1. Chapter 14 Antihistamines and Nasal Decongestants

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 2 Common Cold Virus infection  Rhinovirus  Influenza virus  Initiates the inflammatory response (continues)

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 3 Common Cold Cough reflex  Irritant stimulates sensory receptors  Removes  Respiratory secretions  Foreign object (continued)

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 4 Inflammatory Response Mucosal irritation Release of several inflammatory and vasoactive substances  Histamine  Dilating small blood vessels in the nasal sinuses  Produces nasal congestion

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 5 Symptomatic Treatment Combined use of:  Antihistamines, nasal decongestants, antitussives, and expectorants

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 6 Antihistamines and Nasal Decongestants Compete with histamine for receptor sites Two histamine receptors  H 1 (histamine 1)  H 2 (histamine 2)

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 7 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

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 8 H 1 Antagonists Respiratory antihistamines Effects  Antihistaminic  Mild anticholinergic  Parasympathetic nervous system  Sedative

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 9 Antihistamines  Cardiovascular: small blood vessels Histamine effects  Dilation  Permeability Antihistamine effects  Prevent dilation  Prevent increased permeability (continues)

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 10 Skin  Prevent itching  Wheal and flare Anticholinergic  Drying effect Sedative  Drowsiness Antihistamines (continues) (continued)

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 11 Antihistamines Management of:  Nasal allergies  Seasonal or perennial allergic rhinitis  Allergic reactions  Motion sickness (continues) (continued)

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 12 Antihistamines More effective in prevention Give early  Prevent binding of histamine receptors (continued)

13. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 13 Classes of Antihistamines Two types  Traditional: sedating  Nonsedating

14. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 14 Traditional Antihistamines Older Work both peripherally and centrally Anticholinergic properties Examples: diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton)

15. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 15 Nonsedating/Peripherally Acting Antihistamines Work peripherally  Eliminate sedation Longer duration of action  Increases compliance Examples: fexofenadine (Allegra) and loratadine (Claritin)

16. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 16 Antihistamines: Nursing Implications Assess allergy history Contraindicated  Asthma attacks  Chronic obstructive pulmonary disease  Cardiovascular disease

17. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 17 Client Teaching Instruction for traditional/sedating antihistamines  Avoid driving  No alcohol  No central nervous system depressants

18. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 18 Nasal Decongestants Two main types are used:  Adrenergics (largest group)  Constrict dilated blood vessels Nasal mucosa  Corticosteroids  Reduce inflammation

19. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 19 Goal of Nasal Decongestants To reduce congestion Two dosage forms  Oral  Topical  Nasal spray

20. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 20 Oral Decongestants Prolonged effects Less potent No rebound congestion Exclusively adrenergics Example: pseudoephedrine (Sudafed)

21. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 21 Topical Decongestants Adrenergics  Prompt onset  Sustained use–rebound congestion Both adrenergics and steroids  Potent; work well

22. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 22 Nasal Steroids Anti-inflammatory  Decrease inflammation  Relieve nasal congestion

23. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 23 Nasal Decongestants Intranasal steroids  Beclomethasone dipropionate  Beconase  Vancenase  Flunisolide (Nasalide) Adrenergics  Ephedrine (Vicks)  Naphazoline (Privine)  Oxymetazoline (Afrin)  Phenylephrine (Neosynephrine)

24. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 24 Nasal Decongestants: Side Effects Adrenergics  Nervousness  Insomnia  Palpitations  Tremors Steroids  Local mucosal dryness and irritation

25. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 25 Treatment with Nasal Decongestants Acute or chronic rhinitis Common cold Sinusitis Hay fever Other allergies

26. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 14 - 26 Nasal Decongestants: Nursing Implications Avoid decongestants in the following clients:  Heart disease  Hypertensive disease  Respiratory disease Assess for drug allergies