1. Antihistamines and Nasal Decongestants
Chapter 14
Antihistamines and Nasal Decongestants

2. Common Cold Virus infection Rhinovirus Influenza virus
Initiates the inflammatory response
(continues)
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3. Common Cold Cough reflex Irritant stimulates sensory receptors Removes
(continued)
Common Cold
Cough reflex
Irritant stimulates sensory receptors
Removes
Respiratory secretions
Foreign object
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4. Inflammatory Response
Mucosal irritation
Release of several inflammatory and vasoactive substances
Histamine
Dilating small blood vessels in the nasal sinuses
Produces nasal congestion
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5. Symptomatic Treatment
Combined use of:
Antihistamines, nasal decongestants, antitussives, and expectorants
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6. Antihistamines and Nasal Decongestants
Compete with histamine for receptor sites
Two histamine receptors
H1 (histamine 1)
H2 (histamine 2)
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8. Vasodilatation—GI effects
Increase gastrointestinal and respiratory secretions
Increase capillary permeability
The binding of H1 and H2 blockers to histamine receptors prevent histamine stimulation
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9. H1 Antagonists Respiratory antihistamines Effects Antihistaminic
Mild anticholinergic
Parasympathetic nervous system
Sedative
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10. Antihistamines Antihistamines Histamine effects Antihistamine effects
Cardiovascular: small blood vessels
Histamine effects
Dilation
Permeability
Antihistamine effects
Prevent dilation
Prevent increased permeability
(continues)
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11. Antihistamines Skin Anticholinergic Sedative Prevent itching
(continued)
Antihistamines
Skin
Prevent itching
Wheal and flare
Anticholinergic
Drying effect
Sedative
Drowsiness
(continues)
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12. Antihistamines Management of: Nasal allergies
(continued)
Antihistamines
Management of:
Nasal allergies
Seasonal or perennial allergic rhinitis
Allergic reactions
Motion sickness
(continues)
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13. Antihistamines More effective in prevention Give early
(continued)
Antihistamines
More effective in prevention
Give early
Prevent binding of histamine receptors
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14. Classes of Antihistamines
Two types
Traditional: sedating
Nonsedating
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15. Traditional Antihistamines
Older
Work both peripherally and centrally
Anticholinergic properties
Examples: diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton)
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16. Nonsedating/Peripherally Acting Antihistamines
Work peripherally
Eliminate sedation
Longer duration of action
Increases compliance
Examples: fexofenadine (Allegra) and loratadine (Claritin)
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17. Antihistamines: Nursing Implications
Assess allergy history
Contraindicated
Asthma attacks
Chronic obstructive pulmonary disease
Cardiovascular disease
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18. Client Teaching Instruction for traditional/sedating antihistamines
Avoid driving
No alcohol
No central nervous system depressants
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19. Nasal Decongestants Two main types are used:
Adrenergics (largest group)
Constrict dilated blood vessels
Nasal mucosa
Corticosteroids
Reduce inflammation
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20. Goal of Nasal Decongestants
To reduce congestion
Two dosage forms
Oral
Topical
Nasal spray
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21. Oral Decongestants Prolonged effects Less potent No rebound congestion
Exclusively adrenergics
Example: pseudoephedrine (Sudafed)
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22. Topical Decongestants
Adrenergics
Prompt onset
Sustained use–rebound congestion
Both adrenergics and steroids
Potent; work well
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23. Nasal Steroids Anti-inflammatory Decrease inflammation
Relieve nasal congestion
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24. Nasal Decongestants Adrenergics Intranasal steroids Ephedrine (Vicks)
Naphazoline (Privine)
Oxymetazoline (Afrin)
Phenylephrine (Neosynephrine)
Intranasal steroids
Beclomethasone dipropionate
Beconase
Vancenase
Flunisolide (Nasalide)
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25. 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
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29. Nasal Decongestants: Side Effects
Adrenergics
Nervousness
Insomnia
Palpitations
Tremors
Steroids
Local mucosal dryness and irritation
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30. Treatment with Nasal Decongestants
Acute or chronic rhinitis
Common cold
Sinusitis
Hay fever
Other allergies
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31. Nasal Decongestants: Nursing Implications
Avoid decongestants in the following clients:
Heart disease
Hypertensive disease
Respiratory disease
Assess for drug allergies
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