NASAL DECONGESTANTS – Flashcards

Symptomatic management of nasal congestion associated with acute viral upper respiratory tract infections. Used in combination with antihistamines in the management of allergic conditions. Used to open obstructed eustachian tubes in chronic otic inflammation or infection.

Stimulates alpha- and beta-adrenergic receptors. Produces vasoconstriction in the respiratory tract mucosa (alpha-adrenergic stimulation) and possibly bronchodilation (beta2-adrenergic stimulation). Reduction of nasal congestion, hyperemia, and swelling in nasal passages.

CNS: SEIZURES, anxiety, nervousness, dizziness, drowsiness, excitability, fear, hallucinations, headache, insomnia, restlessness, weakness. Resp: respiratory difficulty. CV: CARDIOVASCULAR COLLAPSE, palpitations, hypertension, tachycardia. GI: anorexia, dry mouth. GU: dysuria. Misc: diaphoresis.

Assess congestion (nasal, sinus, eustachian tube) before and periodically during therapy. Monitor pulse and BP before beginning therapy and periodically during therapy. Assess lung sounds and character of bronchial secretions. Maintain fluid intake of 1500-2000 mL/day to decrease viscosity of secretions. Do not confuse Sudafed with sotalol or Sudafed PE. Administer pseudoephedrine at least 2 hr before bedtime to minimize insomnia. PO: Extended-release tablets and capsules should be swallowed whole; do not crush, break, or chew. Contents of the capsule can be mixed with jam or jelly and swallowed without chewing for patients with difficulty swallowing. Instruct patient to take medication as directed and not to take more than recommended. Take missed doses within 1 hr; if remembered later, omit. Do not double doses.Caution parents to avoid OTC cough and cold products while breastfeeding or to children <4 yr. Instruct patient to notify health care professional if nervousness, slow or fast heart rate, breathing difficulties, hallucinations, or seizures occur, because these symptoms may indicate overdose. Instruct patient to contact health care professional if symptoms do not improve within 7 days or if fever is present

PO (Adults and Children >12 yr): 60 mg q 6 hr as needed (not to exceed 240 mg/day) or 120 mg extended-release preparation q 12 hr or 240 mg extended-release preparation q 24 hr

Drug-Drug: Concurrent use with MAO inhibitors may cause hypertensive crisis. Additive adrenergic effects with other adrenergics . Concurrent use with beta blockers may result in hypertension or bradycardia. Drugs that acidify the urine may ↓ effectiveness. Phenothiazines and tricyclic antidepressants potentiate pressor effects. Drugs that alkalinize the urine (sodium bicarbonate, high-dose antacid therapy) may intensify effectiveness. Drug-Food: Foods that acidify the urine may ↓ effectiveness. Foods that alkalinize the urine may intensify effectiveness.

Contraindicated in: Hypersensitivity to sympathomimetic amines; Hypertension, severe coronary artery disease; Concurrent MAO inhibitor therapy; Known alcohol intolerance (some liquid products). Use Cautiously in: Hyperthyroidism; Diabetes mellitus; Prostatic hyperplasia; Ischemic heart disease; Glaucoma; OB: Lactation: Safety not established; Pedi: Avoid OTC cough and cold products containing this medication in children <4 yr.

Therapeutic: allergy, cold and cough remedies; nasal drying agents decongestants Pharmacologic: adrenergics, alpha adrenergic agonists

Seasonal or perennial allergic rhinitis. Seasonal or perennial nonallergic rhinitis (Flonase only).

Potent, locally acting anti-inflammatory and immune modifier. Decrease in symptoms of allergic and nonallergic rhinitis.

CNS: headache. EENT: epistaxis, nasal burning, nasal irritation, nasopharyngeal fungal infection, pharyngitis. GI: nausea, vomiting. Endo: adrenal suppression (↑ dose, long-term therapy only), ↓ growth (children). Derm: rash, urticaria. Resp: cough. Misc: ANAPHYLAXIS, ANGIOEDEMA.

Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing. Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration. Monitor growth rate in children receiving chronic therapy; use lowest possible dose. Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritis, swelling of face and neck, dyspnea) periodically during therapy. Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression. Do not confuse Flovent (fluticasone oral inhalation) with Flonase (fluticasone nasal spray). After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount. Gradually decrease dose every 2-4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose. Patients also using a nasal decongestant should be given decongestant 5-15 min before corticosteroid nasal spray. If patient is unable to breathe freely through nasal passages, instruct patient to blow nose gently in advance of medication administration. Advise patient to take medication exactly as directed. Take missed doses as soon as remembered unless almost time for next dose. Instruct patient in correct technique for administering nasal spray (see Medication Administration Techniques). Shake well before use. Before first-time use, prime unit by spraying 6 times. If not used for at least 7 days or if cap left off for more than 5 days, reprime unit. Warn patient that temporary nasal stinging may occur. Instruct patient to stop fluticasone and notify health care professional immediately if signs of anaphylaxis (rash, hives, difficulty breathing, swollen lips or throat) occur. Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking other Rx, OTC, or herbal products. Advise female patients to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Instruct patient to notify health care professional if symptoms do not improve within 1 mo or if symptoms worsen.

Intranasal (Adults): Flonase-2 sprays in each nostril once daily or 1 spray in each nostril twice daily (not to exceed 2 sprays in each nostril/day); after several days, attempt to ↓ dose to 1 spray in each nostril once daily. Patients ≥ 12 yr with seasonal allergic rhinitis may also use 2 sprays in each nostril once daily on an as-needed basis; Veramyst-2 sprays in each nostril once daily or 1 spray in each nostril twice daily; once symptoms controlled, attempt to ↓ dose to 1 spray in each nostril once daily.

Drug-Drug: Ritonavir and ketoconazole ↓ metabolism and ↑ levels of fluticasone. Concomitant use of ritonavir and fluticasone not recommended.

Contraindicated in: Hypersensitivity (Flonase contains alcohol). Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying immunosuppression (due to disease or concurrent therapy); Systemic corticosteroid therapy (should not be abruptly discontinued when intranasal therapy is started); Concurrent use of ritonavir; Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids); OB: Lactation: Pedi: Pregnancy, lactation, or children <4 yr (for Flonase) or <2 yr (for Veramyst) (safety not established; prolonged or high-dose therapy may lead to complications).

Therapeutic: anti inflammatories steroidal Pharmacologic: corticosteroids

Treatment of nasal symptoms of seasonal and perennial allergic rhinitis. Prophylaxis of nasal symptoms of seasonal allergic rhinitis. Treatment of nasal polyps.

Potent, locally acting anti-inflammatory and immune modifier. Decrease in symptoms of allergic rhinitis and nasal polyps.

CNS: headache. EENT: pharyngitis, epistaxis, nasal burning, nasal irritation, nasopharyngeal fungal infection, sinusitis. GI: vomiting. GU: dysmenorrhea. Endo: adrenal suppression (↑increased dose, long-term therapy only), ↓decreased growth (children). MS: pain. Resp: cough.

Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration. Monitor growth rate in children receiving chronic therapy; use lowest possible dose. Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression. After the desired clinical effect has been obtained, attempts should be made to decrease dose to lowest amount. Gradually decrease dose every 2-4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose. Intranasal: Patients also using a nasal decongestant should be given decongestant 5-15 min before glucocorticoid nasal spray. Advise patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless almost time for next dose. Instruct patient in correct technique for administering nasal spray (see Medication Administration Techniques). Shake well before use. Before first-time use, prime unit by spraying 10 times or until fine spray appears. If not used for at least 7 days, reprime by spraying 2 times or until fine spray appears. Prior to administering dose, gently blow nose to clear nostrils. Close 1 nostril. Tilt head forward slightly and insert nasal applicator into other nostril. Spray and breathe inward through nostril. Breathe out through mouth. Repeat procedure in other nostril. Warn patient that temporary nasal stinging may occur. Instruct patient to notify health care professional if symptoms do not improve within 2 wk, or if symptoms worsen.

Treatment of Season and Perennial Allergic Rhinitis • Intranasal (Adults and Children ≥12 yr): 2 sprays in each nostril once daily (not to exceed 2 sprays in each nostril once daily) Prophylaxis of Seasonal Allergic Rhinitis • Intranasal (Adults and Children ≥12 yr): 2 sprays in each nostril once daily initiated 2-4 wk prior to beginning of pollen season. Treatment of Nasal Polyps • Intranasal (Adults ≥18 yr): 2 sprays in each nostril 1-2 times daily (not to exceed 2 sprays in each nostril twice daily)

Drug-Drug: None known.

Contraindicated in: Hypersensitivity to mometasone. Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying immunosuppression (resulting from disease or concurrent therapy); Systemic glucocorticoid therapy (should not be abruptly discontinued when intranasal therapy is started); Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids); Pregnancy, lactation, or children <2 yr (safety not established; prolonged or high-dose therapy may lead to complications)Pregnancy, lactation, or children < 2 yr (safety not established; prolonged or high-dose therapy may lead to complications).

Therapeutic: anti inflammatories steroidal Pharmacologic: corticosteroids

Seasonal and perennial allergic rhinitis.

Potent, locally acting anti-inflammatory and immune modifier. Decrease in symptoms of allergic rhinitis.

CNS: headache. EENT: epistaxis, nasal burning, nasal irritation, nasopharyngeal fungal infection, otitis media, pharyngitis, rhinitis, sinusitis, sneezing. GI: vomiting. Endo: adrenal suppression (high-dose, long-term therapy only). Resp: cough.

Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency of sneezing.Patients on long-term therapy should have periodic otolaryngologic examinations to monitor nasal mucosa and passages for infection or ulceration. Monitor growth rate in children receiving chronic therapy; use lowest possible dose. Periodic adrenal function tests may be ordered to assess degree of hypothalamic-pituitary-adrenal (HPA) axis suppression in chronic therapy. Children and patients using higher than recommended doses are at highest risk for HPA suppression. After desired clinical effect has been obtained, attempt to decrease dose to lowest amount. Gradually decrease dose every 2-4 wk as long as desired effect is maintained. If symptoms return, dose may briefly return to starting dose. Intranasal: Patients also using a nasal decongestant should be given decongestant 5-15 min before glucocorticoid nasal spray. If patient is unable to breathe freely through nasal passages, instruct patient to blow nose gently before medication administration. Advise patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless almost time for next dose. Instruct patient in correct technique for administering nasal spray or aerosol (see Medication Administration Techniques). Shake well before use. Warn patient that temporary nasal stinging may occur. Instruct patient to notify health care professional if symptoms do not improve within 3 wk, if symptoms worsen, or if nasal irritation occurs. Nasal spray: Before first-time use, prime unit by spraying 5 times. If not used for more than 2 wk, re-prime unit with 1 spray.

Intranasal (Adults and Children >12 yr): 2 sprays in each nostril once daily

Drug-Drug: None known.

Contraindicated in: Hypersensitivity (aerosol contains alcohol). Use Cautiously in: Active untreated infections; Diabetes or glaucoma; Underlying immunosuppression (resulting from disease or concurrent therapy); Systemic glucocorticoid therapy (should not be abruptly discontinued when intranasal therapy is started); Recent nasal trauma, septal ulcers, or surgery (wound healing may be impaired by nasal corticosteroids); OB: Lactation: Pedi: Pregnancy, lactation, or children <2 yr (safety not established; prolonged or high-dose therapy may lead to complications).

Therapeutic: anti inflammatories steroidal

Nasal congestion. Treatment & prevention of middle ear infections. Facilitates intranasal exam. Before surgery.

alpha adrenergic agonist that induces vasoconstriction

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives); seizures; unusual behavior or hallucinations; or an irregular or fast heartbeat. More commonly, you may experience some sneezing or burning, stinging, dryness, or irritation of the nose. These side effects are usually mild and temporary.

Assess the following for: Local: Transient burning, stinging. Respiratory: Dryness of the nasal mucosa, sneezing. Cardiovascular: Hypertension, palpitations. Respiratory: Rebound congestion with prolonged use.

Spray Adult & children >6 yr 2-3 spray in each nostril 2 times daily. Drops 2-3 drops in each nostril 2 times daily.

Pressor effects enhanced by MAOI. Reversal of action of antihypertensives.

Use >3 days; may worsen nasal congestion. Concurrent administration w/ MAOI. Cardiac disease; diabetes mellitus.

Pharmacologic: Sympathomimetic