Medications for Upper Respiratory Infections

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Questions and Answers

What is a potential consequence of using pseudoephedrine during breastfeeding?

Enhanced maternal energy levels

Occasional irritability in infants (correct)

Improved infant sleep patterns

Increased milk production

What warning does the American Academy of Pediatrics give regarding pseudoephedrine?

It is recommended for use during pregnancy.

It is safe for all breastfeeding mothers.

It helps prevent fetal hypoxia.

It may interfere with lactation. (correct)

What is unknown regarding the use of oxymetazoline during lactation?

The effects on milk production.

How it affects infant behavior.

Its passage into breast milk. (correct)

Whether it is absorbed into the maternal bloodstream.

What is recommended before considering oral-systemic decongestants like Sudafed?

Nasal administration of oxymetazoline. Signup and view all the answers

What is a concern with the use of phenylephrine in pregnant women?

It may lead to fetal hypoxia. Signup and view all the answers

What is the primary role of H1 receptor antagonists in treating cold symptoms?

They block the binding of histamine to H1 receptors. Signup and view all the answers

Which statement accurately describes the anticholinergic effects of 1st generation antihistamines?

They can lead to symptoms such as dry mucous membranes and urinary retention. Signup and view all the answers

What can happen with regular use of 1st generation antihistamines over several weeks?

Tolerance or drug failure to the effects of the drug. Signup and view all the answers

Which of the following is NOT a characteristic of 1st generation antihistamines?

They selectively target H1 receptors only. Signup and view all the answers

Which symptom is primarily targeted by antihistamines during a cold?

Nasal discharge. Signup and view all the answers

What is a common mnemonic used to describe anticholinergic effects?

Blind as a bat, dry as a bone. Signup and view all the answers

Why do 1st generation antihistamines have central nervous system side effects?

They readily cross the blood-brain barrier. Signup and view all the answers

How do antihistamines provide relief from nasal symptoms during a cold?

They dry up mucous membranes and nasal secretions. Signup and view all the answers

Which medication is primarily used to relieve a nonproductive cough?

Dextromethorphan Signup and view all the answers

Which class of medications is most effective for controlling allergic rhinitis symptoms?

Intranasal corticosteroids Signup and view all the answers

What is a potential adverse effect of using intranasal antihistamines?

Sedation Signup and view all the answers

Why should opioids be avoided in certain patients when treating cough?

They can cause respiratory depression in COPD patients. Signup and view all the answers

What is the main role of expectorants in cough treatment?

Thinning secretions Signup and view all the answers

Which medication is known to have neuropsychiatric effects and should be considered carefully?

Montelukast Signup and view all the answers

Which of the following is not a recommended approach for managing allergic rhinitis?

Complete avoidance of all medications Signup and view all the answers

What is the primary action of leukotriene modifiers in allergic rhinitis treatment?

Decreasing airway constriction Signup and view all the answers

What is recommended for patients with a productive cough?

Increase fluid consumption. Signup and view all the answers

What is the first step in managing allergic rhinitis?

Educating on allergen avoidance Signup and view all the answers

Which of the following medications is used for acute symptom relief in allergic rhinitis?

2nd generation oral antihistamines Signup and view all the answers

How do intranasal antihistamines aid in allergic rhinitis treatment?

By competing with histamine for receptor sites Signup and view all the answers

Which of the following statements about immunotherapy is incorrect?

It is the first-line treatment for allergic rhinitis. Signup and view all the answers

What should be monitored in patients taking Montelukast for allergic rhinitis?

Neuropsychiatric effects Signup and view all the answers

What effect do first-generation antihistamines generally have on the elderly?

They can cause sedative effects and anticholinergic symptoms. Signup and view all the answers

Why do second-generation antihistamines cause less sedation than first-generation antihistamines?

They do not cross the blood-brain barrier or do so in negligible amounts. Signup and view all the answers

Which antihistamine is noted for its sedative effects among the second generation?

Cetirizine Signup and view all the answers

What is a common adverse effect of oral decongestants?

Nasal rebound congestion Signup and view all the answers

What is an important consideration when recommending antihistamines to pilots?

Sedation can impair functioning. Signup and view all the answers

What is the primary action of nasal decongestants?

They constrict blood vessels in the nasal mucosa. Signup and view all the answers

Which population should avoid cough and cold medications according to recent FDA recommendations?

Children under the age of 2 Signup and view all the answers

What might occur if oral decongestants are used in individuals with hypertension?

Increased risk of elevated blood pressure and palpitations Signup and view all the answers

How do antihistamines contribute to impaired learning and memory?

By blocking histamine receptors in the central nervous system. Signup and view all the answers

Why is it essential to provide education about combination cough and cold products?

They can lead to overdosing and adverse effects from multiple ingredients. Signup and view all the answers

Which of the following symptoms may occur with the use of second-generation antihistamines?

Minimal sedation Signup and view all the answers

What is the recommended maximum duration for using nasal decongestants?

Three days Signup and view all the answers

What class of medications do antihistamines belong to?

H1 receptor antagonists Signup and view all the answers

What is the recommended approach for antihistamine use during pregnancy?

Begin with sedating, first-generation antihistamines. Signup and view all the answers

Which of the following antihistamines is considered the safest for both pregnant and breastfeeding women?

Chlorpheniramine Signup and view all the answers

What concern is associated with the use of oxymetazoline during lactation?

Reduction in milk supply. Signup and view all the answers

In which case is codeine recommended for use?

When cough significantly impacts well-being. Signup and view all the answers

What is the safest recommendation regarding decongestant use in pregnancy?

Only short-term use is advised. Signup and view all the answers

What is the effect of first-generation antihistamines like diphenhydramine if used in large doses during breastfeeding?

Cause infant sedation and reduce milk supply. Signup and view all the answers

How should cetirizine be administered to breastfeeding mothers?

After a feeding and before the longest sleep period. Signup and view all the answers

What is a significant concern regarding the use of guaifenesin during pregnancy?

It could be associated with birth defects in the first trimester. Signup and view all the answers

What concern should be raised with a lactating mother using codeine?

Infant drowsiness and sedation may occur. Signup and view all the answers

What is advised for a pregnant woman considering pseudoephedrine use?

Consider it safe in the second and third trimesters. Signup and view all the answers

Which of the following statements is true about doxylamine?

It likely passes into breast milk and may cause CNS effects. Signup and view all the answers

What is the primary recommendation for decongestants during pregnancy?

Should be used only when necessary. Signup and view all the answers

What is the recommendation for administering antihistamines to avoid sedation in breastfeeding infants?

Use them right after the last breastfeeding session at bedtime. Signup and view all the answers

What should be considered when using antihistamines during pregnancy?

The potential for teratogenic effects varies among different antihistamines. Signup and view all the answers

What is the primary mechanism by which nasal corticosteroids work to alleviate allergic rhinitis?

Suppress the synthesis of inflammatory mediators Signup and view all the answers

When should intranasal corticosteroids be used to achieve maximum efficacy?

Daily for building up an effective barrier Signup and view all the answers

What is the recommended treatment strategy for a patient using intranasal corticosteroids for the first five days?

Use oral antihistamines for immediate relief Signup and view all the answers

Which of the following factors is NOT associated with the lack of efficacy of intranasal corticosteroids?

Using it only during severe symptoms Signup and view all the answers

What is the primary reason for the limited use of intranasal Cromolyn?

Less effective than corticosteroids Signup and view all the answers

What is the impact of allergic conjunctivitis combined with allergic rhinitis?

It is termed rhinoconjunctivitis Signup and view all the answers

What is a recommended first-line therapy for patients experiencing significant ocular allergy symptoms?

Antihistamines or mast cell stabilizers Signup and view all the answers

Which clinical condition may warrant referral to an ophthalmologist?

Significant comorbidities or new ocular symptoms Signup and view all the answers

What is the safety category of Budesonide during pregnancy?

Category B Signup and view all the answers

What is the main recommendation for treating mild colds in pregnant patients?

Begin with non-pharmacologic treatments Signup and view all the answers

Why should combination medications be avoided during pregnancy?

They often contain multiple active ingredients Signup and view all the answers

Why are corticosteroids generally considered safe in pregnancy?

They have low maternal systemic absorption Signup and view all the answers

Which nasal steroid is considered to have safety and effectiveness during pregnancy?

Budesonide Signup and view all the answers

What dosing frequency does intranasal Cromolyn require for effectiveness?

3-4 times per day Signup and view all the answers

Study Notes

Upper Respiratory Infection/Illness Medications

Antihistamines (H1 receptor antagonists) treat symptoms like itching, sneezing, ocular and nasal discharge, but not the infection itself. Their anticholinergic effects, not antihistamine effects, may help by drying mucous membranes.
First-generation antihistamines have a quick onset (15-30 minutes), but tolerance can develop quickly. They have low receptor specificity, cross the blood-brain barrier easily, and lead to central nervous system side effects (sedation, drowsiness, cognitive decline, etc).
First-gen antihistamines can also cause dry mouth, sinus tachycardia, dry mucous membranes, dilated pupils, and more. Use cautiously in narrow-angle glaucoma, benign prostatic hyperplasia, and the elderly.
Second-generation antihistamines act peripherally and are less sedating due to being large molecules with low lipid solubility that don't cross the blood-brain barrier.
Cetirizine is the exception, as it has a long half-life and may cause sedation.
Oral antihistamines generally reduce rhinitis, sneezing, and itching. Effective for preventing and relieving urticaria and angioedema.

Cough and Cold Medications

Often combination products (e.g., acetaminophen, ibuprofen, decongestants, antihistamines, suppressants, expectorants, sometimes alcohol).
Be cautious of potential risks associated with each component (liver damage from too much acetaminophen, decongestants and hypertension, antihistamines and sedation, alcohol effects).
Single-agent products are safer—particularly in children, pregnancy, and lactation.
Use caution with driving, heavy machinery, and around young children.
Recent studies suggest safety concerns associated with OTC cough/cold medications for children and recommend avoiding in those under 2.

Nasal Decongestants

Nasal decongestants are vasoconstrictors that relieve nasal congestion by constricting dilated blood vessels due to histamine.
Oral and topical formulations; available over-the-counter often combined with other agents.
Not recommended for use longer than 3 days due to potential rebound nasal congestion ("rhinitis medicamentosa").

Oral Decongestants

Activate alpha1-adrenergic receptors, causing vasoconstriction.
More potential side effects (e.g., high blood pressure, heart rate, insomnia, palpitations).
Avoid in patients with hypertension, arrhythmias, and sleep problems.

Antitussives

Prevent or relieve nonproductive coughs (e.g., codeine, dextromethorphan, diphenhydramine).
Evidence does not support their effectiveness for colds. Use as needed for nonproductive coughs/rest.
Avoid opioids in COPD or substance abuse history.

Expectorants

Thin secretions, making coughs more effective (e.g., guaifenesin).
Encourage fluid intake for increased effectiveness. Helpful for productive coughs.

Allergic Rhinitis

Medications are categorized as controllers (prevent symptoms) and relievers (relieve acute symptoms).
Allergen avoidance is crucial. Immunotherapy is another option.

Allergic Rhinitis Treatment

Issue	Intervention	Comment
Allergen avoidance	Educate first	Education on exposure lessening methods
Controller therapy	Intranasal steroids (e.g., fluticasone)	High efficacy; use daily for long-term symptom control
	Leukotriene modifiers (e.g., montelukast)	Some neuropsychiatric concerns; risk vs benefits must be discussed
Relievers	2nd-generation oral antihistamines (e.g., loratadine)	Less sedating than 1st gen
	Intranasal antihistamines	Can address nasal symptoms
	Ocular antihistamines	For allergic conjunctivitis
Immunotherapy	For inadequate response	Specialist consult, SQ or SL routes

Intranasal Antihistamines

Rapid onset, aid in reducing nasal congestion, offer as first/additional therapy (ages >5).
Compete with histamine at H1 receptors, reducing allergic response.
Potentially less sedating than oral antihistamines.

Leukotriene Modifiers

Inhibit leukotriene action, decreasing congestion, airway constriction, mucus production, swelling and inflammation (e.g., montelukast).
Most effective at bedtime; multiple days to see benefit.
Usually used in combination with 2nd-generation antihistamines, intranasal steroids; less effective as monotherapy.

Nasal Corticosteroids

Interrupt inflammation, suppressing histamine and other inflammatory mediators. Use daily for symptom control.
Effective for allergic rhinitis, considered first-line.
Benefit building can take 5 days, so use antihistamine initially.
Common problem is improper use leading to ineffectiveness.

Intranasal Cromolyn

Less effective than nasal corticosteroids; histamine release inhibitor, suppresses inflammation; alternative for corticosteroid-intolerant patients.
Requires frequent dosing.

Allergic Conjunctivitis

Significant impact on patients' lives. Combination with allergic rhinitis called rhinoconjunctivitis.
Characterized by itching, redness, tearing, swollen eyelids, inflammation of the conjunctiva.
Ocular antihistamines, mast cell stabilizers, or dual-action medications as first-line.
Refer to ophthalmologist in cases of significant comorbidities.

Pregnancy and Lactation

Pregnant patients more prone to colds, allergies.
Prioritize non-pharmacological treatments first (rest, hydration, diet, saline).
Avoid medications in first trimester when possible.
Specific symptom treatments with single-agent medications as needed.
Avoid combination, long-acting, extended-release, and alcohol-containing medications.
Nasal corticosteroids often a first-line choice.
Data suggests nasal forms have low amounts absorbed.
First-generation antihistamines generally considered safe in pregnancy.
Second-generation antihistamines are more likely to reduce milk supply if combined with sympathomimetics.
Decongestants often not first-line. Use for short periods, limiting usage to when and where needed.
Antitussives generally not effective and should be avoided.

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Description

This quiz covers essential medications used to treat upper respiratory infections, focusing on antihistamines. It delves into the differences between first and second-generation antihistamines, their effects, and precautions for use. Test your understanding of how these medications work and their potential side effects.