objective 2.3 (1)

Question 1

what is the treatment of the common cold?

Answer 1

Involves combined use of antihistamines, nasal decongestants,
antitussives, and expectorants
Treatment is symptomatic only, not curative.
Viral – sometime treated with antivirals
Bacterial – can be treatment with antibiotics
Difficult to determine so often treat the most likely cause “empirical
therapy”.

Question 2

 Major inflammatory mediator in many allergic disorders
 Allergic rhinitis (e.g., hay fever and mould and dust allergies)
 Anaphylaxis
 Angioedema
 Drug fevers
 Insect bite reactions
 Urticaria (pale red, raised, itchy bumps)

Answer 2

histamine

Question 3

Severe Allergic Reactions
 Release of excessive amounts of histamine can lead to:
 Constriction of smooth muscle, especially in the stomach and lungs
 Vasodilatation and increased capillary permeability, movement of fluid out of the blood vessels and
into the tissues, and drop in blood pressure and edema

Answer 3

anaphylaxis

Question 4

Drugs that directly compete with histamine for specific receptor sites

Answer 4

antihistamines

Question 5

what are the histamine antagonists?

Answer 5

H1-antagonists
H2-antagonists

Question 6

Examples: chlorpheniramine, fexofenadine (Allegra®), loratadine (Claritin®), cetirizine (Reactine®), desloratadine
(Aerius®), diphenhydramine (Benadryl®

Answer 6

H1-antagonists

Question 7

 Used to reduce gastric acid in peptic ulcer disease
 Examples: cimetidine, ranitidine (Zantac®), famotidine (Pepcid AC®), nizatidine (Axid®)

Answer 7

H2-antagonists

Question 8

what is the MOA of antihistamines?

Answer 8

Block action of histamine at H1-receptor sites
Binds with unoccupied receptors
Early treatment is key!
Effects on : CVS, Smooth muscle, Immune System

Question 9

what are the 2 types of antihistamines?

Answer 9

traditional
nonsedating

Question 10

brompheniramine, chlorpheniramine, dimenhydrinate,
diphenhydramine, and promethazine

Answer 10

traditional antihistamines

Question 11

loratadine, cetirizine, and fexofenadine

Answer 11

nonsedating antihistamines

Question 12

 Older, Work both peripherally and centrally
 Have anticholinergic effects, making them more effective than nonsedating
drugs in some cases
 Examples: diphenhydramine (Benadryl), brompheniramine, chlorpheniramine,
dimenhydrinate (Gravol), promethazine

Answer 12

traditional antihistamines

Question 13

 Developed to eliminate unwanted adverse effects, mainly sedation
 Work peripherally to block the actions of histamine; thus, fewer central
nervous system adverse effects
 Longer duration of action (increases compliance with once-daily dosing)
 Examples: loratadine (Claritin), cetirizine(Reactine), and fexofenadine (Allegra)

Answer 13

nonsedating peripherally acting antihistamines

Question 14

what are the indications of antihistamines?

Answer 14

Management of: Nasal allergies, Seasonal or perennial allergic rhinitis (hay
fever), Allergic reactions, Motion sickness, Parkinson’s disease, Vertigo, Sleep
disorders, Sneezing and runny nose associated with ‘a cold’

Question 15

what are the contraindications of antihistamines?

Answer 15

 Known drug allergy, Acute-angle glaucoma, Cardiac disease, hypertension, Kidney
disease, Peptic ulcer disease, Seizure disorders, Benign prostatic hyperplasia, Pregnancy,
Bronchial asthma, chronic obstructive pulmonary disease (COPD)
 Not to be used as sole drug therapy during acute asthmatic attacks
 salbutamol or epinephrine should be used.

Question 16

what are the AE of antihistamines?

Answer 16

Anticholinergic (drying) effects: most common
Dry mouth
Difficulty urinating
Constipation
Changes in vision
Cardiovascular, central nervous system, gastrointestinal, and other
effects
Drowsiness
Mild drowsiness to deep sleep

Question 17

what are the 3 main types of decongestants?

Answer 17

adrenergics
anticholinergics
corticosteroids

Question 18

what are the dose forms of decongestants?

Answer 18

oral
inhaled or topically applied

Question 19

Prolonged decongestant effects; delayed onset
Effect less potent than topical
No rebound congestion
Exclusively adrenergics
Example: pseudoephedrine

Answer 19

oral decongestants

Question 20

 Prompt onset, Potent
 Sustained use over several days causes rebound congestion, making the condition worse.
 ephedrine, oxymetraxoline hydrochloride (Dristan), phenylephrine, and tetrahydrozoline

Answer 20

topical adrenergics

Question 21

 *Not associated with rebound congestion, Often used prophylactically to prevent nasal
congestion in patients with chronic upper respiratory tract symptoms
 Intranasal anticholinergic: ipratropium (Atrovent®)

Answer 21

inhaled intranasal- steroids and anticholinergic drugs

Question 22

what are intranasal steroids?

Answer 22

beclomethasone dipropionate (Qvar®), budesonide (Rhinocort®),
flunisolide (Rhinalar®), fluticasone (Avamys®), triamcinolone (Nasacort®), mometasone
(Nasonex®)

Question 23

what is the MOA of adrenergics?

Answer 23

 Constrict small blood vessels that supply upper respiratory tract structures
 As a result, these tissues shrink, and nasal secretions in the swollen mucous
membranes are better able to drain

Question 24

what is the MOA of nasal steroids?

Answer 24

 Anti-inflammatory effect
 Work to turn off the immune system cells involved in the inflammatory response
 Decreased inflammation results in decreased congestion.

Question 25

what are the indications of nasal decongestants?

Answer 25

Relief of nasal congestion associated with: Acute or chronic rhinitis,
Common cold, Sinusitis, Hay fever, Other allergies
Reduce swelling of the nasal passage and facilitate visualization of
the nasal or pharyngeal membranes before surgery or diagnostic
procedures

Question 26

what are the contraindications of nasal decongestants?

Answer 26

 Drug allergy, Acute-angle glaucoma, Uncontrolled cardiovascular disease, hypertension,
Diabetes and hyperthyroidism, Prostatitis, Inability to close the eyes, History of
cerebrovascular accident or transient ischemic attacks, Cerebral arteriosclerosis, Long-
standing asthma, Benign prostatic hyperplasia, Diabetes

Question 27

what are the AE of adrenergics and steroids?

Answer 27

Adrenergics: Nervousness, Insomnia, Palpitaiions, Tremors
Steroids: Local mucosal dryness and irritation

Question 28

what are the interactions of nasal decongestants?

Answer 28

Systemic sympathomimetic drugs and sympathomimetic nasal
decongestants are likely to cause drug toxicity when given together.
Monoamine oxidase inhibitors and sympathomimetic nasal
decongestants raise blood pressure.
Ask if pregnant client is on Methyldopa
Urinary acidifiers and alkalinizers

Question 29

Respiratory secretions and foreign objects are naturally removed by
the cough reflex.
Induces coughing and expectoration
Initiated by irritation of sensory receptors in the respiratory tract

Answer 29

cough physiology

Question 30

what are the 2 types of coughs?

Answer 30

productive
nonproductive

Question 31

congested; removes excessive secretions

Answer 31

productive cough

Question 32

dry cough

Answer 32

nonproductive

Question 33

 Drugs used to stop or reduce coughing, Primarily used only for nonproductive coughs!
 Opioid and nonopioid
 May be used in cases when coughing is harmful

Answer 33

antitussives

Question 34

what is the MOA for opioids?

Answer 34

Suppress the cough reflex by direct action on the cough centre in the medulla
 They have analgesia effect.
 Drying effect on the mucosa of the respiratory tract, increased viscosity of respiratory secretions,
reduction of runny nose and postnasal drip
 Examples: codeine, hydrocodone

Question 35

what is the MOA of nonopioids?

Answer 35

 Suppresses cough reflex
 Dextromethorphan: works in the same way
* Not an opioid, No analgesic properties, No central nervous system depression

Question 36

what are the contrainidications of antitussives?

Answer 36

Drug allergy, Opioid dependency, Respiratory depression

Question 37

what are the AE of antitussives?

Answer 37

 diphenhydramine:
 Sedation, dry mouth, and other anticholinergic effects
 dextromethorphan
 Dizziness, drowsiness, nausea
 Opioids
 Sedation, nausea, vomiting, lightheadedness, constipation

Question 38

 Drugs that aid in the expectoration (removal) of mucus
 Reduce the viscosity of secretions
 Disintegrate and thin secretions
 Example: guaifenesin

Answer 38

expectorants

Question 39

what is the MOA of expectorants?

Answer 39

 Reflex stimulation: Irritation of the gastrointestinal tract; Loosening and thinning of
respiratory tract secretions.
 Direct stimulation: The secretory glands are stimulated directly to increase their production
of respiratory tract fluids.
 Final result: thinner mucus that is easier to remove
 Drug Effects: By loosening and thinning sputum and bronchial secretions, the
tendency to cough is indirectly diminished.

Question 40

Reduces symptoms of the common cold and recovery time

Answer 40

echinacea

Question 41

what are the AE of echinacea?

Answer 41

Dermatitis
Gastrointestinal disturbance or vomiting
Dizziness
Headache
Unpleasant taste