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Chapter 77

Chapter 77. Drugs for Allergic Rhinitis, Cough, and Colds. Allergic Rhinitis. Inflammatory disorder of the upper airway, lower airway, and eyes Symptoms Sneezing Rhinorrhea Pruritus Nasal congestion For some people: conjunctivitis, sinusitis, and asthma. Allergic Rhinitis.

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Chapter 77

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  1. Chapter 77 Drugs for Allergic Rhinitis, Cough, and Colds

  2. Allergic Rhinitis • Inflammatory disorder of the upper airway, lower airway, and eyes • Symptoms • Sneezing • Rhinorrhea • Pruritus • Nasal congestion • For some people: conjunctivitis, sinusitis, and asthma

  3. Allergic Rhinitis • Seasonal and perennial • Triggered by airborne allergens • Allergens bind to immunoglobulin (Ig)E on mast cells • Inflammatory mediators released • Histamine, leukotrienes, and prostaglandins

  4. Classes of Drugs Used for Allergic Rhinitis • Oral antihistamines • Intranasal glucocorticoids • Sympathomimetics (oral and intranasal)

  5. Oral Antihistamines • For allergic rhinitis • Do not reduce nasal congestion • Most effective if taken prophylactically • Adverse effects are mild: sedation with first generation (much less with second generation) • Anticholinergic effects • Azelastine nasal spray • Only intranasal antihistamine available • Benefits equivalent to oral antihistamines • Metered-spray device, leaves bitter taste

  6. Intranasal Glucocorticoids • First choice—most effective for treatment and prevention of rhinitis • Mild adverse effects • Drying of nasal mucosa or sore throat • Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)

  7. Intranasal Cromolyn • Trade name: NasalCrom • Extremely safe, but only moderately effective • Suppresses release of histamines from mast cells • Best used for prophylaxis, not for treatment • Response may take 1–2 weeks to develop

  8. Sympathomimetics (Oral/Nasal) • Reduce nasal congestion (do not reduce rhinorrhea, sneezing, or itching) • Activate alpha1-adrenergic receptors on nasal blood vessels • Adverse effects • Rebound congestion • CNS stimulation • Cardiovascular effects and stroke • Abuse

  9. Sympathomimetics (Oral/Nasal) • Factors in topical administration • Should not use longer than 5 consecutive days • Drops vs. sprays • Phenylephrine, ephedrine, pseudoephedrine • Antihistamine-sympathetic combinations • Ipratropium bromide (Atrovent) • Montelukast (Singulair) • Omalizumab (Xolair)

  10. Drugs for Cough • Antitussives • Drugs that suppress cough • Opioid antitussives • Codeine and hydrocodone • Nonopioid antitussives • Dextromethorphan • Diphenhydramine

  11. Common Cold • Acute upper respiratory viral infection • Rhinorrhea, nasal congestion, cough, sneeze, sore throat, headache, hoarseness, malaise, myalgia • Fever common in kids, rare in adults • Self-limited and usually benign • No cure; just treatment of symptoms

  12. 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) OTC = over-the-counter.

  13. Pediatric OTC Cold Remedies • Use with caution in young children • No proof of efficacy or safety, but proof of harm • Avoid OTC cold remedies in children younger than 2 years of age • Use only products labeled for pediatric use • Consult a healthcare professional before giving 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

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