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Summary NURSE PRACTITIONER Certification Examination and Practice Preparation FIFTH EDITION

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Systemic antihistamines are usually divided into two groups: standard or first generation products, such as diphenhydramine (Benadryl®) or chlorpheniramine (ChlorTrimeton®), and newer or second generation products, such as loratadine (Claritin®), desloratadine (Clarinex®), cetirizine (Zyrtec®), fexofenadine (Allegra®), and levocetirizine (Xyzal®). The first generation antihistamines readily cross the bloodbrain barrier, causing sedation; as a result, these medications should be used with appropriate caution and should not be taken during activities when risk of accident or injury is significant. Their anticholinergic activity can result in drying of secretions, visual changes, and urinary retention; the last mentioned is most often a problem for older men with benign prostatic hyperplasia. Te use of frst generation antihistamines by older adults, particularly in higher doses as a sleep aid, can result in negative cognitive effects. The second generation antihistamines do not easily cross the blood-brain barrier, which results in lower rates of sedation. With little anticholinergic effect, the use of a product such as loratadine is likely to provide less drying of nasal secretions compared with diphenhydramine use, but also will have less negative effect on cognition, particularly in older adults. Antihistamines 21.

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