17-1
❖ Rifampin : Reduces absorption of
How do they
work? “Action”
Antihistamines aka H1
receptor agonists, block
most but not all effects
of histamines from
entering the receptor
sites.
Types
❖ First generation: Bind
nonselective to central
and peripheral H1
receptors, resulting in
CNS stimulation for
depression.
❖ Second generation:
Bind selectively to H1
receptors and are less Second generation
sedating.
Why do we give them?
“ Indications”
❖ Relief of symptoms of seasonal or
perennial allergies
❖ Allergic and vasomotor rhinitis
❖ Allergic conjunctivitis
❖ Mild, uncomplicated angioneurotic
edema and urticaria
❖ Relief of allergic reactions to drugs &
blood products
❖ Relief of coughs
❖ Anaphylactic shock treatment
adjunct
❖ Treats parkinson's like symptoms
❖ Relieves nausea, vomiting, & motion
sickness
❖ Sedation & adjunct to analgesia
Generic
Diphenhydramine: 1st Generation
Promethazine: 1st Generation
Cetirizine: 2nd Generation
Fexofenadine: 2nd Generation
Loratadine : 2nd Generation
Antihistamines Interactions
Adverse reactions antihistamine
❖ Drowsiness
❖ MAOI: Increased anticholinergic and
sedative effects
❖
❖
Sedation, disturbed coordination
Dry mouth, nose, & throat, thickening
❖ CNS depressants: Increased risk of
CNS depression
of bronchial secretions ❖ Beta Blockers: Risk for increased
❖ Urticaria ( second generation) cardiovascular effects
❖ Aluminum or magnesium based
antacid: Decrease serum
concentration of antihistamine
Contraindications
❖ Known hypersensitivity
❖ Pregnancy or lactation , newborns, nursing
❖
infants
Angle closure glaucoma Nursing management
❖ Those on MAOI antidepressants ❖ Obtain a complete health history
❖ Peptic ulcer including data on anaphylaxis,
❖ Symptomatic prostatic hypertrophy asthma, or cardiac disease, plus
❖ Bladder neck obstruction allergies, drug history, and possible
drug interactions.
❖ Monitor airway
❖ Known hypersensitivity ❖ Obtain vital signs
❖ Hypersensitivity to hydroxyzine ❖ Assess respiratory status, especially
breathing pattern
Caution
❖ Assess neurological status and level
of consciousness.
❖ Patients with bronchial asthma ❖ Auscultate breath sounds before
❖ Overuse of nasal decongestants can administering.
cause rebound congestion ❖ Monitor thyroid function.
❖ Cardiovascular disease ❖ Monitor for vision changes.
❖ Narrow angle glaucoma: ❖ Monitor neurological status,
Antihistamines can increase especially LOC. Use with caution in
intraocular pressure and cause clients with a history of seizure
photosensitivity.) disorder. (Antihistamines lower the
❖ Hypertension seizure threshold. The elderly are at
❖ Impaired kidney function increased risk of serious sedation
❖ Urinary retention and other anticholinergic Understand
❖ Pyloroduodenal obstruction that overuse of topical nasal
❖ hyperthyroidism decongestants can make the
symptoms worse, causing rebound
congestion.
Trade Uses Dose
Benadryl Allergic reactions, motion sickness, sleep aid 25-50 mg orally, q4-6hr
10-400 mg IM/IV
Phenergan Antiemetic, hypersensitivity,motion sickness, Individualize dose to smallest
sedation. effective dose. 12.5-25 mg orally.
25 mg IM/IV. Motion sickness 25
mg BID, pre op 50 mg IM.
zyrtec Seasonal or perennial rhinitis, chronic urticaria 5-10mg/day orally
Max dose 20 mg/day
Allegra Seasonal rhinitis 30-60 mg orally BID
Max dose 180 mg/day
claritin Allergic rhinitis 10 mg /day orally
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17-2 Decongestants
Contraindications Nursing management
❖ ❖ Administer pseudoephedrine at least
How do they work?
Sustained release pseudoephedrine
is contraindicated in children under 2 hr before bedtime to minimize
insomnia.
“Action”
12
❖ Known hypersensitivity ❖ PO: Extended-release tablets and
❖ Patients taking MAOIs capsules should be swallowed whole;
Nasal decongestants are do not crush, break, or chew.
sympathomimetic. They cause Contents of the capsule can be mixed
vasoconstriction which reduces with jam or jelly
swelling in the nasal passages. ❖ Instruct patient to take medication as

Caution directed and not to take more than

recommended. Take missed doses
❖ Thyroid disease within 1 hr
❖ Diabetes mellitus ❖ Instruct patient to notify health care

Why do we give them?

❖ Cardiovascular disease professional if nervousness, slow or
❖ Prostatic hypertrophy fast heart rate, breathing difficulties,
❖
“Indications”
Coronary artery disease hallucinations, or seizures occur,
❖ Peripheral vascular disease because these symptoms may indicate
❖ Hypertension overdose. Instruct patient to contact
❖ Common cold ❖ Glaucoma health care professional if symptoms
❖ Hay fever
do not improve within 7 days or if fever
❖ Sinusitis
is present.
❖ Allergic rhinitis
❖ Congestion associated with

Interactions Nclex alert!

rhinitis

❖ MAOIs: Severe headache, ❖ Do not confuse Sudafed with sotalol

hypertension, hypertensive or Sudafed PE.
crisis ❖ Make sure to educate the patient to
❖ B-adrenergic blockers: look at OTC cold medication labels
Hypertension followed by as some have phenylephrine in

Adverse reactions bradycardia them.

❖ Tachycardia
❖ Nervousness, restlessness,
insomnia
❖ Blurred vision
❖ Nausea and vomiting

Generic Trade Use Dose

Epinephrine Adrenalin Nasal congestion 2-3 drops/spray in each nare

q4-6hr

Phenylephrine Neosynephrine Nasal congestion 2-3 sprays of 25% solution q

3-4hr

Pseudoephedrine Sudafed Nasal congestion 60mg orally, q 4-6 hr.

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 17-3
How do they work?
“ Action “
Antitussives are used to relieve non
productive coughs by depressing
the cough center in the medulla of
the brain “ central acting” or
anesthetized stretch receptors in
the respiratory passages
“peripheral acting”
Why do we give them?
“Indications”
❖ Used to relieve non
productive coughs.
Adverse reactions
When combined with
antihistamines :
❖ Lightheadedness
❖ Dizziness
❖ Drowsiness
❖ sedation
Generic
Codeine : Opioid
antitussive
Benzonatate : Non opioid
antitussive
Dextromethorphan
Antitussives
Contraindications
❖ Known hypersensitivity
❖ Opioid antitussives can not be given to
premature infants or during labor when
a premature infant is anticipated.
Caution
❖ Persistence of chronic cough
❖ Cough that produces excess
secretions
❖ High fever, rash,persistent
headache, nausea, vomiting
❖ Antitussives with codeine are
used with caution in patients
with COPD, acute asthma attack,
pre-existing respiratory disorders
❖
❖
Acute abdominal conditions
Head injury, increased
intracranial pressure, convulsive
disorders
❖ Hepatic or renal impairment
❖ Prostatic hypertrophy
Interactions
❖ Use with other CNS
depressants such as alcohol
may cause increased
depressive effects when
administered with opioid
antitussives.
❖ When dextromethorphan is
administered with an MAOI :
Hypotension, fever, nausea,
coma & jerking motions
Trade Use
Suppression of non productive
cough. Relief of mild to moderate
pain
Tessalon perles Symptomatic relief of cough
Robitussin Symptomatic relief of cough
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Herbal considerations
❖ Eucalyptus is used as an
expectorant and decongestant
and is commonly found as a
component in most OTC products
used to treat sinusitis or
pharyngitis.
❖ Eucalyptus should not be used
during pregnancy or in children
younger than 12.
Nursing management for the
older adult
Older adults are more likely to experience injury
from dizziness because with age comes an
increased risk for falls. Sensorimotor deficits, such
as hearing loss, visual impairments, or balance
problems, increase the older adult’s risk for injury.
Codeine may cause orthostatic hypotension when
a patient rises too quickly from a sitting or lying
position. Patients should not take codeine
preparations for persistent or chronic cough, such
as occurs with smoking, asthma, or emphysema,
or when the cough is accompanied by excessive
secretions, except when under the supervision of
the health care provider. (Ford 320)
Dose
10-20 mg orally q4-6hr. Max dose 120
mg/day
adults/children older than 10 100-200 mg
TID max 600 mg/day
Adults and children older than 12 yr: 10–30 mg q
4–8hr; sustained-release (SR) 60 mg q 12 hr
orally
Children 6–12 yr: 5–10 mg q 4 hr or 15 mg q 6–8
hr; SR 30 mg q 12 hr orally
Children 2–5 yr: 2.5–7.5 mg q
4–8 hr; SR 15 mg q 12 hr orally
 17-4
How do they work?
“Action”
Expectorants are used to thin
out respiratory secretions which
aids in removing them from the
respiratory tract.
What are they used for?
“Indications”
Used to help bring up respiratory
secretions
Adverse reactions
When combined with
antihistamines :
❖ Lightheadedness
❖ Dizziness
❖ Drowsiness
❖ sedation
Generic
guaifenesin
Potassium iodide
Expectorants
contraindications
❖potassium iodide is contraindicated during
Herbal considerations
pregnancy (pregnancy category D). ❖ Eucalyptus is used as an expectorant
and decongestant and is commonly
found as a component in most OTC
products used to treat sinusitis or
Caution
pharyngitis.
❖ Eucalyptus should not be used during
During pregnancy and lactation pregnancy or in children younger than
12.
(guaifenesin is a pregnancy category C
drug and acetylcysteine is a pregnancy
category B drug); in patients with
persistent cough, severe respiratory
insufficiency, or asthma; and in older
adults or debilitated patients. (Ford 318)
Nursing management
❖
❖
Use with caution in the elderly
Encourage the patient to
increase fluid intake to help
Interactions
loosen secretions
❖ Monitor for signs of overdose
“When used with iodine products, lithium ❖ Report fever lasting longer
and other antithyroid drugs may potentiate than one week.
the hypothyroid effects of these drugs.
When potassium-containing medications
and potassium-sparing diuretics are
administered with iodine products, the
patient may experience hyperkalemia,
cardiac arrhythmias, or cardiac arrest.
Thyroid function test results may also be
altered by iodine “,(Ford, 319)
Trade Use Dose
Robitussin Relieves cough associated with Adults and children 12 yr and
respiratory infection and asthma older: 200–400 mg orally q 4 hr
Children 6–12 yr: 100–200 mg q 4
hr orally
Children 2–6 yr: 50–100 mg q 4 hr
sski Symptomatic relief of chronic 300–1000 mg orally after meals
pulmonary disease complicated BID or TID, to 1.5 g oral
by tenacious mucus
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 17-5
How do they work?
“ Action”
An agent which thins out thick
mucus and is usually used to help
relieve respiratory issues, It
dissolves various chemical bonds
within secretions, which lowers
the viscosity of the mucus making
it easier to expectorate.
Why do we give them?
“Indications”
❖ Acute bronchopulmonary
disease (pneumonia,
bronchitis, tracheobronchitis)
❖ Tracheostomy care
❖ Pulmonary complications of
cystic fibrosis
❖ Pulmonary complications
associated with surgery and
during anesthesia
❖ Posttraumatic chest conditions
❖ Atelectasis due to mucous
obstruction
❖ Acetaminophen overdosage
This drug is also used for diagnostic
bronchial studies, such as
bronchograms and bronchial wedge
catheterizations. It is primarily given by
nebulizer but also may be directly
instilled into a tracheostomy to liquefy
(thin) secretions. (Ford 318)
Adverse reactions
When combined with
antihistamines :
❖ Lightheadedness
❖ Dizziness
❖ Drowsiness
❖ sedation
Generic
acetylcystine
Mucolytics
Contraindications
❖ Mucolytics are not recommended for
Herbal considerations
use by patients with asthma.
❖ Eucalyptus is used as an
expectorant and
decongestant and is
commonly found as a
component in most OTC
products used to treat
sinusitis or pharyngitis.
❖ Eucalyptus should not be
used during pregnancy or in
Caution children younger than 12.
During pregnancy and lactation
(guaifenesin is a pregnancy category C
drug and acetylcysteine is a pregnancy
category B drug); in patients with
persistent cough, severe respiratory
insufficiency, or asthma; and in older
adults or debilitated patients. (Ford 318)
Nursing management
❖ Use with caution in the elderly
❖ Encourage the patient to
increase fluid intake to help
loosen secretions
❖ Monitor for signs of overdose
❖ Report fever lasting longer
than one week.
Interactions
❖ There are no known
interactions with these
drugs.
Trade Use Dose
Mucomyst Reduction of viscosity of mucus 1–10 mL of 20% solution by
in acute and chronic nebulization or 2–20 mL of 10%
bronchopulmonary diseases solution q 2–6 hr PRN
and diagnostic bronchial Acetaminophen toxicity: initially
studies, acetaminophen toxicity 140 mg/kg orally, then 70 mg/kg
orally q 4 hr for 17 doses (total)
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