EAQ ch 36, Antihistamines, Decongestants, Antitussives, and Expectorants

2 (Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. To avoid future rebound congestion with nasal sprays, it is recommended that they be used for no more than 3 to 5 days. It is not correct to give the drug hourly, because that will increase the risk of rebound congestion. )

A patient complains of worsening nasal congestion despite the use of oxymetazoline nasal spray every 2 hours. What is the nurse's most appropriate response? 1 "Oxymetazoline is not an effective nasal decongestant." 2 "Overuse of nasal decongestants results in rebound congestion." 3 "Oxymetazoline should be administered every hour for severe congestion." 4 "You are probably displaying an unexpected reaction to oxymetazoline."

3 (Phenytoin decreases the fexofenadine level in the body. Therefore, the drug does not have the desired therapeutic effect. Dystonic reaction is related to muscles contractions. Twisting and repetitive movements or abnormal postures can be observed in this condition. Paradoxical reaction is observed in elderly patients and children due to the use of antihistaminic drugs. The patient complains of allergic rhinitis due to drug interaction and not due to drug tolerance.)

A patient complains that symptoms of allergic rhinitis are persistent even after taking fexofenadine (Allegra). After checking the patient's history, the nurse finds that the patient is taking phenytoin (Dilantin) for the treatment of seizures. What will the nurse interpret from this information? 1 It indicates dystonic reaction. 2 It indicates paradoxical reaction. 3 It indicates drug-drug interaction. 4 It indicates drug tolerance.

1 (Antitussive medications also affect the central nervous system, causing drowsiness and dizziness. There is no reason to anticipate that the medication will cause diarrhea, abdominal cramping, tremors and anxiety, or headache and hypertension.)

A patient is prescribed an antitussive medication. What is the most important instruction for the nurse to include in the patient teaching? 1 "This medication may cause drowsiness and dizziness." 2 "Watch for diarrhea and abdominal cramping." 3 "This medication may cause tremors and anxiety." 4 "Headache and hypertension are common side effects."

4 (Dextromethorphan (Robitussin DM) is a nonopioid antitussive drug which may also cause sedation, drowsiness, or dizziness. The nurse should advise the patient to avoid activities that require mental alertness. It helps prevent injury to the patient. Use of a humidifier helps maintain hydration levels, but does not reduce the risk of injury to the patient. Elevating one's head while sleeping helps with lung expansion and promotes breathing. Fluid intake should be increased when decongestants are administered, as fluids help liquefy secretions and make it easier to cough up secretions.)

A patient is prescribed dextromethorphan (Robitussin DM) for treatment of cough. What instruction will the nurse give to the patient for safe administration of the drug? 1 "Use a humidifier while sleeping." 2 "Elevate your bed while sleeping." 3 "Increase your fluid intake to 3000 mL per day." 4 "Restrict activities that require mental alertness."

1 (Echinacea should not be administered if the patient is on the disulfiram (Antabuse) treatment as it may result in acetaldehyde syndrome. Therefore, the nurse should instruct the patient to stop further use of echinacea. Increase in carbohydrate intake may not be helpful for preventing this interaction. Disulfiram (Antabuse) should not be administered in higher dose to the patient because it causes severe hazardous effects. The nurse should not administer echinacea and disulfiram (Antabuse) simultaneously because it causes drug-drug interaction and results in acetaldehyde syndrome.)

A patient is prescribed disulfiram (Antabuse) for alcohol abuse. During the assessment, the nurse finds that the patient is also taking echinacea for wound healing. What will the nurse instruct the patient to do? 1 Stop using echinacea 2 Increase carbohydrate intake 3 Increase the dose of disulfiram (Antabuse) 4 Take both drugs simultaneously

1 (The nurse should instruct the patient to increase fluid intake as it helps to liquefy secretions, assists in breaking up thick secretions, and makes it easier to cough up secretions. The nurse may advise an increase in proteins and carbohydrates in the patient's diet in case there is a deficiency of these nutrients. The nurse may advise an increase in dietary fiber to prevent constipation.)

A patient is prescribed guaifenesin (Mucinex) for treatment of productive cough. What instruction will the nurse give to the patient for maximum therapeutic effect? 1 "Increase your fluid intake." 2 "Increase your protein intake." 3 "Increase your carbohydrate intake." 4 "Increase your fiber intake."

1 (Diphenhydramine (Benadryl) interacts with alcohol, causing CNS depression and leading to a decrease in respiratory rate, heart rate, and loss of consciousness. Therefore, the nurse should instruct the patient to avoid alcohol consumption. Nighttime insomnia, motion sickness, and allergic rhinitis are indications for the use of diphenhydramine (Benadryl). These conditions are not the result of an interaction between diphenhydramine (Benadryl) and alcohol.)

A patient presenting with cough is prescribed diphenhydramine (Benadryl). The nurse instructs the patient to avoid consuming alcohol. Which consequence of drug interaction with alcohol would be prevented if the patient follows the nurse's instructions? 1 Central nervous system (CNS) depression 2 Nighttime insomnia 3 Motion sickness 4 Allergic rhinitis

2 (The nurse should advise the patient to consult with the health care provider so that the patient can be evaluated and the prescription can be changed accordingly. The patient should not take expectorants for more than one week because it may cause drug dependency and drug tolerance. Increase in fluid intake helps in thinning secretions for easier expectoration. As the patient already has a productive cough, this intervention may not be helpful. Loratadine (Claritin) is not helpful in treating productive cough. Loratadine (Claritin) is used for the treatment of allergic rhinitis and chronic urticaria. The nurse should not advise the patient to take an increased dose of guaifenesin (Mucinex) because it produces hazardous effects in the patient.)

A patient reports to the nurse that after taking guaifenesin (Mucinex) for one week, the productive cough still persists. What advice will the nurse give to the patient? 1 "Decrease your fluid intake." 2 "Consult your health care provider." 3 "Take loratadine (Claritin) twice a day." 4 "Increase the dose of guaifenesin (Mucinex.)"

2 (The patient needs an expectorant. This medication will help the patient cough the fluid out of her lungs. Dextromethorphan and fluticasone will not help the patient expectorate. There is no information about the patient's fluid intake, so hourly fluids may be too much.)

A patient tells the nurse that she has a cold, is coughing, and feels like she has fluid in her lungs. What action will the nurse anticipate performing next? 1 Administering dextromethorphan 2 Administering guaifenesin 3 Encouraging the patient to drink fluids hourly 4 Administering fluticasone (Flonase)

1 (Allergic rhinitis is usually treated with antihistamines. The drug may give false results in an allergy test, as allergic reactions are also medicated by histamines. All antihistamines should be stopped 4 days before the scheduled allergy test. Severe symptoms of rhinitis are unrelated to the allergy test, and hence cannot be a reason for rescheduling the test. Oral antibiotics do not interfere with the allergy test and are not the reason for postponing the test. A fear of injections cannot be resolved by postponing the allergy test.)

A patient who has allergic rhinitis comes to the clinic for a scheduled allergy test. After performing a health history, the nurse informs the patient that the allergy test will have to be rescheduled. What may be the reason for this? 1 The patient is being treated with antihistamine drugs. 2 The patient has severe symptoms of rhinitis. 3 The patient is being treated with oral antibiotic drugs. 4 The patient is afraid of injections.

3 (The patient needs non-sedating antihistamines for treatment to prevent drowsiness while driving. Fexofenadine (Allegra) should be prescribed to the patient as it acts peripherally on histamine receptors and does not cross the blood-brain barrier. As a result, it does not cause drowsiness. Clemastine (Tavist) has moderate sedative effect and should be avoided in this patient. Promethazine (Phenargan) and diphenhydramine (Benadryl) have high sedative action and should be avoided.)

A patient who is a taxi driver is diagnosed with allergic rhinitis. Which antihistamine will the nurse expect to be included in the treatment plan? 1 Clemastine (Tavist) 2 Promethazine (Phenargan) 3 Fexofenadine (Allegra) 4 Diphenhydramine (Benadryl)

2, 3, 4 (Following the treatment of cough and difficulty breathing, the nurse should look for signs of worsening during the follow-up visit. The normal respiratory rate is 12 to 20 breaths per minute. The respiratory rate of 30 breaths per minute indicates dyspnea and difficulty breathing. A change in color of the sputum indicates infection and should be immediately reported. Temperature of 100.8° F indicates fever and is a sign of infection. Clear breath sounds indicate that lungs are clear of secretions. Increased expectoration of mucus also indicates treatment effectiveness.)

A patient who presents with cough and difficulty breathing is prescribed decongestants and antitussives. Which assessment findings in the follow-up visit will the nurse immediately report to the primary health care provider? ****Type all that apply, separated by comma and space.**** 1 Clear breath sounds on auscultation 2 Respiratory rate of 30 breaths per minute 3 Change in color of the sputum 4 Temperature of 100.8° F 5 Increased expectoration of mucus

3 (Guaifenesin is the best treatment for a patient who takes many medications because it can help thin secretions when taken with sufficient water and facilitates expectoration of the secretions to stop the cough. Dextromethorphan, loratadine, and benzonatate have more adverse effects and potential drug interactions than guaifenesin, which could be especially problematic for a patient who takes many medications.)

A patient who takes different medications experiences a troublesome cough associated with allergic rhinitis. Which is the best choice of treatment to manage the cough? 1 Dextromethorphan (Recofen) 2 Loratadine (Claritin) 3 Guaifenesin (Robitussin) 4 Benzonatate (Tessalon Perles)

1 (The nurse should instruct the patient to take the medication with food to avoid gastrointestinal (GI) upset. Although food may slightly decrease absorption of the drug, it has the benefit of minimizing the GI upset caused by diphenhydramine (Benadryl). Using a humidifier, elevating one's head while sleeping, and increasing fluid intake to up to 3000 mL is helpful for maintaining hydration but not for minimizing the GI upset.)

A patient will begin taking diphenhydramine (Benadryl) to treat of motion sickness. What instruction will the nurse give to the patient to prevent GI upset? 1 "Take the medication with food." 2 "Use a humidifier while sleeping." 3 "Sleep with your head in an elevated position." 4 "Increase fluid intake to up to 3000 mL."

4 (Guaifenesin (Mucinex) is the best choice of treatment for management of cough associated with chronic paranasal sinusitis. It works by loosening and thinning the secretions and facilitating expectoration of the secretions. Loratadine (Claritin), naphazoline (Privine), and fexofenadine (Allegra) are contraindicated in patients with glaucoma. Loratadine (Claritin) is used for the treatment of allergic rhinitis and chronic urticaria. Naphazoline (Privine) is used to treat nasal congestion. Fexofenadine (Allegra) is a nonsedating antihistamine and useful for the treatment of allergic rhinitis and urticaria.)

A patient with chronic paranasal sinusitis and cough is found to have glaucoma. What is the best choice of treatment for management of cough in this situation? 1 Loratadine (Claritin) 2 Naphazoline (Privine) 3 Fexofenadine (Allegra) 4 Guaifenesin (Mucinex)

3 (Diphenhydramine (Benadryl) is not administered to elderly patients because it produces a "hangover" effect and increases the risk for falls, which may cause severe injury. Diphenhydramine (Benadryl) does not produce constipation, seizure, or lightheadedness. Seizure is a side effect of over-the-counter cough and cold products. Constipation and lightheadedness are side effects of codeine and hydrocodone.)

An elderly patient who presents with a cough is instructed not to use diphenhydramine (Benadryl). What is the possible reason for this? 1 Diphenhydramine (Benadryl) causes seizures. 2 Diphenhydramine (Benadryl) causes constipation. 3 Diphenhydramine (Benadryl) causes a "hangover" effect. 4 Diphenhydramine (Benadryl) causes lightheadedness.

4 (Diphenhydramine (Benadryl) is an antihistaminic drug. Antihistaminic drugs may produce paradoxical reactions such as dizziness, confusion, sedation, and hypotension in elderly patients. These are not allergic reactions to the drug. In cases of dystonic reaction, sustained muscle contractions cause twisting and repetitive movements or abnormal postures. Rebound congestion occurs due to long-term use, or overdose, of nasal decongestant.)

During the assessment of a patient, the nurse finds symptoms of dizziness, confusion, sedation, and hypotension. After reviewing the patient's medical history, the nurse finds that the patient is taking diphenhydramine (Benadryl) for treatment of nighttime insomnia. What will the nurse interpret from the assessment? 1 It is an allergic reaction. 2 It is a dystonic reaction. 3 It is rebound congestion. 4 It is a paradoxical reaction.

4 (Guaifenesin (Robitussin) is classified as an expectorant. The other drugs listed are classified as traditional antihistamines. )

The health care provider indicates that the patient will be ordered an expectorant. Which medication does the nurse anticipate the provider will order? 1 Brompheniramine maleate (Dimetane) 2 Chlorpheniramine maleate (Chlor-Trimeton) 3 Dexchlorpheniramine maleate (Polaramine) 4 Guaifenesin (Robitussin)

3 (Guaifenesin (Mucinex) should be prescribed to the patient as it is an expectorant and pregnancy category C drug. It is safe to use during pregnancy. Loratadine (Claritin), fexofenadine (Allegra), and diphenhydramine (Benadryl) are antihistamines and are pregnancy category B drugs that are unsafe to use during pregnancy. These drugs are not helpful for treatment of respiratory congestion. These drugs are used for perennial allergic rhinitis allergic reactions, motion sickness, and nighttime insomnia. )

The nurse is assessing a patient with respiratory congestion and finds that the patient is pregnant. Which medicine will the nurse expect the health care provider to prescribe for this patient? 1 Loratadine (Claritin) 2 Fexofenadine (Allegra) 3 Guaifenesin (Mucinex) 4 Diphenhydramine (Benadryl)

3 (Nonsedating antihistamines may be safer for the patient to take, but the patient should still monitor for signs of sedation. If sedation occurs, the patient should be instructed to avoid taking these drugs while driving. Taking a lower dose will decrease the drug's effectiveness.)

The nurse is caring for a patient in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this patient? 1 "Take the medication only when you are not driving." 2 "Take a lower dose than normal when you have to drive." 3 "You may be able to safely take a nonsedating antihistamine." 4 "You are correct; you should not take antihistamines."

1 (Traditional antihistamines cause drowsiness. There is no evidence to indicate that the patient should force fluids, take the medication on an empty stomach, or place the medication on hold for any period of time.)

The nurse is caring for a patient who is taking a traditional antihistamine. What is the most important information for the nurse to teach the patient? 1 "Do not drive after taking this medication." 2 "Make sure you drink a lot of liquids while on this medication." 3 "Take this medication on an empty stomach." 4 "Do not take this medication for more than 2 days."

2 (Beclomethasone dipropionate (Tessalon Perles) is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the patient does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids. Because the medication has a localized effect, it will not produce the changes in blood sugar that would be generated by systemic steroids.)

The nurse is instructing the patient on the use of beclomethasone dipropionate (Beconase). Which statement by the patient indicates an understanding of the teaching? 1 "I will need to taper off the medication to prevent acute adrenal crisis." 2 "This medication will help prevent the inflammatory response of my allergies." 3 "I will need to monitor my blood sugar more closely because it may increase." 4 "I need to take this medication only when my symptoms get bad."

3 (Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action. The medications should be taken twice daily with extra fluids. It is not necessary to increase fiber.)

The nurse is teaching a patient about the use of an expectorant. What is the most important instruction for the nurse to include in the patient teaching? 1 "Restrict your fluids in order to decrease mucus production." 2 "Take the medication once a day only, at bedtime." 3 "Increase your fluid intake in order to decrease viscosity of secretions." 4 "Increase your fiber and fluid intake to prevent constipation."

2 (Antitussives are used to suppress cough. The patient who has undergone hernia repair needs to keep the abdominal muscles relaxed, and coughing can strain the abdominal muscles and worsen the hernia. Antihistamines are used to treat allergic symptoms. Expectorants are used to thin secretions and promote coughing out secretions. Decongestants are used to relieve congestion of the upper and lower respiratory tract.)

The nurse observes a mild cough in a patient after hernia repair. Which medication will the nurse expect the provider to order for this patient? 1 Antihistamine 2 Antitussive 3 Expectorant 4 Decongestant

4 (Rebound congestion occurs due to frequent, long-term use or overdose of decongestant. Phenylephrine (Lusonal) and vitamin C do not cause any drug-drug interaction. Rebound congestion is not associated with vitamin C. Rebound congestion does not indicate that the patient has phenylephrine (Lusonal) tolerance.)

The nurse observes that a patient who is taking phenylephrine (Lusonal) and vitamin C tablets has developed rebound congestion. What is the probable reason for rebound congestion? 1 Drug-drug interaction 2 Allergic reaction to vitamin C 3 Phenylephrine (Lusonal) tolerance 4 Frequent use of phenylephrine (Lusonal)

2 (Loratadine (Claritin) does not affect the central nervous system and, therefore, is nonsedating. There is insufficient evidence to indicate that loratadine (Claritin) can cause dysrhythmias, can act as a bronchodilator, or cause less gastrointestinal upset than other comparable medications. )

What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine (Benadryl) to loratadine (Claritin)? 1 Loratadine can potentially cause dysrhythmias. 2 Loratadine has fewer sedative effects. 3 Loratadine has increased bronchodilating effects. 4 Loratadine causes less gastrointestinal upset

4 (The sedative effects of diphenhydramine can be problematic for patients who are involved in activities such as driving that require mental alertness. The patient's condition does not worsen over time; the side effects diminish when the medication is terminated. The nurse does not advise the patient to take a stimulant if it is not prescribed by the primary health care provider. The nurse does not advise the patient to stop taking the drug as drowsiness is the expected effect of the drug.)

What will the nurse tell a patient who reports feeling drowsy after beginning drug therapy with diphenhydramine (Benadryl)? 1 "This may worsen over time." 2 "Take a stimulant to combat fatigue." 3 "Stop taking the drug at once." 4 "Use caution when driving."

2 (The most common adverse effects with diphenhydramine include sedation and antimuscarinic effects, including dry mouth, urinary retention, and constipation. Hay fever is a symptom of allergic rhinitis and not a side effect of diphenhydramine. Insomnia is an adverse effect of adrenergic drugs. Hypertension is a side effect of excessive dosages of topically applied adrenergic nasal decongestant.)

Which adverse drug effect is the nurse alert for in an older adult male patient taking diphenhydramine (Benadryl)? 1 Hay fever 2 Urinary retention 3 Insomnia 4 Hypertension

4 (Antihistamines such as brompheniramine cause reduced salivary flow, leading to dry mouth. They may also cause urinary retention, not frequent urination. Antihistamines help relieve excessive watering of eyes. Anticholinergic effects of antihistamines, such as blurred vision, are common, not colored vision.)

Which anticholinergic effect is seen in a patient who takes brompheniramine (Dimetane)? 1 Frequent urination 2 Excessive watering of eyes 3 Blue-green vision 4 Dry mouth

3 (The most common adverse effects with diphenhydramine include sedation and antimuscarinic effects, including dry mouth, urinary retention, and constipation. The newer antihistamines such as desloratadine (Clarinex), fexofenadine (Allegra), and loratadine (Alavert, Claritin), are usually less sedating because of reduced distribution to the central nervous system.)

Which antihistamine causes sedation in the patient as an adverse drug effect? 1 Desloratadine (Clarinex) 2 Fexofenadine (Allegra) 3 Diphenhydramine (Benadryl) 4 Loratadine (Claritin)

1, 2, 3 (Cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) are peripherally acting antihistamines. These drugs work peripherally to block the actions of histamine and do not readily cross the blood-brain barrier. Therefore, these drugs have less effect on the central nervous system. Hence, these drugs are called as peripherally acting antihistamines. Diphenhydramine (Benadryl) and brompheniramine (Dimetane) are traditional antihistamines and work both peripherally and centrally.)

Which drugs are peripherally acting antihistamines? Select all that apply. 1 Cetirizine (Zyrtec) 2 Loratadine (Claritin) 3 Fexofenadine (Allegra) 4 Diphenhydramine (Benadryl) 5 Brompheniramine (Dimetane)

1 (Codeine is the most effective opioid antitussive drug as it is effective in suppressing the cough reflex and does not cause dependency in patients. Benzonatate and dextromethorphan are nonopioid antitussives; diphenhydramine is a first-generation histamine1 blocker that can help relieve a cough caused by postnasal drip or upper respiratory congestion but has no antitussive effect.)

Which is the most effective antitussive? 1 Codeine (Dicodin) 2 Benzonatate (Tessalon) 3 Diphenhydramine (Benadryl) 4 Dextromethorphan (Robitussin)

4 (An antihistamine can cause paradoxical reaction in children. Dizziness, confusion, sedation, and hypotension are paradoxical reaction-associated symptoms. An antacid may cause constipation or other reactions due to overdose. An antitussive can cause drowsiness or dizziness in the patient. A decongestant can cause rebound congestion due to frequent use or overdose.)

Which medication can cause paradoxical reactions in children? 1 Antacid 2 Antitussive 3 Decongestant 4 Antihistamine

3 (Antitussives are administered to patients who have recently undergone hernia surgery in order to enhance their comfort and reduce respiratory distress. Expectorants are used to relieve productive cough in patients with pharyngitis and bronchitis. Nasal decongestants are used to relieve nasal congestion in patients with rhinitis. In patients with chronic paranasal sinusitis, expectorants are used for cough suppression.)

Which patients are the best candidates to receive antitussive cough medication? 1 Patients with pharyngitis and rhinitis 2 Patients with bronchitis with productive cough 3 Patients who have undergone hernia surgery 4 Patients with chronic paranasal sinusitis

1 (H1 antagonists exert anticholinergic effects, including constipation, dry mouth, and blurred vision. The drugs' capacity for drying the mucous membranes makes them useful in treating upper respiratory infections and allergic rhinitis. Drowsiness, palpitations, and constipation are adverse effects of H1, which should be reported immediately to the primary health care provider.)

Which side effect of a histamine (H1) antagonist is used therapeutically for patients with allergic rhinitis? 1 Dryness 2 Drowsiness 3 Palpitations 4 Constipation

1 (Fluticasone (Flonase) relieves the symptoms of allergic rhinitis such as nasal congestion and hay fever. Increased blood pressure is not a symptom of allergic rhinitis. Antihypertensives are used to lower blood pressure. Bronchospasm is not a symptom of allergic rhinitis. Release of excessive amounts of histamine can lead to fluid retention due to vasodilatation and increased capillary permeability.)

Which symptom of allergic rhinitis is treated with fluticasone (Flonase)? 1 Nasal congestion 2 Increased blood pressure 3 Bronchospasm 4 Fluid retention

a measure of a liquid's resistance to gradual deformation by shear stress or tensile stress. (For liquids, it corresponds to the informal concept of "thickness". For example, honey has a much higher viscosity than water. So viscous=resistant, the opposite of slipperiness)

define viscosity

expectorant

drug class of guaifenesin

hives

synonym of urticaria

related to muscles contractions. Twisting and repetitive movements or abnormal postures can be observed in this condition

what is a dystonic reaction

observed in elderly patients and children due to the use of antihistaminic drugs, it is the opposite reaction as to what the drug is supposed to do

what is a paradoxical reaction