Professional Documents
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Decongestants
AH-D combinations
Corticosteroids
Anticholinergics
Antileukotrienes
Nasal decongestant
Nasal congestion
Caused by vasodilatation
Reduce smell acuity
Nasal decongestant
Sympathomimetic
ex. PPA=phenyl-propanol-amine, etc
Topical and systemic
Topical
rebound phenomenon,
systemic effect
Decongestants
Oral or Intranasal Sympathomimetics
Most common
Alleviate nasal congestion of allergic rhinitis or the
common cold
Many available OTC
Ipratropium bromide anticholinergic
Caution/nursing consideration
Monitor pulse and B/P
Avoid within 2 hours of bedtime
Instruct regarding proper positioning and technique
for intranasal administration
Histamine and anti-histamine
What is histamine?
What two receptors interact with histamine?
Describe the difference between first-generation H1 receptor
antagonists and second generation H1 receptor antagonists.
Identify the prototype for each generation
What is another term used for H1-antagonist?
What is the mechanism of action of this class of drugs?
What are indications for OTC treatment with this class
of drugs?
H1 Receptor Antagonists
Contraindicated:
dysrhythmia, heart failure, HTN, sleep
disorders, asthma, narrow angle
glaucoma, urinary retention (e.g. BPH)
Can have paradoxical effect in children
(increased CNS stimulation instead of
drowsiness)
Must monitor elderly for safety
H1 Receptor Antagonists
Key Client Education
Report: chest pain, insomnia,
restlessness, visual changes, seizure
activity
Avoid driving until side effects are known
Avoid alcohol and other CNS depressants
Increase fluid intake to facilitate
expectoration of dry oral mucus
Antihistamines
First Generation
i.e.: Benadryl, Chlor-Trimeton (CTM)
Mechanism: inhibition of histamine (H1)
receptors.
Effect: reduce sneezing, nasal pruritus and
rhinorhea, but not congestion.
Note:
OTC
Work better in seasonal rhinitis.
Side Effects: anticholinergic activity --> adverse
CNS effects.
Antihistamines
Second Generation
i.e.: Claritin, Allegra, Zyrtec
Mechanism: inhibit histamine (H1) receptors.
Effect: same as First generation.
Note:
Nonsedating (Zyrtec is low-sedating)
Prescription only
Side effects: Seldane (Terenadine, now off
market) -- Black-box warnings related with
serious cardiac arrhythmias (w/ macrolide,
antifungals).
Decongestants (oral/topical)
i.e.: Sudafed (oral), Afrin (topical)
Mechanism: alpha-adrenergic agonist.
Effect: vasoconstriction restricts blood flow to
nasal mucosa decreasing nasal obstruction (no
influence on pruritis, sneezing or nasal
secretion).
Side effects:
Oral: HA, nervousness, irritability, tachycardia,
palpitations, insomnia.
Topical(nasal): prolonged use (>5-7 days) leads to
rhinitis medicamentosa
Ipratropium (intranasal)
i.e.: Atrovent (intransal)
Mechanism: inhibits muscarinic cholinergic
receptors.
Effect: reduces watery rhinorrhea (no effect on
nasal itching, sneezing or nasal congestion).
Note:
limited to control of watery secretions.
effective at reducing both cold-air and
gustatoryrhinitis.
Side effects: irritation, crusting, epistaxis.
Intranasal Glucocorticoids
Drug of choice for seasonal allergic rhinitis
Highly efficacious; Wide margin of safety
Use decongestant first
Prototype: fluticasone
Metered Spray Devise:
Shake
Clear nose
Avoid swallowing
Adverse effects:
Nasal irritation
Epistaxis
Corticosteroids (intranasal)
i.e.: Vancenase, Flonase
Mechanism:
reduce inflammation
suppress neutrophil chemotaxis
mildly vasoconstrictive
reduce intracellular edema
Effect: reduce nasal blockage, pruritis,
sneezing and rhinirrhea.
Actions of Various Nasal Preparations in
the Treatment of Rhinitis
Nasal Sneezing Itching Rhino- Conges
Preparation rhoea tion
Antihistamine +++++ ++++ +++ 0
Anticholinergic 0 0 +++++ 0
Corticosteroid +++++ +++++ +++ +++
Decongestant 0 0 + +++++
Mast cell +++++ +++ + 0
stabilizer
Anti-leukotriene +++ ++ 0 +++
SMELL
Smell
Garlic aroma
Plain MSG
Medications that alter smell and taste
Antibiotics Anti-inflammatory agents
Ampicillin, Azithromycin, Colchicine, Dexamethasone, Gold,
Ciprofloxacin, Clarithromycin, Hydrocortisone, Penicillamine
Griseofulvin, Metronidazole, Antineoplastics
Ofloxacin, Tetracycline Cisplatin, Doxorubicin,
Antidepressants/Mood Stabilizer Methotrexate, Vincristine
Amitriptyline, Clomipramine, Antiparkinsonian agents
Desipramine, Doxepin, Levodopa, Sinemet
Imipramine, Nortriptyline Antipsychotics
Antihistamines and Clozapine , Trifluoperazine
decongestants Antithyroid agents
Chlorpheniramine, Loratadine, Methimazole, Propylthiouracil
Pseudoephedrine
Lipid-lowering agents
Antihypertensives/Cardiac Fluvastatin, Lovastatin, Pravastatin
Acetazolamide, Amiloride,
Betaxolol, Captopril, Diltiazem, Anticonvulsants
Enalapril, Hydrochlorothiazide, Carbamazepine, Phenytoin
Nifedipine, Nitroglycerin, Muscle relaxants
Propranolol, Spironolactone Baclofen, Dantrolene