Drus Used in the Upper Respiratory System | NURS211

what is rhinitis?

inflammation and swelling of the mucous membrane in the nose - mucuous membranes of the noses and pharynx swell and increase secretion or mucous production

what is sinusitis?

inflammation of the sinus

what is pharyngitis?

inflammation of the pharynx

what is laryngitis?

inflammation of the larynx

what does the H1 receptors of histamine do (physiology)? what are the sign and symptoms if this receptor where to be activated?

a histamine receptor primarily involved in allergic responses like inflammation, broncoconstriction, increased vascular permeability by dilating the blood vessel, and increased secretion

• signs and symptoms can varies but some can be itchy skin, hives, sneezing, runny nose, nasal congestion, flusing

• physiology → dilate the blood vessels → increased blood flow → lower blood pressure → increased heart rate (tachycardia)

what does the H2 receptors of histamine do (physiology)? what are the sign and symptoms if this receptor where to be activated?

a histamine receptor primarily involved in stimulating gastric secretion, stimulate the heart, and (while less signifcant than H1) also vasodilates

• signs and symptoms can varies but some can be increased gastric acid secretion leading to epigastric pain/burning sensation, increased heart rate and force of contraction, or flushing and milkd drop in blood pressure due to the vasodilation

• physiology → increase gastric acid secretion & heart rate + contractility

true or false: antihistamine does not prevent the release of histamine but rather it reduces the symptoms by preventing histamine (most of them) from binding to the H1 receptor

true

antihistamine is also known as what?

H1-receptor antagonist

why does the capillaries become permeable during inflammation when H1 receptor is activated?

the endothelial cells contract, creating gaps → gluid, proteins, and immune cells leak into tissues → deliver immune fenses to the site of injury → causes swelling, redness, and heat

what is the main purpose of antihistamines (H1-receptor antagonist)? are there unwanted side effect?

to reduce symptoms of nasal itching, sneezing, rhinorrhea, lacrimation, and conjunctival itching

• does not reduce nasal congestion - because since the nasal congestion is mainly cause by blood vessel dilation, antihistamine causes vessel dilation too so it won’t work

• can cause unwanted side effects → anticholinergic effects - (occur when the parasympathetic nervous system is blocked) - dilated pupil, dry mouth, thickned secretion, bronchodilation, increased heart rate, decreased motility, urinary retention, drowsiness, confusion)

what is the first-generation antihistamine and what is its functions?

1. impact the histamine receptor int the brain and spinal cord because it is able to cross BBB

   → causes CNS sedation, drowsiness, strong anticholinergic effect (dry mouth, urinary retention, blurred vision, constipation)

   → shorter duration - multiple daily doses needed

   → used for allergies, motion sickness, insomnia, anaphyxis adjunct

2. example - Diphendramine (Benadryl), chlorpheniramine (Chlor-Trimeton), brompheniramine (Dimetapp)

3. often ends in amine

what is the second-generation antihistamine and what is it functions?

1. do not cross the BBB, so no CNS effect (minimal sedation)

   → still effective for allergic rhinitis, urticaria, but less useful for motion sickness/insomnia

   → fewer anticholinergic effects

2. examples - cetirizine (Zyrtec), levocetirizine (Xyzal), loratadine (Claritin)

3. often ends in irizine except for loratadine

what is the third-generation antihistamine and what is its functions?

1. do not cross the BBB and even more selective than the second-generation

   → virtually non-sedating and minimal side effects

   → some decongestant properties

2. example fexofendadine (Allergra), desloratadine (Clarinex)

3. often ends in adine!!!

does the first, second, or third generation of antihistamine cross the BBB?

the first generation histamine receptor

what is the main differences between the first, second, and third-generation antihistamine?

• 1st gen = “Sleepy & Dry” (sedation + anticholinergic).

• 2nd gen = “Clear-headed, long-lasting.”

• 3rd gen = “Cleanest, safest, longest.”

what is anticholinergic medications?

medications that block action of acetylcholine

• muscarinic - blocks muscarinic receptors

• anticotinics - blocks nicotinic receptors

what are the conditions that anticholinergic medication are use for? why?

1. (antimuscarinic) overactive bladder syndrome - blocks the parasympathetic effects (since the bladder contract when the parasympathetic system is activated, blocking PsNS will allow the bladder to relax)

2. (antimuscarinic) irritable bowel syndrome - allows the gut to slow down because the bowel would increase in motility when relax so it prevent the body from relaxing

3. (antimuscarinic) bradycardia - blocking the PsNS to allow the heart to speed up

4. (antinicotinics) smoking cessation - partial agonist at the neuronal nicotinic receptor to reduce cravings and withdrawl by giving some stimulation byt blocking nictone from fully activating the receptor

5. muscle relaxation in anesthesia - since nictonic receptor at the neuromuscular junction mediate skeletal muscle contraction - this one prevents it!

6. depression - some research suggst blocking certain nicotinic receptors may help in treatment-resistant depression by balacing the neurotransmitter circuits

what is the purpose of acetylcholine?

1. voluntary muscle movement

2. memory

3. thinking

4. learning

what is the anticholinergic effects?

1. dry mouth

2. sore throat

3. tachycardia

4. urinary retention

5. obstipation (severe form of constipation)

6. visual & neurological disturbances

what is the MOA, indications, drug interactions, food interactions, and adverse effects of diphenhydramine (Benadryl)?

1. antagonizes H1 receptor sites

2. indications: rhinitis, allergy sx, motion sickness, sleep aid

3. drug interactions: CNS depressants, MAO inhibitors

4. food interactions: alcohol

5. adverse: drowsiness, dizziness, confusion, hypotension, dry mouth, urinary retention

which generation of histamine is Benadryl (Diphenhydramine)?

first

what is the MOA, indications, drug interactions, food interactions, and adverse effects of loratadine (Claritin)?

1. MOA: blocks effects of histamine at receptor sites (H1 receptor antagonist)

2. indications: allergic rhinitis, urticaria relief, itching

3. drug interactions: ketoconzazole

4. food interactions: alcohol

5. adverse: HA, some drowsiness, some sedation, fatigue, insomnia, nervousness, dry mouth

which generation is loratadine (Claritin)?

second generation - so it does not cross the BBB thus causing minimal sedation compaed to diphehydramine

what is one food interaction that is common across most-all antihistamine?

alcohol?

what is the MOA, indications, drug interactions, food interactions, and adverse effects of fexofenadine (Allegra)?

1. inhibits H1 receptors

2. indications: seasonal allergies, chronic urticaria

3. drug interactions: antacids, ertyhromycin, ketoconazole, rifampin

4. food interactions: alcohol, fruit juice

5. adverse: fatigue, HA (headache), fever, dizziness, insomnia, otitis media (not really???), rhinorrhea (huh???), abdominal pain

which generation of antihistamine is fexofenadine?

third-generation (according to the prof and some sources but some othe sources say it is second generation)

can exceeding recommended dose for antihistamine causes heart complications, seizures, and unconsciousness? why?

YES!

1. heart complication - some antihistamine can block cardiac potassium channels (hERG/K+ channels) - disrupt normal repolarization of the heart → QT prolongation → arrythmias → cardiac arrest

2. seizures (CNS hyperexciteability) - much more common with 1st-gen but not exclusive - at toxic levels, they don’t just block H1 receptors, they also interfere with sodium and potassium channel channels in the brain → channel blockade causes erratic firing → causes neuronal hyperexciteability

3. unconsciouness - high doses can cause severe CNS depression after initial excitation due to anticholinergic overload (blocking too much acetylcholine in the brain and sedative properties)

which generation of antihistamine blocks both histamine (H1) and acetylcholine (muscarinic) receptors significantly leading to also antiholinergic effects?

1st generation

what should the patient do if the patient start taking antihistamine and the symptoms last for more than 1 week, worsen, or accompanied with other symptoms?

call HCP!

true or false: antihistamine may be contraindicated in pregnancy or breastfeeding?

yes!

why should the nurse monitor a patient secretion viscosity when the patient is taking antihistamine?

because since antihistamine block H1 receptor and muscarinic receptor (for 1st-gen), this decrease in parasymphatetic stimulation causes decreased in watery secretion, which causes the secretion more thick

what is decongestant, its functions, and side effects?

1. sympathomimetic drugs (mimic the sympathetic nervous system) - a1-adrenergic receptor agonist

2. stimulate the adrenaline receptors in the nasal mucous membranes to cause vasoconstriction → less swelling, less fluid leakage and less thickening of nasal lining → better airflow

3. if systemic decongestant (does not apply if nasal) - systemic vasconstriction leading to increase blood pressure which can lead to tachycardia, palpitations, jitteriness - increased CNS stimulation leading to insomnia, anxiety, restlessness, rebound congestion with prolonged intranasal use

who should avoid and what should be avoided if taking decongestants

1. those with heart problem, glaucoma, hyperthyridism, should avoid systemic decongestant

2. if taking systemic decogestion (pseudoephedrine), avoid caffeine!!!

does nasal drops or spray cause systemic decongestant?

NO! it is considered topically and is limited to the nasal lining!

what is the MOA, indications, drug interactions, food interactions, and adverse effects of phenylephrine (sudafed PE)?

1. MOA: alpha-1 adrenergic agonist (stimulate the adrenaline receptor)

2. indications: hypotension, facilitation of mydriasis, nasal congestion, hemorrhoids (causes vasocontrisction, thrink hemorroidal blood vessels and reduces sweeling and irritation)

3. drug interactions: lot s of cardiac medication, MAO inhibitor (blocking the enzyme monoamine oxidase), antipsychotics, alpha-1 adrenergic antagonist

4. food interactions: caffeine

5. adverse, nausea, vomiting, headache (HA), nervousness, cardiac complications

what should the nurse consider when administering decongestant for patient? why?

1. use sparingly if hypertensive or cardiac because the medications would raises blood pressure and increases cardiac workload, straining an already weakened heart

2. take history re: thyroid issues, glaucoma, renal impairment or urinary voiding issues because

   a. Thyroid issues (esp. hyperthyroidism):
   Already ↑ metabolism, ↑ heart rate, ↑ BP → decongestants can worsen tachycardia, palpitations, arrhythmias.

   b. Glaucoma (esp. narrow-angle):
   α₁ stimulation → mydriasis (pupil dilation) → increases intraocular pressure → may trigger an acute glaucoma attack.

   c. Renal impairment:
   Decongestants are partly excreted by kidneys → accumulation can ↑ risk of toxicity, BP elevation, arrhythmias.

   d. Urinary retention / BPH (benign prostatic hyperplasia):
   α₁ stimulation contracts smooth muscle of bladder neck/prostate → worsens urinary retention.

3. encourage the patient ot increase fluid intake so the drug can be broken down effectively

4. decongestant is not safe for children under 6!

true or false: decongestant is not safe for children under 6

true

what is antitussives, its functions, and side effects (for both central-acting & peripheral-acting)?

1. AKA cough suppressant

2. act on the cough center in the medulla oblongata of the brainstem (codeine) μ-opioid receptor agonist → depresses neuronal activity in the medullary cough center & (detromethorphan) NMDA receptor antagonist → suppresses the cough reflex.

   → some can also act peripherally - anesthetize stretch receptors in the respiratory tract

3. side effects

   → central-acting: CNS effect (drowsiness, dizziness, sedation), N, V, constipation, respiratory depression, potentiual abuse (coedine is an opioid)

   → peripheral-acting: dizziness, nausea, sedation, oral numbness

is antitussives recommended for productive cough?

NO! because if the patient is having productive cough, their body is trying to get rid of whatever is irritating their airway so we shouldn’t be stopping that!

review the opioid and nonopioid antitussives?

1. opioid: codeine

2. nonopioid: benzonatate, dextromethorphan

what are the central acting antitussive we learned in this class?

coedine and dexmothorphan

what is the peripheral acting expectorant we learned in this class?

guiafenesin - acting on the respiratory tract - increases hydration of respiratory secretions (make mucus thinner and easier to expel) → stimulate respiratory tract secretory gland - basically an expectorant to stimulate cough

what is the peripheral acting suppressants we learned in this class?

benzonatate - acting on the lungs, bronchi and airways - anesthesizes stretch receptor (mechanoreceptors) - reduces sneosry input to the medullary cough center → suppress the cough reflex

what is the MOA, indications, drug interactions, food interactions, and adverse effects of codeine?

1. MOA: acts on the cough center in the medulla to suppress the cough reflex

2. indications: nonproductive or chronic cough

3. drug interactions: CNS depressants, serotonergic drugs, St. John’s wort

4. food interaction: alcohol

5. adverse effects: drowsiness, dizziness, confusion, hypotension, respiratory depression, constipation

what is the MOA, indications, drug interactions, food interactions, and adverse effects of guaifenesin?

1. MOA: increases hydration of respiratory tract secretions, decreases mucous viscosity (make mucus thinner and easier to expel with coughing), promotes productive coughs (help clear airways!)

2. indications: relief productive cough associated with common cold, bronchitis, influenza, other respiratory infections with thick mucus

3. drug interactions: CNS depressant if guaifenesin is already a combination product in the medication → may increase the risk of kidney stones if combined with calcium supplements

4. food interactions: no major food interactions

5. adverse effects: may cause GI upset, drowsiness, dizziness, headache, rash, and in large doses: kidney stones

what is the MOA, indications, drug interactions, food interactions, and adverse effects of dextromethorphan (Robitussin)?

1. MOA: acts on the cough center in the medulla to suppress the cough reflex

2. indications: nonproductive cough

3. drug interactions: MAOIs (blocking the enzyme monoamine oxidase)

4. food interactions: grapefruit juice

5. adverse effects: drowsiness, dizziness, confusion, nausea, vomitting

what is the one food item that interact with a lot of different medications?

grapefruit juice

what is expectorants and mucolytics, their functions, and side effects?

1. class of drugs that help clear mucus from airways when coughing

2. can be stand-alone or part of a combination drug

3. should be used with productive cough

   → expectorant thin the mucus and mucolytics directly break down the structure of mucus by breaking its protein bonds

4. expectorant: GI upset, dizziness, headache | mucolytics: N, V, upset stomach, bronchospasm, dizziness, drowsiness

what is the MOA, indication, drug interaction, food interaction, and side effects of acetylcyteine (Mucomyst)?

1. MOA: breaks disulfide bonds in mucus glycoproteins → decreases mucus viscosity → make it easier to clear via coughing

2. indications: COPH, cystic fibrosis, pnuemonia, bronchitis - those conditions that produces thick, tenacious mucus (can be used for acetaminephen overdose)

3. drug interaction: nitrglycerin, activated charcoal, broncodilation

4. food interaction: no major food interactions

5. side effects: bronchospasm, cough, chest tightness, N, V, D, dizziness, drowsiness, unpleasant odor taste (rotten eggs)

can you give acetylcysteine (Mucomyst) to patient with heart burn and acid reflex?

No because increasing the amount of cough can bring acid up the GI tract, worsening acid reflex and heart burn

what is the patient safety, nursing consideration, and patient teaching point of diphenhydramine (Benadryl)?

1. patient safety: (1st-gen) causes sedation, dizziness, confusion (increased fall risk, especially int the elderly) → antichlonergic effects (dry mouth → increase oral care, urinary retention, and constipation)

2. nursing considerations: avoid in eldelry due to Beers Criteria; monitor for dorwisness and urinary retention → Implement fall precautions (side rails, call light, assist with ambulation). → Encourage fluids, high-fiber diet, and scheduled toileting for constipation/urinary retention.

1. teaching point: avoid alcohol or driving, rise slowly to avoid falls, increase fluids/fiber for constipation, and don’t use for more than 1 weeks for colds

what is the patient safety, nursing consideration, and patient teaching point of loratadine (Claritin)?

1. patient safety: (2nd-gen) less sedation than diphenhydramine, but still possible

2. nursing consideration: monitor for headache, mild drowsiness → safer for the elderly

3. teaching point: take once daily, avoid alcohol, report persistent allergy (for more than one week) or asthma symptoms

what is the patient safety, nursing consideration, and patient teaching points of fexofenadine (Allergra)?

1. patient safety: 2nd-gen - non-sedating, but dizziness and headache may occur

2. nursing considerations: avoid fruit juices (reduce absorption) and alcohol (may intensify the affects of dizziness and headache)

3. teaching points: take with water only; avoid alcohol; works best for allergy prevention when taken regularly

what is the patient safety, nursing consideration, and patient teaching point of phenylephrine (Sudafed PE)?

1. patient safety (alpha-adrenergic agonist): can increase blood pressure and heart rate → unsafe in unctorlled hypertension, arrhythmia, and glaucoma → the nursing need to take note if the patient have hyperthyroidism (worsen already increased metabolism, tachycardia and hypertension) and renal impairement (causes the drug to accumdulate and increasing risk for hypertension and vasoconstriction)

2. nursing consideration: monitor vital signs, especially in cardiac patient

→ Monitor BP/HR; encourage rest and relaxation techniques for tachycardia.

• Fall precautions if dizzy; cluster care to allow sleep.

• Encourage fluids, humidifier use, sugar-free lozenges for dryness.

1. teaching points: limit the use to less than 3-5 times a week for cardiac patient but patient with diabetes, thyroid or renal problems should talkt to their provider before using → patient should increase fluid intake when taking this medication

true or false: patient that are taking decongestants should increase their fluid intake unless contraindicated (e.g., CHF, renal failure)

true

what are the patient safety, nursing consideration, and patient teaching point for codeine (Opioid antitussive) ?

1. patient safety: potential respiratoey depression, drowsiness, constipation, and addiction potential

2. nursing consideration: monitor respiration rate and sedation; fall risk; assess bowel functions; and it is considered to be a controlled substance

→ Monitor RR, hold if <12/min; provide fall precautions.

→ Encourage fluids, fiber, stool softeners for constipation.

1. teaching pointsL avoid alcohol/other CNS depressants → patient on codeine should increase their fiber/fluis for constipation and that they should not drive and should only use the medication are short-tern non-productive cough

what is the patient safety, nursing considerations/interventions, and patient teaching points of Dextromethorphan (Robitussin DM - non-opioid antitussive) ?

• patient Safety: May cause drowsiness, dizziness, nausea; risk of misuse/abuse in high doses (esp. adolescents).

• nursing Considerations/Interventions:

  • Implement fall precautions (assist with ambulation, call light within reach).

  • Monitor for misuse or frequent requests for refills.

• teaching Points:

  • Avoid alcohol, sedatives, or driving until effects are known.

  • Do not exceed recommended dose.

  • Report cough lasting >1 week or cough with fever (may indicate infection).

what are the patient safety, nursing considerations/intervention, and patient teaching point for acetylcysteine (Mucomust)?

• Patient Safety: Can cause bronchospasm, nausea/vomiting; has a strong sulfur “rotten egg” odor that may trigger gagging.

• Nursing Considerations/Interventions:

  • Keep suction equipment available (liquefies secretions quickly).

  • Monitor airway, breath sounds, and oxygenation during and after administration.

  • Give with antiemetic if needed to reduce nausea.

• Teaching Points:

  • Warn patient about the unpleasant odor but reassure it is normal.

  • Encourage coughing and deep breathing to clear mucus.

  • Report worsening shortness of breath immediately.

which antihistamine make patients sleepy and increases fall risk?

diphenhydramine (Benadryl, 1st gen)

which antihistamines are safer for datime use and elderly patients?

loratadine, fexofenadine (2nd gen, non-sedating/less sedating)

which decongestant can raise blood pressure, cause rebound congestion if more than 3 days, and worsen prostate problems?

phenylephrine

which antitussive is strongest but causes respiratory depression, constipation, and sedation?

codeine (opioid)

which drug thins mucus and works best with water?

guaifenesin (Mucinex)

whcih mucolytic breaks up mucus, smells like rotten eggs, and may cause bronchospasm?

acetylcysteine (Mucomyst)

a 72-year-old patient with seasonal allergies reports difficulty sleeping and asks if they can take diphenhydramine (Benadryl). Which nursing response is most appropriate?

A. “Yes, it’s safe to take at bedtime since it will help you sleep.”
B. “No, diphenhydramine is not effective for allergies.”
C. “Diphenhydramine may cause confusion and increase your risk of falls; a non-sedating antihistamine would be safer.”
D. “Take diphenhydramine during the day, and it should not cause drowsiness.”

✅ Answer: C
Rationale: In elderly patients, 1st-generation antihistamines (like diphenhydramine) cause sedation, confusion, and increase fall risk. Safer options are loratadine or fexofenadine.

a patient with hypertension is prescribed phenylephrine nasal spray for congestion. Which action should the nurse take?

A. Teach the patient to use the spray for up to 5 days.
B. Advise the patient that phenylephrine may increase blood pressure.
C. Instruct the patient to increase fluid intake to prevent rebound congestion.
D. Recommend doubling the dose if congestion persists.

✅ Answer: B
Rationale: Phenylephrine causes vasoconstriction → ↑ BP. This is dangerous in hypertension. Limit spray to ≤3 days to prevent rebound congestion.

A patient with a persistent, nonproductive cough is prescribed codeine. Which nursing intervention is most important?

A. Encourage increased fluid intake.
B. Monitor respiratory rate and level of sedation.
C. Administer the dose only at night.
D. Remind the patient to take with food.

✅ Answer: B
Rationale: Codeine suppresses the cough reflex but can cause respiratory depression and sedation. The priority is safety—monitor RR and LOC

The nurse is educating a teenager with a dry cough about dextromethorphan (OTC). Which teaching is most important?

A. “This medication is safe for long-term use.”
B. “Avoid alcohol while taking this drug.”
C. “You can double the dose if your cough doesn’t improve.”
D. “It’s okay to share this medication with friends who also have a cough.”

✅ Answer: B
Rationale: Dextromethorphan can cause CNS depression and is sometimes abused (“robo-tripping”), especially in teens. Alcohol increases CNS effects.

A patient is prescribed guaifenesin (Mucinex). Which statement by the patient indicates correct understanding?

A. “I’ll take this medication and avoid drinking fluids so my cough isn’t worse.”
B. “This medication will help loosen mucus if I drink plenty of water.”
C. “I can stop coughing completely after taking this drug.”
D. “This medication will dry up my nasal secretions.”

✅ Answer: C
Rationale: Guaifenesin thins mucus to make coughs more productive. Fluids are needed for it to work. It does not stop coughing.

A patient with cystic fibrosis is prescribed acetylcysteine (Mucomyst) via nebulizer. Which nursing intervention is a priority?

A. Administer a sedative before giving the drug.
B. Keep suction equipment nearby during administration.
C. Teach the patient to avoid coughing after treatment.
D. Warn the patient that the medication has a sweet taste.

✅ Answer: B
Rationale: Acetylcysteine liquefies secretions quickly, which can cause coughing and potential airway obstruction. Suction equipment must be available.

when are expectorant used and when are mucolytic used?

1. expectorant (e.g., guaifenesin - Mucinex) - helps the patient cough it UP! for patients with a productive cough but the mucus is too thick/sticky to clear up easily

2. mucolytic (e.g., acetylcysteiene - Mucomyst) - help the patient break the mucus DOWN! for patients with very thick, tenacious mucus that even a productive cough can’t clear (usually for conditions like cystic fibrosis or really severe pneumonia or chronic bronchitis)

what are the one side effects of mucolytics that can be extremely dangerous?

bronchospasm - so sunction and monitoring airway are big safety point when administering this medication for patient

The patient in the scenario, who has been taking Vicks Sinex for allergies, asks the nurse about the frequent upper respiratory symptoms that have been experienced lately. The nurse responds with which appropriate statement?

1. “The medications you are taking can cause a worsening of your symptoms before they will start to improve.”

2. “If you use that medication for longer than a few days, you may get a rebound of the symptoms you are using it for.”

3. “Apparently, you are not taking your medication the proper way or your symptoms would be improving.”

4. “I will let your healthcare provider know about this adverse effect that we may have to hospitalize you for.”

2. “If you use that medication for longer than a few days, you may get a rebound of the symptoms you are using it for.”

The nurse is teaching the patient in the scenario who recently started an antihistamine. Which statement by the patient indicates that further teaching is needed?

1. “I should drink 8 to 10 glasses of water every day while taking this medication.”

2. “If my vision starts to blur, I will need to call my doctor.”

3. “I can suck on candy or chew gum when my mouth gets dry from this drug.”

4. “I will be able to drive without any problem because I will know when I am impaired.”

4. “I will be able to drive without any problem because I will know when I am impaired.”

The patient in the scenario is inquiring about decongestants and asks the nurse to explain the common and serious adverse effects. Which statement by the nurse is correct?

1. “Topical aerosol products are highly effective in reducing sneezing and nasal itching, but just remember they are for a long period of time only.”

2. “This drug prevents histamine from being released so you will not have allergic rhinitis. Make sure to blow your nose before spraying the medicine in your nose and watch for coughing.”

3. “This drug will reduce your nasal congestion, but keep in mind it may cause urinary retention and sometimes elevate your blood pressure.”

4. “This drug will not stop the nasal congestion but will reduce the runny nose and runny eyes and itching that you have. These types of drugs may cause drowsiness, so do not drive or operate heavy equipment while taking this.”

3. “This drug will reduce your nasal congestion, but keep in mind it may cause urinary retention and sometimes elevate your blood pressure.”

The nurse knows that intranasal corticosteroids are used to treat seasonal allergies and explains to the patient that which of the following needs to be done before application? (Select all that apply.)

1. Rinse mouth before application.

2. Blow nose before application.

3. Suck on hard candy or ice chips before application.

4. Drink 8 ounces of water before application.

5. Use decongestant before use if nasal passages are blocked.

6. Spray both nostrils with 1 to 2 sprays once a day as prescribed.

2. Blow nose before application.

5. Use decongestant before use if nasal passages are blocked.

6. Spray both nostrils with 1 to 2 sprays once a day as prescribed.

Before initiating decongestant medications, the nurse knows that the patient’s history should be checked for which of the following medical conditions in which these medications should be used with caution? (Select all that apply.)

1. Prostatic hyperplasia

2. Hypothyroidism

3. Glaucoma

4. Hypertension

5. Asthma

1. prostatic hyperplasia (urinary retention)

2. glaucoma

3. hypertension