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

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

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

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

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

15. 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

16. 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

17. 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

18. 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.

19. 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.