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Chapter 77
Drugs for Allergic Rhinitis, Cough,
and Colds
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Allergic Rhinitis


Inflammatory disorder of the upper airway,
lower airway, and eyes
Symptoms
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

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
Sneezing
Rhinorrhea
Pruritus
Nasal congestion
For some people: Conjunctivitis, sinusitis, and
asthma
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Allergic Rhinitis



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Seasonal and perennial
Triggered by airborne allergens
Allergens bind to immunoglobulin E (Ig E) on
mast cells
Triggers release of inflammatory mediators

Histamine, leukotrienes, prostaglandins
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Classes of Drugs Used for
Allergic Rhinitis

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Glucocorticoids (intranasal)
Antihistamines (oral and intranasal)
Sympathomimetics (oral and intranasal)
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Intranasal Glucocorticoids
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
First choice ‒ most effective for treatment and
prevention of rhinitis
Mild adverse effects



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Drying of nasal mucosa or sore throat
Epistaxis (nosebleed)
Headache
Rarely, systemic effects (adrenal suppression and
slowing of linear pediatric growth)
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Oral Antihistamines
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For allergic rhinitis
Do not reduce nasal congestion
Most effective if taken prophylactically
Should be taken regularly throughout the
allergy season, even when symptoms are
absent, to prevent an initial histamine
receptor activation
Mild adverse effects: Sedation with first
generation (much less with second
generation)
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Intranasal Antihistamines:
Azelastine & Olopatadine
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
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Indicated for allergic rhinitis in adults and in
children over 12 years old
Systemic absorption can be sufficient to
cause somnolence
Nosebleeds
Anticholinergic effects
Unpleasant taste
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Intranasal Cromolyn Sodium
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
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Reduces symptoms by suppressing release
of histamine and other inflammatory
mediators from mast cells
Prophylaxis
Administer before symptoms start
Response develops in 1 to 2 weeks
Minimal adverse reactions: Less than with
any other drug for allergic rhinitis
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Sympathomimetics



Reduce nasal congestion (do not reduce
rhinorrhea, sneezing, or itching)
Activate alpha1-adrenergic receptors on nasal
blood vessels
Adverse effects


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
Rebound congestion
CNS stimulation
Cardiovascular effects and stroke
Abuse
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Sympathomimetics (Oral/Nasal)

Factors in topical administration
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Should not use longer than 5 consecutive days
Drops or sprays
Comparison: Drops versus sprays
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Topical agents act more quickly than oral agents
and are usually more effective
Oral agents act longer than topical preparations
Systemic effects occur primarily with oral agents;
topical agents usually elicit these responses only
when dosage is higher than recommended
Rebound congestion is common with prolonged
use of topical agents but rare with oral agents
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Sympathomimetics (Oral/Nasal)


Phenylephrine, ephedrine, pseudoephedrine
Antihistamine-sympathomimetic combinations
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

Ipratropium bromide [Atrovent]
Montelukast [Singulair]
Omalizumab [Xolair]
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Drugs for Cough

Antitussives
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
Drugs that suppress cough
Opioid antitussives
•

Codeine and hydrocodone
Nonopioid antitussives
•
•
•
Dextromethorphan
Diphenhydramine
Benzonatate
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Expectorants

Guaifenesin [Mucinex, Humibid]


Renders cough more productive by stimulating
flow of respiratory tract secretions
Higher doses may be effective
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Mucolytics
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

Hypertonic saline
Acetylcysteine
Mucolytics react directly with mucus to make
it more watery


High sulfur content, “rotten egg” smell
Can trigger bronchospasm
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Common Cold
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Acute upper respiratory viral infection
Rhinorrhea, nasal congestion, cough,
sneezing, sore throat, headache, hoarseness,
malaise, myalgia
Fever common in kids, rare in adults
Self-limited, usually benign
No cure; just treatment of symptoms
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Over-the-Counter (OTC)
Cold Remedies

Combination cold remedies usually contain
two or more of the following:





Nasal decongestant
Antitussive
Analgesic
Antihistamine (for cholinergic actions)
Caffeine (to offset effect of antihistamine)
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Pediatric OTC Cold Remedies

Use with caution in young children

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Avoid OTC cold remedies in children younger than 4
to 6 years
Use only products labeled for pediatric use
Consult a health care professional before giving
these drugs to a child
Read all product safety information before dosing
Use the measuring device provided with the product
Discontinue the medicine and seek professional care
if the child’s condition worsens or fails to improve
Avoid using antihistamine-containing products to
sedate children
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Question 1
A patient asks what medication would be most effective in the
treatment of seasonal hay fever. The nurse will teach the patient
about the use of which drug?
A.
B.
C.
D.
Azelastine [Astelin]
Chlorpheniramine [Chlor-Trimeton]
Fluticasone [Flonase)
Pseudoephedrine [Sudafed]
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Question 2
A patient is prescribed codeine as an antitussive. Which symptom
will the nurse observe for as an adverse effect of this medication?
A.
B.
C.
D.
Respiratory depression
Increased heart rate
Productive cough
Restlessness
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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