Rhinitis And Common Cold

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H1-receptor

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sites located on smooth muscle cells in the bronchial tree and blood vessels that are stimulated by histamine to produce bronchodilation and vasodilation; responsible for allergic symptoms.

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Diphenhydramine ( Benadryl, Others) h1 - receptor Antagonist (First Generation)

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Is a Fisrt- Generation H1- Receptor Antagonist. Primary use is to treat minor symtoms of alergy and the common cold. such as sneezing, runny nose, and tearing of the eyes. is often combined with the analgesic decongestant, or rashes.

Phamacokinestics-
Onset: 15- 30 mins
Duration: 4-7 hrs

Adverse Effects:
Anticholingergic efects such as dry mouth, tachycardia, and mild hypotension occur in some clients. Diphenhydramine may cause photosensitivity.

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Fluticasone (Flonase, Flovent) Intranasal Glucocorticoid

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Intranasal glucocorticoid; treats seasonal allergic rhinitis. acts to decrease local inflammation in the nasal passages.
Duration: 12- 24 hrs

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Fexofenadine (Allegra) H1 Antagonist (Second Generation)

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2nd Generation H1- Receptor antagonist. Blocks the effects of histamine at H1- Receptors. Reduces the severity of nasal congestion, Sneezing and tearing of the eyes. Onset: 1 hrs; Duration: 12 hrs. Causes the less drowsiness.

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Oxymetazoline (Afrin, others) Decongestant/ Sympathomimetic

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Oxymetazoline (Afrin) stimulates alpha-adrenergic receptors in the sympathetic nervous system. This causes arterioles in the nasal passages to constrict, thus drying the mucous membranes.

Pharmacokinetics-
Onset: 5-10 min
Duration: 6- 10 hrs

Adverse Effects-
Rebounds congestion is common when oxymetazoline is used for longer than 3 to 5 days.

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Dextromethorphan (Benylin)
Antitussive

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component in most OTC severe cold and flu preparations. It lacks the analgesic and euphoric effects on the opioids and does not produce dependence. onset 15-30, duration 3-6 hrs

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antihistamines

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drugs that block histamine from reaching its receptors, thus alleviating allergic symptoms. Also used for motion sickness and insomnia.

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anticholinergic effects of antihistamines

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drying of mucous membranes which results in less nasal congestion and tearing

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1st generation antihistamines

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dyphenhydramine (benadryl)
cause significant drowsiness and anticholinergic effect

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2nd generation antihistamines

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fexofenadine (allegra)
causes less drowsiness, less dry mouth

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intranasal glucocorticoids

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decrease the secretion of inflammatory mediators, reduce tissue edema, and cause a mild vasoconstriction

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antihistamines nursing considerations

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v/s, ECG in hx of heart disease, ax hx of allergies, symptoms
Contraindicated in those with narrow angle glaucoma, hx of dysrhythmias, heart failure and HTN

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intranasal glucocorticoids
nursing considerations

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assess nares for excoriation or bleeding, examine mouth and throat for s/s of infection, monitor s/s of GI distress, cushion's syndrome.
teach client-clear nose before spraying, shake inhaler, avoid swallowing

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decongestants (intranasal sympathomemetics- ie: Afrin)

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common side effect of rebound congestion; should not use more than 3-5 days

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decongestants nursing considerations

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assess for presence or hx of nasal congestion. assess nares for s/s of excoriation or bleeding. assess v/s-HR,BP. contraindicated in those with HTN, prostatic enlargement.

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antitussives

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drugs that dampen the cough reflex; opioid (hydrocodone, codeine) or non-opioid (tessalon, dextromethorphan)

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expectorants (ie: guaifenesin)

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reduce thickness or viscosity of bronchial secretions;

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and mucolytics

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directly loosen thick, viscous bronchial secretions by breaking down the chemical structure of their molecules.