CH 39: Drugs for Allergic Rhinitis and the Common Cold

Question 1

Drugs for Allergic Rhinitis and the Common Cold

Answer 1

 H1 Receptor Antagonists – Antihistamine
 Mast Cell Stabilizers
 Intra-nasal Corticosteroids
 Decongestants
 Antitussives
 Expectorants, mucolytics, and drugs for cystic fibrosis

Question 2

jobs of the upper respiratory tract

Answer 2

 warm, humidify, and clean the air before it enters the lungs
 traps particulate matter and many pathogens, preventing them from being carried to bronchioles and alveoli, where they could access the capillaries of the systemic circulation.
 mucous membranes of the URT are lined with ciliated epithelium, which traps and “sweeps” the pathogens and particulate matter posteriorly, where it is swallowed when someone coughs or clears the throat.

Question 3

dynamic structure, richly supplied with vascular tissue that is controlled, in part, by the autonomic nervous system.

Answer 3

nasal mucosa

Question 4

Activation of the sympathetic nervous system:

Answer 4

constricts arterioles in the nose, reducing the thickness of the mucosal layer. This serves to widen the airway and allow more air to enter.

Question 5

Parasympathetic activation

Answer 5

Arterioles dilate and more mucus is
produced.

Question 6

the administration of a sympathomimetic will:

Answer 6

shrink the nasal mucosa, relieving the nasal stuffiness associated with the common cold.

Question 7

parasympathetic drugs cause:

Answer 7

increased blood flow to the nose, with increased nasal stuffiness and a runny nose as side effects.

Question 8

inflammation of the nasal mucosa due to exposure to allergens

Answer 8

Allergic Rhinitis
Hayfever

Question 9

symptoms of allergic rhinitis

Answer 9

resemble those of the common cold: tearing eyes,sneezing, nasal congestion, post-nasal drip, and itching of the throat.

Question 10

preventers of allergic rhinitis

Answer 10

antihistamines,
intranasal corticosteroids,
leukotriene modifiers,
mast cell stabilizers.

Question 11

relievers of allergic rhinitis

Answer 11

oral and intranasal decongestants
usually drugs from the sympathomimetic class.

Question 12

 Mediator of inflammation
 Responsible for many of the symptoms of allergic rhinitis

Answer 12

histamines

Question 13

where are histamines released

Answer 13

mast cells
basophils

Question 14

what do histamines cause

Answer 14

 cause itching, increased mucus secretion, and nasal congestion.
 with more severe allergic states: bronchoconstriction, edema, hypotension, and other symptoms of anaphylaxis.

Question 15

block all histamine

Answer 15

antihistamine

Question 16

MOA and uses of H1 receptor antagonists

Answer 16

selectively block H1 at the receptor
 allergy symptoms, motion sickness, and insomnia.
 Most frequent use is for the treatment of allergies
 Provide symptomatic relief
 Used for cold and sinus problems when combined with decongestants and antitussives
 Most effective for prophylaxis

Question 17

anticholinergic effects of H1 receptor blockers

Answer 17

increased heart rate, urinary retention, constipation, blurred vision

Question 18

diphenhydramine (1st gen antihistamine) therapeutic effects

Answer 18

Counteract the effects of histamine
Oral, po, IV, IM, topical uses

Question 19

diphenhydramine (1st gen antihistamine) adverse effects

Answer 19

Dry mouth,
headache,
dizziness,
urinary retention,
thickening of bronchial secretions,
nausea,
vomiting
Paradoxical excitation,
sedation,
hypersensitivity
reactions,
hypotension,
extrapyramidal symptoms (promethazine),
agranulocytosis (brompheniramine, promethazine),
respiratory depression
DROWSINESS

Question 20

diphenhydramine (1st gen antihistamine) what to monitor and safety precautions

Answer 20

Paradoxical CNS stimulation
Anticholinergic effects
Alcohol with caution
Drowsiness
Not good for men with BPH
Caution for people with asthma or hyperthyroidism

Question 21

Loratadine (2nd gen antihistamine) adverse effects

Answer 21

Dry mouth,
headache,
dizziness,
drowsiness,
bitter taste (olopatadine),
nausea
Paradoxical excitation,
hypersensitivity reactions,
hypotension

Question 22

 Applied directly to nasal mucosa to prevent symptoms of allergic rhinitis
 have largely replaced antihistamines as preferred drugs for the treatment of perennial allergic
rhinitis.

Answer 22

intranasal corticosteroids

Question 23

fluticasone (inhaled corticosteroids) therapeutic effects

Answer 23

Limits inflammation – decreases secretion of inflammatory mediators –
reduce edema –
Also used for asthma

Question 24

fluticasone (inhaled corticosteroids) adverse effects

Answer 24

Transient nasal irritation,
burning,
sneezing, or
dryness,
nasopharyngitis
Hypercorticism
(only if large amounts are swallowed)

Question 25

fluticasone (inhaled corticosteroids) what to monitor and safety precautions

Answer 25

Can mask signs of infection Hypersensitivity Advise to take as directed

Question 26

ipratropium therapeutic effects

Answer 26

Inhibits secretions of nasal mucosa Also used for asthma

Question 27

ipratropium adverse effects

Answer 27

transient nasal irritation, burning, sneezing, or dryness, cough, headache Urinary retention, worsening of narrow-angle glaucoma

Question 28

ipratropium what to monitor

Answer 28

anticholinergic effects with other drugs

Question 29

drugs that relieve nasal congestion

Answer 29

decongestant

Question 30

the most common decongestant included in oral OTC cold and allergy medicines

Answer 30

pseudoephedrine

Question 31

oxymetazoline (nasal decongestants sympathomimetic) therapeutic effects

Answer 31

Drying of mucous membranes – causes arterioles in nasal passageway to constrict

Question 32

oxymetazoline (nasal decongestants sympathomimetic) adverse effects

Answer 32

rebound congestion

Question 33

oxymetazoline (nasal decongestants sympathomimetic) contraindications

Answer 33

Patients with thyroid disorders, hypertension, diabetes, or heart disease should use sympathomimetics only on the direction of their healthcare provider.

Question 34

 Dampen the cough reflex  Opioid or non-opioid

Answer 34

antitussives

Question 35

- Raise the cough threshold in the CNS at very low doses  Caution with pt with asthma  Codeine and hydrocodone more frequent

Answer 35

opioid

Question 36

 Dextromethorphan  It also raises the cough threshold

Answer 36

non-opioid

Question 37

Suppresses cough by anesthetizing receptors in the lungs

Answer 37

benzonatate (Tessalon)

Question 38

dextromethorphan (Antitussive non-opioid) therapeutic effects

Answer 38

Suppresses cough

Question 39

dextromethorphan (Antitussive non-opioid) adverse effects

Answer 39

dizziness drowsiness GI upset

Question 40

dextromethorphan (Antitussive non-opioid) what to monitor

Answer 40

excitation, hypotension, and hyperpyrexia when used concurrently with MAOIs.

Question 41

dextromethorphan (Antitussive non-opioid) contraindications

Answer 41

Dextromethorphan is contraindicated in the treatment of chronic cough due to excessive bronchial secretions, such as in asthma, smoking, and emphysema Use with alcohol, opioids, or other CNS depressants may result in sedation.

Question 42

Reduce the thickness or viscosity of bronchial secretions, thus increasing mucus flow that can then be removed more easily by coughing

Answer 42

expectorants and mucolytics

Question 43

one of the few drugs available to directly loosen thick, viscous bronchial secretions

Answer 43

Acetylcysteine (Acetadote, Cetylev, Mucomyst)

Question 44

break down the chemical structure of mucus molecules.

Answer 44

mucolytics

Question 45

can trigger bronchospasm and has an offensive odor resembling rotten eggs. Used for overdose of acetaminophen

Answer 45

mucomyst