objective 2.3 (1) Flashcards by Kaitlyn Dominie

what is the treatment of the common cold?

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”.

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 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)

histamine

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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

anaphylaxis

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Drugs that directly compete with histamine for specific receptor sites

antihistamines

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what are the histamine antagonists?

H1-antagonists
H2-antagonists

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

H1-antagonists

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

H2-antagonists

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what is the MOA of antihistamines?

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

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what are the 2 types of antihistamines?

traditional
nonsedating

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brompheniramine, chlorpheniramine, dimenhydrinate,
diphenhydramine, and promethazine

traditional antihistamines

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loratadine, cetirizine, and fexofenadine

nonsedating antihistamines

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 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

traditional antihistamines

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 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)

nonsedating peripherally acting antihistamines

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what are the indications of antihistamines?

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’

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what are the contraindications of antihistamines?

 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.

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what are the AE of antihistamines?

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

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what are the 3 main types of decongestants?

adrenergics
anticholinergics
corticosteroids

what are the dose forms of decongestants?

oral
inhaled or topically applied

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

oral decongestants

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

topical adrenergics

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

inhaled intranasal- steroids and anticholinergic drugs

what are intranasal steroids?

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

what is the MOA of adrenergics?

 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

what is the MOA of nasal steroids?

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

what are the indications of nasal decongestants?

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

what are the contraindications of nasal decongestants?

 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

what are the AE of adrenergics and steroids?

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

what are the interactions of nasal decongestants?

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

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

cough physiology

what are the 2 types of coughs?

productive nonproductive

congested; removes excessive secretions

productive cough

dry cough

nonproductive

 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

antitussives

what is the MOA for opioids?

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

what is the MOA of nonopioids?

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

what are the contrainidications of antitussives?

Drug allergy, Opioid dependency, Respiratory depression

what are the AE of antitussives?

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

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

expectorants

what is the MOA of expectorants?

 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.

Reduces symptoms of the common cold and recovery time

echinacea

what are the AE of echinacea?

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