucocorticoid receptors are located INSIDE the cell rather
than on the cell surface
 Glucocorticoids modulate the production of regulatory
proteins rather than the activity of signaling pathways
 Glucocorticoids penetrate the cell membrane  bind with receptors
in the cytoplasm  converting the receptor from an inactive form to
an active form  Receptor-steroid complex migrates to the cell
nucleus binding to chromatin in DNA  altering activity of target
genes
o Pharmacologic Effects
 Effects on metabolism and electrolytes
 High doses: Glucose levels rise
 Anti-inflammatory and immunosuppressant effects
o Adverse Effects
 Osteoporosis with resultant fractures
 Infection (by suppressing host defenses)
 Impaired wound healing
 Hyperglycemia
 Myopathy
 Fluid and electrolyte disturbance
 Growth delay
 Psych disturbances
 Cataracts and glaucoma
 PUD
 Iatrogenic cushing syndrome
 Adrenal suppression
o Allergic Reaction Management
 Glucocorticoid responses are delayed, so these drugs have little
value as SOLE therapy for severe allergic reactions (anaphylaxis)
 Good for: Allergic rhinitis, bee stings, drug-induced allergies



Chapter 63
 Intranasal Glucocorticoids
o Indications
 Most effective drugs for prevention and treatment of seasonal and
perennial rhinitis

,  These drugs can prevent or suppress the major symptoms of
allergic rhinitis: congestion, rhinorrhea, sneezing, nasal itching, and
erythema
o Allergic Rhinitis Management
 Drugs available:
 Glucocorticoids (intranasal)
 Antihistamines (oral and intranasal)
 Sympathomimetics (oral and intranasal)
o Adverse Effects
 Drying of the nasal mucosa & a burning or itching sensation
 Also may occur: Sore throat, epistaxis, headache
 Antihistamines- 1st Generation Vs. 2nd Generation
o First-gen are sedating, 2nd-gen are nonsedating
 Intranasal cromolyn sodium indications
o Treatment of allergic rhinitis
o The drug is best suited for prophylaxis and hence should be given before
symptoms start
 Sympathomimetics
o MOA
 Reduce nasal congestion by activating a1-adrenergic receptors on
nasal blood vessels
o Indications
 Reduce nasal congestion by activating a1-adrenergic receptors on
nasal blood vessels
 For allergic rhinitis: Only relieve congestion (not rhinorrhea,
sneezing, itching)
 Also indicated to reduce congestion associated with sinusitis and
colds
o Adverse Effects
 Rebound congestion
 CNS stimulation (most common of the oral route): restlessness,
irritability, anxiety, insomnia
 CV effects
 Abuse
 Dextromethorphan indications: Most effective OTC nonopioid cough medicine,
and also shown to help relieve pain
 Montelukast
o MOA: Block binding of leukotrienes to their receptors
 This allows the drug to relieve nasal congestion, although it has
little effect on sneezing or itching
o Indications: Originally approved for asthma, is now approved for
seasonal and perennial allergic rhinitis as well
 Ipratropium bromide MOA
o Blockade of cholinergic receptors inhibits secretions from the serous and
seromucous glands lining the nasal mucosa and decreases rhinorrhea