Antihystamines,+Decongestants,+Antitussives,+Expectorants+&+Bronchodilators

=Antihistamines, Decongestants, Antitussives & Expectorants =

 URI caused by influenza or a rhinovirus --> inflammatory response --> excessive mucous production -->Symptoms: sore throat, coughing, upset stomach, sneezing and nasal congestion **Symptomatic Treatment**: Antihistamines, Decongestants, Antitussives & Expectorants

**Antihistamine**  · Substances capable of reducing the physiologic and pharmacologic effects of histamine, including a wide variety of drugs that block histamine receptors  · H1 antagonists-compete with histamine for receptors-can’t remove histamine from receptor-reduces dilation of blood vessels & increased permeability-reduces salivary, gastric, lacrimal & bronchial secretions  · Two types Traditional & Non-sedating/peripheral acting Traditional  · Diphenhydramine (Benadryl)  § Used for allergies, motion sickness, sleep disorder, common cold  § Drowsiness and has anticholinergic effects  § No driving, heavy machinery, alcohol or CNS depressants  § Caution use with asthma, COPD, PUD, BPH, HTN, pregnancy, cardiac and renal diseases. Contraindicated with acute asthma Non-sedating/peripheral acting  · Fexofenadine (Allegra)  · Loratadine (Claritin) <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Cetirizine (Zyrtec) <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> § Non-sedating, work peripheral to block actions of histamine <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> § Headache, stimulation, drowsiness, constipation, urinary retention <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> § Increased compliance due to longer duration of action

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<span style="font-family: Georgia,serif;">**Decongestants** <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · Drugs that reduce congestion or swelling, especially of the upper and lower respiratory tract <span style="font-family: Georgia,serif; margin-left: 0.25in; text-indent: 0in;"> · Three main types: Adrenergic, Anticholinergic & Corticosteroid <span style="font-family: Georgia,serif; margin-left: 0.25in;">Adrenergic <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Pseudoephedrine (Sudafed) <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> v Oral route delayed onset with prolonged effect, less potent than topical, no rebound congestion <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Oxymetazoline (Afrin) <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Phenylephrine (Neo-Synephrine) <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> v Topical/Inhaled route quicker onset, more potent and rebound congestion <span style="font-family: Georgia,serif; margin-left: 63pt; text-indent: -0.25in;"> § Relief of nasal congestion <span style="font-family: Georgia,serif; margin-left: 63pt; text-indent: -0.25in;"> § Nervousness, insomnia, palpitations, tremors, HTN <span style="font-family: Georgia,serif; margin-left: 63pt; text-indent: -0.25in;"> § Avoid caffeine, report fever, cough or other symptoms that persist longer than one week <span style="font-family: Georgia,serif; margin-left: 0.25in;">Anticholinergic <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Ipratropium (Atrovent) <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> § Prophylactic use for chronic nasal congestion <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> § Anxiety, dizziness, headache, dry mouth <span style="font-family: Georgia,serif; margin-left: 0.25in;">Corticosteroid <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Beclomethasone (Beconase) <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> § Anti-inflammatory effect, “turns down” immune response <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> § Local mucosal dryness and irritation

<span style="font-family: Georgia,serif;">**Antitussives** <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · A drug that reduces coughing, often by inhibiting neural activity in the cough center of the CNS <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · Treat non-productive cough or dry cough <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · Two types Opioid and Non-opioid <span style="font-family: Georgia,serif; margin-left: 0.25in; text-indent: -0.25in;"> Opioid <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Codeine (Robitussin A-C) <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Hydrocodone <span style="font-family: Georgia,serif; margin-left: 89.85pt; text-indent: -0.25in;"> § Stops cough reflex <span style="font-family: Georgia,serif; margin-left: 89.85pt; text-indent: -0.25in;"> § Sedation, nausea, vomiting, lightheadedness & constipation <span style="font-family: Georgia,serif; margin-left: 89.85pt; text-indent: -0.25in;"> § Avoid driving or operating heavy equipment <span style="font-family: Georgia,serif; margin-left: 89.85pt; text-indent: -0.25in;"> § Report cough that persists more than a week, persistent headache, fever, rash <span style="font-family: Georgia,serif; margin-left: 0.25in;">Non-opioid <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Dextromethorphan (Vicks Formula 44 & Robitussin-DM) <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> v Stops cough reflex without CNS depression <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Benzonatate (Tessalon Perles) <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> v Numbs stretch receptors in respiratory tract, prevents reflex stimulation <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.5in;"> § Dizziness, nausea <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.5in;"> § No liquids for 30 minutes after chewable tablet or lozenges <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.5in;"> § Report cough that persists more than a week, persistent headache, fever, rash

<span style="font-family: Georgia,serif;">**Expectorants** <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · Drugs that increase the flow of fluid in the respiratory tract, usually by reducing the viscosity of bronchial and tracheal secretions, and facilitate their removal by coughing and ciliary action <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · Direct stimulation of secretory glands increases production <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · Treatment for productive cough <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> · Guaifenesin (Mucinex, Robitussin Chest Congestion) <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> § Thinner mucous is easier to move <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.5in;"> § N/V, gastric irritation <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.5in;"> § Report cough that persists more than a week, persistent headache, fever, rash <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> § Caution with elderly, asthma, respiratory insufficiency <span style="font-family: Georgia,serif; margin-left: 1in; text-indent: -0.25in;"> § Increase fluids to liquefy and loosen secretions

=<span style="font-family: Georgia,serif;">**Bronchodilators and Respiratory Agents** = <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · Bronchodilators-medications that improve airflow by relaxing bronchial smooth muscle cells <span style="font-family: Georgia,serif; text-indent: -0.25in;"> · Beta-adrenergic agonists, anticholinergic, antileukotriene, corticosteroids & mast cell stabilizer

<span style="font-family: Georgia,serif;">**Xanthine derivatives** <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · Thephylline (Theo-dur) <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · Caffeine <span style="font-family: Georgia,serif; margin-left: 108.3pt; text-indent: -0.25in;"> § Taken systemically; relief of bronchospasm; CNS & CV stimulation-diuretic effect <span style="font-family: Georgia,serif; margin-left: 108.3pt; text-indent: -0.25in;"> § N/V, anorexia, sinus tachycardia, palpitations, gastroesophageal reflux during sleep <span style="font-family: Georgia,serif; margin-left: 108.3pt; text-indent: -0.25in;"> § Contraindicated Hx of PUD or GI disorders; caution cardiac disease

<span style="font-family: Georgia,serif;">**Beta-adrenergic agonists** <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · Epinephrine <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> v Non-selective, stimulates alpha and beta2 receptors <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> v Insomnia, restlessness, anorexia, vascular headache, hyperglycemia, tremor & cardiac stimulation <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · Albuterol <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> v Selective, stimulates beta2 receptors <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> v HTN or HypoTN, vascular headaches, tremor <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> § Relief of bronchospasm related to asthma, bronchitis, other pulmonary diseases <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> § Activation of beta2, receptors; relaxes smooth muscles of airway and other organs; results in bronchodilation and increased airflow <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: -0.25in;"> § Take medication as prescribed, do not skip or double up

<span style="font-family: Georgia,serif;">**Anticholinergic** <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · Ipratropium bromide (Atrovent) <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> § PREVENT bronchoconstriction, not used for acute asthma exacerbations <span style="font-family: Georgia,serif; margin-left: 1.25in; text-indent: -0.25in;"> § Dry mouth or throat, GI distress, headache, coughing & anxiety

<span style="font-family: Georgia,serif;">**Antileukotrienes** <span style="font-family: Georgia,serif; margin-left: 0.75in; text-indent: 0in;"> · Montelukast (Singulair) <span style="font-family: Georgia,serif; margin-left: 1.5in; text-indent: -0.25in;"> § Prophylaxis and chronic treatment for ages 12 and up; approved for two years and up. Blocks leukotrienes <span style="font-family: Georgia,serif; margin-left: 1.5in; text-indent: -0.25in;"> § Take every night on continuous schedule even when symptoms improve <span style="font-family: Georgia,serif; margin-left: 1.5in; text-indent: -0.25in;"> § Assess liver function before therapy; Multiple drug interactions so check OTC and prescriptions with physician

<span style="font-family: Georgia,serif;">**Corticosteroids** <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · Beclomethasone dipropionate (Beclovent, Vanceril) <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · Triamcinolone acetonide (Azmacourt) <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · Fluticasone (Flovent, Fionase, Advair) <span style="font-family: Georgia,serif; margin-left: 108.3pt; text-indent: -0.25in;"> § Treatment of bronchospastic disorders that are not controlled by conventional bronchodilators <span style="font-family: Georgia,serif; margin-left: 108.3pt; text-indent: -0.25in;"> § Pharyngeal irritation, coughing, dry mouth, oral fungal infections; if discontinuing wean by physician <span style="font-family: Georgia,serif; margin-left: 108.3pt; text-indent: -0.25in;"> § Contraindicated-fungal infections, AIDS, TB; Caution with diabetes, glaucoma, osteoporosis, PUD, renal disease, HF & edema <span style="font-family: Georgia,serif; margin-left: 108.3pt; text-indent: -0.25in;"> § Teach patients to gargle and rinse with water to prevent fungal infections <span style="font-family: Georgia,serif; margin-left: 108.3pt; text-indent: -0.25in;"> § Report weight gain >5lbs/week & chest pain to physician

<span style="font-family: Georgia,serif;">**Mast Cell Stabilizer** <span style="font-family: Georgia,serif; margin-left: 72.3pt; text-indent: -0.25in;"> · ** Cromolyn (NasalCrom, Intal) ** <span style="font-family: Georgia,serif; margin-left: 1.5in; text-indent: -0.25in;"> § Used prophylactically, stabilizes cell membranes of inflammatory cells: provides anti-inflammatory response <span style="font-family: Georgia,serif; margin-left: 1.5in; text-indent: -0.25in;"> § Coughing, change in taste, sore throat, dizziness, rhinitis, headache & bronchospasm <span style="font-family: Georgia,serif; margin-left: 1.5in; text-indent: -0.25in;"> § Contraindicated for acute exacerbations; therapeutic effects may not be seen for up to 4 weeks; not recommended for kids under 5 years <span style="font-family: Georgia,serif; margin-left: 1.5in; text-indent: -0.25in;"> § Teach patients to gargle and rinse with water to minimize irritation to throat and oral mucosa

<span style="font-family: Georgia,serif;">** Questions: **

<span style="font-family: Georgia,serif; font-size: 120%;"> 1) Name the drug(s) that work peripherally to block actions of histamine

<span style="font-family: Georgia,serif; font-size: 120%;"> 2) Name the drug(s) that can be used as a prophylactic for chronic congestion

<span style="font-family: Georgia,serif; font-size: 120%;"> 3) Is Sudafed given PO or Topically? What are the +/- traits of this route for Sudafed?

<span style="font-family: Georgia,serif; font-size: 120%;"> 4) Antitussives are used for a productive or non-productive cough?

<span style="font-family: Georgia,serif; font-size: 120%;"> 5) Which drug relieves a dry cough by stretching the receptors of the respiratory tract?

<span style="font-family: Georgia,serif; font-size: 120%;"> 6) What is the mechanism of action for Guaifenesin?

<span style="font-family: Georgia,serif; font-size: 120%;"> 7) Name the mast cell stabilizer, why is it important to gargle and rinse?

<span style="font-family: Georgia,serif; font-size: 120%;"> 8) Name the drug(s) that is/are used for treatment when bronchospastic disorders are not controlled by conventional bronchodilators

<span style="font-family: Georgia,serif; font-size: 120%;"> 9) Name the drug that blocks leukotrienes

<span style="font-family: Georgia,serif; font-size: 120%;"> 10) Name of the non-selective adrenergic bronchodilator

<span style="font-family: Georgia,serif;">** Answers: **

<span style="font-family: Georgia,serif; font-size: 110%;"> 1) Name the drugs that work peripherally to block actions of histamine
 * <span style="color: black; font-family: Georgia,serif; font-size: 110%;"> Fexofenadine (Allegra)
 * <span style="color: black; font-family: Georgia,serif; font-size: 110%; text-indent: 0.5in;">Loratadine (Claritin)
 * <span style="color: black; font-family: Georgia,serif; font-size: 110%;"> Cetirizine (Zyrtec)

<span style="font-family: Georgia,serif; font-size: 110%;">2) Name the drug(s) that can be used as a prophylactic for chronic congestion
 * <span style="color: black; font-family: Georgia,serif; font-size: 110%;"> Ipratropium (Atrovent)

<span style="font-family: Georgia,serif; font-size: 110%;">3) Is Sudafed given PO or Topically? What are the +/- traits of this route for Sudafed?
 * <span style="font-family: Georgia,serif; font-size: 110%;">Sudafed is given PO
 * <span style="font-family: Georgia,serif; font-size: 110%; margin-left: 0.5in;">Oral route has a delayed onset with prolonged effect, is less potent than a topical and there is no rebound congestion

<span style="font-family: Georgia,serif; font-size: 110%;">4) Antitussives are used for a productive or non-productive cough?
 * <span style="font-family: Georgia,serif; font-size: 110%;">Non-productive

<span style="font-family: Georgia,serif; font-size: 110%;">5) Which drug relieves a dry cough by stretching the receptors of the respiratory tract?
 * <span style="font-family: Georgia,serif; font-size: 110%;">Benzonatate (Tessalon Perles)

<span style="font-family: Georgia,serif; font-size: 110%;">6) What is the mechanism of action for Guaifenesin?
 * <span style="font-family: Georgia,serif; font-size: 110%; margin-left: 0.5in;">Guaifenesin works by stimulating the secretory glands which increase production; this leads to GI irritation which leads to the thinning and loosening of the secretions, thus making it easier to move.

<span style="font-family: Georgia,serif; font-size: 110%;">7) Name the mast cell stabilizer, why is it important to gargle and rinse? <span style="font-family: Georgia,serif; font-size: 110%; margin-left: 0.5in;">It is important to gargle and rinse with water to minimize irritation to throat and oral mucosa
 * <span style="font-family: Georgia,serif; font-size: 110%;">Cromolyn (NasalCrom, Intal)

<span style="font-family: Georgia,serif; font-size: 110%;">8) Name the drug(s) that is/are used for treatment when bronchospastic disorders are not controlled by conventional bronchodilators <span style="font-family: Georgia,serif; font-size: 110%; margin-left: 72.3pt;">Beclomethasone dipropionate (Beclovent, Vanceril) <span style="font-family: Georgia,serif; font-size: 110%; margin-left: 72.3pt;"> Triamcinolone acetonide (Azmacourt) <span style="font-family: Georgia,serif; font-size: 110%; margin-left: 72.3pt;"> Fluticasone (Flovent, Fionase, Advair)

<span style="font-family: Georgia,serif; font-size: 110%;">9) Name the drug that blocks leukotrienes
 * <span style="font-family: Georgia,serif; font-size: 110%;">Montelukast (Singulair)

<span style="font-family: Georgia,serif; font-size: 110%;">10) Name of the non-selective adrenergic bronchodilator
 * <span style="font-family: Georgia,serif; font-size: 110%;">Epinephrine

<span style="font-family: Georgia,serif;">References

<span style="color: black; font-size: 10pt; line-height: 18pt; margin: 0in 0in 9.2pt 13.45pt; text-indent: -13.45pt;">Lilley, L. L., Harrington, S. & Snyder, J. S. (2005). //Pharmacology and the nursing process//. St. Louis, MO: Mosby. <span style="color: black; font-size: 10pt; line-height: 18pt; margin: 0in 0in 9.2pt 13.45pt; text-indent: -13.45pt;">Petges, Nancy, RN MSN. Antihistamines, Decongestants, Antitussives and Expectorants Power Point, 2011 <span style="color: black; font-size: 10pt; line-height: 18pt; margin: 0in 0in 9.2pt 13.45pt; text-indent: -13.45pt;">Petges, Nancy, RN MSN. Bronchodilators and other Respiratory Agents Power Point, 2011 <span style="color: black; font-size: 10pt; line-height: 18pt; margin: 0in 0in 9.2pt 13.45pt; text-indent: -13.45pt;">Petges, Nancy, RN MSN. Antihistamines, Decongestants, Antitussives, Expectorants and Bronchodilators Study Guide, 2011