Chapter 14 Antihistamines and Nasal Decongestants

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Common Cold Virus infection  Rhinovirus  Influenza virus  Initiates the inflammatory response (continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Common Cold Cough reflex  Irritant stimulates sensory receptors  Removes  Respiratory secretions  Foreign object (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Inflammatory Response Mucosal irritation Release of several inflammatory and vasoactive substances  Histamine  Dilating small blood vessels in the nasal sinuses  Produces nasal congestion

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Symptomatic Treatment Combined use of:  Antihistamines, nasal decongestants, antitussives, and expectorants

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Antihistamines and Nasal Decongestants Compete with histamine for receptor sites Two histamine receptors  H 1 (histamine 1)  H 2 (histamine 2)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Vasodilatation—GI effects Increase gastrointestinal and respiratory secretions Increase capillary permeability The binding of H 1 and H 2 blockers to histamine receptors prevent histamine stimulation

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved H 1 Antagonists Respiratory antihistamines Effects  Antihistaminic  Mild anticholinergic  Parasympathetic nervous system  Sedative

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Antihistamines  Cardiovascular: small blood vessels Histamine effects  Dilation  Permeability Antihistamine effects  Prevent dilation  Prevent increased permeability (continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Skin  Prevent itching  Wheal and flare Anticholinergic  Drying effect Sedative  Drowsiness Antihistamines (continues) (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Antihistamines Management of:  Nasal allergies  Seasonal or perennial allergic rhinitis  Allergic reactions  Motion sickness (continues) (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Antihistamines More effective in prevention Give early  Prevent binding of histamine receptors (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Classes of Antihistamines Two types  Traditional: sedating  Nonsedating

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Traditional Antihistamines Older Work both peripherally and centrally Anticholinergic properties Examples: diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nonsedating/Peripherally Acting Antihistamines Work peripherally  Eliminate sedation Longer duration of action  Increases compliance Examples: fexofenadine (Allegra) and loratadine (Claritin)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Antihistamines: Nursing Implications Assess allergy history Contraindicated  Asthma attacks  Chronic obstructive pulmonary disease  Cardiovascular disease

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Client Teaching Instruction for traditional/sedating antihistamines  Avoid driving  No alcohol  No central nervous system depressants

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nasal Decongestants Two main types are used:  Adrenergics (largest group)  Constrict dilated blood vessels Nasal mucosa  Corticosteroids  Reduce inflammation

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Goal of Nasal Decongestants To reduce congestion Two dosage forms  Oral  Topical  Nasal spray

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Oral Decongestants Prolonged effects Less potent No rebound congestion Exclusively adrenergics Example: pseudoephedrine (Sudafed)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Topical Decongestants Adrenergics  Prompt onset  Sustained use–rebound congestion Both adrenergics and steroids  Potent; work well

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nasal Steroids Anti-inflammatory  Decrease inflammation  Relieve nasal congestion

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nasal Decongestants Intranasal steroids  Beclomethasone dipropionate  Beconase  Vancenase  Flunisolide (Nasalide) Adrenergics  Ephedrine (Vicks)  Naphazoline (Privine)  Oxymetazoline (Afrin)  Phenylephrine (Neosynephrine)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nasal Decongestants: Side Effects Adrenergics  Nervousness  Insomnia  Palpitations  Tremors Steroids  Local mucosal dryness and irritation

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Treatment with Nasal Decongestants Acute or chronic rhinitis Common cold Sinusitis Hay fever Other allergies

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nasal Decongestants: Nursing Implications Avoid decongestants in the following clients:  Heart disease  Hypertensive disease  Respiratory disease Assess for drug allergies