Summary Pharmacology Exam 2- NURS 3502- NCLEX RN

PHARMACOLOGY EXAM 2- NURS 3502-STUDY GUIDE

CHAPTER 38 – ANTIHISTAMINES, GLUCOCORTICOIDS, AND RELATED
MEDICATIONS
Advantages of Second-Generation vs First-Generation Antihistamines
 Antihistamines are H1 receptor blockers (antagonists) used primarily for treating allergic
rhinitis and common cold symptoms.
 H1 receptor stimulation normally causes constriction of extravascular smooth muscle.
o Blocking H1 receptors reduces nasopharyngeal secretions.
 H2 receptors, when stimulated, increase gastric acid secretion.
General Effects of H1 Antihistamines
 Decrease nasal and respiratory secretions by blocking H1 receptors.
 Reduce smooth muscle constriction, including in nasal passages.
 Decrease nasal drainage, itching, and sneezing.
 Many also have anticholinergic effects, leading to dry mouth and reduced secretions,
which can be helpful in treating allergic rhinitis and cold symptoms.
First-Generation Antihistamines
 Example: Diphenhydramine (Benadryl)
 Commonly used for allergic rhinitis, insomnia, motion sickness, and allergy-related
symptoms (itching, urticaria, sneezing, cough, common cold).
 Side effects:
o Drowsiness (most significant)
o Dry mouth
o Dizziness
o Fatigue
o Impaired coordination
 Anticholinergic effects may also include urinary retention, blurred vision, and other
related symptoms.
 Contraindications:
o Acute asthma attacks
o COPD
o Liver disease
o Narrow-angle glaucoma
o Use with MAO inhibitors
 Avoid use with alcohol, narcotics, hypnotics, or barbiturates due to CNS depression
risk.
 Patients should avoid driving or hazardous tasks if sedation occurs.
 Many OTC cold medications contain first-generation antihistamines and may cause
sedation.
Second-Generation Antihistamines
 Considered non-sedating or minimally sedating.
 Preferred over first-generation due to fewer anticholinergic effects and reduced
drowsiness.
 Examples:
o Cetirizine (Zyrtec)

, o Fexofenadine (Allegra)
o Loratadine (Claritin)
 Azelastine is also included but used less frequently due to a longer half-life.
 Available in oral and nasal spray forms.
 Advantages:
o Much lower incidence of sedation
o Fewer anticholinergic side effects
o Better tolerated overall
Antihistamines and Asthma Considerations
 First-generation antihistamines are contraindicated in patients with asthma and COPD
due to anticholinergic effects.
 Antihistamines are not effective for emergencies such as anaphylaxis.
o They are absorbed relatively quickly (about 15 minutes), but are not strong
enough to treat anaphylactic reactions.
Intranasal Glucocorticoids
 Used primarily for allergic rhinitis.
 Provide anti-inflammatory effects and may be combined with H1 antihistamines.
 Route: nasal spray
 Examples:
o Fluticasone (Flonase)
o Triamcinolone (Nasacort)
o Beclomethasone
Side Effects and Teaching
 Local effects: nasal dryness, irritation, pharyngitis
 Rare systemic effects: headache, fatigue, insomnia, candidiasis
 Long-term use may dry nasal mucosa.
 Rapidly metabolized after absorption.
 Should generally be used short term (often less than 30 days) due to seasonal nature
of allergic rhinitis.
 Improper use may cause nasal septum perforation.
o Spray should be directed away from the septum.
o Patient should sniff gently during administration.
 May be used alone or with antihistamines.
Azelastine (Astelin)
 Second-generation antihistamine with non-sedating properties.
 Used for allergic rhinitis and itching (pruritus).
 Available as oral and nasal spray (typically 1 spray per nostril twice daily).
 Long half-life (~22 hours), allowing less frequent dosing.
 Can be taken daily.
 Side effects:
o Drowsiness
o Headache
o Fatigue
o Confusion
o Blurred vision
o Pharyngitis

, o Dry mouth
o Tachycardia
o Urinary retention
o Palpitations
Guaifenesin (Expectorant) Teaching
 Expectorant used for nonproductive cough and cold symptoms.
 Works by loosening bronchial secretions to improve cough effectiveness.
 Oral administration; may be combined with other medications.
 Side effects:
o Nausea
o Vomiting
o Possible dizziness, headache, drowsiness
Patient Teaching
 Increase fluid intake (about 8 glasses per day) to improve effectiveness.
 Hydration is the most effective natural expectorant.
 Example: Guaifenesin (Mucinex)

CHAPTER 39 – RESPIRATORY PHARMACOLOGY
Albuterol: Indications and Use
 Sympathomimetic drug that increases cAMP, leading to bronchodilation.
 Beta2-adrenergic agonist used for asthma and COPD.
 Used for treatment and prevention of bronchospasm.
 Causes relaxation of bronchial smooth muscle, improving airflow.
 More selective than epinephrine, so fewer side effects.
 Administered via inhaler or nebulizer.
Side Effects: Palpitations, Tachycardia, Blood pressure changes, Tremor, Nervousness,
Hyperglycemia, Hypokalemia, Chest pain, Dizziness, headache, weakness, GI upset (nausea,
vomiting)
 May reduce potassium levels and increase blood glucose.
 Overuse can lead to beta1 effects (increased heart rate, tremor, nervousness).
 Possible tolerance development may require dose adjustment.
Drug Interactions
 Caution with other sympathomimetics.
 Interacts with MAO inhibitors and tricyclic antidepressants.
 Levalbuterol may cause fewer side effects than albuterol.
Inhaler Patient Teaching and Order of Administration
 Use spacer to improve medication delivery to lungs.
 Proper inhaler technique:
o Shake inhaler
o Exhale fully
o Place mouthpiece or hold 1–2 inches away
o Inhale while pressing canister
o Hold breath briefly
o Exhale slowly through pursed lips
o Repeat after 2 minutes if needed
 If using multiple inhaled medications: