Pharm CH 36

Question 1

Pharmacotherapy of Allergic Rhinitis Preventers and Relievers

Answer 1

Preventers: antihistamines, intranasal, corticosteroids and has cell stabilizers
Relievers: oral and intranasal decongestant

Question 2

H1-receptor Antagonists/ Antihistamines

Answer 2

diphenhydramine (Benadryl), clemastine (Tavist), cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin)

Question 3

H1- receptor Antagonists/ Antihistamines Actions

Answer 3

-block histamine from reaching its receptors
-block cholinergic receptors–> drying of mucous membranes (less nasal congestion & tearing eyes)

Question 4

H1- receptor Antagonists/ Antihistamines Uses

Answer 4

Treatment of allergies (most effective as preventers than relievers)
-insomnia, motion sickness and vertigo

Question 5

H1- receptor Antagonists/ Antihistamines Adverse Effects

Answer 5

drowsiness, blurred vision, dry mouth and urinary retention
-paradoxical CNS stimulation

Question 6

H1- receptor Antagonists/ Antihistamines Contraindications and Lifespan Considerations

Answer 6

Pts. with bronchial asthma, narrow-angle glaucoma and seizure disorders
-Monitor older adults for alter consciousness and profound sedation
-Use caution in older adult male with BPH

Question 7

Antihistamine Pt Teaching

Answer 7

-Avoid high level activities requiring mental alertness
-Avoid alcohol
-report difficulty w/ urination
-suck on hard candy and increase fluid intake
-take drug w/ meals to minimize possible GI upset

Question 8

Intranasal Corticosteroids

Answer 8

-beclomethasone (Beconase), fluticasone (Flonase), triamcinolone (Nasacort) & budesonide (Rhinocort)

Question 9

Intranasal Corticosteroids Action and Use

Answer 9

-Lower secretion of inflammatory mediators, reduce tissue edema and cause mild vasoconstriction
Use: Allergic Rhinitis- may require 1-3 weeks for peak response; taken daily to produce maximum benefit and in advance of allergen exposure

Question 10

Intranasal Corticosteroids Adverse Effects

Answer 10

-intense burning sensation in nose and excessive drying of nasal mucosa–> epitaxis
-GI distress from swallowing large amounts- potential for systemic drug absorption

Question 11

Intranasal Corticosteroid Nursing Considerations

Answer 11

-Assess nares for bleeding or excoriation
-Examine mouth and throat for signs of infection
- Monitor S/S of Cushing’s syndrome

Question 12

Intranasal Corticosteroids Patient Teaching

Answer 12

-follow instructions to prime & shake metered-spray device before first dose
-administer nasal decongestant spray first with concurrent use
- clear nose before administering drug
-avoid swallowing drug
-use humidifier, petroleum jelly or preservative-free nasal saline spray

Question 13

Decongestants

Answer 13

oxymetazoline (Afrin) & pseudoephedrine (Sudafed)

Question 14

Decongestants Action and Use

Answer 14

Action: stimulate alpha-adrenergic receptors in sympathetic nervous system (constrict arterioles in nasal mucosa –>dry mucous membranes and open nasal passages)
Use: relieves nasal congestion associated with allergic rhinitis and common cold

Question 15

Decongestants Adverse Effects

Answer 15

Intranasal: rebound congestion (hypersecretion of mucus and worsening nasal congestion once drug effect wear off after prolonged use)- use no longer than 3-5 days
Oral: CNS stimulation (dizziness, headache or nervousness), hypertension and palpitations

Question 16

Decongestants Contraindications

Answer 16

Patients with BPH, CAD, DM, HTN

Question 17

Decongestants Nursing Considerations and Pt. Teach

Answer 17

-Assess BP & P
Patient Teaching: do not take other OTC allergy or cold preparations w/o contacting physician
-Follow directions on proper administration technique w/ nasal spray
- increase fluid intake to 3,000 mL per day if possible

Question 18

Antitussives

Answer 18

codeine, hydrocodone, benzonatate (Tessalon Perles) & dextromethorphan (Robitussin-DM)

Question 19

Antitussives Action

Answer 19

raise cough threshold in medulla of CNS (codeine, hydrocodone, dextromethophan)
-suppress cough reflex by anesthetizing stretch receptors in lungs (benzonatate)

Question 20

Antitussives Uses

Answer 20

treats dry, hacking, nonproductive cough that can irritate throat membranes and interfere with rest

Question 21

Antitussives Adverse and Contraindication

Answer 21

-dizziness, drowsiness, GI upset
- minimal potential dependence w/ opioid
-numb mouth & pharynx if drug chewed (benzonatate)
Contraindication: use caution in patients w existing respiratory disease

Question 22

Antitussives Nursing Considerations

Answer 22

-Assess respiratory rate/rhythm/depth, presence of nonproductive/productive cough and breath sounds
-Ensure pt. safety

Question 23

Antitussives Pt Teaching

Answer 23

-take drug as prescribes
-do not take OTC cold or cough preparations w/o physician
-no alcohol
-no driving

Question 24

Expectorants and Mucolytics

Answer 24

guaifenesin (Mucinex) and acetylcysteine (Mucomyst)

Question 25

Expectorants and Mucolytics Action

Answer 25

-reduce viscosity of bronchial secretions (guaifenesin)- increase mucus flow; more easily removed by coughing - directly loosen thick bronchial secretions (acetylcysteine)- mucus thinner; more easily removed by cough

Question 26

Expectorants and Mucolytics Uses

Answer 26

-relief of productive cough commonly associated with the common cold (guaifenesin) -cystic fibrosis, chronic bronchitis, acetaminophen overdose (acetylcysteine)

Question 27

Expectorants and Mucolytics- Adverse and Pt. teaching

Answer 27

Adverse: n/v, dizziness, headache (guaifenesin) ; bronchospasm, fever, n/v, offensive rotten egg odor (acetylcysteine) Pt teaching: encourage intake of fluids -contact a physician for a fever > 100.4 or other symptoms that last longer than 3-4