Chapter 63: Drugs For Rhinitis, Cough, And Cold Flashcards
Acute rhinitis
Inflammation of nasal mucous membranes
Causes:
Common cold
Etiology: rhinovirus
Affects nasopharyngeal tract
Allergic Rhinitis
Inflammation of nasal mucous membranes
Causes: Triggers
Symptoms are Triggered by airborne allergens, which bind to IgE and release inflammatory mediators
Triggers can be seasonal ( Hay fever)
Perennial (non seasonal) (indoor allergens)
IN glucocorticoids
OTC
Flonase (fluticasone)
Nasacort (triamcinolone)
Rhinocort (budesonide)
Nasonex (mometasone)
IN glucocorticoids MOA
Antiinflammatory
IN glucocorticoids use
Prevent OR Suppress the allergy symptoms of allergic and non allergic rhinitis
Treat nasal polyp
May be used alone or in combination with H1 antihistamines
IN glucocorticoid SE
Headache
Epistaxis
Nasal burning, itching or drying of nasal mucosa
Sore throat
1st gen oral antihistamines
OTC
chlorpheniramine ( Chlor-Trimiton)
diphenhydramine (Benadryl)
1st gen AH MOA
H1-blockers (antagonists)
1st gen AH uses
Relieves allergic rhinitis, sneezing, itching, hives, itchy/watery eyes, nose, throat, skin; promotes sleep; prevents motion sickness
2nd gen AH
cetirizine (Zyrtec),
fexofenadine (Allegra),
loratadine (Claritin)
OTC
2nd gen AH MOA
H1-blockers (antagonists)
2nd gen Antihistamines uses
relieving allergic rhinitis, sneezing, itchy watery eyes, chronic urticaria
Non-sedating antihistamines; little to no effect on sedation
Differences bw 1st gen and 2nd gen AH
2nd gen have:
Less sedation
Fewer anticholenergic effects
Dry mouth, blurred vision, wheezing, urinary retention
May be taken with a moderate amount of alcohol, but this is not recommended
IN AH
Antihistamines are also available in intranasal routes
Azelastine (Astelin)
AH safety and monitoring
Obtain list of environmental exposures, drugs, recent foods eaten, stressors
Avoid operating motor vehicles if drowsiness occurs
Avoid alcohol and other CNS depressants
Use sugarless candy or gum, as well as ice chips for temporary relief of mouth dryness
Teach client to take drug at least 30 minutes before offending event.
Decongestants (sympathomimetics)
Sudafed (pseudoephedrine)
Decongestants use
Reduce nasal congestion
decongestants MOA
Activating α1-adrenergic receptors on nasal blood vessels causing vasoconstriction and shrinkage of swollen nasal blood vessels
Decongestation SE
tachycardia, Hypertension, urinary retention, insomnia, agitation, BPH
Decongestants precautions
use cautiously in patients with CAD, HTN, DM, hyperthyroidism, BPH
Nasal spray decongestants
Oxymetazoline (Afrin)
Phenylephrine (Neo-synephrine)
Nasal spray decongestants use
Decongestant for reducing nasal /sinus stuffiness.
Nasal spray ADR
Nasal irritation and dryness
Rebound congestion
Same as above decongestants
Frequent use of nasal decongestants- for longer that 3-5 days
May lead to tolerance
May lead to rebound nasal congestion
Should not use longer than 3-5 days
Leukotriene Receptor Antagonists
Singulair (montelukast)
Singulair (montelukast) MOA
Selectively binds to leukotriene receptors
Singulair (montelukast) use
prophylactic and maintenance for chronic asthma. (DO NOT ADMINISTER FOR ACUTE ASTHMA ATTACK.) and now perennial allergic rhinitis as well.
Administer in the evening.
Adverse reactions: mild but if severe CNS symptoms occur, DC
Antitussive
Opioid and Non Opioid
Codeine (hydrocodone)
Opioid
Can suppress RR
Schedule 5
No euphoria or dependence
Abuse still occurs
Dex is more effective non opioid cough medicine and in over 100 cough medicines
Dextromethorphan and Benzonatate (Tessalon)
Non opioid anti tussive
Benzo like local anesthetic in resp system
Expectorants
Guaifenesin (Mucinex)
Guaifenesin (Mucinex) MOA
Loosen bronchial secretions by reducing viscosity of secretions so they can be eliminated by coughing
Guaifenesin (Mucinex) us
Chest congestion or productive cough
Guaifenesin (Mucinex) SE
Drowsiness, nausea/ vomiting
Mucolytics
Acetylcysteine
Hypertonic saline
Mucolytics MOA
Acts directly on mucous to make it more watery. Helping to make cough more productive
Mucolytics SE
Bronchospasm
Acetylcysteine considerations
sulfur content
Taste/smells like rotten eggs
Common Cold Safety and Monitoring
OTC cough & cold remedies will increase BP. Use caution in CAD, HTN, hyperthyroidism, DM, asthma, COPD.
Antibiotics are not helpful in treating common cold viruses. They may be prescribed, however, if a secondary infection occurs.
Antihistamines may cause drowsiness. Advise no driving during initial use of cold remedies.
Maintain adequate fluid intake.
No smoking
Wash hands! Common colds and flu viruses are transmitted frequently by hand to hand contact or touching a contaminated surface. Cold viruses can live on the skin for several hours and on hard surfaces for several days.
