antipruritic and bronchodilators

7/31/2019 Antipruritic and Bronchodilators

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(itching) is an unpleasantsensation that elicits the desire toscratch.

It is a distressing symptom thatcan cause discomfort andthreaten the effectiveness of theskin as a major protective barrier.


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Symptoms of generalized itching, withoutrash or skin lesions, may be related toanything from dry skin to an occultcarcinoma, and the etiology of the symptoms

should be explored.

Common nonmalignant etiologic factorsinclude drug reactions, xerosis, scabies, and

primary skin diseases. The most common diagnosis related to

pruritus in this population is simply dry skin.


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skin accounts for 15%of the body's totalweight and is thelargest organ of thebody.

The skin hassignificantpsychosocial andphysical functions.

Its function as aprotective mechanismis the skin's mostimportant role.


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Various malignant diseases are known toproduce pruritus. Hodgkin lymphoma causespruritus in 10% to 25% of patients.

Pruritus associated with Hodgkin lymphomais characterized by symptoms of burning andintense itching occurring on a localized skinarea, frequently on the lower legs.

Other lymphomas and leukemias have beenassociated with a less intense but moregeneralized pruritus.


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Adenocarcinomas and squamous cellcarcinomas of various organs (i.e., stomach,pancreas, lung, colon, brain, breast, andprostate) sometimes produce generalized

pruritus that is more pronounced on the legs,upper trunk, and extensor surfaces of theupper extremities.

Pruritus associated with malignant diseases

has been observed to diminish or disappearwith eradication of the tumor and reappearwith recurrence of disease.


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antineoplastic agents (alkylating agents,antimetabolites, antibiotics, plant alkaloids,nitrosoureas, and enzymes) include drugscapable of producing cutaneous reactionsincluding pruritus.

Hypersensitivity to cytotoxic agents can be

manifested by pruritus, edema, urticaria, anderythema. Hypersensitivity reactions vary insymptomatology and depend on the drug, thedosage, and the allergy history of the patient.


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related pruritus is usually associated with dry

desquamation of skin within the treatment field.Dryness and pruritus may occur and is caused byobliteration of sebaceous glands within the field.

combining radiation and chemotherapy plays a

significant role in state-of-the-art cancertherapy. The synergism of these cytotoxicmodalities enhances normal tissue reaction andcan be expected to precipitate highercomplication rates.

Significant cutaneous reactions are thought tooccur more frequently when chemotherapy andirradiation are administered concurrently


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pharmacologic agents employed at any point

during the cancer course, whether in a primarytreatment plan or incorporated into a symptomcontrol or supportive care program, are capableof eliciting a pruritic reaction.

Drugs associated with secondary pruritusinclude opium derivatives (cocaine, morphine,butorphanol), phenothiazines, tolbutamide,erythromycin estolate, anabolic hormones,estrogens, progestins, testosterone and

aspirin, quinidine and other antimalarials,biologics such as monoclonal antibodies, andvitamin B complex.


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Therapeutic actionsCompletely blocks the effects of histmaine at

peripheral H1 receptor sites, have anticholinergic(atropine-like) and antipruritic effects.

Indications Relief of symptoms associated with perennial and

seasonal allergic rhinitis; vasomotor rhinitis;allergic conjunctivitis; mild,uncomplicated urticaria andangioedema;

amelioration of allergic reactions to blood orplasma;dermatographism; adjunctive therapy inanaphylactic reactions


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Contraindicated with allergy to any

antihistamines, third trimester of pregnancy,lactation.

Use cautiously with narrow-angleglaucoma, stenosing peptic ulcer,

symptomaticprostatic hypertrophy, asthmaticattack, bladder neckobstruction, pyloroduodenalobstruction,pregnancy; elderly patients who may be

sensitive to anticholinergiceffects.


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Allergy to any antihistamines, narrow-angle

glaucoma, stenosing peptic ulcer,symptomatic prostatic hypertrophy, asthmatic attack,bladder neckobstruction, pyloroduodenal obstruction, thirdtrimester of pregnancy, lactation

Skin color, lesions, texture; orientation,

reflexes, affect; vision examination; P, BP; R,adventitious sounds; bowel sounds; prostatepalpation; CBC with differential

Administer with food if GI upset occurs.

Administer syrup form if patient is unable to taketablets. Monitor patient response, and arrange for adjustment

of dosage to lowest possible effective dose.


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Take as prescribed; avoid excessive dosage. Take with food if GI upset occurs.

Avoid alcohol; serious sedation could occur. You may experience these side effects:

Dizziness, sedation, drowsiness (use cautiondriving or performing tasks requiringalertness); epigastric distress, diarrhea or

constipation (take drug with meals); dry mouth(use frequent mouth care, suck sugarlesslozenges); thickening of bronchial secretions,dryness of nasal mucosa (use a humidifier).

Report difficulty breathing, hallucinations,

tremors, loss of coordination, unusual bleedingor bruising, visual disturbances, irregularheartbeat.
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corticosteroid preparation may be applied tothe skin to reduce inflammation and therebyrelieve itching caused by skin conditions suchas psoriasis, contact dermatitis, or eczema.

educe the production of substances calledprosta-glandins that trigger inflammation.


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Enters target cells and bindsto cytoplasmic receptors; initiates manycomplex reactions that are responsible for itsanti-inflammatory, immunosuppressive(glucocorticoid), and salt-retaining(mineralocorticoid) actions. Some actions maybe undesirable, depending on drug use.


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Replacement therapy in adrenal cortical insufficiency Allergic statessevere or incapacitating allergic conditions Hypercalcemia associated with cancer

Short-term inflammatory and allergic disorders, such asrheumatoid arthritis, collagen diseases (SLE), dermatologicdiseases (pemphigus), status asthmaticus, and autoimmunedisorders

Hematologic disordersthrombocytopenic purpura, erythroblastopenia

Trichinosis with neurologic or myocardial involvement Ulcerative colitis, acute exacerbations of MS, and palliation

in some leukemias and lymphomas Intra-articular or soft-tissue administration: Arthritis,

psoriatic plaques Retention enema: For ulcerative colitis, proctitis

Dermatologic preparations: To relieve inflammatoryand pruritic manifestations of dermatoses that are steroidresponsive

Anorectal cream, suppositories: To relieve discomfort ofhemorrhoids and perianal itching or irritation


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Topical dermatologic administration Contraindicated with fungal, tubercular, herpes

simplex skin infections; vaccinia, varicella; earapplication when eardrum is perforated.

Use cautiously with pregnancy, lactation.

Systemic administration:Weight, T; reflexes,affect, bilateral grip strength, ophthalmologic

examination; BP, P, auscultation, peripheralperfusion, discoloration, pain or prominence ofsuperficial vessels; R, adventitious sounds, chest x-ray; upper GI x-ray (history or symptoms of pepticulcer), liver palpation; CBC, serum electrolytes, 2-hrpostprandial blood glucose, urinalysis, thyroidfunction tests, serum cholesterol. Topical,dermatologic preparations:Affected area, integrity ofskin


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Topical dermatologic administration Use caution with occlusive dressings; tight or

plastic diapers over affected area can increasesystemic absorption.

Avoid prolonged use, especially near eyes, ingenital and rectal areas, on face, and in skin creases.

Topical dermatologic administration Apply sparingly, and rub in lightly

Avoid contacting your eye with the medication. Report burning, irritation, or infection of the

site, worsening of the condition. Avoid prolonged use.
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Itching, such as that caused by insect bites,sunburn, or an allergic rash such as urticaria,can often be soothed using calamine lotion orcream or an emollient. Emollient preparationsreduce moisture loss from the skin,preventing dryness and easing itching, andcan be used to relieve the symptoms ofeczema, psoriasis, and other dry skinconditions.


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Relaxes bronchial smooth muscle,causing bronchodilation and increasing vitalcapacity, which has been impairedby bronchospasm and air trapping; in higherconcentrations, it also inhibits the release ofslow-reacting substance of anaphylaxis (SRS-A) and histamine.


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Symptomatic relief or prevention of bronchialasthma and reversible bronchospasm associated with

chronic bronchitis and emphysema Unlabeled uses: Respiratory stimulantin Cheyne-Stokes respiration; treatment of apneaand bradycardia in premature babies

Contraindicated with hypersensitivity toany xanthine or to ethylenediamine, peptic ulcer,active gastritis; rectal or colonic irritation or infection(use rectal preparations).

Use cautiously with cardiac arrhythmias, acutemyocardial injury, CHF, cor pulmonale, severe

hypertension, severe hypoxemia, renal or hepaticdisease, hyperthyroidism, alcoholism, labor, lactation,pregnancy.


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Hypersensitivity to any xanthine orto ethylenediamine, peptic ulcer, active gastritis,cardiac arrhythmias, acute myocardial injury,CHF, corpulmonale, severe hypertension, severehypoxemia, renal or hepatic disease,

hyperthyroidism, alcoholism, labor, lactation,rectal or colonic irritation or infection(aminophylline rectal preparations)

Bowel sounds, normal output; P,

auscultation, BP, perfusion, ECG; R, adventitioussounds; frequency of urination, voiding, normaloutput pattern, urinalysis,


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Administer to pregnant patients only when clearlyneededneonatal tachycardia, jitteriness, and withdrawal apneaobserved when mothers receivedxanthines up until delivery.

Caution patient not to chew or crush enteric-coatedtimed-release forms. Give immediate-release, liquid dosage forms with food if

GI effects occur. Do not give timed-release forms with food; these should

be given on an empty stomach 1 hr before or 2 hr after meals. Maintain adequate hydration. Monitor results of serum theophylline levels carefully, and

arrange for reduced dosage if serum levels exceed therapeuticrange of 1020 mcg/mL.

Take serum samples to determinepeak theophylline concentration drawn 1530 min after an IVloading dose.

Monitor for clinical signs of adverse effects, particularly ifserum theophylline levels are not available.

Ensure that diazepam is readily available to treat seizures.


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Take this drug exactly as prescribed; if a timed-release product isprescribed, take this drug on an empty stomach, 1 hour before or 2hours after meals.

Do not to chew or crush timed-release preparations.

Administer rectal solution or suppositories after emptying therectum. It may be necessary to take this drug around-the-clock for

adequate control of asthma attacks. Avoid excessive intake of coffee, tea, cocoa, cola beverages, and

chocolate. Smoking cigarettes or other tobacco products impacts the drug's

effectiveness. Try not to smoke. Notify your health care provider ifsmoking habits change while taking this drug. Frequent blood tests may be necessary to monitor the effect of

this drug and to ensure safe and effective dosage; keep all appointmentsfor blood tests and other monitoring.

You may experience these side effects: Nausea, loss of appetite(taking this drug with food may help if taking the immediate-release or

liquid dosage forms); difficulty sleeping, depression,emotional lability (reversible). Report nausea, vomiting, severe GI pain, restlessness, seizures,

irregular heartbeat.
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antipruritic and bronchodilators

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