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NURS 306 > Chapter 36: Antihistamines, Decongestants, Antitussives and Expectorants > Flashcards

Chapter 36: Antihistamines, Decongestants, Antitussives and Expectorants Flashcards

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1
Q

Antihistamines, Decongestants, Antitussives and Expectorants treat

A

Upper respiratory tract infections

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2
Q

Cold is most often caused by

A

Virus, and also by bacteria

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3
Q

Typical S&S of a Cold

A

Sore throat, coughing and upset stomach

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4
Q

Excessive mucus =

A

Inflammatory response

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5
Q

Irritation of nasal mucosa triggers

A

Sneeze reflex

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6
Q

Nasal congestion

A

Dilation of small blood vessel in nasal sinuses from mucosal irritation

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7
Q

Treatments for Colds

A 
Empiric Therapy (Is symptomatic, not curative)
Herbals: echinacea and goldenseal
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8
Q

The highest priority for pt education of OTC meds

A

Do NOT use in children < 2 years unless prescribed

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9
Q

Empiric Therapy

A

Treating based on S&S rather than actual cause of disease

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10
Q

Antihistamines are responsible for

A

blocking histamine a in inflammatory response in mast cells.

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11
Q

Antihistamines

A

Directly compete w/ histamine for specific receptor sites

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12
Q

Antihistamines include

A 
Chlorpheniramine
fexofenadine 
loratadine 
cetirizine 
diphenhydramine
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13
Q

Histamine1 Receptors

A

Mediates smooth muscle contraction and dilation of capillaries.
Increases histamine

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14
Q

Increased histamine =

A

Anaphylaxis

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15
Q

Functions of Histamine1

A
  • Nerve impulse transmission in CNS
  • Dilate capillaries and contract smooth muscle
  • Stimulation of gastric secretions and increased HR
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16
Q

Histamine1 agonists (aka Antihistamines) are more effective in

A

Preventing actions rather than reversing them, therefore give earlier in traeatment

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17
Q

Indications for Histamine1 Agonists

A

Management of nasal allergies, seasonal/perennial allergic rhinitis, and allergic reactions.
Relieves common cold: sneezing, runny nose, cough.
Also useful for vertigo, motion sickness, insomnia, and Parkinson’s disease.

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18
Q

Mechanism of Action: Histamine1 Agonists

A
  • Released from mast cells, basophils, other cells in response to antigens.
  • Block histamine receptors on basophils/mast cells.
  • Prevent release/actions of histamine.
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19
Q

Antihistamines: MOA on Cardiovascular System

A

reduces dilation of the blood vessels

reduces increased permeability of the blood vessels

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20
Q

Antihistamines: MOA on Immune System

A

prevent release of histamine, binds to histamine receptors and prevents actions.

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21
Q

Antihistamines: MOA on Smooth Muscle

A

reduces salivary, gastric, lacrimal, bronchial sections

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22
Q

Antihistamines: MOA on the Skin

A

reduces capillary permeability, wheal flare formation, and itching

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23
Q

Antihistamines: Anticholinergic MOA

A

drying effect reducing nasal, salivary and lacrimal secretions (runny nose)

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24
Q

Contraindications of Histamine1 Agonists

A
  • Presence of acute asthma attack and lower respiratory diseases (pneumonia)
  • Caution in increased intraocular pressure, cardiac/renal disease, HTN, asthma, COPD, peptic ulcer disease, BPH, pregnancy
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25
Adverse Effects of Histamine1 Agonists
CC- drowsiness | Anticholinergic (drying) effects most common (Dry mouth, difficulty urinating, constipation, changes in vision)
26
Nonsedating antihistamines include
Fexodenadine Loratadine Cetirizine
27
Nonsedating Antihistamines
Eliminates adverse effects mainly sedation Work peripherally to block actions of histamine Longer duration of action
28
Traditional Antihistamines include
Diphenhydramine Chlorpheniramine Dimenhydrinate Meclizine
29
Traditional Antihistamines
Peripherally and centrally acting | Anticholinergic effects, makes more effective than nonsedating in some cases.
30
Antihistamine interactions
Cough syrup mixed with antihistamines can decrease CNS effects.
31
Nursing Implications: Antihistamines
- Gather data of condition/allergic reaction; assess for drug allergies - Report excessive sedation, confusion, hypotension.
32
Antihistamines should be taken when in regards to meals?
Best taken with meals - Reduces GI upset
33
The nurse should advise the patient who is taking antihistamines to avoid what when taking this medication?
Avoid driving/ operating; Avoid consuming alcohol or CNS depressants
34
Antihistamines can cause dry mouth, therefore the nurse should have
Put perform frequent mouth care, chew gum, or suck on a hard, sugarless candy
35
You should discontinue antihistamine medications at least
4 days prior to allergy testing
36
Indications for Decongestants
Used to relieve nasal congestion r/t acute/chronic rhinitis, common cold, sinusitis, hay fever and other allergies Used for ability to shrink engorged nasal mucous membranes
37
Decongestants
Decrease swelling of nasal passage and facilitate visualization of nasal/pharyngeal membranes before surgery/diagnostic procedures
38
Types of Decongesants
Oral Decongestants Topical Adrenergics Intranasal Steroids Intranasal Anticholinergic
39
Rhinitis medicamentosa
Rebound congestion if nasal sprays are overused
40
Humidifier
Used to prevent nose bleeds from drying effect of nasal spray
41
Oral Decongestants include
Pseudoephedrine
42
Oral Decongestants
Prolonged effects, delayed onset Less potent than topical No rebound congestion Exclusively adrenergic
43
Adrenergic
Sympathomimetic
44
Anticholinergic
Parasympathetic
45
Topical Adrenergics include
Phenylephrine
46
Topical Adrenergics
Prompt onset Potent Can cause rebound congestion
47
Intranasal Steroids include
``` beclomethasone dipropionate budesonide flunisolide fluticasone triamcinolone ciclesonide ```
48
Intranasal Anticholinergic
Ipratropium
49
Mechanism of Action: Adrenergic Decongestants
Constrict small blood vessels that supply UR tract structures Tissues shrink, nasal secretions are better able to drain
50
Mechanism of Action: Nasal Steroids (Decongestant)
Anti-inflammatory effect Turns off immune system cells involved in inflammatory response Decreases inflammation = decreased congestion
51
Site of Action for Decongestants
Blood vessels surrounding nasal sinuses
52
Contraindications for Adrenergic Decongestants
- Narrow-angled glaucoma, uncontrolled CVD, HTN, diabetes, hyperthyroidism, prostatitis, atrial fibrillation - Unable to close eyes. - History of CVA, cerebral arteriosclerosis, long-standing asthma, BPH
53
Adverse Effects of Adrenergic Decongestants
Nervousness Insomnia Palpitations Tremor
54
Adverse Effects of Intranasal Steroids (Decongestant)
Localized, mucosal dryness and irritation
55
Excessive dosages of decongestants can cause
Systemic effects of cardiovascular: HTN, palpitations | CNS effects: headache, nervousness and dizziness.
56
Nursing Implications for Decongestants
Avoid caffeine or caffeine-containing products | Report fever, cough, other symptoms lasting longer than a week
57
Indications for Antitussives
Nonproductive or harmful cough
58
Antitussives
Opioid vs nonopioid
59
Opioids include
Codeine and hydrocodone
60
Nonopioids include
Dextromethorphan, benzonatate levorphanol
61
Mechanism of Action: Opioids
Suppress cough reflex by direct action on cough center in medulla
62
Mechanism of Action: Nonopioids
Suppress cough reflex by numbing stretch receptors in respiratory tract and preventing the cough reflux from being stimulated
63
Contraindications of Antitussives
Opioid caution in elderly patient and alcohol use
64
Adverse Effects of Antitussives
Effect CNS
65
Adverse Effects of Nonopioids (Antitussives)
Benzonatate: Dizziness, headache, sedation, nausea, nasal congestion Dextromethorphan: Sedation, nausea, drowsiness and dizziness
66
Adverse Effects of Opioids (Antitussives)
Sedation N/V Lightheadedness Constipation
67
Nursing Implications for Antitussives
Perform respiratory and cough assessment Avoid driving or operating heavy machinery Report cough lasting more than a week, persistent headache, fever, rash.
68
Expectorant
Aid in expectoration (removal of mucus) Decreases viscosity of secretions Disintegrate and thin secretions
69
Expectorants include
Guaifensein
70
Mechanism of Action: Expectorant
Reflex Stimulation Direct Stimulation Loosening and thinning sputum and bronchial secretions -> tendency to cough is indirectly diminished.
71
Reflex Stimulation
Drug causes irritation of GI tract, loosening and thinning of respiratory tract secretions in response to this irritation
72
Direct Stimulation
Secretory glands are stimulated directly to increase their production of repository tract fluids
73
Indications for Expectorants
Relief of productive cough r/t common cold, bronchitis, laryngitis, pharyngitis, pertussis, influenza and measles
74
Nursing Implications for Expectorants
Used cautiously in elderly and those with asthma and respiratory insufficiency Receive more fluids to help loosen and liquefy secretions. Report fever, cough, other symptoms lasting longer than a week
75
Antihistamines have several properties
antihistaminic anticholinergic sedative
76
Histamine effects on the heart
dilation and increased permeability (allowing substances to leak into tissues)
77
Histamine effects on the immune system
mast cells release histamine and other substances, resulting in allergic reactions
78
Histamine effects on the smooth muscle
stimulates salivary, gastric, lacrimal and bronchial secretions

NURS 306 (26 decks)

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