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Drugs for Allergic Rhinitis

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Title: Drugs for Allergic Rhinitis


1
Drugs for Allergic Rhinitis the Common Cold
  • Chapter 38

2
Review
  • What structures comprise the upper respiratory
    tract?
  • What is the primary function of the upper
    respiratory tract?

3
Nasal Mucosa
  • dynamic structure, richly supplied with vascular
    tissue, under control of the autonomic nervous
    system. (p. 579)
  • What is the relevance of this statement to
    pharmacotherapy of the upper respiratory tract?

4
Autonomic Nervous System and Nasal Mucosa
  • Describe the effects of sympathetic activation.
  • Describe the effects of parasympathetic
    activation
  • How is this information important to drug therapy?

5
Nasal Mucosa
  • First line of immunologic defense
  • What is the significance of this statement?
  • What components are involved in immunologic
    defense?

6
Allergic Rhinitis
  • Describe the etiology of allergic rhinitis.
  • Identify common triggers.
  • Discuss the physiologic characteristics of
    allergic rhinitis.

7
Allergic Rhinitis
  • Why should allergic rhinitis be treated?
  • Discuss potential secondary complications.
  • Describe the difference between seasonal and
    perennial allergic rhinitis.
  • How does the difference affect pharmacotherapy?

8
Histamine
  • What is histamine?
  • What two receptors interact with histamine?
  • Where are the receptors located and what are they
    associated with?

9
H1 Receptor Antagonists
  • What is another term used for this class of
    medications?
  • What is the mechanism of action of this class of
    drugs?
  • What are indications for OTC treatment with this
    class of drugs?

10
Generations
  • Describe the difference between first-generation
    H1 receptor antagonists and second generation H1
    receptor antagonists.
  • Identify the prototype for each generation.

11
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13
H1 Receptor Antagonists Key Nursing
Considerations
  • Contraindicated
  • dysrhythmias, heart failure, HTN, sleep
    disorders, asthma, narrow angle glaucoma, urinary
    retention (e.g. BPH)
  • Can have paradoxical effect in children
    (increased CNS stimulation instead of drowsiness)
  • Must monitor elderly for safety

14
H1 Receptor Antagonists- Key Client Education
  • Report chest pain, insomnia, restlessness,
    visual changes, seizure activity
  • Avoid driving until side effects are known
  • Avoid alcohol and other CNS depressants
  • Increase fluid intake to facilitate expectoration
    of dry oral mucus

15
Intranasal Glucocorticoids
  • Drug of choice for seasonal allergic rhinitis
  • Highly efficacious Wide margin of safety
  • Describe multiple mechanisms of action.
  • Discuss optimal time for initiation of
    pharmacotherapy with intranasal glucocorticoids.

16
Intranasal Glucocorticoids
  • Metered Spray Devise
  • Shake
  • Clear nose
  • Avoid swallowing
  • Use de-congestant first
  • Prototype fluticasone (Flonase)
  • Adverse effects
  • Nasal irritation
  • epistaxis

17
Decongestants
  • Oral or Intranasal Sympathomimetics
  • Most common
  • Alleviate nasal congestion of allergic rhinitis
    or the common cold
  • Many available OTC
  • Ipratropium bromide (Atrovent)-- anticholinergic

18
Decongestants
  • Compare and contrast intranasal and oral
    sympathomimetics.
  • Describe the mechanism of action.
  • What are two of the most important teaching
    points related to intranasal sympathomimetic use?

19
Decongestants- Key Nursing Considerations
  • Monitor pulse and B/P
  • Avoid within 2 hours of bedtime
  • Instruct regarding proper positioning and
    technique for intranasal administration

20
Common Cold
  • Compare and contrast allergic rhinitis and the
    common cold.

21
Antitussives
  • What is the main action of an antitussive?
  • Compare and contrast the two classes of
    antitussives.
  • Identify the prototype antitussive.

22
Antitussives- Key Nursing Considerations
  • All
  • Assess history and characteristics of cough
  • Use carefully in chronic lung conditions
  • Limit use to 3 days
  • Opioids
  • Monitor for drowsiness and urinary retention
  • Warn against driving until sedative effect is
    known

23
Expectorants and Mucolytics
  • Name a common expectorant and mucolytic.
  • Compare and contrast the actions of expectorants
    and mucolytics

24
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