Pharmacology – Drugs for Allergic Rhinitis, Cough, and Colds – Flashcards
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What is allergic rhinitis?
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An inflammatory disorder of the upper airway, lower airway, and eyes
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What are symptoms of allergic rhinitis?
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- Sneezing - Rhinorrhea (runny nose) - Pruritus (itching) - Nasal congestion (from dilated nasal vessels) - For some people: conjunctivitis (inflamed conjunctiva(, sinusitis, and asthma
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Allergic Rhinitis
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- Seasonal (hay fever) usually in the spring and fall from pollen, mold, and grass - Perennial (non-seasonal) - from household allergens - Triggered by airborne allergens - Allergens bind to immunoglobin (IgE) on mast cells - like other mild allergic reactions - Inflammatory mediators released (histamine, leukotrienes, and prostaglandins)
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What are the classes of drugs used for allergic rhinitis?
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- Oral antihistamines - Intranasal glucocorticoids - Sympathomimetics/decongestants (oral and intranasal)
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Oral Antihistamines for allergic rhinitis
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- Do not reduce nasal congestion - Most effective if taken prophylactically (preventive, before symptoms) - Adverse effects are mild: sedation with first generation (much less with second generation) - Anticholinergic effects (dry mouth, urine retention, constipation)
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Intranasal Glucocorticoids
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- FIRST CHOICE - most effective for treatment and prevention of rhinitis - Reduce nasal inflammation - Can take daily or PRN
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What are the adverse effects of intranasal glucocorticoids?
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- Drying, burning, itching of nasal mucosa or sore throat - Nosebleed (epistaxis) - Headache - Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)
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Intranasal Cromolyn
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- Extremely safe, but only moderately effective - Suppresses release of histamines from mast cells - Bestused for prophylaxis, not for treatment - Response may take 1-2 weeks to develop
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Sympathomimetics (Oral/Nasal)
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- Also can use sinus or nasal decongestants - Reduce nasal congestion - does not reduce rhinorrhea, sneezing, or itching - Activate alpha1-adrenergic receptors on nasal blood vessels - Causes dilated vessels to constrict, reducing swollen membranes, reducing congestion - Need to clean tip between uses - Do not share
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What drugs are sympathomimetics?
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- phenylephrine (Neo-Synephrine) - pseudoephedrine (Sudafed) - ephedrine - Afrin nasal spray
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Sympathomimetics
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- In the US, can only obtain a limited amount monthly, yearly without a prescription, must sign for it and provide your driver's license to track amounts - Some states have banned without a prescription - One of the main ingredients in the illicit drug - methamphetamines - "meth, crystal meth, ice" - Phenylephrine is less effective orally but is available OTC with no restriction
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What are the adverse effects of sympathomimetics?
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- Rebound congestion - generally only with nasal spray. The congestion actually worsens when the effects wear off. Easy to become addicted to the spray, overuse in common. Must use spray to not be congested even when healthy with abuse. To prevent, only use for 3-5 days. Use a nasal glucocorticoid when you stop to lessen inflammation. - CNS Stimulation - mainly with oral - insomnia, irritability - Cardiovascular effects - most likely with oral (systemic) - may cause increased generalized vasoconstriction, elevated heart rate & BP - should avoid use if risk for or history of hypertension, stroke (CVA), MI, heart disease
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Why are nasal sympathomimetics different than oral sympathathomimetics?
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Nasal works faster, and wears off faster
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Antihistamine-sympathomimetic combinations
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- Usually have a "D" in the name, meaning decongestant - Example - loratadine (Claritin D)
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Anticholinergics like Atrovent for allergic rhinitis
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Dry mucous membranes to reduce runny nose
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How do antitussives work for cough?
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- Suppresses cough - Usually for a dry, nonproductive cough - Generally, if the cough is productive, we do not want to suppress expectoration - May not help cough from common cold - Opioid antitussives are Codeine and hydrocodone - Nonopioid antitussives are dextromethorphan and diphenhydramine
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How does codeine work for cough?
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- It elevates the cough threshold in the brain - It is the most effective cough suppressant available - Decreases cough frequency and intensity - Much lower dose than what is used for pain - Not much risk for abuse in the low dose form - May suppress breathing, use with caution - Not generally used in children
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dextromethorphan (DM, Robitussin DM)
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- Most effective non-opioid antitussive - Can be abused for the euphoria it produces in high doses - Works like codeine on the cough centers of the brain
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Tessalon Pearls
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- Capsules - Must be swallowed whole - Act on the throat and respiratory tract to reduce irritation - Can be dangerous if opened because they an cause airway spasm
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What does a mucolytic do?
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Breakdown secretions
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What do expectorants do?
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- Help to thin secretions and aid in coughing them up - Increase liquid secretion by the lungs helping to expectorate the mucus by thinning it
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What drug is a common mucolytic?
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Mucomist
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What drug is a common expectorant?
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guaifenesin (Robitussin, Mucinex)
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What are expectorants used for?
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Respiratory diseases that cause mucus/sputum production
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Use caution when administering expectorants to whom?
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Women who are pregnant
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What drugs are expectorants often combined with?
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- Antihistamines - Nasal decongestants - Antitussives
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Common cold
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- Acute upper respiratory viral infection: rhinorrhea, nasal congestion, cough, sneeze, sore throat, headache, hoarseness, malaise, myalgia (muscle ache) - Fever common in kids, rare in adults - Self-limited and usually benign - No cure; just treatment of symptoms
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Combination OTC cold remedies often contain two or more of the following
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- Nasal decongestant - Antitussive - Analgesic - like (Tylenol) acetaminophen - Antihistamine (for cholinergic actions = drying, reduced respiratory secretion) - no longer recommended - Caffeine (to offset sedative effect of antihistamine)
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OTC Herbal Remedies for prevention
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- Zinc and Vitamin C - May be helpful but not enough proof
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Use Caution when Using OTC Cold Remedies in Children
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- No proof of efficacy or safety, but proof of harm: Young children have died from use of OTC cough remedies - or have had serious side effects like hallucinations, seizures, tachycardia - Avoid OTC cold remedies in children younger than 4-6 years of age - Use only products labeled for pediatric use - Consult a healthcare professional before giving to a child - Read all protect safety information before dosing - Use the measuring device provided with the product - Discontinue the medicine and seek professional care if the child's condition worsens
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How do you assess a cough? (Antitussives)
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Assess the type and quality of cough, monitor for injury risk if dizziness occurs
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How do you implement/ educate when a patient has a cough, and when giving antitussives?
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- Report if any fever, chest pain, sputum production or if cough is not relieved by 7 days - Drink plenty of fluids - Do not crush or chew capsules - Do not drink after taking lozenge for 30 minutes - Avoid respiratory irritants like dust - Educate to monitor for pain medicine side effects if taking codeine, hydrocodone (part of Lortab, Vicodin)
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How do you evaluate a patient after giving an antitussive?
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Is the cough relieved?
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How do you assess a patient when they are congested?
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- Assess cough type and quality - Assess the type and quality of sputum - Listen to lungs - Report any SOB/SOA or distress
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What is a nursing diagnosis for a patient who is congested?
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Ineffective Airway Clearance
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How do you plan/implement/educate a patient who is congested?
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- Have then drink plenty of fluids to thin secretions - Instruct them on appropriate administration
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How do you evaluate after giving a decongestant?
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- Is their congestion improved? - Is the patient educated?
