HEENT Flashcards
Classifications of Antitussive medications and examples
Centrally acting
- Dextromethorphan
- Codeine
Peripherally acting
- Benzonatate
Dextromethorphan and Codeine Mechanism of Action
- acts centrally in the medulla to elevate the threshold for coughing
- affects serotonin
- suppresses the cough reflex
- risk for abuse
Benzonatate (Tessalan Perles) Mechanism of Action
- thought to anesthetize the stretch receptors in the respiratory passages, calming the cough
- numbs the lungs
- makes lungs more relaxed
- does cross blood-brain barrier
Antitussive medications cautions/ contraindications
- avoid in persistent/chronic cough caused by smoking, asthma, or emphysema
- additive CNS depression when dextromethorphan or codeine is used with CNS depressants - can decrease respiratory drive
- do not self-medicate for more than 7 days
- Risk for overdose with benxonatate, keep away from children
Antitussive Adverse drug reactions
- dextromethorphan and codeine: drowsiness, dizziness, and GI upset
- benxonatate: chest numbness, dizziness, GI upset, headache, and “chilly” sensation
Expectorant Mechanism of Action
Guaifenesin (Mucinex and Robitussin)
- decreases the surface tension of mucus making the mucus more thin and loose for clearance
- questionable efficacy
Expectorant/Mucinex indication for use
- for cough due to common cold or upper respiratory infections
- good for patients who have congestion but are unable to expectorate
Expectorant/Mucinex ADRs
- GI upset - diarrhea - nausea - vomiting
- drowsiness - dizziness
Expectorant cautions/ contraindications
- do not use for persistent cough
- do not use for cough r/t heart failure or ACE inhibitor therapy
Demulcents Mechanism of Action and Examples
Cough drops, honey, acacua, licorice, glycerin, wild cherry
- Act as a protective film on mucous membranes thereby reducing irritation
Name examples of decongestants
Psuedoephederine
Phynylephrine
Afrin (nasal)
Decongestants Mechanism of Action
Alpha 1 agonists (sympathomimetics) - they mimic the endogenous catecholamines of the sympathetic nervous system
- produces vasoconstriction by stimulating the Alpha 1 receptors in the mucosa of the resp. tract, thus temporarily reducing swelling and inflammation
**used to treat symptoms
Decongestants cautions and contraindications
- avoid in HTN and CAD
- oral not recommended in children < 4 years old - not recommended in pregnancy and lactation
- avoid in combination with beta blockers - potentiate CV issues
- topical/nasal: do not use for longer than 3 days (can cause rebound congestion)
Decongestants Adverse Drug Reactions
- anxiety, restlessness, headache, insomnia, psychological disturbances, tremors, HTN, tachycardia (fight or flight symptoms)
- topical: nasal irritation and rebound congestions with prolonged use
Non-pharm interventions for Allergic Rhinitis
- Avoid triggers (close windows and doors to reduce pollen exposure)
- Remove carpets
- Clean frequently (vaccuum, dust ect.)
- Keep pets out of bedroom area if possible
Antihistamine Mechamism of Action
Competitively binds to histamine recptors thereby blocking action of histamine.
H1 vs H2 histamine recptors
1st Generation Antihistamines
Diphenhydramine, hydroxyine, chlorpheniramine, dimenhydramine
- crosses BBB and may lead to sedation
- anticholinergic effects
2nd generation Antihistamines
Loratidine, cetirizine, fexofenadine
- less sedating that 1st gen, doesn’t cross BBB as well
Intranasal Glucocorticoids Mechanism of Action
Down regulate inflammatory response and inhibit cytokines to decrease allergic response
-Most effective therapy for allergic rhinitis
Intranasal glucocorticoids adverse drug reactions
Minimal systemic effects
- nasal irritation, nosebleeds, sore throat
- can take 1 week for full effectiveness
Additional pharmacological agents for allergic rhinitis (not glucocorticoids)
Topical Cromolyn
Topical antihistamines
Leukotriene modifiers
Pharmacological options for allergic conjunctivitis
Antihistamine/vasoconstrictor drops
Antihistimine with mast cell stabilizing drops
Mast cell stabilizer
Oral antihistamine
Intranasal glucocorticoid
