Antihistamines: First and Second Generation

Antihistamines

• Antihistamines may cause drowsiness
• Alcohol or other CNS depressants should be avoided when taking antihistamines

First-Generation Antihistamines

• Diphenhydramine is used to relieve allergy or cold symptoms
• Other examples include: Brompheniramine, Chlorpheniramine, Dexchlorpheniramine, and Clemastine fumarate
• Temporarily relieve symptoms of hay fever or other upper respiratory allergies like runny nose, sneezing, and itchy, watery eyes
• They also temporarily relieve itching of the nose or throat
• Side effects include sedation and anticholinergic effects, such as dry mouth, blurry vision, urinary retention, constipation, and tachycardia
• Gastrointestinal effects like nausea and vomiting may occur
• Excitation in children may occur

Second-Generation Antihistamines

• Cetirizine and Loratadine temporarily relieve symptoms of hay fever or other upper respiratory allergies such as runny nose, sneezing, and itchy, watery eyes, relieving of the nose or throat
• These are nonsedating
• Anticholinergic effects may occur
• Gastrointestinal effects of nausea and vomiting may occur
• Paradoxical effect of excitation may occur in children
• Take as directed
• Avoid allergens, alcohol, and CNS depressants due to sedation

Decongestants

• Decongestants relieve nasal obstruction due to inflammation
• Pseudoephedrine temporarily relieves nasal congestion due to the common cold, hay fever, or other upper respiratory allergies
• Pseudoephedrine temporarily relieves sinus congestion and pressure
• Other examples include: Ephedrine HCl, Phenylephrine HCl, Naphazoline HCl, Oxymetazoline HCl, and Tetrahydrozoline
• Cardiovascular stimulation, hypertension, dysrhythmia, dizziness, headache, and tachycardia are possible side effects
• Rebound congestion with nasal route can occur
• Avoid prolonged use for greater than 7 days
• Use cautiously with cardiovascular disease
• Hydration should be maintained, drinking 2-3 liters per day
• Decongestants are not safe for children under 4 years old

Antitussives

• A dry, hacking, nonproductive cough is treated with this class of drugs
• Care should be taken to avoid irritants that stimulate cough, such as smoking

Non-Opioid Antitussives

• Dextromethorphan is used for a dry, hacking, nonproductive cough that interferes with rest and sleep

• CNS sedation and dizziness and mild gastrointestinal effects can occur

• Avoid taking Dextromethorphan with other CNS depressants or alcohol

• This medication is not safe for children under the age of 4

• Benzonatate is used to treat cough associated with respiratory infections and conditions such as bronchitis and pneumonia

• CNS: Sedation and dizziness, GI: Constipation and nausea, Headache, and itchy skin rash are possible side effects

• Take with food to minimize the risk of gastrointestinal upset

• The pill should be swallowed whole and not crushed, chewed, or dissolved in the mouth

• Avoid taking with other CNS depressants or alcohol

Opioid Antitussives

• Codeine-guaifenesin alleviates coughing and loosens mucus in the airways
• CNS Sedation and dizziness, respiratory depression, blurred vision, dry mouth, urinary retention and GI upset may occur
• Avoid taking with other CNS depressants
• Take as directed
• Monitor for signs of abuse/dependence
• Administer in the lowest effective dose for the shortest duration possible to minimize the risk of adverse effects

Expectorants

• Guaifenesin helps loosen sputum (mucus) and thin bronchial secretions to make coughs more productive
• Guaifenesin may cause increased drowsiness in large doses and gastrointestinal issues such as nausea, vomiting, and diarrhea
• No eating or drinking for 30 minutes after syrup
• Encourage the client to cough and breathe deeply
• Increased fluid intake it help thin secretions, if not contraindicated

Beta-2 Agonist

• Avoid taking Beta-2 Agonists with other CNS depressants or alcohol
• Monitor respiratory rate, oxygen saturation, and lung sounds before and after administration

Short-Acting Beta-2 Agonists (SABA)

• Albuterol causes rapid bronchodilation, and is used to prevent or treat bronchospasms in people with asthma
• CNS stimulation (excitability) and cardiovascular stimulation (tachycardia) may occur
• When using an inhaler for the first time, clients should be instructed to prime the inhaler unit prior to administering their medication
• Rinsing the mouth with water after use can cause an unusual taste in the mouth

Long-Acting Beta-2 Agonist (LABA)

• Salmeterol is used in the prevention of bronchospasm
• LABA's have a slow onset of action and will not stop an acute bronchospasm
• Tachycardia, dysrhythmias, hypokalemia, and hyperglycemia may occur
• Increased risk of death with use during an “asthma attack" due to slow onset of action
• Rinsing the mouth with water after use - can cause an unusual taste in the mouth

Anticholinergics

• Clients should be instructed to use the inhaler as directed and be careful not to exceed dosage recommendations
• Information should be received regarding the onset of medication use, and differences in short and long-acting anticholinergics
• Some long-acting anticholinergics may cause signs of angioedema, and the health care provider should be notified if this occurs

Short-Acting Anticholinergics

• Ipratropium is used for the maintenance therapy of bronchoconstriction associated with asthma, chronic bronchitis, and emphysema, and long-term management of pulmonary disease
• Cough and drying of the nasal mucosa can occur
• Slower onset of action, and is not a rescue inhaler

Long-Acting Anticholinergics

• Tiotropium prevents bronchospasm and reduces exacerbations in COPD clients, and for long-term management of pulmonary disease
• Cough and drying of the nasal mucosa can occur

Corticosteroids

• Slower onset of action and are not a rescue inhaler
• Rinse mouth after use to help prevent risk for oral thrush

Class Corticosteroids

• Fluticasone inhalers prevent asthma attacks and reduce inflammation of sinus passages
• Other examples: Beclomethasone, Dexamethasone, Mometasone and Budesonide
• Nasal spray: Dry nasal passages and epistaxis(nosebleed)
• Inhalers cause hoarseness, dry mouth, cough, sore throat, and oropharyngeal candidiasis
• Do not use as a quick-relief medication for asthma attacks
• Prednisone, an oral corticosteroid, is used to control severe or incapacitating allergic conditions, severe asthma, and acute exacerbations of COPD
• Adverse effects include fluid retention, edema, hypertension, and electrolytic and glucose imbalances
• Other effects include mood swings, insomnia, nausea, increased appetite, weight gain, and adrenal suppression
• Infection risk is increased, and infections can be masked
• Do not use if signs of a systemic infection
• When using more than 10 days, the dose must be slowly tapered
• Monitor blood glucose levels, monitor for signs of infection, and don't abruptly discontinue

Leukotriene Receptor Antagonists

• Leukotriene Receptor Antagonists are used for the long-term control of asthma and for decreasing the frequency of asthma attacks

Leukotriene Inhibitors

• Montelukast (examples Zafirlukast), can cause headache, cough, nasal congestion, nausea, toxicity
• Suicidal ideation has occurred as a side effect
• Use as directed; not to be used as a quick relief medication for asthma attacks
• Typically, 3-7 days to reach effectiveness
• Should be avoided for treating mild asthma unless conventional treatment is ineffective
• Medications should not be discontinued without notifying the health care provider Blackbox Warning: for serious mental health side effects, including suicidal ideation

Class Xanthine Derivatives

• Theophylline, a Xanthine Derivative is for long-term of chronic asthma and COPD unresponsive to other treatment
• Adverse effects include GI nausea and vomiting, CNS stimulation, nervousness and insomnia
• Avoid caffeine
• Requires evaluation of therapeutic blood level to prevent toxicity every 6-12 months
• Administer this medication in the morning, if possible, due to potential CNS stimulation