Chapter 63: Drugs For Rhinitis, Cough, And Cold

Question 1

Acute rhinitis

Answer 1

Inflammation of nasal mucous membranes

Causes:
Common cold
Etiology: rhinovirus
Affects nasopharyngeal tract

Question 2

Allergic Rhinitis

Answer 2

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)

Question 3

IN glucocorticoids

Answer 3

OTC
Flonase (fluticasone)
Nasacort (triamcinolone)
Rhinocort (budesonide)
Nasonex (mometasone)

Question 4

IN glucocorticoids MOA

Answer 4

Antiinflammatory

Question 5

IN glucocorticoids use

Answer 5

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

Question 6

IN glucocorticoid SE

Answer 6

Headache
Epistaxis
Nasal burning, itching or drying of nasal mucosa
Sore throat

Question 7

1st gen oral antihistamines

Answer 7

OTC
chlorpheniramine ( Chlor-Trimiton)
diphenhydramine (Benadryl)

Question 8

1st gen AH MOA

Answer 8

H1-blockers (antagonists)

Question 9

1st gen AH uses

Answer 9

Relieves allergic rhinitis, sneezing, itching, hives, itchy/watery eyes, nose, throat, skin; promotes sleep; prevents motion sickness

Question 10

2nd gen AH

Answer 10

cetirizine (Zyrtec),
fexofenadine (Allegra),
loratadine (Claritin)
OTC

Question 11

2nd gen AH MOA

Answer 11

H1-blockers (antagonists)

Question 12

2nd gen Antihistamines uses

Answer 12

relieving allergic rhinitis, sneezing, itchy watery eyes, chronic urticaria

Non-sedating antihistamines; little to no effect on sedation

Question 13

Differences bw 1st gen and 2nd gen AH

Answer 13

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

Question 14

IN AH

Answer 14

Antihistamines are also available in intranasal routes
Azelastine (Astelin)

Question 15

AH safety and monitoring

Answer 15

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.

Question 16

Decongestants (sympathomimetics)

Answer 16

Sudafed (pseudoephedrine)

Question 17

Decongestants use

Answer 17

Reduce nasal congestion

Question 18

decongestants MOA

Answer 18

Activating α1-adrenergic receptors on nasal blood vessels causing vasoconstriction and shrinkage of swollen nasal blood vessels

Question 19

Decongestation SE

Answer 19

tachycardia, Hypertension, urinary retention, insomnia, agitation, BPH

Question 20

Decongestants precautions

Answer 20

use cautiously in patients with CAD, HTN, DM, hyperthyroidism, BPH

Question 21

Nasal spray decongestants

Answer 21

Oxymetazoline (Afrin)
Phenylephrine (Neo-synephrine)

Question 22

Nasal spray decongestants use

Answer 22

Decongestant for reducing nasal /sinus stuffiness.

Question 23

Nasal spray ADR

Answer 23

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

Question 24

Leukotriene Receptor Antagonists

Answer 24

Singulair (montelukast)

Question 25

Singulair (montelukast) MOA

Answer 25

Selectively binds to leukotriene receptors

Question 26

Singulair (montelukast) use

Answer 26

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

Question 27

Antitussive

Answer 27

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

Question 28

Expectorants

Answer 28

Guaifenesin (Mucinex)

Question 29

Guaifenesin (Mucinex) MOA

Answer 29

Loosen bronchial secretions by reducing viscosity of secretions so they can be eliminated by coughing

Question 30

Guaifenesin (Mucinex) us

Answer 30

Chest congestion or productive cough

Question 31

Guaifenesin (Mucinex) SE

Answer 31

Drowsiness, nausea/ vomiting

Question 32

Mucolytics

Answer 32

Acetylcysteine
Hypertonic saline

Question 33

Mucolytics MOA

Answer 33

Acts directly on mucous to make it more watery. Helping to make cough more productive

Question 34

Mucolytics SE

Answer 34

Bronchospasm

Question 35

Acetylcysteine considerations

Answer 35

sulfur content
Taste/smells like rotten eggs

Question 36

Common Cold Safety and Monitoring

Answer 36

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.