Drugs for Allergic Rhinitis

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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?

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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.

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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

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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.

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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

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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?

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Decongestants- Key Nursing Considerations

• Monitor pulse and B/P
• Avoid within 2 hours of bedtime
• Instruct regarding proper positioning and
  technique for intranasal administration

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Common Cold

• Compare and contrast allergic rhinitis and the
  common cold.

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Antitussives

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

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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

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Expectorants and Mucolytics

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

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