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NURS 306 > Chapter 36: Antihistamines, Decongestants, Antitussives and Expectorants > Flashcards

Chapter 36: Antihistamines, Decongestants, Antitussives and Expectorants Flashcards

1
Q

Antihistamines, Decongestants, Antitussives and Expectorants treat

A

Upper respiratory tract infections

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2
Q

Cold is most often caused by

A

Virus, and also by bacteria

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3
Q

Typical S&S of a Cold

A

Sore throat, coughing and upset stomach

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4
Q

Excessive mucus =

A

Inflammatory response

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5
Q

Irritation of nasal mucosa triggers

A

Sneeze reflex

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6
Q

Nasal congestion

A

Dilation of small blood vessel in nasal sinuses from mucosal irritation

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7
Q

Treatments for Colds

A 
Empiric Therapy (Is symptomatic, not curative)
Herbals: echinacea and goldenseal
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8
Q

The highest priority for pt education of OTC meds

A

Do NOT use in children < 2 years unless prescribed

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9
Q

Empiric Therapy

A

Treating based on S&S rather than actual cause of disease

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10
Q

Antihistamines are responsible for

A

blocking histamine a in inflammatory response in mast cells.

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11
Q

Antihistamines

A

Directly compete w/ histamine for specific receptor sites

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12
Q

Antihistamines include

A 
Chlorpheniramine
fexofenadine 
loratadine 
cetirizine 
diphenhydramine
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13
Q

Histamine1 Receptors

A

Mediates smooth muscle contraction and dilation of capillaries.
Increases histamine

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14
Q

Increased histamine =

A

Anaphylaxis

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15
Q

Functions of Histamine1

A
  • Nerve impulse transmission in CNS
  • Dilate capillaries and contract smooth muscle
  • Stimulation of gastric secretions and increased HR
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16
Q

Histamine1 agonists (aka Antihistamines) are more effective in

A

Preventing actions rather than reversing them, therefore give earlier in traeatment

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17
Q

Indications for Histamine1 Agonists

A

Management of nasal allergies, seasonal/perennial allergic rhinitis, and allergic reactions.
Relieves common cold: sneezing, runny nose, cough.
Also useful for vertigo, motion sickness, insomnia, and Parkinson’s disease.

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18
Q

Mechanism of Action: Histamine1 Agonists

A
  • Released from mast cells, basophils, other cells in response to antigens.
  • Block histamine receptors on basophils/mast cells.
  • Prevent release/actions of histamine.
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19
Q

Antihistamines: MOA on Cardiovascular System

A

reduces dilation of the blood vessels

reduces increased permeability of the blood vessels

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20
Q

Antihistamines: MOA on Immune System

A

prevent release of histamine, binds to histamine receptors and prevents actions.

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21
Q

Antihistamines: MOA on Smooth Muscle

A

reduces salivary, gastric, lacrimal, bronchial sections

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22
Q

Antihistamines: MOA on the Skin

A

reduces capillary permeability, wheal flare formation, and itching

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23
Q

Antihistamines: Anticholinergic MOA

A

drying effect reducing nasal, salivary and lacrimal secretions (runny nose)

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24
Q

Contraindications of Histamine1 Agonists

A
  • Presence of acute asthma attack and lower respiratory diseases (pneumonia)
  • Caution in increased intraocular pressure, cardiac/renal disease, HTN, asthma, COPD, peptic ulcer disease, BPH, pregnancy
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25
Q

Adverse Effects of Histamine1 Agonists

A

CC- drowsiness

Anticholinergic (drying) effects most common (Dry mouth, difficulty urinating, constipation, changes in vision)

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26
Q

Nonsedating antihistamines include

A

Fexodenadine
Loratadine
Cetirizine

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27
Q

Nonsedating Antihistamines

A

Eliminates adverse effects mainly sedation
Work peripherally to block actions of histamine
Longer duration of action

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28
Q

Traditional Antihistamines include

A

Diphenhydramine
Chlorpheniramine
Dimenhydrinate
Meclizine

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29
Q

Traditional Antihistamines

A

Peripherally and centrally acting

Anticholinergic effects, makes more effective than nonsedating in some cases.

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30
Q

Antihistamine interactions

A

Cough syrup mixed with antihistamines can decrease CNS effects.

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31
Q

Nursing Implications: Antihistamines

A
  • Gather data of condition/allergic reaction; assess for drug allergies
  • Report excessive sedation, confusion, hypotension.
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32
Q

Antihistamines should be taken when in regards to meals?

A

Best taken with meals - Reduces GI upset

33
Q

The nurse should advise the patient who is taking antihistamines to avoid what when taking this medication?

A

Avoid driving/ operating; Avoid consuming alcohol or CNS depressants

34
Q

Antihistamines can cause dry mouth, therefore the nurse should have

A

Put perform frequent mouth care, chew gum, or suck on a hard, sugarless candy

35
Q

You should discontinue antihistamine medications at least

A

4 days prior to allergy testing

36
Q

Indications for Decongestants

A

Used to relieve nasal congestion r/t acute/chronic rhinitis, common cold, sinusitis, hay fever and other allergies
Used for ability to shrink engorged nasal mucous membranes

37
Q

Decongestants

A

Decrease swelling of nasal passage and facilitate visualization of nasal/pharyngeal membranes before surgery/diagnostic procedures

38
Q

Types of Decongesants

A

Oral Decongestants
Topical Adrenergics
Intranasal Steroids
Intranasal Anticholinergic

39
Q

Rhinitis medicamentosa

A

Rebound congestion if nasal sprays are overused

40
Q

Humidifier

A

Used to prevent nose bleeds from drying effect of nasal spray

41
Q

Oral Decongestants include

A

Pseudoephedrine

42
Q

Oral Decongestants

A

Prolonged effects, delayed onset
Less potent than topical
No rebound congestion
Exclusively adrenergic

43
Q

Adrenergic

A

Sympathomimetic

44
Q

Anticholinergic

A

Parasympathetic

45
Q

Topical Adrenergics include

A

Phenylephrine

46
Q

Topical Adrenergics

A

Prompt onset
Potent
Can cause rebound congestion

47
Q

Intranasal Steroids include

A 
beclomethasone dipropionate
budesonide
flunisolide
fluticasone
triamcinolone
ciclesonide
48
Q

Intranasal Anticholinergic

A

Ipratropium

49
Q

Mechanism of Action: Adrenergic Decongestants

A

Constrict small blood vessels that supply UR tract structures
Tissues shrink, nasal secretions are better able to drain

50
Q

Mechanism of Action: Nasal Steroids (Decongestant)

A

Anti-inflammatory effect
Turns off immune system cells involved in inflammatory response
Decreases inflammation = decreased congestion

51
Q

Site of Action for Decongestants

A

Blood vessels surrounding nasal sinuses

52
Q

Contraindications for Adrenergic Decongestants

A
  • Narrow-angled glaucoma, uncontrolled CVD, HTN, diabetes, hyperthyroidism, prostatitis, atrial fibrillation
  • Unable to close eyes.
  • History of CVA, cerebral arteriosclerosis, long-standing asthma, BPH
53
Q

Adverse Effects of Adrenergic Decongestants

A

Nervousness
Insomnia
Palpitations
Tremor

54
Q

Adverse Effects of Intranasal Steroids (Decongestant)

A

Localized, mucosal dryness and irritation

55
Q

Excessive dosages of decongestants can cause

A

Systemic effects of cardiovascular: HTN, palpitations

CNS effects: headache, nervousness and dizziness.

56
Q

Nursing Implications for Decongestants

A

Avoid caffeine or caffeine-containing products

Report fever, cough, other symptoms lasting longer than a week

57
Q

Indications for Antitussives

A

Nonproductive or harmful cough

58
Q

Antitussives

A

Opioid vs nonopioid

59
Q

Opioids include

A

Codeine and hydrocodone

60
Q

Nonopioids include

A

Dextromethorphan, benzonatate levorphanol

61
Q

Mechanism of Action: Opioids

A

Suppress cough reflex by direct action on cough center in medulla

62
Q

Mechanism of Action: Nonopioids

A

Suppress cough reflex by numbing stretch receptors in respiratory tract and preventing the cough reflux from being stimulated

63
Q

Contraindications of Antitussives

A

Opioid caution in elderly patient and alcohol use

64
Q

Adverse Effects of Antitussives

A

Effect CNS

65
Q

Adverse Effects of Nonopioids (Antitussives)

A

Benzonatate: Dizziness, headache, sedation, nausea, nasal congestion
Dextromethorphan: Sedation, nausea, drowsiness and dizziness

66
Q

Adverse Effects of Opioids (Antitussives)

A

Sedation
N/V
Lightheadedness
Constipation

67
Q

Nursing Implications for Antitussives

A

Perform respiratory and cough assessment
Avoid driving or operating heavy machinery
Report cough lasting more than a week, persistent headache, fever, rash.

68
Q

Expectorant

A

Aid in expectoration (removal of mucus)
Decreases viscosity of secretions
Disintegrate and thin secretions

69
Q

Expectorants include

A

Guaifensein

70
Q

Mechanism of Action: Expectorant

A

Reflex Stimulation
Direct Stimulation
Loosening and thinning sputum and bronchial secretions -> tendency to cough is indirectly diminished.

71
Q

Reflex Stimulation

A

Drug causes irritation of GI tract, loosening and thinning of respiratory tract secretions in response to this irritation

72
Q

Direct Stimulation

A

Secretory glands are stimulated directly to increase their production of repository tract fluids

73
Q

Indications for Expectorants

A

Relief of productive cough r/t common cold, bronchitis, laryngitis, pharyngitis, pertussis, influenza and measles

74
Q

Nursing Implications for Expectorants

A

Used cautiously in elderly and those with asthma and respiratory insufficiency
Receive more fluids to help loosen and liquefy secretions.
Report fever, cough, other symptoms lasting longer than a week

75
Q

Antihistamines have several properties

A

antihistaminic
anticholinergic
sedative

76
Q

Histamine effects on the heart

A

dilation and increased permeability (allowing substances to leak into tissues)

77
Q

Histamine effects on the immune system

A

mast cells release histamine and other substances, resulting in allergic reactions

78
Q

Histamine effects on the smooth muscle

A

stimulates salivary, gastric, lacrimal and bronchial secretions

NURS 306 (26 decks)

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