Pharm NCLEX Ch 77: Drugs for Allergic Rhinitis, Cough, and Colds

Which medication is indicated for suppression of cough? A. Benzonatate (Tessalon) B. Guaifenesin (Mucinex) C. Acetylcysteine (Mucomyst) D. Fluticasone furoate (Flonase)

A. Benzonatate suppresses cough by reducing the sensitivity of respiratory stretch receptors (components of the cough reflex pathway). Acetylcysteine reacts directly with mucus to make it more watery and is administered by inhalation treatment. Guaifenesin is an expectorant. Fluticasone furoate is an intranasal glucocorticoid used to treat the clinical manifestations of allergic rhinitis.

The parent of a pediatric patient with nasal stuffiness and congestion asks a nurse about cold remedies. Which additional information is the priority for the nurse to obtain? A. Age B. Developmental stage C. Body weight D. Swallowing ability

A. Cold remedies should not be used for children younger than 2 years because of the risk of harm with little evidence of efficacy. In 2008, the U.S. Food and Drug Administration (FDA) recommended that over-the-counter (OTC) cold remedies no longer be given to children younger than 2 years because of the risk of life-threatening events. Safety is still being reviewed for children ages 2 to 11 years. Developmental stage, body weight, and swallowing ability are secondary considerations with dosing of cold remedies for children.

A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? A. Pseudoephedrine (Sudafed) B. Montelukast (Singulair) C. Mometasone (Nasonex spray) D. Oxymetazoline (Afrin spray)

A. Pseudoephedrine is a sympathomimetic that activates alpha1 receptors and causes vasoconstriction. Only oral agents cause widespread vasoconstriction that warrants caution in patients with hypertension. Montelukast blocks leukotrienes and has no adverse effects. Oxymetazoline spray is a topical sympathomimetic that causes rebound congestion with prolonged use. Mometasone spray is a glucocorticoid intranasal spray for which systemic side effects are rare.

A nurse is planning care for a patient who takes fexofenadine (Allegra) for allergic rhinitis. Which outcome should the nurse anticipate? A. No complaints of dry mouth B. Relief of sneezing and itching C. Use limited to allergy season D. Absence of rebound congestion

B. Fexofenadine, a second-generation antihistamine, is prescribed as a first-line medication for allergic rhinitis to relieve sneezing, rhinorrhea, and nasal itching. Anticholinergic effects (dry mouth, constipation) are uncommon with second-generation antihistamines. Antihistamines are most effective when taken prophylactically. Rebound congestion develops in topical sympathomimetic agents.

Which statement by a patient indicates understanding of a nurse's teaching about fluticasone nasal spray (Flonase)? A. "I'll gradually stop taking this so I don't have any problems with withdrawal." B. "This drug will help prevent the inflammation and irritation from my allergies." C. "I'll have to be more careful about not falling, because my bones may break more easily." D. "I realize that I only need to take this when my symptoms are really bad."

B. Fluticasone nasal spray is a steroid drug used to prevent the symptoms of allergy. Its effect is localized; therefore, the patient does not have systemic adverse effects with normal use and does not have to wean down the medication, as with oral corticosteroids. Intranasal glucocorticoids are most effective for preventing and treating allergic rhinitis.

Which instruction should the nurse include in the teaching for a patient prescribed cetirizine (Zyrtec) for seasonal allergic rhinitis? A. "Clean the nasal applicator after use to prevent contamination." B. "Take the medication daily throughout the allergy season." C. "Expect a decrease in your nasal congestion in a day or two." D. "Take a stool softener daily to avoid the side effect of constipation."

B. For treatment of allergic rhinitis, antihistamines such as cetirizine are most effective when taken prophylactically throughout the allergy season, even when symptoms are absent. The medication is taken orally, not intranasally. Oral antihistamines relieve sneezing, rhinorrhea, and nasal itching but not nasal congestion. Constipation is rare in patients taking second-generation agents, such as cetirizine.

Which complaint indicates that a patient is experiencing an adverse effect of beclomethasone (Beconase AQ) nasal spray? A. Sneezing B. Sore throat C. Runny nose D. Rebound congestion

B. Sore throat is an adverse effect associated with intranasal glucocorticoids, such as beclomethasone. More common adverse effects include drying of the nasal mucosa and a burning or itching sensation. Sneezing and runny nose are two of the symptoms of allergic rhinitis for which intranasal glucocorticoids are used. Rebound congestion is an adverse effect of intranasal sympathomimetics.

A nurse should recognize that recent research has shown which statement is true about the use of zinc in children with colds? A. Efficacy is seen within the first 24 hours of signs and symptoms. B. Evidence has been inconclusive, and more research is needed. C. Lozenges with the lemon-lime formula are the most effective. D. Recovery is accelerated, and symptoms resolve quickly.

B. Studies have shown that zinc can benefit adults with colds. However, the one study done in children showed no beneficial effects. The study left unanswered questions; therefore, more research is required. Conclusions about efficacy, lozenge formula, and time to recovery are open to other possible interpretations in the one study done in children.

Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? A. Warm, dry, pink skin B. Oriented to time, place, and person C. Respiratory rate of 12 to 24 breaths per minute D. Effective productive cough

C. Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Doses are small (one-tenth those needed to relieve pain), so orientation and peripheral effects are minimal.

Which instruction by the nurse should be the priority for a patient scheduled to start intranasal cromolyn (NasalCrom)? A. "It is only moderately effective." B. "There are few adverse reactions." C. "Relief may take a week or two." D. "It suppresses histamine release."

C. Cromolyn is best suited for prophylaxis and should be given before symptoms start, because responses may take a week or 2 to develop. It is important for the patient to know about cromolyn's moderate effectiveness, few adverse reactions, and suppression of histamine release, but it is more important that the patient be informed of the delay in response.

A nurse instructs a patient that which nonprescription medication requires patient identification and a signature for purchase? A. Chlorpheniramine (Chlor-Trimeton) B. Cetirizine (Zyrtec) C. Ephedrine D. Ipratropium bromide (Atrovent)

C. Ephedrine is a sympathomimetic agent associated with abuse, because it can be converted to methamphetamine. Legal availability has been reduced by having the product behind the counter, and patients must present identification and sign a log for purchase. Chlorpheniramine and cetirizine are first- and second-generation antihistamines that are available without legal constraints. Ipratropium bromide, an anticholinergic intranasal agent for allergic rhinitis, also does not require patient identification.

A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions? A. "Restrict cold fluids to promote reduced mucus production." B. "Take the medication once a day only, usually at bedtime." C. "Increase your fluid intake to reduce the viscosity of secretions." D. "Increase your fiber and fluid intake to prevent constipation."

C. Expectorant drugs are used to reduce the viscosity of secretions, allowing them to be more easily expectorated. Reduction of mucus production is unrelated to an expectorant. Expectorants may be taken several times a day and do not cause constipation.

Which finding in a patient taking oxymetazoline (Afrin) nasal spray every 2 hours would indicate that the patient has developed an adverse effect? A. Dry mouth and constipation B. Drowsiness and sedation C. Congestion and stuffiness D. Itching and skin rash

C. Oxymetazoline is an effective nasal decongestant, but overuse results in worsening, or rebound, congestion. It should not be used more often than every 4 hours for several days. Dry mouth and constipation, drowsiness and sedation, and itching and skin rash are not adverse effects of oxymetazoline.

Which instruction should be included in the teaching for a patient being started on the antihistamine azelastine (Astelin)? A. "Take the pill in the morning before breakfast." B. "Headache may be a side effect of the medication." C. "You may experience an unpleasant taste in your mouth when using azelastine." D. "You will experience a decrease in nasal congestion if the medication is working."

C. With both formulations of azelastine (Astelin and Astepro), patients often complain of an unpleasant taste. Azelastine is administered as an intranasal metered spray. Headache is a side effect of the intranasal antihistamine olopatadine. Antihistamines do not reduce nasal congestion.

Which class of drugs is most effective in preventing and treating seasonal and perennial rhinitis? A. Antitussives B. Oral antihistamines C. Oral sympathomimetics D. Intranasal glucocorticoids

D. Intranasal glucocorticoids are the most effective drugs for preventing and treating seasonal and perennial rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema. Antihistamines are less effective than glucocorticoids, because histamine is only one of several mediators of allergic rhinitis. Sympathomimetics relieve only nasal congestion. Antitussives are used to suppress cough.

A nurse should teach a patient receiving oral pseudoephedrine (Sudafed) to observe for which adverse effects? (Select all that apply.) Sedation Irritability Paranoia Anxiety Weight loss

Irritability & Anxiety. Oral pseudoephedrine activates alpha1 receptors on nasal and systemic blood vessels, causing vasoconstriction and central nervous system (CNS) excitation. This results in restlessness, irritability, anxiety, and insomnia. Sedation, paranoia, and weight loss are not adverse effects associated with pseudoephedrine.