Kee: Pharmacology, 8th Edition

Chapter 40: Drugs for Upper Respiratory Disorders

Donloada!le Key Points
Upper respiratory infections include the common cold, acute rhinitis, sinusitis,
and acute pharyngitis.
The common cold is the most prevalent type of upper respiratory infection. A cold
is not considered a life-threatening illness, but it causes physical and mental
discomfort and loss of time at work and school.
The common cold is caused by the rhinovirus and primarily affects the
nasopharyngeal tract.
Acute rhinitis (acute inflammation of the mucous membranes of the nose) usually
accompanies the common cold. A cold is most contagious to ! days before the
onset of symptoms and during the first " days of the cold. Transmission occurs
more fre#uently from touching contaminated surfaces and then touching the nose
or mouth than it does from viral droplets released by snee$ing.
The groups of drugs used to manage cold symptoms include antihistamines,
decongestants, antitussives, and e%pectorants.
&f a bacterial infection secondary to the cold occurs, infectious rhinitis may result,
and nasal discharge becomes tenacious, mucoid, and yellow or yellow-green.
Antihistamines compete with histamine for receptor sites, preventing a histamine
response. 'hen the ( receptor is stimulated, the e%travascular smooth muscles,
including those lining the nasal cavity, are constricted.
The antihistamine group can be divided into first and second generations. )ost
first-generation antihistamines cause drowsiness, dry mouth, and other
anticholinergic symptoms, whereas second-generation antihistamines have fewer
anticholinergic effects and a lower incidence of drowsiness.
)any *T+ cold remedies contain a first-generation antihistamine, which can
cause drowsiness, therefore, patients should be alerted not to drive or operate
dangerous machinery when taking such medications.
-asal congestion results from dilation of nasal blood vessels caused by infection,
inflammation, or allergy. 'ith this dilation, there is a transudation of fluid into the
tissue spaces, resulting in swelling of the nasal cavity.
-asal decongestants stimulate the alpha-adrenergic receptors, producing vascular
constriction of the capillaries within the nasal mucosa. The result is shrinking of
the nasal mucous membranes and a reduction in fluid secretion.
.re#uent use of decongestants, especially nasal spray or drops, can result in
tolerance and rebound nasal congestion. /ebound nasal congestion is caused by
irritation of the nasal mucosa.
0phedrine, phenylephrine, and pseudoephedrine are fre#uently combined with an
antihistamine, analgesic, or antitussive in oral cold remedies.
1econgestants can make a patient 2ittery, nervous, or restless.
Usage of nasal decongestants for as little as " days could result in rebound nasal
+opyright 3 456, 454, 4557, 4558, 455", 4555, 779, 77" by :aunders, an imprint of 0lsevier &nc.
1ownloadable ;ey <oints !5-4
congestion. The nurse should emphasi$e the importance of limiting the use of
nasal sprays and drops.
&ntranasal glucocorticoids or steroids are effective for treating allergic rhinitis.
These have an antiinflammatory action, thus decreasing the allergic rhinitis
symptoms of rhinorrhea, snee$ing, and congestion. 'ith continuous use, dryness
of the nasal mucosa may occur.
Antitussives act on the cough-control center in the medulla to suppress the cough
refle%. The three types of antitussives are nonnarcotic, narcotic, or combination
preparations.
0%pectorants loosen bronchial secretions so they can be eliminated by coughing.
(ydration is the best natural e%pectorant. 'hen taking an e%pectorant, one should
increase fluid intake to at least = glasses per day to help loosen mucus.
:inusitis is an inflammation of the mucous membranes of one or more of the
ma%illary, frontal, ethmoid, or sphenoid sinuses. Acetaminophen, fluids, and rest
may also be helpful. .or acute or severe sinusitis, an antibiotic may be prescribed.
Acute pharyngitis can be caused by a virus, beta-hemolytic streptococci, or other
bacteria. &t can occur alone or with the common cold and rhinitis or acute
sinusitis.
A throat culture should be obtained to rule out beta-hemolytic streptococcal
infection. &f the culture is positive for beta-hemolytic streptococci, a 5-day
course of antibiotics is often prescribed.
:aline gargles, lo$enges, and increased fluid intake are usually indicated in acute
pharyngitis. Acetaminophen may be taken to decrease an elevated temperature.
Antibiotics are not effective for viral pharyngitis.
+opyright 3 456, 454, 4557, 4558, 455", 4555, 779, 77" by :aunders, an imprint of 0lsevier &nc.