pharm week 5 w/o study guide

What do H₁ antihistamines treat?

Allergic rhinitis symptoms (sneezing + itching + rhinorrhea).

How do H₁ antihistamines work?

Block H₁ receptors → prevent histamine effects.

When are antihistamines most effective?

Taken before allergen exposure + regularly during allergy season.

Which drugs are first-generation antihistamines?

Diphenhydramine (Benadryl) + chlorpheniramine (Chlor-Trimeton).

Why do first-generation antihistamines cause sedation?

Cross the blood-brain barrier → block CNS H₁ receptors.

What adverse effects occur with first-generation antihistamines?

Sedation + dizziness + anticholinergic effects (dry mouth

What mnemonic identifies anticholinergic effects?

“Can’t see

Which drugs are second-generation antihistamines?

Loratadine (Claritin) + cetirizine (Zyrtec).

Which second-generation antihistamine may still cause drowsiness?

Cetirizine (Zyrtec).

Which drugs are third-generation antihistamines in the slides?

Fexofenadine (Allegra) + desloratadine (Clarinex).

How do antihistamine generations compare?

First = most sedation; second = less sedation; third = minimal sedation + more selective.

Why are newer antihistamines usually preferred?

Less CNS penetration → less sedation + fewer anticholinergic effects.

Which antihistamine is preferred for daytime allergy relief?

Loratadine or fexofenadine because they cause minimal sedation.

A patient takes diphenhydramine. What teaching is priority?

Avoid driving + alcohol/CNS depressants because sedation can occur.

Which patient requires caution with diphenhydramine?

Older adult with glaucoma, urinary retention, or constipation.

A patient taking diphenhydramine cannot urinate. What should the nurse do?

Hold the drug + notify the provider (anticholinergic urinary retention).

What paradoxical effect can antihistamines cause?

CNS excitement/restlessness, especially in some children.

Which patients require caution with antihistamines?

Young children + older adults + patients worsened by anticholinergic effects.

According to the slides, when are antihistamines contraindicated?

Third-trimester pregnancy + breastfeeding + newborn infants.

What does “-D” in Claritin-D or Allegra-D mean?

Contains pseudoephedrine decongestant → may ↑ BP/HR.

A patient with hypertension asks for Claritin-D. What should the nurse recognize?

Pseudoephedrine can ↑ BP → use only with provider approval.

What is the antihistamine-generation mnemonic?

“First makes you fall asleep; second/third stay alert.”

What is the “-D” mnemonic?

“D = decongestant that drives BP up.”

How do decongestants work?

Stimulate α₁ receptors → nasal vasoconstriction → ↓ swelling/congestion.

Which drugs are oral decongestants?

Pseudoephedrine (Sudafed) + phenylephrine (Sudafed PE).

Which drugs are topical nasal decongestants?

Oxymetazoline (Afrin) + phenylephrine (Neo-Synephrine) + naphazoline (Privine).

What adverse effects occur with oral decongestants?

Nervousness + insomnia + tachycardia + hypertension.

Which patient should avoid decongestants?

Patient with uncontrolled hypertension or cardiovascular disease.

Why should an oral decongestant be taken early in the day?

CNS stimulation may cause insomnia.

What is rhinitis medicamentosa?

Rebound congestion caused by prolonged topical decongestant use.

A patient has worse congestion after using oxymetazoline for 8 days. What is the cause?

Rhinitis medicamentosa (rebound congestion).

How long should topical decongestants be used according to the slides?

No longer than 5 consecutive days.

How do topical and oral decongestants compare?

Topical = faster + more local effect; oral = longer acting + more systemic effects.

What is the topical-decongestant mnemonic?

“Five days

What is the first-choice drug class for allergic rhinitis?

Intranasal glucocorticoids.

Which intranasal glucocorticoids are listed?

Fluticasone (Flonase) + mometasone (Nasonex) + triamcinolone (Nasacort).

How do intranasal glucocorticoids relieve allergies?

↓ local nasal inflammation → ↓ congestion.

What adverse effects occur with intranasal glucocorticoids?

Dry nasal mucosa + sore throat + headache + epistaxis.

What rare systemic effects can intranasal glucocorticoids cause?

Adrenal suppression + slowed growth in children.

What is the intranasal-steroid mnemonic?

“Spray for swelling; watch for bleeding.”

How does intranasal cromolyn work?

Stabilizes mast cells → prevents histamine + inflammatory-mediator release.

When should intranasal cromolyn be started?

Before allergen exposure/symptoms; full response takes 1–2 weeks.

Can cromolyn provide immediate allergy relief?

No → it is preventive.

What is a major advantage of cromolyn?

Minimal adverse effects.

What is the cromolyn mnemonic?

“Cromolyn comes before symptoms.”

What is an antitussive?

Drug that decreases the intensity + frequency of coughing.

When is an antitussive appropriate?

Dry, irritating, nonproductive cough that interferes with rest.

Why should a productive cough not always be suppressed?

Coughing removes mucus; suppression can cause secretion retention.

How do centrally acting antitussives work?

Suppress the cough center in the medulla.

Which antitussives are opioids?

Codeine + hydrocodone.

How does codeine suppress coughing?

Activates μ-opioid receptors → suppresses the medullary cough center.

What must the nurse assess before giving codeine?

Respiratory rate + level of consciousness.

A patient taking codeine has an RR of 8/min. What is the priority action?

Hold the drug + notify the provider (respiratory depression).

What adverse effects occur with opioid antitussives?

Sedation + respiratory depression + constipation + misuse/dependence.

What teaching is important for codeine?

Avoid alcohol/driving + report excessive sedation or difficulty breathing.

What is the opioid-antitussive mnemonic?

“Codeine calms cough—and breathing.”

Which antitussives are nonopioids?

Dextromethorphan + benzonatate + diphenhydramine.

How does dextromethorphan work?

Suppresses the CNS cough reflex.

What serious interaction can occur with dextromethorphan?

Other serotonergic drugs may cause serotonin syndrome.

What findings suggest serotonin syndrome?

Agitation + sweating + fever + diarrhea + tremor/hyperreflexia.

What is the serotonin-syndrome mnemonic?

“Hot + sweaty + shaky + agitated.”

How does benzonatate work?

Anesthetizes respiratory stretch receptors → ↓ cough reflex.

What is the priority teaching for benzonatate?

Swallow whole; never chew, crush, or dissolve.

Why must benzonatate remain intact?

Mouth/throat numbness can impair swallowing → choking/aspiration.

A patient chews benzonatate and develops mouth numbness. What is the priority concern?

Aspiration from impaired swallowing.

What is the benzonatate mnemonic?

“Tessalon Perles stay pearls—swallow whole.”

Why can diphenhydramine suppress coughing?

Sedative + anticholinergic effects decrease the cough response.

Are OTC cough/cold drugs recommended for children under 6 according to the slides?

No → limited benefit + risk for serious adverse reactions.

What is an expectorant?

Drug that thins secretions → makes mucus easier to cough up.

What is the prototype expectorant?

Guaifenesin (Mucinex/Robitussin).

How does guaifenesin work?

↓ mucus viscosity → secretions are easier to remove.

What teaching improves guaifenesin’s effect?

Increase fluids if allowed → helps thin mucus.

How does the nurse know guaifenesin worked?

Cough becomes more productive + mucus is easier to clear.

What is the guaifenesin mnemonic?

“Guaifenesin gets mucus going.”

What is a mucolytic?

Drug that breaks mucus proteins into smaller strands → makes mucus more watery.

What is the prototype mucolytic?

Acetylcysteine.

What are the major uses of acetylcysteine?

Thick respiratory mucus + cystic fibrosis + acetaminophen toxicity.

What odor should the nurse expect with acetylcysteine?

Sulfur-like “rotten egg” odor; this is expected.

A patient refuses acetylcysteine because of its odor. What should the nurse explain?

The sulfur odor is expected and does not mean the drug is spoiled.

What is the acetylcysteine mnemonic?

“Acetylcysteine clears mucus + counters acetaminophen.”

How do β₂ agonists improve breathing?

Stimulate β₂ receptors → relax bronchial smooth muscle → bronchodilation.

What is the prototype SABA?

Albuterol.

What is albuterol used for?

Rapid relief of acute bronchospasm + prevention of exercise-induced bronchospasm.

How quickly does albuterol work?

Within 5 minutes or less.

How long does albuterol last?

About 4–6 hours.

What adverse effects occur with albuterol?

Tremor + nervousness + tachycardia + headache.

What serious effects can albuterol cause?

Chest pain + dysrhythmias + myocardial ischemia.

Which patient requires caution with albuterol?

Patient with cardiac disease or hypertension.

What should the nurse assess before and after albuterol?

HR/BP + lung sounds + work of breathing + oxygen saturation.

A patient develops sudden wheezing. Which inhaler should be used?

Albuterol (rescue bronchodilator).

Which finding shows albuterol was effective?

↓ wheezing/work of breathing + improved airflow.

A patient has tremors and tachycardia after albuterol. What do these findings mean?

Expected β₂-agonist effects; assess severity + HR.

What does frequent albuterol use indicate?

Poor disease control → controller therapy may need adjustment.

What is the albuterol mnemonic?

“Albuterol acts ASAP.”

LABAs?

Long-Acting Beta2 Agonists

Which medications are LABAs?

Salmeterol + formoterol + arformoterol.

What is the purpose of LABAs?

Long-term bronchodilation for maintenance.

Can a LABA treat sudden bronchospasm?

No → use a SABA such as albuterol.

How are LABAs used for persistent asthma?

With an inhaled corticosteroid (ICS).

What adverse effects occur with LABAs?

Tremor + anxiety + insomnia + ↑ HR/BP.