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Antihistamines,

Decongestants,

Antitussives, & Expectorants

Nova Southeastern University

Ron and Kathy Assaf College of Nursing

NUR 3161: Fundamentals of Pharmacology

Antihistamines

• (^) Drugs that directly compete with histamine for specific receptor sites
• (^) Histamine 1 (H 1 ) antagonists (H 1 Blockers^  antihistamines - (^) First-generation (traditional) - (^) Second-generation (non-sedating)
• (^) Antihistamine Properties
  • (^) Antihistaminic
  • (^) Anticholingeric
  • (^) Sedative

Antihistamines:

Indications

• (^) Management of:
  • (^) Nasal allergies
  • (^) Seasonal or perennial allergic rhinitis (hay fever)
  • (^) Allergic reactions
  • (^) Motion sickness
  • (^) Parkinson’s disease
  • (^) Sleep disorders
• (^) Also used to relieve symptoms associated with the common cold - (^) Sneezing, runny nose - (^) Palliative treatment, not curative

Antihistamines:

Contraindications

• (^) Known drug allergy
• (^) Narrow-angle glaucoma
• (^) Cardiac disease
• (^) Hypertension (HTN)
• (^) Kidney disease
• (^) Bronchial asthma, chronic obstructive pulmonary disease (COPD)
• (^) Peptic ulcer disease (PUD)
• (^) Seizure disorders
• (^) Benign prostatic hyperplasia (BPH)
• (^) Pregnancy

Antihistamines: Nursing

Management

• (^) Assess for allergic reactions that require treatment, including drug allergies
• (^) Assess for contraindications
• (^) Best tolerated when taken with meals  reduces GI upset
• (^) Monitor for intended therapeutic effects

Antihistamines: Client

Teaching

• (^) Report excessive sedation, confusion, or hypotension
• (^) Avoid driving or operating heavy machinery, consuming alcohol or other central nervous system (CNS) depressants
• (^) Do not to take these medications with other prescribed or over-the-counter (OTC) medications without checking with prescriber
• (^) If dry mouth occurs, instruct to perform frequent mouth care, chew gum or suck on hard candy (preferably sugarless), use humidifier, and drink plenty of fluids to ease discomfort

Decongestants: Types

• (^) Three main types are used
  • (^) Adrenergics
  • (^) Anticholinergics
  • (^) Corticosteroids
• (^) Preparations
  • (^) Oral
  • (^) Inhaled/Topical

Decongestants:

Topical Nasal

• (^) Topical adrenergics
  • (^) Prompt onset
  • (^) Potent
  • (^) Sustained use over several days causes rebound congestion - (^) Making the condition worse
• (^) Examples
  • (^) oxymetazoline (Afrin)
  • (^) phenylephrine (Coricidin)
  • (^) tetrahydrozoline (Tyzine)
  • (^) xylometazoline (Otrivin)

Decongestants:

Nasal Steroids

• (^) Not associated with rebound congestion
• (^) Often used prophylactically to prevent nasal congestion in clients with chronic upper respiratory tract symptoms
• (^) Examples
  • (^) beclomethasone (Beconase)
  • (^) budesonide (Pulmicort)
  • (^) flunisolide
  • (^) fluticasone (Flonase)
  • (^) triamcinolone

Nasal Decongestants:

Mechanism of Action

• (^) Site of action: blood vessels surrounding nasal sinuses
• (^) Adrenergics
  • (^) Constrict small blood vessels that supply upper respiratory tract structures
  • (^) As a result these tissues shrink  nasal secretions in the swollen mucous membranes are better able to drain

Nasal Decongestants:

Indications

• (^) Relief of nasal congestion
  • (^) Acute or chronic rhinitis
  • (^) Common cold
  • (^) Sinusitis
  • (^) Hay fever
  • (^) Other allergies
• (^) To reduce swelling of the nasal/pharyngeal membranes before surgery or diagnostic procedures

Nasal Decongestants:

Contraindications

 (^) Known drug allergy  (^) Glaucoma  (^) HTN  (^) Diabetes  (^) Thyroid disease  (^) Coronary disease  (^) BPH  (^) Pregnancy  (^) Lactation