Drugs for Allergic Rhinitis, Cough, and Colds Chapter 77 Drugs for Allergic Rhinitis, Cough, and Colds 1

Allergic Rhinitis Inflammatory disorder of the upper airway, lower airway, and eyes Symptoms Sneezing Rhinorrhea Pruritus Nasal congestion For some people: Conjunctivitis, sinusitis, and asthma 2

Allergic Rhinitis Seasonal and perennial Triggered by airborne allergens Allergens bind to immunoglobulin E (Ig E) on mast cells Triggers release of inflammatory mediators Histamine, leukotrienes, prostaglandins 3

Classes of Drugs Used for Allergic Rhinitis Glucocorticoids (intranasal) Antihistamines (oral and intranasal) Sympathomimetics (oral and intranasal) 4

Intranasal Glucocorticoids First choice ‒ most effective for treatment and prevention of rhinitis Mild adverse effects Drying of nasal mucosa or sore throat Epistaxis (nosebleed) Headache Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth) 5

Oral Antihistamines For allergic rhinitis Do not reduce nasal congestion Most effective if taken prophylactically Should be taken regularly throughout the allergy season, even when symptoms are absent, to prevent an initial histamine receptor activation Mild adverse effects: Sedation with first generation (much less with second generation) 6

Intranasal Antihistamines: Azelastine & Olopatadine Indicated for allergic rhinitis in adults and in children over 12 years old Systemic absorption can be sufficient to cause somnolence Nosebleeds Anticholinergic effects Unpleasant taste 7

Intranasal Cromolyn Sodium Reduces symptoms by suppressing release of histamine and other inflammatory mediators from mast cells Prophylaxis Administer before symptoms start Response develops in 1 to 2 weeks Minimal adverse reactions: Less than with any other drug for allergic rhinitis 8

Sympathomimetics Reduce nasal congestion (do not reduce rhinorrhea, sneezing, or itching) Activate alpha1-adrenergic receptors on nasal blood vessels Adverse effects Rebound congestion CNS stimulation Cardiovascular effects and stroke Abuse 9

Sympathomimetics (Oral/Nasal) Factors in topical administration Should not use longer than 5 consecutive days Drops or sprays Comparison: Drops versus sprays Topical agents act more quickly than oral agents and are usually more effective Oral agents act longer than topical preparations Systemic effects occur primarily with oral agents; topical agents usually elicit these responses only when dosage is higher than recommended Rebound congestion is common with prolonged use of topical agents but rare with oral agents 10

Sympathomimetics (Oral/Nasal) Phenylephrine, ephedrine, pseudoephedrine Antihistamine-sympathomimetic combinations Ipratropium bromide [Atrovent] Montelukast [Singulair] Omalizumab [Xolair] 11

Drugs for Cough Antitussives Drugs that suppress cough Opioid antitussives Codeine and hydrocodone Nonopioid antitussives Dextromethorphan Diphenhydramine Benzonatate 12

Expectorants Guaifenesin [Mucinex, Humibid] Renders cough more productive by stimulating flow of respiratory tract secretions Higher doses may be effective 13

Mucolytics Hypertonic saline Acetylcysteine Mucolytics react directly with mucus to make it more watery High sulfur content, “rotten egg” smell Can trigger bronchospasm 14

Common Cold Acute upper respiratory viral infection Rhinorrhea, nasal congestion, cough, sneezing, sore throat, headache, hoarseness, malaise, myalgia Fever common in kids, rare in adults Self-limited, usually benign No cure; just treatment of symptoms 15

Over-the-Counter (OTC) Cold Remedies Combination cold remedies usually contain two or more of the following: Nasal decongestant Antitussive Analgesic Antihistamine (for cholinergic actions) Caffeine (to offset effect of antihistamine) 16

Pediatric OTC Cold Remedies Use with caution in young children Avoid OTC cold remedies in children younger than 4 to 6 years Use only products labeled for pediatric use Consult a health care professional before giving these drugs to a child Read all product safety information before dosing Use the measuring device provided with the product Discontinue the medicine and seek professional care if the child’s condition worsens or fails to improve Avoid using antihistamine-containing products to sedate children 17

Question 1 A patient asks what medication would be most effective in the treatment of seasonal hay fever. The nurse will teach the patient about the use of which drug? A. Azelastine [Astelin] B. Chlorpheniramine [Chlor-Trimeton] C. Fluticasone [Flonase) D. Pseudoephedrine [Sudafed] Answer: C Rationale: Glucocorticoids (fluticasone [Flonase]) are the most effective agents used to treat allergic rhinitis.

Question 2 A patient is prescribed codeine as an antitussive. Which symptom will the nurse observe for as an adverse effect of this medication? A. Respiratory depression B. Increased heart rate C. Productive cough D. Restlessness Answer: A Rationale: Codeine is an opioid that can suppress respiration.