Antihistamines, Decongestants, Antitussives, and Expectorants Lilley Pharmacology Text: Chapter 34 Original Text modified by: Anita A. Kovalsky, R.N., M.N.Ed., Professor of Nursing Original PPT by: Professor Pat Woodbery, ARNP, CS

Review of Glossary Terms: Lilley pg. 527 n Adrenergic (smypathomimetic): n Antagonist: n Anticholinergic (parasympatholytic): n Histamine antagonist: n Antihistamines: n Expectorants: n Corticosteroids:

Antihistamines (Antagonize the Action of Histamine) n Histamine found in tissues exposed to environment (eyes, nose, lungs, GI) n Histamine mainly found in Mast Cells n Histamine found in Basophils (RBC)

Histamine Causes: Stimulation of H1 Receptors n Contraction of smooth muscle  Wheeze n Stimulation of Vagus  Cough n Permeability veins  Edema n Vasodilation  Flushing n secretions  Mucous n Stimulation of nerve endings  Pruritus

Histamine Causes: Stimulation of H2 Receptors n Gastric Acid and Pepsin  Abdominal Pain n Rate & Force of Myocardial Contraction  tachycardia n Vasodilation  Hypotension, Flushing, HA

When Histamine is Stimulated How Does the Client Look? n Allergic Rhinitis n Allergic Bronchitis n Allergic Conjunctivitis n Allergic Dermatitis n Anaphylaxis

Prototype Drug (Brand name in parentheses) (Refer to Prototype List in syllabus Also listed in Lilley, pg. 531) Diphenhydramine (Benadryl)

Nursing Assessment n Why is the client getting this drug? n Is there any reason the client should not get an Antihistamine? n Pregnancy, glaucoma, ulcer, medication interaction, allergy??? n Drowsiness ? n Dry secretions ? ( Think of Asthma) n Alcohol ?

Special Considerations n Prevention of Allergic Reaction is the Best Care n Paradoxical Excitement May Occur n Use in Elder May Cause Confusion n Consider Side Effects: Dryness, Drowsiness

Nasal Decongestants: Classifications 1) Adrenergics (sympathomimetics) 2) Anticholinergics (parasympatholytics) 3) Corticosteroids (topical)

Nasal Decongestant Classification : 1) Adrenergic Agents n Sympathomimetic Drugs n Relieve Nasal Obstruction by constricting arterioles and blood flow n Treatment of rhinitis

Prototype Drug: Adrenergic (Brand name in parentheses) (Refer to Prototype List in syllabus Also listed in Lilley, pg. 534) n Pseudoephedrine (Sudafed)

Antitussives n Suppress the cough center in the Medulla n Suppress the cough receptors in the throat, lungs n Narcotic, non-narcotic n Local anesthetics n Lozengers

n Codeine n Dextromethorphan (Benylin DM) Prototype Drug: Antitussive (Brand name in parentheses) (Refer to Prototype List in syllabus Also listed in Lilley, pg. 537)

n Guaifenesin (Robitussin) Prototype Drug: Expectorants (Brand name in parentheses) (Refer to Prototype List in syllabus Also listed in Lilley, pg. 538)

Mucolytics n Used to liquefy thick viscous mucous n Inhalation n Effective within 1 minute  peaks in 5-10 minutes n Also used for Tylenol overdose... given orally

n Acetylcysteine (Mucomyst) Prototype Drug: Mucolytics (Brand name in parentheses) (Refer to Prototype List in syllabus Also listed in Lilley, pg. 132)

Nursing Considerations n Relieve symptoms…NOT a cure n Nose drops for no more then 7 days n Read the labels carefully n Note if syrups……remember sugar! n Report palpitations, dizziness, drowsiness

n Rebound nasal congestion n Side effects: tachycardia, arrhythmias, hypertension (adrenergic effects) n Many drugs alter the effects of OTC cold remedies……BE CAREFUL…..HTN, Arrhythmias! Summary

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