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A. Histamine Synthesis
Function Location Type
Causes:
vasodilation
Bronchoconstriction
bronchial smooth muscle
contraction separation of
endothelial cells
(responsible for hives), Found on:
and pain and itching due • Smooth muscle H1 histamine
to insect stings; • Endothelium receptor
• CNS tissue
the primary receptors
involved in allergic rhinitis
symptoms and motion
sickness;
sleep regulation.
Primarily stimulate Located on parietal H2 histamine
gastric acid secretion cells receptor
Decreased
Found on central
neurotransmitter
nervous system and
release: histamine, H3 histamine
to a lesser extent
acetylcholine, receptor
peripheral nervous
norepinephrine,
system tissue
serotonin
Found primarily in
the basophils and in
the bone marrow. It
Plays a role in H4 histamine
is also found on
chemotaxis. receptor
thymus, small
intestine, spleen, and
colon.
B. Release of histamine can occur by two
processes:
A. Histamine (H1)-receptors
– H1-receptors are found in the brain, heart,
bronchi, gastrointestinal tract, vascular
smooth muscles, and leukocytes.
• Classification:
1. First-generation agents
2. Second-generation agents
First-generation agents
• Groups:
1. Alkylamines
2. Ethanolamines
3. Ethylenediamines
4. Piperazines
5. Tricyclics
First-generation agents
1.Alkylamines
– Alkylamines include
– Chlorpheniramine
– Brompheniramine
– Include:
– pyrilamine and antazoline.
– Ethylenediamines produce
moderate sedation and can cause
gastrointestinal upset.
4. Piperazines
– include meclizine and cyclizine.
– Piperazines produce marked adverse
gastrointestinal effects and moderate
sedation.
2. Piperidines
Loratadine [Claritin]
Desloratadine [Clarinex]
– Poor CNS penetration: reduced sedation
– Little or no anticholinergic activity
– Desloratadine:
• is the active metabolite of loratadine
• has about 15-fold greater affinity for the H1
receptor than the parent compound
Fexophenadine
– is structurally different than the other
piperidine antihistamines,
– sedative activity is low but dose dependent.
2. Clemastine
• is a second-generation ethanolamine
• longer duration of action than
dimenhydramine
• it has some antiemetic activity.
3. Alkylamines:
A. acrivastine.
• Acrivastine is not associated with cardiac
effects.
B. Cetirizine [Zyrtec]
– Cetirizine is not associated with cardiac
abnormalities.
– Cetirizine has poor penetration into the
CNS.
– Cetirizine is less sedating;
– it is ineffective for motion sickness or
antiemesis.
Pharmacologic properties
of Histamine (H1)-receptor antagonists
• well absorbed after oral administration.
2nd 1st
generation generation
30 min 30 min Onset
5. Appetite suppressants
Adverse effects
• (significantly reduced with second-generation agents)
• Sedation, dizziness, and loss of appetite.
• These agents can cause gastrointestinal upset, nausea,
and constipation or diarrhea.
• H1-receptor antagonists produce anticholinergic effects
(dry mouth, blurred vision, and urine retention).
• Nedocromil sodium
– more effective in reducing bronchospasm
caused by exercise or cold air.