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Dosage Forms
Tablets
Timed or sustained release
Tablets or controlled release
Capsule
Troches
Suppositories
Solutions
Douche
Suspensions
Emulsions
Topicals
o Patches
Drug implants
Parenteral Product Packaging
Ampules
o Sterile
o Sealed glass or plastic container
o Contain a single liquid dose
Vials: either single or multiple dose
o Glass or plastic container
o Sterile liquid dose
o Sealed with a rubber diaphragm
Drug Names
Chemical name
- The drug’s chemical composition and molecular structure
Generic name (nonproprietary name)
- Name given by the United States Adopted Names Council
- Allows the drug to be marketed
Brand Name
- Also called trade name (proprietary name)
- The drug has a registered trademark; use
of the name is restricted by the drug’s owner
(usually the manufacturer)
- Allows the drug to be commercially distributed
- The superscript ® is registered by the U.S. Patent Office and approved by the FDA (Food and
Drug Administration)
Drug Names: Examples
Chemical name
- (+/-)-2-(p-isobutyl phenyl) propionic acid
Generic name
- Ibuprofen
Trade name
- Motrin
- U.S. Drug Legislation
- Pure Food and Drug Act of 1906
o Required all drugs to meet minimal standards
- Federal Food, Drug, and Cosmetic Act of 1938
o Required the drug to be safe before being distributed over state lines
- U.S. Drug Legislation
o 1970: Comprehensive Drug Abuse Prevention and Control Act
o Also known as Controlled Substance Act: classified drugs according to their abuse potential
o Regulates the manufacture and distribution of drugs causing dependence
Drug receptor interaction. Binding with specific receptors occurs only when
the drug and its receptors have a compatible chemical shape.
Pharmacokinetics: Absorption
Routes
Oral
Parenteral
Topical
Metabolism: First-Pass Effect
The metabolism of a drug and its passage from the liver into the circulation
Metabolism occurs in the liver
o Liver enzymes react with the drug
o Increases the dosage requirement
The same drug—given IV—bypasses the liver, preventing the first-pass effect from taking place, and
more drug reaches the circulation.
Pharmacokinetics: Distribution
The transport of a drug in the body by the bloodstream to its site of action
Elimination/Excretion
The elimination of drugs from the body
Kidneys (main organ)
Liver
Bowel
Renal excretion of drugs. Note sites where drugs
are secreted and reabsorbed.
Chapter 2
Principles and Methods of Drug Administration
Nursing Process
Assessment
Nursing diagnosis
Planning
Implementation
Evaluation
Administering Medication
Assessment
Nursing diagnosis
Planning
Implementation
Evaluation
Parenteral Medications
Intramuscular administration
Subcutaneous administration
Intradermal administration
Intravenous administration
Chapter 3
Nursing Clients Receiving Drugs Intravenously
Intravenous Administration
Collect materials needed.
o Select IV tubing.
o Select IV needle.
Explain the procedure.
Prepare the site.
Secure the site.
Infiltration
Extravasation
Thrombophlebitis
Pain
Fluid overload
Pyrogenic reactions
Tissue necrosis
Calculations
Total number of milliliters to be infused = Time in hours
mL/hr
mL/hr = mL/min
time in minutes
mL/min x SDF = gtt/min
IV Administration at Home
Home care/client teaching
Home health nurses
o Provide written guidelines
o Teach IV complications
o Teach when to call the nurse
o Teach dressing change guidelines
o Teach how to heparinize and flush a catheter
Have the client return demonstrate skills
Chapter 5
Drug Therapy for Pediatric Clients
Absorption
Gastric acid (hydrochloric acid) secretion in infants
Choosing the intramuscular injection site
Topical drug absorption
Intravenous drug administration
Distribution
Dependent upon the amount of water and/or fat present in the child, as well as plasma affinity of the
drug and protein-binding activity
Water-soluble drugs effectively utilized
Protein binding capacity is less
Metabolism
Difficult to predict
Maternal drug history is important
Excretion
Kidney maturation
Excretion increases as the kidney matures
Drug toxicity decreases as the kidney matures
Administration Methods
Liquid medications are administered using an infant dropper, syringe without a needle, or a small
spoon
Parenteral Medications
Explain the procedure to the child and to the parents.
Use additional materials such as:
Booklets
Coloring books
Puppets
Dolls
IV setup with colored water
Pain Procedure
Allow the parents to stay.
Painful procedures should be done in a separate room designated as the “owie” room.
Use a firm positive manner.
Assemble equipment first.
Maintain the child’s safety.
Intramuscular Injections
Vastus lateralis is the preferred site for children under the age of 3.
Ventrogluteal site is the preferred site for children over the age of 3.
The child should be walking.
Anterior view of the location of the vastus lateralis
muscle in a young child.
Chapter 6
Drug Therapy for Geriatric Clients
Drug Consumption
Age ≥ 65 = increasing population growth
Elderly are estimated to consume approximately 1/3 of all prescription drugs
Estimate elderly use 3/4 of over-the-counter drugs
Absorption
Diminishes with increased age
GI concerns
Reduced stomach acid (HCl)
GI absorptive surface area is reduced
Prolonged gastric emptying rate
Blood flow to the intestines is reduced
Reduced muscle tone in the stomach and intestines
Distribution
Water loss
Muscle loss
Fatty tissue increase
Protein binding: decreased capacity
Metabolism
General decline as age increases
Causes are obscure; possibly due to:
Reduced blood flow to the liver
Excretion
Measure creatinine function
Blood flow to the kidneys reduced
Renal function is reduced
Loss of intact nephrons
Drug Receptors
Internal drug receptors may change
Results in diminished or greater responses
Close monitoring is required
Other Factors
Memory loss
Sensory loss
Multiple health problems
Multiple medications at multiple times
Use of multiple pharmacies
Economic factors
Lack of education
Communication problems
Cultural considerations
Diet therapy
Implementation
Oral medications
Position for administration: high Fowler’s
Speak clearly and slowly.
Offer the most important medication first.
Have plenty of liquid available.
Do not rush the elderly client.
Intramuscular Medications
Use ventrogluteal site.
Avoid deltoid muscle.
Avoid vastus lateralis because of loss of muscle mass.
Storage
Safe storage of medications
Keep out of the reach of grandchildren and other young children.
Evaluation
Evaluate
Communication: Does client understand?
Drug action
Promoting Health
Prevent infections.
Improve nutrition.
Encourage exercise and activity.
Facilitate social interaction.
Promote restful sleep.
Chapter 7
Antimicrobial Agents
Anti-infective Therapy
Modern age
Discovery of sulfanilamide in 1936
Commercial introduction of penicillin in 1941
Antimicrobial Therapy
Original antimicrobials: derived from microorganisms
Newer agents: chemically synthesized
Sources of Infection
Bacteria
Fungi
Viruses
Resistant Organisms
MRSA/VRSA: methicillin/vancomycin-resistant Staphylococcus aureus
VRE: vancomycin-resistant Enterococcus
ORSA: oxacillin-resistant Staphylococcus aureus
Antimicrobial Therapy
Prevent infections.
Use Universal Precautions.
Classifications
Antimicrobial agents are classified based on the following factors:
Bactericidal or bacteriostatic
Site of action
Narrow or broad spectrum
Adverse effects
Antimicrobial Classes
Sulfonamides
Penicillins
Cephalosporins
Tetracyclines
Macrolides
Aminoglycosides
Fluoroquinolones
Carbapenem
Ketolides
Sulfonamides
First group of antibiotics
General action
Bacteriostatic effect
Inhibit para-aminobenzoic acid (PABA)
• PABA is essential for bacterial growth
Broad spectrum
Sulfonamides: Therapeutic Uses
Treatment of urinary tract infections
Otitis media
Certain vaginal infections
Some respiratory infections
Sulfonamides: Adverse Effects
Hypersensitivity
Renal dysfunction
Hematological changes
Sulfonamides: Nursing Implications
Consume at least 1 liter of fluid/day
Avoid sunlight and tanning beds
Reduce the effectiveness of oral contraceptives
Sulfonamide Combinations
Sulfonamides also combined with:
Antimicrobials, diuretics, oral hypoglycemics, and carbonic anhydrase inhibitors
Penicillins
Part of a large group of chemically related antibiotics
Derived from fungus or mold
Cephalosporins currently used instead of the penicillins
Penicillins: Action
Inhibit synthesis of the bacterial cell wall
Most effective on newly forming and actively growing cell walls
Some of the penicillins are rapidly destroyed in the stomach.
Given IM or IV
Resistance to Penicillins
Frequent early use of penicillin caused:
Penicillinase
The bacteria to produce penicillin-destroying enzymes
Potassium clavulanate inhibits penicillinase: combined with penicillin
Penicillins: Therapeutic Uses
Prevention and treatment of gram (+) bacterial infections:
Enterococcus, Streptococcus, and Staphylococcus bacteria
Penicillins: Adverse Effects
Hypersensitivity
Gastrointestinal symptoms
Neurotoxicity
Renal dysfunction
Cephalosporins
Chemically and pharmacologically related to penicillins
Action: prevent bacterial cell wall synthesis
Cephalosporins: Action
Either bactericidal or bacteriostatic; depends on:
Susceptibility of organism
Dose of drug
Tissue concentration
Rate of bacteria multiplication
Classes of Cephalosporin
Include several generations:
First: good gram-positive coverage
Second: good gram-positive coverage; some gram-negative coverage
Third: less gram-positive coverage; more gram-negative coverage
Fourth: good gram-negative coverage
Treatment with Cephalosporins
Treat infections of:
Skin
Bone
Heart
Blood
Respiratory tract
Gastrointestinal tract
Urinary tract
Cephalosporins: Adverse Effects
Hypersensitivity
Cross-sensitivity reaction to penicillin
Thrombophlebitis (when given IV)
Sterile abscess (when given IM)
Nephrotoxicity
Tetracyclines
Action: inhibit protein synthesis in the bacterial cell; bacteriostatic
Broad spectrum
Bacteria: gram – and gram +
Effective against: protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme disease
Tetracyclines: Nursing Implications
Bind to Ca2+, Mg2+, and Al3+ ions and form insoluble complexes
Do not give tetracycline with:
Dairy products, antacids, or iron salts
Tetracyclines: Toxic Effects
Do not give to children.
Affects tooth development from:
Fourth month of fetal development to 8 years old
Temporary and permanent discoloration of developing teeth
Photosensitivity
Superinfection
Macrolides
Action
Bacteriostatic: inhibits protein synthesis in the bacterial cell
Primarily used for respiratory, gastrointestinal, urinary, skin, and soft tissue infections
Treatment with Macrolides
Treat both gram + and some gram – organisms
Erythromycin: preferred (pertussis)
Primarily metabolized by the liver and excreted in the urine
Macrolides: Adverse Effects
Hypersensitivity
Gastrointestinal effects
Hepatotoxicity
Jaundice
Aminoglycosides
Poor oral absorption
Given intravenously, not orally
Action
Bactericidal: inhibit cell wall protein synthesis
Effective: gram – and some gram +
Narrow therapeutic range
Potent antibiotics with serious toxicities!
Aminoglycosides: Toxicities
Serious toxicities: caution
Nephrotoxicity
Ototoxicity
Block neuromuscular action, which can lead to respiratory paralysis
Monitor drug levels, both peak and trough
Fluoroquinolones
First oral antibiotics effective against gram-negative bacteria
Excellent oral absorption
Fluoroquinolones: Action
Bactericidal: alter DNA
Broad spectrum: effective against gram-negative organisms and some gram-positive organisms
Carbapenems
Action: Inhibit synthesis of the bacterial cell wall
Broad spectrum
Effective:
Gram negative
Gram positive
Treat community acquired pneumonia
Carbapenems: Nursing Considerations
Given intravenously and intramuscularly
Cross-sensitivity to penicillins
Advantage
Given once every 24 hours
Carbapenems: Adverse Effects
Hypersensitivity
Diarrhea
Local reactions at intramuscular and intravenous sites
Ketolides
FDA approved in 2004
New class
Developed from macrolides
Semisynthetic
Treat macrolide-resistant strep pneumonia
Ketolides: Adverse Effects
Hypersensitivity
Headache
Diarrhea
Urinary Tract Anti-infectives
Trimethoprim
Most common
Blocks the synthesis of folate in bacteria, thus inhibiting formation of nucleic acid and protein
Others
Methenamine products: produces local bactericidal effect
Nitrofurantoin: stops CHO metabolism
Produces yellow-brown urine
Antimicrobial Therapy
General nursing implications
Instructions take as prescribed:
Length of time: do not stop before antimicrobials are gone
Assess for signs and symptoms of returning infection
Antimicrobials: Nursing Implications
Obtain cultures from appropriate sites before beginning therapy.
Antitubercular Agents
Tuberculosis (TB)
Mycobacterium tuberculosis
An aerobic bacillus
Requires oxygen to survive
Antitubercular agents treat all forms of Mycobacterium
Tuberculosis
TB close to eradication; new resistant strain developed in immunocompromised individuals and
immigrants to the U.S.
Drug therapy is given in two forms:
Preventive therapy
Active therapy
TB: Preventive Therapy
Preferred agent
INH (Isoniazid)
Known as chemoprophylaxis
Safest
Low cost
Action: tuberculostatic and tuberculocidal
Treatment: 18 months to 2 years
Isoniazid
INH
Action: inhibits the synthesis of mycolic acid
Adverse effects of INH
Hepatotoxicity: jaundice
Peripheral neuritis
Nausea
Skin rashes
Multiple Drug Therapy
Required: combination of two or three agents
Helps prevent development of resistant strains
Antitubercular Therapy
Effectiveness depends on:
Where
Strain
Effective drug combination
Sufficient duration
Effective drug compliance
Antitubercular Agents: Nursing Implications
Client education is critical.
Therapy may last for up to 24 months.
Take medications exactly as ordered.
Emphasize the importance of strict compliance.
Do not consume alcohol.
Diabetic: monitor blood glucose levels
INH and rifampin:
Oral contraceptives ineffective
Lyme Disease
Spirochete Borrelia burgdorferi
Transmitted from a deer tick
Symptoms
Rash
Flulike symptoms, followed by arthritis and fatigue
Treatment for Lyme Disease
Oral doxycycline
Adults: 100 mg b.i.d
Length: 10 to 14 days
Adverse effect
Photosensitivity
Fungi
Contracted
Air
Skin to skin
Due to normal flora being killed off:
Antibiotics
Corticosteroid therapy
Antineoplastic agents
Suppressed immune system
Mycotic Infections
Three general types
Cutaneous
Subcutaneous
Systemic (can be life threatening)
Antifungal Agents
Treatment
Antibiotic therapy will not work.
Requires prolonged treatment
Human cell structure resembles fungi cell structure.
Action
Antifungal agents take advantage of the slight differences of the cell structures.
Antiviral Agents
Viruses cause many infectious disorders:
Acute: common cold
Chronic: herpes
Slow growing: AIDS
Available vaccines
Polio, rabies, and smallpox
Viral Replication
A virus cannot replicate on its own.
It must attach to and enter a host cell.
Uses the host cell’s energy to synthesize protein: DNA and RNA
Interferons
Normally, interferons protect the cells from infecting viruses.
Interferon: continuous research
Recent antifungal agents end in “vir”
Antiviral Agents: Key Characteristics
Inhibit viral replication by interfering with:
Viral nucleic acid synthesis and/or regulation
Ability of virus to bind to cells
Chapter 8
Antiparasitic Drug Therapy
Antiparasitic Therapy
Millions of people worldwide are infected with protozoal organisms.
Protozoa: a single-celled microorganism
Protozoal Illnesses
Protozoal diseases are prevalent in tropical regions and in immuno-compromised hosts
Exposure: international travel and immigration from areas where such infections are endemic
Malaria
Malaria causes high morbidity and mortality
Protozoa called Plasmodium
Resides in the red blood cell of humans
Signs and symptoms
Fever, prostration, and recurrent chills
Transmission of Malaria
Malaria is transmitted by the bite of a female mosquito.
Malaria is also transmitted via infected blood during blood transfusions.
Has become more common in the United States
Treating Malaria
Humans: antimalarial agents work during the asexual cycle of the parasite
Mosquito: antimalarial agents do not work during the sexual cycle
Antimalarial Agents
Quinine sulfate: action is still unknown
Declining in use because of toxic effects
Mefloquine (Lariam): synthetic analogue of quinine sulfate
Used as preventive therapy and has fewer side effects
Chloroquine (Aralen): safe and effective
Used for acute treatment
Fewer side effects
Given orally and intramuscularly
Chapter 9
Antiseptics and Disinfectants
Antiseptic
- An agent that kills or inhibits the growth of microorganisms
- Used on skin
Disinfectant
- An agent that rapidly destroys pathogenic microorganisms, thus preventing infection
- Used on inanimate objects
Germicide
- A general term for agents capable of destroying microorganisms
Actions of Agents
Cell wall protein is destroyed; cell death occurs
Cell membrane permeability increases and vital contents leak out; cell death occurs
Metabolism is disrupted; cell death occurs
Cell components become oxidized; cell death occurs
Antiseptics and Disinfectants
Phenolic agents
Alcohols and aldehydes
Acids
Iodine and iodophors
Chlorine and chlorophors
Mercury compounds
Silver compounds
Surface-active agents
Oxidizing agents
Chlorhexidine
Chapter 10
Analgesics and Antipyretics
Pain
- When nerve signals are sent to the brain (CNS) after feeling a hurtful sensation inside or outside the
body, the brain perceives these signals as pain.
When the client complains of pain, it is important for the nurse to treat it.
- Pain: the fifth vital sign
Pain Transmission
Tissue injury causes the release of:
Bradykinin
Histamine
Prostaglandins
Serotonin
These substances stimulate nerve endings, starting the pain process.
Pain Transmission Gate Theory
Most common and well-described theory of pain
Uses the analogy of a gate to describe how impulses from injured tissues are sensed in the brain
Pain Transmission in the Spinal Cord
A fibers
Myelin sheath
Large fiber size
Conduct quickly
Sharp and well-localized
C fibers
No myelin sheath
Small fiber size
Conduct slowly
Dull and nonlocalized
Neurotransmitters
Body has endogenous neurotransmitters
Endorphins
Enkephalins
Produced by body to fight pain
Marathon runners and cyclists
Bind to opioid receptors
Inhibit transmission of pain by closing the gate
Management of Pain
Treat the cause.
Select a safe analgesic.
Select the analgesic that provides effective relief.
Provide psychological support.
Nursing actions: position change
and back rub
Analgesics
Analgesic drugs relieve pain without causing loss of consciousness.
Opioid Analgesics
- Opium has been used for thousands of years to alleviate pain.
- Opium is derived from the poppy plant.
- Opium produces pain relief by attaching to pain receptors.
- Narcotics are derivatives of opium.
- Narcotics are strong pain relievers.
Classifications of Opioid Analgesics
Classifications based on their actions:
Agonist
Agonist-antagonist
Partial agonist
Uses for Opioid Analgesics
Main use: to alleviate moderate to severe pain
Opioids are also used for:
Cough suppression
Diarrhea treatment
Effects of Opioid Analgesics
Euphoria
Nausea and vomiting
Respiratory depression
Urinary retention
Diaphoresis and flushing
Pupil constriction (miosis)
Constipation
Complications of Opioid Analgesics
Respiratory implications
Constipation concerns
Opioid Analgesics: Nursing Assessments
Perform a thorough history.
Obtain baseline vital signs and assessments.
Assess for potential contraindications and drug interactions.
Opioid Analgesics: Nursing Implications
Oral forms–take with food
Ensure safety measures
Opiate Antagonists
Naloxone (Narcan) and naltrexone (ReVia)
Opiate antagonists
Bind to opiate receptors and prevent a response
Used for reversal of opioid-induced respiratory depression
Opioid Analgesics: Nursing Implications
Rotate site for IM injections.
Follow proper guidelines for IV administration, such as dilution and rate of administration.
Check dosages carefully.
Opioid Analgesics: Nursing Implications
Prevent constipation.
Provide fluid and fiber.
Prevent respiratory depression.
Provide instruction for clients.
Drug administration
Position changes
Analgesic Agents
Analgesic agents
Salicylates (ASA)
Acetaminophen (Tylenol)
Combination narcotic and non-narcotic analgesics
Anti-inflammatory analgesic agents
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Anesthetics
- Defined as a group of drugs used to block the transmission of nerve conduction so that the sensation of
pain is not perceived by the brain
Two classifications
General
Regional
General Anesthetics
Produce balanced anesthesia
Gas and injection
Prevent pain during surgery
Administration of Anesthetics
Administered
Gas or volatile liquid–inhalation
Injection
Surgery–secession of use
Induction gas—first stage
Intravenous injection—second stage
Risks of Gas Anesthetics
Most are explosive
Nausea and vomiting
Coughing
Renal and liver toxicity
Risks of Injected Anesthetics
Blood pressure changes
Emergence delirium
Malignant hyperthermia
Regional Anesthesia
Local
Extent anesthetized
Surface area
Drug concentration
Adjuncts to General Anesthesia
Narcotic opioid analgesics
Benzodiazepines
Antiemetics
Presurgical Nursing Interventions
Administer preanesthetic medications
Provide safety.
Monitor vital signs.
Maintain NPO status.
Educate the client.
Promote confidence.
Postsurgical Nursing Interventions
Monitor for hypotension.
Monitor for rapid pulse rate.
Monitor for gastrointestinal upset.
Monitor for urinary retention.
Monitor for hyperthermia.
Chapter 12
Anti-inflammatory Agents
Chapter 13
Agents Used to Treat Hyperuricemia and Gout
Gout
- Gout is a metabolic disease associated with the development of high uric acid in the blood.
- It is a metabolic defect and is not caused by excessive intake of meat and alcohol.
Uric Acid
- Uric acid is formed from the breakdown of proteins.
- The accumulation of uric acid causes a problem in the joints and kidneys:
Kidney stones
Kidney failure
Gouty arthritis
Hyperuricemia
Acute Attacks
Acute attacks of gout are treated with:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Colchicine: intravenously or orally
Agents Used
Corticosteroids and NSAIDs actions
Produce anti-inflammatory effects
Produce analgesic effects
Colchicine’s action is unclear
Reduces leukocyte production of lactic acid
Reduces phagocytic activity
Colchicine
Not a first-line agent because of its adverse side effects
Major adverse effects:
Nausea, vomiting, and diarrhea
Gastrointestinal bleeding
Neuritis
Myopathy
Alopecia
Bone marrow depression
Long-term Control
Most commonly used agent for gout:
Allopurinol: prevents formation of uric acid
Adverse effects: hepatotoxicity and skin rash
Gouty Arthritis
Most commonly used agent
NSAIDs
Indomethacin (Indocin)
Naproxen (Aleve)
Sulindac (Clinoril)
Uricosuric Agents
Increase excretion of uric acid
Probenecid (Benemid)
Side effects
• Headaches
• Dizziness
Sulfinpyrazone (Anturane)
Side effects
• Nausea and vomiting
• Diarrhea
Therapeutic Effects
Monitor for:
Decreased inflammation
Decreased pain
Ease of movement
Monitor lab values of uric acid
Monitor urine output
Chapter 14
Antihistamines and Nasal Decongestants
Common Cold
Virus infection
Rhinovirus
Influenza virus
Initiates the inflammatory response
Cough reflex
Irritant stimulates sensory receptors
Removes
Respiratory secretions
Foreign object
Inflammatory Response
Mucosal irritation
Release of several inflammatory and vasoactive substances
Histamine
Dilating small blood vessels in the nasal sinuses
Produces nasal congestion
Symptomatic Treatment
Combined use of:
Antihistamines, nasal decongestants, antitussives, and expectorants
Antihistamines and Nasal Decongestants
Compete with histamine for receptor sites
Two histamine receptors
H1 (histamine 1)
H2 (histamine 2)
Vasodilatation—GI effects
Increase gastrointestinal and respiratory secretions
Increase capillary permeability
The binding of H1 and H2 blockers to histamine receptors prevent histamine stimulation
H1 Antagonists
Respiratory antihistamines
Effects
Antihistaminic
Mild anticholinergic
Parasympathetic nervous system
Sedative
Antihistamines
Antihistamines
Cardiovascular: small blood vessels
Histamine effects
Dilation
Permeability
Antihistamine effects
Prevent dilation
Prevent increased permeability
Antihistamines
Skin
Prevent itching
Wheal and flare
Anticholinergic
Drying effect
Sedative
Drowsiness
Management of:
Nasal allergies
Seasonal or perennial allergic rhinitis
Allergic reactions
Motion sickness
More effective in prevention
Give early
Prevent binding of histamine receptors
Classes of Antihistamines
Two types
Traditional: sedating
Nonsedating
Traditional Antihistamines
Older
Work both peripherally and centrally
Anticholinergic properties
Examples: diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton)
Nonsedating/Peripherally Acting Antihistamines
Work peripherally
Eliminate sedation
Longer duration of action
Increases compliance
Examples: fexofenadine (Allegra) and loratadine (Claritin)
Antihistamines: Nursing Implications
Assess allergy history
Contraindicated
Asthma attacks
Chronic obstructive pulmonary disease
Cardiovascular disease
Client Teaching
Instruction for traditional/sedating antihistamines
Avoid driving
No alcohol
No central nervous system depressants
Nasal Decongestants
Two main types are used:
Adrenergics (largest group)
Constrict dilated blood vessels
• Nasal mucosa
Corticosteroids
Reduce inflammation
Goal of Nasal Decongestants
To reduce congestion
Two dosage forms
Oral
Topical
Nasal spray
Oral Decongestants
Prolonged effects
Less potent
No rebound congestion
Exclusively adrenergics
Example: pseudoephedrine (Sudafed)
Topical Decongestants
Adrenergics
Prompt onset
Sustained use–rebound congestion
Both adrenergics and steroids
Potent; work well
Nasal Steroids
Anti-inflammatory
Decrease inflammation
Relieve nasal congestion
Nasal Decongestants
Adrenergics
Ephedrine (Vicks)
Naphazoline (Privine)
Oxymetazoline (Afrin)
Phenylephrine (Neosynephrine)
Intranasal steroids
Beclomethasone dipropionate
Beconase
Vancenase
Flunisolide(Nasalide)
Nasal Decongestants: Side Effects
Adrenergics
Nervousness
Insomnia
Palpitations
Tremors
Steroids
Local mucosal dryness and irritation
Treatment with Nasal Decongestants
Acute or chronic rhinitis
Common cold
Sinusitis
Hay fever
Other allergies
Nasal Decongestants: Nursing Implications
Avoid decongestants in the following clients:
Heart disease
Hypertensive disease
Respiratory disease
Assess for drug allergies
Chapter 15
Expectorants and Antitussive Agents