Management of Allergic Rhinitis, the Common Cold, and Cough

Question 1

Intranasal Glucocorticoids (INGC)

Answer 1

RECOGNIZE “-SONE”

The MOST effective/ 1st line drugs for prevention & treatment of seasonal & perennial rhinitis

90% of patients respond well
MOA: decrease inflammation & edema

ADRs:
Systemic effects rare
Local reactions: drying of nasal mucosa; burning or itching sensation; sore throat, epistaxis, headache

Question 2

Antihistamines

Answer 2

Binds selectively to the H1-histaminic receptors, thereby blocking the actions of histamine at these sites.

H1 do not block H2 receptors
Do not block release of histamine from mast cells either

Prevent but DO NOT reverse responses mediated by histamine

Uses:
Relief of symptoms of mild to moderate allergic disorders including allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema

Question 3

2nd Generation Antihistamines

Answer 3

Poorly cross the blood-brain barrier
Have a low affinity for H1 receptors in the CNS
Because of these characteristics – do not cause the sedation seen in
the first generation antihistamines

Question 4

Sympathomimetics

Answer 4

Sympathomimetics are also known as decongestants
Can take most decongestants orally or via nasal spray

MOA: activate alpha1 adrenergic receptors on nasal blood vessels -> vasoconstriction
Decongestants reduce nasal congestion & swelling.

Adverse effects:
Rebound congestion (topicals) used for more than 5 days
CNS stimulation (oral) – restlessness, anxiety, insomnia
CV effects (oral) – tachycardia, inc. BP
Use cautiously HTN, dysrhythmias, cerebrovascular disease
Risk for Abuse – pseudoephedrine used to make methamphetamines

Question 5

Phenylephrine (Neo-synephrine)

Answer 5

Sympathomimetic

Question 6

Pseudoephedrine (Sudafed)

Answer 6

Sympathomimetic

Question 7

Oxymetazoline (Afrin)

Answer 7

Sympathomimetic

Question 8

Expectorants

Answer 8

An agent that increases the flow of fluid in the respiratory tract.
Reduces the viscosity of bronchial & tracheal secretions
facilitates secretions by the cough reflex & ciliary action.
Indication - dry, nonproductive cough, mucous
Pharmacokinetics: absorbed PO, metabolized liver, excreted kidneys
Forms - syrup, tablet, liquid, capsule, sustained-release capsule

Question 9

Guaifenesin

Answer 9

An expectorant found in many cough syrups
Used to decrease mucus viscosity
Convert a nonproductive cough into a productive cough
Other names: glyceryl guaiacolate, guiatuss, humibid, robitussin, antituss, mucinex

Question 10

Codeine

Answer 10

Indication: coughing
MOA: narcotic analgesic; mu receptor agonist
Forms: PO, rectal
ADRs: sedation, confusion, resp. depression, hypotension, N/V, seizures

Question 11

Benzonatate (Tessalon Perles)

Answer 11

Indication: dry, hacking, nonproductive cough interfering with rest & sleep
Pharmacodynamics: anesthetizes stretch receptors in respiratory passages, lungs, pleura (responsible for cough reflex)

Question 12

Dextromethorphan

Answer 12

Pharmacodynamics: Suppresses cough reflex by direct action of the cough center in the medulla.
Pharmacokinetics: action begins within 15-30 minutes
Almost equal in it’s antitussive potency to codeine, but with little or no CNS depression. Also, fewer GI problems.

Contraindications:
Do not use in patient receiving MAO inhibitors within the preceding 2 weeks because of concomitant use can cause decreased BP, coma, death

Use with caution with asthma & other respiratory problems - drug will immobilize secretions

Pregnancy C category

Question 13

Acetylcysteine (Mucomyst, mucosil)

Answer 13

Mucolytic Agent

Indication
Abnormally viscous mucous secretions with acute & chronic bronchopulmonary disease.
MOA:
works directly on mucus to reduce thickness & make secretions less tenacious. Alters metabolism of acetaminophen to decrease injury to the liver in overdose.
A/E: bronchospasms, stomatitis, rhinorrhea, N/V.
Caution: bronchial asthma, elderly, debilitated
Can cause bronchospasms

Question 14

Guifenasin Side Effects

Answer 14

Life-threatening: Rare (Hypersensitivity)
Infrequent: drowsiness, Diarrhea, headache, hives, nausea or vomiting, skin rash, stomach pain, kidney stones
Pregnancy C

Question 15

Antihistamine Side Effects

Answer 15

Warnings:
Caution in children
Asthma, urinary retention, open-angle glaucoma, hypertension, & benign prostatic hypertrophy

Elderly- Anticholinergic effect; Delirium (Suggest a 2nd generation antihistamine)

Question 16

Opioid ADRs

Answer 16

ADRs: sedation, confusion, resp. depression, hypotension, N/V, seizures

Question 17

Opioid Contra

Answer 17

Hypersensitivity, asthma pts, respiratory depression, severe renal, hepatic, CV, GI, neurologic, or pulmonary disease, Pregnancy/ Lactation (neonatal opiod withdrawal), Alcoholics

Question 18

Note about Opioids

Answer 18

CYP2D6 poor metabolizers may not achieve adequate analgesia vs. Ultra-rapid metabolizers = increased toxicity (e.g., resp. depression and death) due to rapid conversion (of codeine into morphine)

Question 19

Tessalon Perles Side Effects and Adverse Effects

Answer 19

Drowsiness, chilly sensation, HA, GI upset, constipation, burning sensation in eyes

Toxicity: Restlessness, tremors, seizures and unconsciousness, profound CNS depression and death can follow.

Take only as prescribed. Keep away from children!
Contraindication: Hypersensitivity to tetracaine-type topical anesthesia (bronchospasm)