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Chapter 36 > Antihistamine > Flashcards

Antihistamine Flashcards

1
Q

Adrenergics

A
  • sympathomimetic
    -stimulate the sympathetic nerve fibers of the ANS
    -Use epinephrine or epinephrine-like substances as neurotransmitters.
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2
Q

Antagonists

A
  • Causes opposite action of a drug
  • Or compete for receptor sites
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3
Q

Antihistamines

A

Reduces the effects of histamine

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4
Q

Antitussive

A
  • Reduces coughs
  • Inhibits neural activity in cough center of CNS
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5
Q

Decongestants

A
  • reduce congestion or swelling,
  • in upper or lower respiratory tract.
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6
Q

Empiric therapy

A
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7
Q

Expectorants

A
  • increase the flow of fluid in the respiratory tract
  • By reducing the viscosity of secretions
  • Facilitate their removal by coughing
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8
Q

Cause of Common colds

A

Caused by: Viral infections (Rhinovirus or Influenza virus)

  • The invade the tissue (mucosa) of the upper respiratory tract (nose, pharynx, larynx)causing upper respiratory tract infection (URI)
    - Stimulates excessive mucus production
    - Leads to symptoms of a cold: sore throat, coughing, upset stomach
  • Irritation of nasal mucosa causes a sneeze reflex
    -Release of inflammatory and vasoactive substances
    -Dilation of small blood vessels
    -Nasal congestion
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9
Q

4 Treatment of the Common Cold symptoms

A

Antihistamines
Nasal decongestants
Antitussives
Expectorants

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10
Q

These drugs can only ______ symptoms of a URI, the do nothing to ________

A
  • relieve
    -eliminate the pathogen
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11
Q

Empiric therapy

A

The treatment is based on what is believed to be the cause of the symptoms

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12
Q

Antihistamines are drugs that

A

directly compete with histamine for specific receptor sites

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13
Q

Therapeutic effect of Antihistamines

A

Nerve impulse transmission in the CNS
Dilation of capillaries
Contraction of smooth muscles
Stimulation of gastric secretion
Increase HR

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14
Q

Types of Histamine receptors

A
  • H1: Histamine 1 receptors: mediate smooth muscle contractions and dilation of capillaries (vasodilation)
  • H2: Histamine 2 receptors: mediate acceleration of HR and gastric acid secretions
    • Increases gastric secretion that leads to peptic ulcers. Give it to people who have gastric issues.
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15
Q

H1 antagonist

A

H1 antagonist: Antihistamines
Drugs that end with -Ine
Chlorpheniramine
Fexofenadine (Allegra)
Loratadine (Claritin)
Cetirizine (Zyrtec)
Diphenhydramine (Benadryl)

Used to treat:
- Nasal Allergies
- Seasonal hay fever
Relieves the symptoms of common viral cold
- Sneezing
- Runny nose

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16
Q

Person experiencing Anaphylaxis you give what drug first _____ because it has a _____ effect

A

Benadryl
Sedative

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17
Q

H2 antagonist: H2 blockers

A

Drugs that end with -ine
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (pepcid)
Nizatidine (Axid)

Used to reduce gastric acid in peptic ulcer disease

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18
Q

Antihistamine MOA

A

All antihistamine compete with histamine for the H1 receptors in the smooth muscles.
- Work by blocking the histamine receptors on the surface of basophils and mast cells
- Preventing the release and actions of histamine stored within the cells
- Do not push histamine already bound to receptors but compete for the unoccupied receptors.
- Preventing vasodilation, increase GI, respiratory salivary, lacrimal secretions and increased permeability with edema.

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19
Q

Cardiovascular (small blood vessels) Antihistamine vs histamine

A

Histamine effects: Dilates BV, increases BV permeability causing edema

Antihistamine effects: Reduces dilation of BV and decreases permeability

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20
Q

Smooth muscle (on exocrine glands) Antihistamine vs histamine

A

Histamine effects:Stimulates salivary gastric , lacrimal and bronchial secretions

Antihistamine effects: Reduces delivery gastric, lacrimal and bronchial secretions

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21
Q

Immune system (release of substances commonly associated with allergic reactions) Histamine vs Antihistamine

A

Histamine effects:Released from mast cells resulting in allergic reactions

Antihistamine effect: Binds to histamine receptors and prevents the actions of histamine

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22
Q

Antihistamine indications

A

Manage/ relieve symptoms of
- nasal allergies
- Seasonal or perennial allergic rhinitis (hay fever)
- Urticaria (hives)
- Typical symptoms of common colds

Treatment of
- Allergic reactions
- Motion sickness
- Parkinson disease (anticholinergic effects)
- Vertigo (spinning sensation)

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23
Q

Antihistamines: Contraindications

A

Known drug allergy
- narrow - angle glaucoma
- Cardiac and kidney disease
- Bronchial asthma
- COPD
- Hypertension
- Caution in patients with impaired liver or renal insufficiencies, lactating mothers

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24
Q

Antihistamine Adverse effects

A
  • Drowsiness
  • Anticholinergic drying effect
  • Dry mouth
  • Changes in vision
  • Difficulty urinating
  • Constipation
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25
Q

Traditional antihistamines work both

A
  • Peripherally and Centrally
  • Cause them to be more effective
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26
Q

Tradition Antihistamines are used alone or in combination with other drugs for

A

Insomnia or motion sickness

27
Q

Diphenhydramine (benadryl)

A

Traditional Antihistamine
- Anticholinergic and sedative effects

Used for: relief or prevention of histamine-mediated allergies, motion sickness, treatment of parkinson’s disease, promotion of sleep, anaphylaxis

Contraindications/ Cautions: nursing mothers, neonates, pt with lower respiratory tract problems, elderly (risk for falls)

28
Q

Nonsedating Antihistamine Work

A

peripherally to block the actions of histamine do not cross blood brain barrier,

29
Q

Nonsedating antihistamines have ___ durations of action compared to traditional antihistamines

A

Longer

30
Q

Loratadine (Claritin)

A

Non-sedating Antihistamine

Used for: relieve the symptoms of seasonal allergic rhinitis (hay fever), urticaria

Active metabolite: Desloratadine

Contraindication: Drug allergy

31
Q

Antihistamine Nursing Implications

A

Instruct patients to report ?
-Adverse effects: Drying effects: Dry mouth, changes in vision, urinary retention, constipation

  • Instruct patients to avoid driving or operating heavy machinery
  • Instruct patients not to take these medications with other prescribed or OTC unless they were previously approved by prescriber

GI upset, how do you take?
- Taken with meals to minimize GI upset

What do you do for dry mouth?
- Chew, suck on candy or chew gum, perform frequent mouth care to ease dryness

32
Q

Traditional Antihistamine Assessment/ implementation

A
  • Best taken with meals
  • Pt experiences dry mouth teach the pt to chew or suck on candy and perform frequent mouth care
    -Should not be take with other OTC cough or could medications
  • Concern in use of drug in patients with
    • acute asthma attack, LRI, Pneumonia
33
Q

Nasal congestion: define, cause

A
  • Due to excessive nasal secretion
  • Inflamed and swollen nasal mucosa
  • Common cause: allergies and URIs (common colds)
34
Q

Types of Decongestants

A

Adrenergics (largest group)
- sympathomimetics
Anticholinergics
- Less commonly used
- Parasympatholytics
Corticosteroids
- Topical, intranasal steroids

35
Q

Routes of Decongestant

A

PO: Produce prolonged systemic decongestant effects

Nasal:Produce a more rapid effect can also cause rebound congestion
- Rebound congestion occurs if repeated use of decongestant causing a rapid absorption leading to decline in therapeutic effect
- Teach patient to limit their usage to 3 day bc it won’t be as effective and can least to rebound congestion

36
Q

Nasal Decongestants MOA:

A

Adrenergic drugs
Shrink engorged nasal mucous membranes and relieve nasal stuffiness
- Constricting small arterioles BV surrounding the nasal sinuses
- Once these BV shrink the nasal secretions in swollen mucous are able to drain through nostrils or lymphatic circulation
- Referred to as sympathomimetics because of their ability to stimulate the PNS

Nasal steroids
Aimed to treat inflammatory response caused by invading organisms (viruses, bacteria, antigens)
Steroids stimulate their antiinflammatory effect by reducing inflammatory symptoms

37
Q

Nasal Decongestants: Adverse Effects
- Adrenergics

A
  • Nervousness
  • Insomnia
  • Palpitations
  • Tremors
    (Systemic effects caused by adrenergic stimulation of the heart, blood vessels, and CNS)
38
Q

Nasal Decongestants: Adverse Effects
- Steroids

A

Local mucosal dryness
Irritation
*Teaching

39
Q

Nasal decongestants- Contraindications/ Cautions

A

Narrow angled glaucoma
Uncontrolled CVD
HTN
Diabetes
Hyperthyroidism

40
Q

Nasal Decongestant Interactions

A

Systemic sympathomimetic drugs and sympathomimetic nasal decongestant cause toxicity when used together

MAOI - additive pressor effect , increase BP

41
Q

Nasal Decongestant Patient teaching

A

-Only take the medication as ordered (does & frequency)

  • Excessive use of nasal inhaled decongestants may lead to rebound congestionnasal passages become more congested as the effects of the drug wear off.
  • Advise the patient to report to the prescriber any excessive dizziness, heart palpitations, weakness, sedation, or excessive irritability.
42
Q

Decongestant Nursing assessments and Implementations

A
  • Generally used for nasal congestion
  • Increase pt taking decongestant fluid intake to 3000 ml per day
    -Fluid helps liquefy secretions , breaking up secretions
    -Excessive use can lead to rebound congestion can cause cardiovascular effects such as increase in blood pressure and CNS stimulation with headache, nervousness, or dizziness.
43
Q

Decongestant drugs

A

End with -ine
Oxymetazoline (Afrin)
Zidovudine (Flonase)

44
Q

Antihistamine drugs

A

Loratidine (Claritin)
Diphenhydramine (Benadryl)

45
Q

The Goal of nasal steroids is to

A

reduce the inflammatory symptoms to improve patient comfort and air exchange.

46
Q

Oxymetazoline (Afrin)

A

Sympathomimetic
Alpha adrenergic vasoconstrictor

  • Used to relieve nasal congestion
  • Vasoconstriction : dilate the arteries , reducing nasal blood flow and congestion’
47
Q

Antitussives

A

Used for: Drugs used to stop or reduce coughing

Types: Opioid and nonopioid

Opioid: Codeine, hydrocodone
Nonopioid: Dextromethorphan, Benzonatate

Used only for nonproductive coughs!
May be used in cases when coughing is harmful

48
Q

Antitussives: Mechanism of Action Opioids

A

Drugs:Codeine, hydrocodone:

  • Suppress the cough reflex through direct action on the cough center in the CNS (medulla)
  • Provide analgesia and have drying effect on mucosa of respiratory tract
  • Increases viscosity of respiratory secretions
  • Reducing runny nose, postnasal drip
49
Q

Nonopioids

A

Drugs:Dextromethorphan, Benzonatate
- Suppress the cough reflux through direct action on cough center
- Does not have analgesia effects or does not cause CNS depressions

50
Q

Antitussives: Indications

A

Used to stop the cough reflex when the cough is nonproductive or harmful

51
Q

Antitussives: Contraindications: Opioids

A

Opioid dependency
Respiratory depression

Opioids: Codeine and Hydrocodone
Alcohol use
CNS depression
Renal and lIver disease
COPD

52
Q

Antitussives: Contraindications:Non Opioids

A

Nonopioids: Dextromethorphan
MAOIs - stop taking within 14 days
Hypertension
CVD

53
Q

Antitussives Adverse effects

A

Benzonatate: dizziness, headache,pruritus, sedation

Codeine and hydrocodone: sedation, nausea, vomiting, lightheadedness, constipation

Dextromethorphan: Dizziness, drowsiness, nausea

Diphenhydramine: sedation, dry mouth, anticholinergic effects

54
Q

Antitussives:Nursing Implications

A

Report any of the following symptoms to the caregiver:
Cough that lasts more than 1 week
Persistent headache
Fever
Rash
Antitussive drugs are for nonproductive coughs.
Monitor for intended therapeutic effects.

55
Q

Benzonatate - non opioid antitussive drug

A

Used to numb the cough receptors

56
Q

Codeine- opioid antitussive drug

A

Used: To control coughs

Potentially addictive and can depress respiration, CNS depressant effects

Contraindicated: respiratory depression, increased icp, seizure disorders, respiratory disorders

57
Q

Dextromethorphan- non opioid antitussive drug

A

Used to control coughs

Non addictive and does not cause respiratory or CNS depression

Contraindicated: asthma, emphysema, persistent headache

58
Q

Expectorants

A
  • Drugs that aid in the expectoration (removal) of mucus in the respiratory tract
  • Reduce the viscosity of secretions (sputum)
  • Most common expectorants: Guaifenesin
59
Q

MOA Expectorants

A
  • Guaifenesin: increasing the hydration of the respiratory tract,
  • Maintaining sol layer
  • Needed for ciliary clearance and reducing viscosity of mucus
  • Facilitates the removal of mucus
60
Q

Guaifenesin MOA

A

increasing the hydration of the respiratory tract,

61
Q

Expectorants Indication

A

Relief of productive coughs
-Commonly associated with common colds, bronchitis, laryngitis,pharyngitis, pertussis, influenza, measles

Suppression of coughs caused by chronic paranasal sinusitis
-Diminishing the tendency to cough

62
Q

Expectorants Adverse effects

A

Nausea
Vomiting
Gastric irritation

63
Q

Expectorants: Nursing Implications

A

Expectorants should be used with caution in older adults and patients with asthma or respiratory insufficiency.

Patients taking expectorants should receive more fluids, if permitted, to help loosen and liquefy secretions.

Report a fever, cough, or other symptoms lasting longer than 1 week.

Monitor for intended therapeutic effects.

Chapter 36 (4 decks)

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