1. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 77 Drugs for Allergic Rhinitis, Cough, and Colds

2. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.2 Allergic Rhinitis  Inflammatory disorder of the upper airway, lower airway, and eyes  Symptoms  Sneezing  Rhinorrhea  Pruritus  Nasal congestion  For some people: conjunctivitis, sinusitis, and asthma

3. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.3 Allergic Rhinitis  Seasonal and perennial  Triggered by airborne allergens  Allergens bind to immunoglobulin (Ig)E on mast cells  Inflammatory mediators released  Histamine, leukotrienes, and prostaglandins

4. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.4 Classes of Drugs Used for Allergic Rhinitis  Oral antihistamines  Intranasal glucocorticoids  Sympathomimetics (oral and intranasal)

5. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.5 Oral Antihistamines  For allergic rhinitis  Do not reduce nasal congestion  Most effective if taken prophylactically  Adverse effects are mild: sedation with first generation (much less with second generation)  Anticholinergic effects  Azelastine nasal spray  Only intranasal antihistamine available  Benefits equivalent to oral antihistamines  Metered-spray device, leaves bitter taste

6. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.6 Intranasal Glucocorticoids  First choice—most effective for treatment and prevention of rhinitis  Mild adverse effects  Drying of nasal mucosa or sore throat  Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)

7. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.7 Intranasal Cromolyn  Trade name: NasalCrom  Extremely safe, but only moderately effective  Suppresses release of histamines from mast cells  Best used for prophylaxis, not for treatment  Response may take 1–2 weeks to develop

8. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.8 Sympathomimetics (Oral/Nasal)  Reduce nasal congestion (do not reduce rhinorrhea, sneezing, or itching)  Activate alpha 1 -adrenergic receptors on nasal blood vessels  Adverse effects  Rebound congestion  CNS stimulation  Cardiovascular effects and stroke  Abuse

9. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.9 Sympathomimetics (Oral/Nasal)  Factors in topical administration  Should not use longer than 5 consecutive days  Drops vs. sprays  Phenylephrine, ephedrine, pseudoephedrine  Antihistamine-sympathetic combinations  Ipratropium bromide (Atrovent)  Montelukast (Singulair)  Omalizumab (Xolair)

10. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.10 Drugs for Cough  Antitussives  Drugs that suppress cough  Opioid antitussives Codeine and hydrocodone Codeine and hydrocodone  Nonopioid antitussives Dextromethorphan Dextromethorphan Diphenhydramine Diphenhydramine

11. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.11 Common Cold  Acute upper respiratory viral infection  Rhinorrhea, nasal congestion, cough, sneeze, sore throat, headache, hoarseness, malaise, myalgia  Fever common in kids, rare in adults  Self-limited and usually benign  No cure; just treatment of symptoms

12. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.12 OTC Cold Remedies  Combination cold remedies usually contain two or more of the following:  Nasal decongestant  Antitussive  Analgesic  Antihistamine (for cholinergic actions)  Caffeine (to offset effect of antihistamine) OTC = over-the-counter.

13. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.13 Pediatric OTC Cold Remedies  Use with caution in young children  No proof of efficacy or safety, but proof of harm  Avoid OTC cold remedies in children younger than 2 years of age  Use only products labeled for pediatric use  Consult a healthcare professional before giving to a child  Read all product safety information before dosing  Use the measuring device provided with the product  Discontinue the medicine and seek professional care if the child’s condition worsens