Chapter 39: Drugs for Allergic Rhinitis and the Common Cold Flashcards
Identify the major functions of the upper respiratory tract.
The upper respiratory tract consists of the nose, nasal cavity, pharynx, and paranasal sinuses. It warms, humidifies, and cleans the air before it gets to the lungs. It is lined with ciliated epithelium that traps particulate matter and pathogens and moves them to the esophagus to be swallowed.
Describe common causes and symptoms of allergic rhinitis.
Cause: inflammation of the nasal mucosa due to exposure to allergens (there is a strong genetic predisposition).
Allergen: anything that is recognized as foreign and provokes a response from the body’s defense system (pollen, mold, dust mites, animal dander).
Symptoms: tearing eyes, sneezing, nasal congestion, postnasal drip, itching of the throat.
Differentiate between H1 and H2 histamine receptors.
H1 receptors: cause allergy symptoms
H2 receptors: cause peptic ulcers (found in gastric mucosa)
Compare and contrast the oral and intranasal decongestants.
Oral decongestants: do not produce rebound congestion, slower onset, less effective at relieving severe congestion, possibly systemic effects (hypertension, CNS stimulation)
Intranasal decongestants: produce rebound congestion, few systemic effects, should only be used for 3 to 5 days
Discuss the pharmacotherapy of cough.
Two methods:
Act on the Medulla of the CNS to suppress the cough reflex
Anesthetize stretch receptors in the lungs to suppress cough reflex
Describe the role of expectorants and mucolytics in treating bronchial congestion.
Mucolytics loosen thick bronchial secretions by breaching down the chemical structure of mucus.
What is the H1-receptor antagonists (antihistamine) drug representative, MOA, primary actions on the respiratory system, and important adverse effects?
Drug: diphenhydramine (Benadryl)
MOA: H1-receptor antagonist (antihistamine). Stops production of histamine.
Actions: Treat minor symptoms of allergy and the common cold.
Adverse Effects: Significant drowsiness, paradoxical CNS stimulation and excitability (in children)
What is the mast cell stabilizers drug representative, MOA, primary actions on the respiratory system, and important adverse effects?
Drug: cromolyn (NasalCrom)
MOA: inhibits histamine production from mast cells
Actions: nasal decongestion; prophylactic for allergies
Adverse Effects: few
What is the intranasal corticosteroids drug representative, MOA, primary actions on the respiratory system, and important adverse effects?
Drug: fluticasone (Flonase, Veramyst, others)
MOA: decreases the secretion of inflammatory mediators, reduces tissue edema, and causes a mild vasoconstriction
Actions: Seasonal allergies, decrease local inflammation. Topically used for: eczema, atopic dermatitis, psoriasis, and contact dermatitis
Adverse Effects: rare for nasal (nasal irritation, epistaxis)l ingested has potential for systemic effects
What is the decongestants drug representative, MOA, primary actions on the respiratory system, and important adverse effects?
Drug: oxymetazoline (Afrin, others)
MOA: activates alpha-adrenergic receptors int he sympathetic nervous system
Actions: Constricts arterioles in the nasal passage drying mucous membranes
Adverse Effects: rebound congestion, minor stinging and dryness
What is the antitussives drug representative, MOA, primary actions on the respiratory system, and important adverse effects?
Drug: dextromethorphan (Delsym, Robitussin DM, others)
MOA: acts on Medulla in the CNS to suppress cough reflex
Actions: cough suppressant
Adverse Effects: dizziness, drowsiness, and GI upset
What is the expectorants, mucolytics, and drugs for cystic fibrosis drug representative, MOA, primary actions on the respiratory system, and important adverse effects?
Drug: acetylcysteine (Acetadote, Cetylev, Mycomyst)
MOA: Loosen thick bronchial secretions by breaking down their chemical structure
Actions: Mycolytic; can be used in cystic fibrosis and chronic bronchitis
Adverse Effects: Bronchospasms
Use the nursing process to care for patients who are receiving pharmacotherapy for allergic rhinitis and the common cold.
Assess history, vitals, and appropriate lab findings, continue to monitor throughout therapy. Assess for desired effects. Teach for seasonal allergies to take prior to getting symptoms and increase fluid intake to help loosen mucus.
The patient has been prescribed oxymetazoline (Afrin) nasal spray for seasonal rhinitis. Which instructions will the nurse provide?
a. Limit use of this spay to 5 days or less
b. The drugs may be sedating so be cautious with activities requiring alertness
c. This drug should not be used in conjunction with antihistamines.
d. This is an over-the-counter drug and may be used as needed for congestion
a. Limit use of this spay to 5 days or less
Prolonged use of oxymetazoline (Afrin) causes hyper-secretion of mucus and worsening nasal congestion, resulting in increased daily use. This medication should not be used longer than 5 days unless otherwise directed. It may be used with antihistamines for symptomatic relief and it is not sedating.
A patient has a prescription for fluticasone (Flonase) for allergic rhinitis. Place the following instructions in order in which the nurse will instruct the patient to use the drug.
- Instill one spray directed high into the nasal cavity
- Clear the nose by blowing
- Prime the inhaler prior to first use
- Spit out any excess liquid that drains into the mouth
- Prime the inhaler prior to first use
- Clear the nose by blowing
- Instill one spray directed high into the nasal cavity
- Spit out any excess liquid that drains into the mouth
When an intranasal inhaler is used, the device should be primed prior to the first use. The nasal passages should be cleared by blowing. The drug should be instilled by spray directed high into the nasal passages. Any liquid that drains should be spit out.
A man, age 67, reports taking diphenhydramine (Benadryl) for hay fever. Considering this patient’s age, the nurse assesses for which findings?
a. A history of prostatic or urinary conditions
b. Any recent weight gain
c. A history of allergic reactions
d. A history of peptic ulcer disease
a. A history of prostatic or urinary conditions
Diphenhydramine (Benadryl) and other antihistamines are contraindicated in patients with BPH or lower urinary tract obstruction because anticholinergic effects may worsen these conditions. Diphenhydramine (Benadryl) is a common treatment for allergic conditions and has no effects on weight gain or peptic ulcer disease.
The nurse is teaching a patient about the use of dextromethorphan with guaifenesin (Robitussin-DM) syrup for a cough accompanied by thick mucus. Which instruction should be included in the patient’s teaching?
a. Lie supine for 30 minutes after taking the liquid
b. Drink minimal fluids to avoid stimulating the cough reflex
c. Take the drug with food for best result
d. Avoid drinking fluids immediately after the syrup, but increase overall fluid intake throughout the day
d. Avoid drinking fluids immediately after the syrup, but increase overall fluid intake throughout the day
The syrup base of dextromethorphan will help soothe throat irritation, and fluids should be avoided immediately following administration. Overall fluid intake should be increased throughout the day. The patient does not need to remain supine after taking this drug, take the drug with food, or avoid fluid intake.
A patient has been prescribed fluticasone (Flonase) to use with oxymetazoline (Afrin). How should the patient be taught to use these drugs?
a. Use the fluticasone first, then the oxymetazoline after waiting 5 minutes
b. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes
c. The drugs may be used in either order
d. The fluticasone should be used only if the oxymetazoline fails to relieve the nasal congestion
b. Use the oxymetazoline first, then the fluticasone after waiting 5 minutes
The oxymetazoline (Afrin) should be used first, followed by the fluticasone (Flonase) after waiting 5 to 10 minutes. When a decongestant and corticosteroid nasal spray are used together, the decongestant spray should be used first to allow time for the nasal passageway to open, allowing the corticosteroid to reach deeper into the nasal passageway. The drugs are ordered in combination for better control of nasal rhinitis. The oxymetazoline should not be used for over 5 days unless otherwise instructed.
Which of the following is the best advice that the nurse can give a patient with viral rhinitis who intends to purchase an over-the-counter combination cold remedy?
a. Dosages in these remedies provide precise dosing for each symptom that you are experiencing
b. These drugs are best used in conjunction with an antibiotic
c. It is safer to use a single-drug preparation if you are experiencing only one symptom
d. Since these drugs are available over the counter, it is safe to use any of them as long as needed
c. It is safer to use a single-drug preparation if you are experiencing only one symptom
Single-symptom OTC preparations are preferred over multi-use preparations to avoid additional drugs that are not needed for symptom relief and to decrease risk of additional adverse effects. Dosing of any OTC preparation is carefully calculated to provide precise dosage for age and symptoms. Antibiotics may be required for serious infections, but for common symptoms OTC remedies are recognized as safe and effective. However, they should not be used indefinitely without consultation with a healthcare provider.
George Orlanski, who is 60 years old, has had bronchitis with coughing for several days. He has been losing sleep because of the severity of the cough, and it is starting to affect his work. He finally goes to the local urgent care clinic for treatment. He is diagnosed with acute viral bronchitis and is given a prescription for an antitussive.
As the nurse, of the two antitussive medications, dextromethorphan and codeine, which is the drug of choice for this patient? Why?
Dextromethorphan
Although codeine is a more powerful antitussive, it can cause dependence and constipation. Dextromethorphan is a more appropriate choice for this patient initially, with codeine syrup as a potential alter choice for more severe cough symptoms.
George Orlanski, who is 60 years old, has had bronchitis with coughing for several days. He has been losing sleep because of the severity of the cough, and it is starting to affect his work. He finally goes to the local urgent care clinic for treatment. He is diagnosed with acute viral bronchitis and is given a prescription for an antitussive.
George asks why the provider did not have him an antibiotic prescription. What is the best answer to his question?
It is a viral infection not bacterial.
Antibiotics are used to treat bacterial infections and will not be effective for viral conditions.
George Orlanski, who is 60 years old, has had bronchitis with coughing for several days. He has been losing sleep because of the severity of the cough, and it is starting to affect his work. He finally goes to the local urgent care clinic for treatment. He is diagnosed with acute viral bronchitis and is given a prescription for an antitussive.
What additional measures can George use to relieve his cough and what additional information does he need?
In addition to the antitussive, George should increase his fluid intake throughout the day to help moisten his airway and liquify any mucus present. Using hard candy or lozenges may prevent the dryness in his throat and decrease coughing. A humidifier at night may also reduce the dryness in his airways. As the nurse, you would also teach George to check his temperature periodically, and if he develops a fever or if he has increasing sputum production, he should return to the provider to be reassessed.
a 74-year-old male patient informs the nurse that he is taking diphenhydramine (Benadryl) to reduce seasonal allergy symptoms. This patient has a history of BPH and mild glaucoma (controlled by medication). What is the nurse’s response?
The nurse should ensure that the patient understand the potential side effects related to the anticholinergic effects of this medication. This patient, based on his age, is at higher risk for urine retention, glaucoma (or other visual changes), and constipation. The nurse should complete a health assessment for these conditions and provide patient education about the need to report any changes to the healthcare provider.
A 67year-old patient has allergic rhinitis and always carries a handkerchief in his pocket because he has nasal discharge nearly every day. Sometimes his nose is stuffy and dry. The healthcare provider prescribes fluticasone (Flonase). He is to take one spray intranasally at bedtime. The patient starts to take fluticasone and a week later calls the provider’s office and talks to the nurse. He says, “This Flonase is not helping me.” What is the nurse’s best response.
Intranasal corticosteroids, such as fluticasone (Flonase), may take as long as 2 to 4 weeks to work The medication should not be discontinued prematurely. If a decongestant spray is being used along with the Flonase, the decongestant should always be administered first to clear the nasal passages, which will facilitate adequate application of the fluticasone.
