Medications for Allergic Rhinitis (Nursing)

00:00 Hi! welcome to our video on medications for allergic rhinitis and cough.

00:07 Now, what is allergic rhinitis? Well, if you lived where I live, you wouldn't have to ask that question because everyone who moves to our part of the country knows what allergic rhinitis is.

00:18 -itis means inflammation.

00:20 It's an allergic response and you end up with that runny nose.

00:24 So it's an inflammatory response to allergens that involves your upper respiratory tract.

00:29 Now this can be just short terms -seasonal, or they can last all year long, that's called perennial.

00:36 So you have symptoms that include swollen sinuses, itchy/watery eyes, stuffy or runny nose and an itchy sore throat.

00:45 We have 3 groups of medications that we use predominantly to treat allergic rhinitis.

00:49 Antihistamines, you can go take them orally or intranasally.

00:54 Intranasal glucocorticoids or sympathomimetic decongestants.

01:00 Now I have a question for you.

01:02 Which of these 3 categories do you think contains an over the counter medication used to make crystal meth? Right, crystal meth the street drug.

01:16 Well I'm not gonna tell you the answer to that question yet.

01:19 Stay tuned and I'll tell you which one of those groups of medication contains that over the counter medication.

01:25 Okay, so first up.

01:26 We're gonna look up antihistamines.

01:29 Now, they get their name because they can act to the histamine receptors in your body.

01:33 Now, histamine wreaks havoc in your body.

01:37 When histamine connects to histamine receptor that release all these nasty beasties in your body and that's why you end up with runny eyes and swollen nose and all those horrible things.

01:48 So we have first generation - diphenhydramine.

01:52 Now those are the ones that make you real sleepy.

01:54 You may know it by the name of Benadryl.

01:56 But first generation antihistamines, they have this central acting thing where they make you real sleepy which is actually helpful.

02:03 Sometimes people use that as a sleep aid at night.

02:05 But if you have to work or go to school, that's not so good.

02:09 Second generations are non-sedating.

02:12 So you can take something like fexofenadine, loratadine and use those drugs to do the same type of thing.

02:18 They'll block that histamine response but they won't make you sleepy.

02:22 Now you can take intranasal antihistamines that sometimes this can be really effective.

02:27 So if the majority of your problem is in your nasal passages and you use a nose spray, you're getting a medication right to the spot where you're having problems.

02:37 You're gonna have fewer systemic side effects and you're gonna have some really good and quick results.

02:42 So we've got a name there for you for an intranasal antihistamine.

02:47 So when we're looking at this first group of medications, what we want to do is get the drug unto those histamine receptors.

02:54 If I can get diphenhydramine or fexofenadine or azelastine on those histamine receptors, I'm gonna stop them from doing what they normally do when they get hit with an agonist.

03:06 They release all those nasty mediators into your body that cause your eyes to be itchy and your nose to be stuffy and for you to feel all over miserable.

03:16 Remember that's the important concept when we're using antagonist or antihistamines.

03:22 The drug fits on those special receptors and will block the nastiness that normally happens in your body.

03:29 Now even more effective for treating allergic rhinitis are intranasal glucocorticoids.

03:36 The antihistamines just block that histamine receptor but the intranasal glucocorticoids really suppress that inflammatory response on a much bigger level.

03:47 So the first generation group, you see them listed there, beclomethasone and the other two medications, they have more systemic effects.

03:55 Remember, anytime a drug is labeled as a first generation, those were the earliest ones that we discovered.

04:00 Second generation means we figured these drugs out a little bit later and are usually better and more effective.

04:07 No difference with the second generation of intranasal glucocorticoids because they also have less systemic effects.

04:14 So if you can, the second generation is usually a better option for you.

04:19 Now, the route matters when we talked about that in our introduction to pharmacology.

04:23 The route and the dose as a drug is administered really impacts the treatment plan.

04:28 Intranasal administration of these corticosteroids or these glucocorticoids is the most effective to treat allergic rhinitis.

04:36 So they're gonna be more effective than antihistamines.

04:40 Now the third group is sympathomimetic decongestants.

04:44 I wanna break that word down for you before we start moving on.

04:48 Sympathomimetic means it mimics the sympathetic nervous system.

04:54 So a sympathetic nervous system response is when my body realizes, woah! we are gonna have to kick in into high gear.

05:01 We've gotta do something really, really fast.

05:03 So what do we need to do here? Well, do you think I'd want my vessels to dilate so my blood pressure drops? Or you think you want them to constrict so I can move faster? Yeah, sympathomimetic response always involves that vasoconstriction and I'll tell you why that's a good thing.

05:20 Have you ever had a stuffy nose and you, and you talk like this.

05:25 And then you can't breathe and you think, "If I can only blow my nose. I would just feel better." So you blow and you blow and you blow and nothing comes out.

05:37 That is so frustrating.

05:39 Well see, the problem is not 'cause your nose is all full of mucus.

05:43 The problem is those membranes are all swollen.

05:47 So what you need to do is to shrink the membranes.

05:51 An antihistamine is not gonna be as effective at shrinking those membranes.

05:55 But if I give a sympathomimetic decongestant, hey! that's gonna mimic the sympathetic nervous system.

06:03 That's gonna cause the blood vessels to restrict and get really tight and small.

06:09 Those membranes are gonna become less.

06:13 They're gonna have that constriction, they're is gonna get them to be opened up.

06:15 So they're gonna become less swollen and far more open.

06:22 You're gonna be able to breathe which is why people get addicted to these nasal sprays because we all kinda like the thought of breathing clearly.

06:33 Now let's talk about this one, pseudoephedrine.

06:36 It can be given either oral or a nasal spray.

06:39 The first medication up there that we've listed for you also can be given nasal or oral.

06:44 So I want you to underline the drug names of both of these.

06:48 Both of these two drug names that are used as sympathomimetic decongestants.

06:54 Make sure that you have big V listed up by these.

06:57 We know, remember that it causes vasoconstriction.

07:01 Now it hits those alpha-1 receptors.

07:03 They're part of the sympathomimetic nervous system and we'll talk more about those specifically in other videos.

07:09 But what you can hit right now is that anytime a drug mimics my sympathetic nervous system, it's gonna cause vasoconstriction.

07:21 And it is because these drugs activate those alpha-1 receptors.

07:24 That's what their job is, cause vasoconstriction, swollen membranes become less swollen, air passages become more open.

07:35 That's why you need to use them in caution with cardiovascular patients.

07:40 Patients who already have problems with high blood pressure or coronary artery disease, they don't need any more vasoconstriction than they already have.

07:51 If I already have high blood pressure and you give me something that causes vasoconstriction, you're gonna make my blood pressure even more difficult to control.

08:00 Now if I take an oral medication, I'm gonna have more systemic effects.

08:05 Putting a cardiovascular patient at even more risk.

08:08 If you take a nose spray, theoretically, you're gonna have less systemic effects because you directly deliver it right to your nose.

08:17 But it's still not a good idea for patient with a cardiovascular history to receive a sympathomimetic decongestant.

08:25 So, put a big star by that point because that would be something if you're doing an assessment on a patient and they told you that they were taking this over the counter medication because I know you're always gonna ask your patients about supplements and over the counter medications and vitamins that they're taking.

08:42 If you find out that they're taking one of these medications and have a cardiovascular history, you're gonna want to follow up on that immediately.

08:50 So i love it that you've got a big heart there on the slide but I want you to really underscore that point.

08:55 Because that can cause significant problems for your patients.

08:58 So because they're sympathomimetics, they shrink that swollen membranes and you have that much easier way to breathe.

09:04 But it has a potential for some abuse.

09:08 Now we call it abuse but really these are just people who like to breathe deeply but you can't be on these medications long term.

09:16 We've gotta find some different kind of solution for you rather than being on a sympathomimetic for a long term.

09:23 So here it is, here's theanswer to your question.

09:27 Pseudoephedrine is the ingredient in crystal meth.

09:30 Which is why in my state you can't buy it in a drugstore without showing your driver's license, answering a bunch of questions and they register.

09:39 So if ever you buy pseudoephedrine, your name is recorded, the amount you purchased and everything is kept in a state wide record so they can keep track of that because people who buy large doses of pseudoephedrine usually have the wrong motive behind it.

09:55 Now for using an intranasal spray for a sympathomimetic, you only wanna use it for a few days.

10:02 That's another real key point.

10:04 So you wanna know that it causes vasoconstriction, I don't want to use it in patients with heart disease and I'm gonna wean that slowly.

10:12 And when I say wean it, you wanna make sure you only use it for a few days 'cause you don't wanna end up in an abused situation.

10:18 It's not like you have an addiction to it but it's really not great for your body and for your health to be on it for a long period of time.

10:26 But when you wean it, you're gonna just use it in one nostril, stop using it in the other, take a few doses like that and you'll slowly wean it off from the other nostril.

10:36 Otherwise, if you just stop it abruptly, then that would just rebound congestion that is worse than your original problem.

10:43 So that's a good note. Write yourself a question in the margin.

10:47 Why do we wean intranasal sympatho decongestants? So why are we weaning this instead of what happens if they're abruptly discontinued?