🫁 Modules 12 & 13 · Respiratory, Eye/Ear & GI

32 drugs · 17 concepts · tested on Exam 7

💡 The big idea

Three body systems bundled into one exam, and each has a clean organizing question. Lungs: is the problem the airway MUSCLE (bronchodilators) or the airway INFLAMMATION (steroids and leukotriene blockers)? Eyes: glaucoma drugs either make less aqueous humor or drain more of it. GI: work top to bottom — acid, nausea, motility, absorption.

🧠 How to think about this module

Asthma splits into rescue and control, and confusing the two is the most common error in this module. Albuterol is rescue. Inhaled steroids, montelukast, salmeterol, and cromolyn are control and do nothing during an attack.
Inhalers have an order and an aftercare: bronchodilator first, wait, then the steroid. Rinse and spit after any inhaled steroid.
Glaucoma: less production (beta blockers, alpha-2 agonists, carbonic anhydrase inhibitors) vs more outflow (prostaglandin analogs, cholinergics). Both lower pressure.
GI acid drugs escalate in strength and slow down in onset: antacids (fastest, shortest), then H2 blockers, then PPIs (slowest to start, strongest), plus protectants that coat rather than reduce acid.
Antiemetics are receptor drugs — match the receptor to the cause. Chemo = 5-HT3 (ondansetron). Motion = anticholinergic/antihistamine (scopolamine, dimenhydrinate). Gastroparesis = dopamine blocker (metoclopramide). Anticipatory = benzodiazepine (lorazepam).

🏷️ The whole module in 9 classes

Learn these groups and the drug list stops being 32 separate names.

Class	What it does	Examples	What gets tested
Bronchodilators	Open a narrowed airway by relaxing bronchial smooth muscle.	albuterol, levalbuterol (short-acting beta-2, RESCUE); salmeterol, formoterol (long-acting, control); ipratropium, tiotropium (anticholinergic); theophylline (xanthine)	Albuterol causes tachycardia, tremor, and hypokalemia. Theophylline has a narrow therapeutic window (about 10 to 20 mcg/mL) and caffeine, smoking, and many drugs shift the level — nausea, restlessness, and tachycardia signal toxicity.
Inhaled and systemic corticosteroids	Reduce airway inflammation. Long-term CONTROL only.	fluticasone, beclomethasone, budesonide (inhaled); prednisone, methylprednisolone (systemic for exacerbations)	Rinse and spit after every inhaled dose or the client gets oral candidiasis and hoarseness. Use a spacer. These take days to weeks and are never used to abort an attack.
Leukotriene modifiers, mast cell stabilizers, and biologics	Prevent the inflammatory cascade before it starts. Prevention only.	montelukast, zafirlukast; cromolyn; omalizumab	Montelukast carries a boxed warning for neuropsychiatric events — teach the client and family to report new agitation, nightmares, depression, or suicidal thoughts. Omalizumab can cause anaphylaxis; observe after each injection.
Antihistamines and decongestants	Dry and decongest the upper airway.	diphenhydramine, dimenhydrinate, hydroxyzine (1st generation); fexofenadine, loratadine, cetirizine (2nd generation); pseudoephedrine, phenylephrine, oxymetazoline (decongestants)	First-generation antihistamines are sedating and anticholinergic — a Beers criteria fall risk in older adults. Decongestants raise BP and heart rate; nasal sprays cause rebound congestion if used more than 3 days.
Cough and mucus agents	Suppress a dry cough or thin and mobilize mucus.	dextromethorphan, codeine (antitussive); guaifenesin (expectorant); acetylcysteine (mucolytic, and the acetaminophen antidote)	Never suppress a productive cough. Guaifenesin needs a big increase in fluid intake to work. Codeine is contraindicated in children under 12 and after tonsillectomy. Acetylcysteine smells like rotten eggs and can trigger bronchospasm.
Glaucoma agents	Lower intraocular pressure by decreasing production or increasing outflow.	latanoprost (prostaglandin, outflow), pilocarpine (cholinergic, outflow); timolol (beta blocker), brimonidine (alpha-2 agonist), dorzolamide (carbonic anhydrase inhibitor) — all decrease production	Latanoprost is dosed once at bedtime and permanently darkens the iris and lengthens the lashes. Ophthalmic timolol is absorbed systemically — apply punctal pressure at the inner canthus for 1 to 2 minutes to reduce bradycardia and bronchospasm.
Acid reducers and mucosal protectants	Lower gastric acid or coat the injured mucosa.	aluminum hydroxide, calcium carbonate (antacids); famotidine (H2 blocker); omeprazole, pantoprazole (PPIs); sucralfate, misoprostol (protectants); amoxicillin plus clarithromycin plus a PPI (H. pylori triple therapy)	Long-term PPIs cause hypomagnesemia, B12 deficiency, C. difficile infection, and fractures. Sucralfate goes 1 hour before meals and at bedtime and must be separated from other drugs by 2 hours. Misoprostol causes uterine contractions and is contraindicated in pregnancy for ulcer prevention. H. pylori is treated with two antibiotics plus a PPI for 10 to 14 days — all of it, or the organism comes back resistant.
Antiemetics	Block whichever receptor is driving the vomiting.	ondansetron (5-HT3), metoclopramide (dopamine), promethazine, dimenhydrinate, scopolamine (anticholinergic/antihistamine), aprepitant (NK-1), dexamethasone, lorazepam, dronabinol	Ondansetron prolongs the QT interval. Metoclopramide has a boxed warning for tardive dyskinesia — limit to 12 weeks. Scopolamine patch goes behind the ear; wash hands after handling or the client rubs it into their eye and gets a dilated pupil.
Laxatives, antidiarrheals, and GI miscellany	Move the bowel, slow the bowel, or replace what the gut cannot do.	psyllium (bulk), senna and bisacodyl (stimulant), lactulose and polyethylene glycol (osmotic), docusate (softener); loperamide, diphenoxylate/atropine (antidiarrheal); pancrelipase, orlistat, phentermine, probiotics, sulfasalazine	Lactulose is titrated to 2 to 3 soft stools a day in hepatic encephalopathy — that IS the therapeutic endpoint, not a side effect. Psyllium needs a full glass of water or it obstructs. Pancrelipase goes with every meal and snack and must not be crushed. Orlistat causes oily leakage and blocks fat-soluble vitamins.

⚖️ Rescue vs controller in asthma (the most-tested distinction here)

Rescue / quick relief	Controller / long-term
Albuterol, levalbuterol; ipratropium in COPD	Inhaled steroids (fluticasone, beclomethasone), montelukast, salmeterol, cromolyn, omalizumab
Works in minutes	Takes days to weeks to reach full effect
Used at the first sign of symptoms and before exercise	Taken every single day whether symptoms are present or not
Carried at all times	Never used to treat an attack — a long-acting beta agonist alone increases asthma deaths
Needing it more than 2 days a week means control has failed	Rinse the mouth after every inhaled steroid dose

🚨 Red flags DANGER

A client using salmeterol or another long-acting beta agonist as a rescue inhaler: stop and re-teach immediately. LABA monotherapy in asthma increases mortality.
A silent chest, rising CO2, or a client too breathless to speak in full sentences is respiratory failure, not improvement. Call rapid response.
Never give loperamide or diphenhydramine/atropine to a client with fever, bloody stool, or suspected C. difficile — slowing the bowel traps the toxin and can cause toxic megacolon.
Involuntary lip smacking, tongue movement, or facial grimacing on metoclopramide: stop the drug and call. Tardive dyskinesia may be permanent.
Ophthalmic timolol in a client with asthma, COPD, bradycardia, or heart block: the drops are systemic. Verify before instilling.

🧵 Exam traps ⭐ HIGH YIELD

Albuterol and montelukast are not substitutes for each other in either direction. Rescue vs control is the single most-tested distinction in this module.
Bronchodilator FIRST, then the steroid inhaler — the airway has to be open for the steroid to reach it.
Guaifenesin is an expectorant (thins and moves mucus); dextromethorphan is an antitussive (suppresses the cough). Opposite jobs, and they are often in the same bottle.
Ondansetron works for chemotherapy and postoperative nausea but not motion sickness; scopolamine works for motion sickness but not chemotherapy nausea. The receptor determines the indication.
Lactulose 'causing diarrhea' is the therapeutic goal in hepatic encephalopathy, not an adverse effect to hold the drug for.
Antacids and sucralfate interfere with the absorption of nearly everything. Separate other medications by at least 1 to 2 hours.
Eye drops: one drop is all the eye holds, apply pressure to the inner canthus, and wait 5 minutes between two different drops. Ear drops: pull the pinna up and back for an adult, down and back for a child under 3.

🧠 Ways to remember it

Rescue equals albuterol. Control equals everything else.
Steroid inhaler: rinse and spit, or you get thrush.
Antiemetic matching: Zofran for chemo, scopolamine for the sea, Reglan for a stomach that will not move.
PPIs end in -prazole. H2 blockers end in -tidine. Antacids are the ones that work in minutes and wear off in an hour.
Latanoprost: Lashes Long, iris dark, one drop at night.

🧠 The concepts 17

Which medications are recommended for the treatment of mild to moderate asthma (Hint: steps 1 & 2)?⭐ HIGH YIELD

Step 1 (intermittent): a short-acting beta-2 agonist, albuterol, as needed. Step 2 (mild persistent): a daily LOW-DOSE INHALED CORTICOSTEROID is the preferred controller plus PRN albuterol; the 2020 update also allows PRN concomitant ICS with the SABA. Alternatives at Step 2 are a leukotriene receptor antagonist (montelukast), cromolyn, nedocromil, or theophylline.

An inhaled corticosteroid is the preferred controller at every persistent step. The alternatives listed are genuinely less effective.
Persistent asthma means symptoms more than 2 days a week or nighttime awakenings more than twice a month. Needing the rescue inhaler more than 2 days a week means step up.
Montelukast carries a boxed warning for neuropsychiatric events. Teach families to report mood changes, agitation, and suicidal thinking.
Theophylline has a narrow therapeutic index: monitor levels and watch for nausea, tachycardia, and seizures. It is rarely used now.
Inhaled corticosteroid technique: use a spacer and RINSE THE MOUTH after every dose to prevent oral candidiasis. If both inhalers are due, give the BRONCHODILATOR first, wait, then the corticosteroid.

Rescue is albuterol. Control is a steroid inhaler. Needing rescue more than twice a week means control is failing.

Compare the adverse effects of 1st generation and 2nd generation antihistamines.⭐ HIGH YIELD

First generation crosses the blood-brain barrier, so it causes heavy SEDATION plus ANTICHOLINERGIC effects. Second generation barely crosses, so it is non-sedating or minimally sedating with few anticholinergic effects, making it the safer choice for daily use and for older adults.

First-generation drugs still have real uses: acute allergic reactions, motion sickness, vertigo, nausea, and as sleep aids. There the sedation is the point.
Both block H1 receptors. NEITHER is the treatment for anaphylaxis; epinephrine is.
Teach: no alcohol or other CNS depressants, and no driving on first-generation agents.
Avoid first-generation agents in narrow-angle glaucoma, BPH, and dementia.

1st generation	2nd generation
Diphenhydramine, chlorpheniramine, hydroxyzine, promethazine, meclizine	Loratadine, cetirizine, fexofenadine, levocetirizine, desloratadine
Crosses the blood-brain barrier readily	Poorly crosses the blood-brain barrier
Strong sedation, drowsiness, impaired driving; paradoxical excitation in children and older adults	Non-sedating to minimally sedating (cetirizine is the most sedating of this group)
Anticholinergic: dry mouth, blurred vision, urinary retention, constipation, tachycardia, confusion	Few or no anticholinergic effects
Short-acting, often every 4 to 6 hours	Long-acting, usually once daily
On the Beers list: avoid in older adults	Preferred in older adults; adjust for renal function

1st gen puts you to sleep AND dries you out. 2nd gen just treats the allergy.

What are the treatment options for a dry cough?⭐ HIGH YIELD

For a dry, nonproductive cough: dextromethorphan (the OTC antitussive) is first-line, codeine or hydrocodone for severe cough, benzonatate (numbs airway stretch receptors), and honey as an effective non-drug option in anyone over 1 year old.

Dextromethorphan: avoid with SSRIs, MAOIs, and other serotonergic drugs because of serotonin syndrome. It has abuse potential at high doses.
Codeine and hydrocodone antitussives: sedation, constipation, respiratory depression. Contraindicated in children under 12 and in nursing mothers.
Benzonatate must be SWALLOWED WHOLE. Chewing or sucking it numbs the mouth and throat and can cause choking and laryngospasm; it is lethal if a young child ingests it.
NEVER give honey to an infant under 1 year: infant botulism.
Suppress only a DRY cough. A productive cough should be helped with an expectorant (guaifenesin) and fluids, not suppressed. Look for the cause: ACE inhibitors cause a persistent dry cough, and the fix is switching to an ARB.

Dry cough, suppress it. Wet cough, loosen it. Never honey under one.

Describe the process for administering eye drops.⭐ HIGH YIELD

Wash hands, tilt the head back, pull the LOWER LID down to make a pocket, drop the medication into the conjunctival sac (never onto the cornea and never touching the eye with the tip), have the patient close the eye gently, then apply pressure to the inner canthus for 30 to 60 seconds to prevent systemic absorption.

Before: check the label, expiration date, and which eye (OD right, OS left, OU both). Inspect the solution and tip for cloudiness or discoloration.
Set the cap on a clean surface tip-side up, and never let the dropper touch the eye, lashes, or any surface. Stabilize the dominant hand by resting it on the patient's forehead or on the back of the non-dominant hand.
Wait 5 MINUTES between different eye drops, give drops before ointments, and remove contact lenses first (reinsert after about 15 minutes).
Punctal occlusion matters most with beta blocker drops such as timolol, where systemic absorption causes bradycardia and bronchospasm.
Blot excess solution with a tissue, wiping from the inner to the outer canthus.

Lower lid pocket, never the cornea. Then press the inner corner, because that is the drain to the bloodstream.

Describe the process for administering ear drops.⭐ HIGH YIELD

Wash hands, warm the drops to room temperature (cold drops cause vertigo and pain), position the patient with the affected ear UP, straighten the canal: ADULTS pull the pinna UP AND BACK, CHILDREN under 3 pull DOWN AND BACK. Instill along the side of the canal, pump the tragus, and keep the ear up for 2 to 5 minutes.

Never warm drops in a microwave. Hold the bottle in your hands or in warm water for a few minutes.
Do not let the dropper touch the ear and do not occlude the canal completely with the dropper tip.
A loose cotton ball may be placed at the outermost canal for a few minutes if ordered, but never packed in.
If the tympanic membrane is perforated or tubes are in place, only specific sterile preparations (fluoroquinolone otic drops) may be used.
Eye drops CAN be used in the ear in a pinch, but ear drops must NEVER go in the eye: otic preparations are not sterile.

Adults UP and back (adults are grown up). Kids DOWN and back (kids are little).

Cromolyn

Cromolyn sodium is a MAST CELL STABILIZER used to PREVENT asthma and allergic symptoms by stopping mast cells from releasing histamine. It is not a rescue drug and will not help an attack already in progress.

Onset takes 2 to 4 weeks of regular use. Teach the patient to keep using it even when they feel fine.
Available as an inhaled or nebulized solution (asthma), a nasal spray (allergic rhinitis), and ophthalmic drops (allergic conjunctivitis).
Also used prophylactically 15 to 20 minutes before exercise or a known allergen exposure.
Very safe drug. Main effects are throat irritation, cough, and a bad taste. Rinse the mouth after use.
It is an alternative (not preferred) controller at Step 2 asthma; inhaled corticosteroids work better.

Cromolyn CALMS the mast cell before it fires. Prevention only, never in a crisis.

Phenylephrine stimulant⭐ HIGH YIELD

Phenylephrine is a pure ALPHA-1 AGONIST. Intranasally or orally it is a decongestant (vasoconstricts nasal mucosa); IV it is a vasopressor that raises blood pressure; as ophthalmic drops it dilates the pupil for eye exams.

Because it is alpha-only, it raises blood pressure without directly stimulating the heart, so it can cause REFLEX BRADYCARDIA.
Adverse effects: hypertension, headache, palpitations, restlessness, urinary retention, and rebound congestion.
Rhinitis medicamentosa: nasal sprays used longer than 3 DAYS cause rebound congestion. Teach the 3-day limit.
Caution or avoid in uncontrolled hypertension, coronary disease, narrow-angle glaucoma, BPH, hyperthyroidism, and with MAOIs (hypertensive crisis).
Oral phenylephrine is poorly absorbed, and the FDA has concluded it is not effective as an oral decongestant.

PhenylEPHRINE is pure alpha: squeeze the vessels. Dry nose, high BP, big pupil, and a reflexively slow heart rate.

Pseudoephedrine Stimulant⭐ HIGH YIELD

Pseudoephedrine is an oral SYMPATHOMIMETIC decongestant. It stimulates alpha-1 receptors to vasoconstrict swollen nasal mucosa, with some beta stimulation, relieving nasal and sinus congestion.

CNS and cardiac stimulation: insomnia, nervousness, tremor, palpitations, tachycardia, and INCREASED BLOOD PRESSURE.
Avoid in hypertension, coronary artery disease, arrhythmias, hyperthyroidism, diabetes (it raises glucose), BPH, narrow-angle glaucoma, and with MAOIs.
Teach: take the last dose several hours before bedtime to avoid insomnia, and never exceed the label dose.
Sold behind the pharmacy counter with ID and quantity limits because it is a methamphetamine precursor.
Combination cold products often contain acetaminophen. Add up the total daily acetaminophen (max 4 g/day, less with liver disease or alcohol use).

PseudoEPHEDRINE dries the nose, wires the patient, and raises the pressure.

Brimonidine

Brimonidine is an ALPHA-2 ADRENERGIC AGONIST eye drop for open-angle glaucoma and ocular hypertension. It lowers intraocular pressure by both decreasing aqueous humor production and increasing outflow. A topical gel form also treats rosacea redness.

Local effects: burning and stinging, ocular redness, dry mouth, blurred vision, foreign-body sensation, and allergic conjunctivitis.
Systemic absorption causes hypotension, bradycardia, drowsiness, and fatigue. Apply punctal occlusion for 1 to 2 minutes after instilling.
CONTRAINDICATED in infants and children under 2 and with MAOIs: it can cause profound CNS depression and apnea.
Remove soft contact lenses before instilling because of benzalkonium chloride, and wait 15 minutes to reinsert.
Separate different eye drops by 5 minutes.

Brimonidine puts alpha-2 brakes on aqueous production. Press the inner corner or the whole body gets sleepy.

Pilocarpine

Pilocarpine is a direct-acting CHOLINERGIC (muscarinic) agonist. As eye drops it causes MIOSIS and ciliary muscle contraction, opening the trabecular meshwork so aqueous humor drains: used for glaucoma, especially acute angle-closure. Orally it treats dry mouth (xerostomia) from Sjogren syndrome or head and neck radiation.

Expect blurred vision, difficulty seeing in the dark, and brow ache or headache from ciliary spasm. Teach caution driving at night.
Systemic cholinergic effects: sweating, salivation, nausea, cramping, diarrhea, bradycardia, bronchospasm. Use punctal occlusion.
Caution or avoid in asthma and COPD (bronchoconstriction), bradycardia, peptic ulcer disease, and iritis.
Atropine is the antidote for excessive cholinergic effect.
Contrast with atropine drops: pilocarpine CONSTRICTS the pupil, atropine DILATES it.

PILOcarpine makes the pupil PIN-point and drains the eye.

Aluminum Hydroxide GERD

Aluminum hydroxide is an ANTACID that directly neutralizes stomach acid already present, giving fast but short-lived relief of heartburn, GERD, and indigestion. It also binds phosphate, so it is used as a phosphate binder in chronic kidney disease.

Signature side effect is CONSTIPATION. That is why it is combined with magnesium hydroxide, which causes diarrhea, so the two balance each other (Maalox, Mylanta).
Give antacids about 1 hour AFTER meals and at bedtime for the longest acid-neutralizing effect.
Big interaction problem: separate from other oral drugs by 1 to 2 hours. It binds tetracyclines, fluoroquinolones, iron, levothyroxine, digoxin, and phenytoin and blocks their absorption.
Long-term or high dose: hypophosphatemia, aluminum accumulation in renal failure, constipation and impaction.
Antacids relieve symptoms only. They do not heal ulcers or treat the cause; PPIs and H2 blockers do that.

ALuminum means A Lot of constipation. Mag means must go (diarrhea). Together they cancel out.

Diphenoxylate/Atropine Loperamide is similar⭐ HIGH YIELD

Diphenoxylate with atropine (Lomotil) is an opioid-derived ANTIDIARRHEAL that slows GI motility so more water is absorbed. The small dose of atropine is added purely to DISCOURAGE ABUSE by causing unpleasant anticholinergic effects at high doses. Loperamide (Imodium) acts on the same gut opioid receptors but does not cross into the CNS at normal doses.

Do NOT use either drug in infectious diarrhea with fever or bloody stools (C. difficile, Shigella, E. coli O157). Trapping the pathogen risks toxic megacolon and sepsis.
Lomotil is contraindicated in children under 2 and in ulcerative colitis flares or toxic megacolon.
LOPERAMIDE AT HIGH DOSES CAUSES QT PROLONGATION, TORSADES DE POINTES, AND CARDIAC ARREST. It is abused for opioid effect; never exceed label dosing.
Both cause drowsiness, so no driving.
The real priority in diarrhea is fluid and electrolyte replacement, not just stopping the stool.

Diphenoxylate/atropine (Lomotil)	Loperamide (Imodium)
Prescription; Schedule V controlled substance	Over the counter; not scheduled
Atropine added as an abuse deterrent	No added deterrent
Can cause CNS effects: sedation, euphoria, respiratory depression in overdose	Minimal CNS penetration at label doses
Anticholinergic effects: dry mouth, blurred vision, urinary retention, tachycardia	Mainly constipation, cramping, and dizziness

Lomotil is an opioid with a booby trap (atropine). Loperamide is the OTC cousin: safe at label dose, deadly to the heart above it.

Dronabinol

Dronabinol (Marinol) is synthetic THC used for chemotherapy-induced nausea and vomiting that has not responded to other antiemetics, and for APPETITE STIMULATION in AIDS-related anorexia with weight loss.

It is a Schedule III controlled substance. CNS effects: dizziness, drowsiness, euphoria or dysphoria, confusion, anxiety, paranoia, and hallucinations, all worse in older adults. Fall precautions and no driving.
Cardiovascular: tachycardia and orthostatic hypotension. Teach the patient to rise slowly.
Additive sedation with alcohol, opioids, benzodiazepines, and other CNS depressants.
Avoid in psychiatric illness (psychosis, mania), substance use disorder, and pregnancy. Use caution in cardiac disease.
Give before meals when used for appetite, and supervise the first doses because the response is unpredictable.

Dronabinol is legal THC in a capsule: eat more, vomit less, feel strange.

Famotidine GERD⭐ HIGH YIELD

Famotidine is an H2 RECEPTOR ANTAGONIST. It blocks histamine at the gastric parietal cell so less acid is SECRETED. Used for GERD, peptic ulcer disease, stress ulcer prophylaxis, and Zollinger-Ellison syndrome.

Take at bedtime for nocturnal acid, or about 30 minutes before a trigger meal.
Reduce the dose in renal impairment. Famotidine is renally cleared, and confusion or delirium can occur in older or renal patients.
Cimetidine, the older H2 blocker, inhibits CYP450 and causes gynecomastia; famotidine does neither, which is why famotidine is preferred.
Separate from antacids by about 1 hour. It can mask the symptoms of gastric cancer.

H2 blocker (famotidine)	PPI (omeprazole)
Blocks the histamine-2 receptor on the parietal cell	Irreversibly blocks the H+/K+ ATPase proton pump, the final common step
Faster relief, about 1 hour; moderate acid suppression	Slower to start, days for full effect; much stronger acid suppression
Good for intermittent or nighttime symptoms; tolerance can develop	Better for healing erosive esophagitis and ulcers
Fewer long-term risks	Long-term: fracture, C. difficile, pneumonia, low B12 and magnesium

The '-tidines' turn down the faucet. The '-prazoles' shut off the pump.

Omeprazole GERD. Is a Protein Pump Inhibitor⭐ HIGH YIELD

Omeprazole is a PROTON pump inhibitor (proton, not protein). It irreversibly blocks the H+/K+ ATPase pump in gastric parietal cells, the final common step of acid secretion. Used for GERD, erosive esophagitis, peptic ulcer disease, H. pylori regimens, and Zollinger-Ellison syndrome.

Take 30 to 60 MINUTES BEFORE the first meal of the day. The pump has to be active for the drug to bind it.
Swallow delayed-release capsules WHOLE. Do not crush or chew. Capsules may be opened onto applesauce only if the label allows.
Full effect takes several days, so it is not an on-demand rescue for heartburn.
Long-term risks: C. difficile infection, pneumonia, hip and spine fractures, hypomagnesemia, B12 and iron deficiency, and rebound acid hypersecretion if stopped abruptly. On the Beers list beyond 8 weeks without a clear indication.
CYP2C19 inhibitor: it reduces activation of CLOPIDOGREL, so use pantoprazole instead when clopidogrel is needed. It also decreases absorption of drugs that need acid, such as ketoconazole, iron, and atazanavir.

'-prazole' means PUMP off. Take it BEFORE breakfast or you are wasting the dose.

Probiotics

Probiotics are live beneficial bacteria and yeasts (Lactobacillus, Bifidobacterium, Saccharomyces boulardii) taken to restore normal gut flora, most commonly to prevent or shorten antibiotic-associated diarrhea, and for irritable bowel symptoms.

Separate from oral antibiotics by about 2 hours so the antibiotic does not kill the probiotic.
CONTRAINDICATED or high risk in severely immunocompromised, critically ill, and central-line patients: risk of bacteremia or fungemia, especially with S. boulardii.
Also use caution with short gut, damaged GI mucosa, and in premature infants.
Common effects: gas, bloating, and mild cramping in the first few days.
Refrigerate products that require it and check the CFU count and expiration. Supplements are not FDA-regulated for potency.

Probiotics rebuild the gut garden, but never plant live bugs in an immunocompromised patient.

Psyllium⭐ HIGH YIELD

Psyllium (Metamucil) is a BULK-FORMING LAXATIVE: soluble fiber that absorbs water, swells, and creates a soft bulky stool that stimulates peristalsis. Used for chronic constipation, IBS, diverticulosis, and to modestly lower LDL cholesterol.

MUST be taken with a full 8 oz glass of water plus adequate fluids all day. Without fluid it can cause esophageal or intestinal OBSTRUCTION and impaction.
Contraindicated in bowel obstruction, fecal impaction, dysphagia, and GI strictures or narrowing.
Onset is 12 to 72 hours. This is the safest laxative for long-term use but useless for immediate relief.
Separate from other oral medications by at least 2 hours. It binds and reduces absorption of digoxin, warfarin, salicylates, and carbamazepine.
Start low and increase slowly to limit gas and bloating. It may lower blood glucose in diabetics.

Bulk-forming means fiber plus fluid. Fiber without water is a plug, not a laxative.

💉 The drugs 32

💉 Acetylcysteine

Mucolytic; antidote—acetaminophen, Amino acid l-cysteine

What it is for

Mucolytic (thins mucus in chronic bronchitis, cystic fibrosis); antidote for acetaminophen overdose.

How it works

Breaks disulfide bonds in mucus → decreases viscosity.

Watch for

Bronchospasm, nausea, unpleasant odor.

Teaching

Use nebulizer; may cause rotten egg smell; rinse mouth after use.
That foul odor and smell may be unpleasant
To clear airway for inhalation
To report vomiting because dose may need to be repeated

🫁 Modules 12 & 13 · Respiratory, Eye/Ear & GI

💡 The big idea

🧠 How to think about this module

🏷️ The whole module in 9 classes

⚖️ Rescue vs controller in asthma (the most-tested distinction here)

🚨 Red flags DANGER

🧵 Exam traps ⭐ HIGH YIELD

🧠 Ways to remember it

🧠 The concepts 17

Which medications are recommended for the treatment of mild to moderate asthma (Hint: steps 1 & 2)?⭐ HIGH YIELD

Compare the adverse effects of 1st generation and 2nd generation antihistamines.⭐ HIGH YIELD

What are the treatment options for a dry cough?⭐ HIGH YIELD

Describe the process for administering eye drops.⭐ HIGH YIELD

Describe the process for administering ear drops.⭐ HIGH YIELD

Cromolyn

Phenylephrine stimulant⭐ HIGH YIELD

Pseudoephedrine Stimulant⭐ HIGH YIELD

Brimonidine

Pilocarpine

Aluminum Hydroxide GERD

Diphenoxylate/Atropine Loperamide is similar⭐ HIGH YIELD

Dronabinol

Famotidine GERD⭐ HIGH YIELD

Omeprazole GERD. Is a Protein Pump Inhibitor⭐ HIGH YIELD

Probiotics

Psyllium⭐ HIGH YIELD

💉 The drugs 32

💉 Acetylcysteine

💉 Albuterol

💉 Beclomethasone

💉 CodeineHIGH ALERTBLACK BOX

💉 Dextromethorphan

💉 Diphenhydramine

💉 Fexofenadine

💉 Fluticasone

💉 Guaifenesin

💉 Ipratropium

💉 MontelukastBLACK BOX

💉 OmalizumabBLACK BOX

💉 TheophyllineHIGH ALERT

💉 Amoxicillin

💉 Dorzolamide

💉 Latanoprost

💉 Timolol

💉 Aprepitant

💉 Dexamethasone

💉 Dimenhydrinate

💉 Lactulose

💉 LorazepamHIGH ALERTBLACK BOX

💉 MetoclopramideBLACK BOX

💉 MisoprostolBLACK BOX

💉 Ondansetron

💉 Orlistat

💉 Pancrelipase

💉 PhentermineHIGH ALERT

💉 Scopolamine

💉 Senna

💉 Sucralfate

💉 Sulfasalazine