Antihistamines and Nasal Decongestants Chapter 14 Antihistamines and Nasal Decongestants

Common Cold Virus infection Rhinovirus Influenza virus Initiates the inflammatory response (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Common Cold Cough reflex Irritant stimulates sensory receptors Removes (continued) Common Cold Cough reflex Irritant stimulates sensory receptors Removes Respiratory secretions Foreign object Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Inflammatory Response Mucosal irritation Release of several inflammatory and vasoactive substances Histamine Dilating small blood vessels in the nasal sinuses Produces nasal congestion Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Symptomatic Treatment Combined use of: Antihistamines, nasal decongestants, antitussives, and expectorants Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Antihistamines and Nasal Decongestants Compete with histamine for receptor sites Two histamine receptors H1 (histamine 1) H2 (histamine 2) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Vasodilatation—GI effects Increase gastrointestinal and respiratory secretions Increase capillary permeability The binding of H1 and H2 blockers to histamine receptors prevent histamine stimulation Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

H1 Antagonists Respiratory antihistamines Effects Antihistaminic Mild anticholinergic Parasympathetic nervous system Sedative Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Antihistamines Antihistamines Histamine effects Antihistamine effects Cardiovascular: small blood vessels Histamine effects Dilation Permeability Antihistamine effects Prevent dilation Prevent increased permeability (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Antihistamines Skin Anticholinergic Sedative Prevent itching (continued) Antihistamines Skin Prevent itching Wheal and flare Anticholinergic Drying effect Sedative Drowsiness (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Antihistamines Management of: Nasal allergies (continued) Antihistamines Management of: Nasal allergies Seasonal or perennial allergic rhinitis Allergic reactions Motion sickness (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Antihistamines More effective in prevention Give early (continued) Antihistamines More effective in prevention Give early Prevent binding of histamine receptors Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Classes of Antihistamines Two types Traditional: sedating Nonsedating Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Traditional Antihistamines Older Work both peripherally and centrally Anticholinergic properties Examples: diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nonsedating/Peripherally Acting Antihistamines Work peripherally Eliminate sedation Longer duration of action Increases compliance Examples: fexofenadine (Allegra) and loratadine (Claritin) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Antihistamines: Nursing Implications Assess allergy history Contraindicated Asthma attacks Chronic obstructive pulmonary disease Cardiovascular disease Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Client Teaching Instruction for traditional/sedating antihistamines Avoid driving No alcohol No central nervous system depressants Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nasal Decongestants Two main types are used: Adrenergics (largest group) Constrict dilated blood vessels Nasal mucosa Corticosteroids Reduce inflammation Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Goal of Nasal Decongestants To reduce congestion Two dosage forms Oral Topical Nasal spray Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Oral Decongestants Prolonged effects Less potent No rebound congestion Exclusively adrenergics Example: pseudoephedrine (Sudafed) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Topical Decongestants Adrenergics Prompt onset Sustained use–rebound congestion Both adrenergics and steroids Potent; work well Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nasal Steroids Anti-inflammatory Decrease inflammation Relieve nasal congestion Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nasal Decongestants Adrenergics Intranasal steroids Ephedrine (Vicks) Naphazoline (Privine) Oxymetazoline (Afrin) Phenylephrine (Neosynephrine) Intranasal steroids Beclomethasone dipropionate Beconase Vancenase Flunisolide (Nasalide) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Common Nasal Steroids Name: Steroid: Available As: Dosing: Rhinocort Budesonide Aerosol, Aqueous (Aqua) 1-2 sprays once or twice daily Flonase Fluticasone Aqueous Nasonex Mometasone Nasacort Triamcinolone Nasalide Flunisolide 1-2 sprays twice daily Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nasal Decongestants: Side Effects Adrenergics Nervousness Insomnia Palpitations Tremors Steroids Local mucosal dryness and irritation Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Treatment with Nasal Decongestants Acute or chronic rhinitis Common cold Sinusitis Hay fever Other allergies Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nasal Decongestants: Nursing Implications Avoid decongestants in the following clients: Heart disease Hypertensive disease Respiratory disease Assess for drug allergies Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.