Antihistamines H1 Receptor Antagonists

Drugs Action Clinical Indications

Dimenhydrinate (Dramamine) Diphenhydramine(Benedryl) Loratadine (Claratin) Block histamine effects that occur in a allergic reaction Block the binding of histamine to H1 receptor sites (not H2)

Allergic rhinitis, conjuctivitis, urticaria (hives), angioedema (submucosal swelling in the hands, face, and feet), adjunctive therapy in anaphylaxis. N/V, Motion sickness, vertigo, pre op sedation, sleep aid, parkinsons disease, treats side effects of antipsychotic med

CNS Depression resulting in sedation (Most common)

Adverse Effects

Gi loss of appetite, N/V, Constipation, Dirrhea (take with meals or milk can help GI complications). Anticholinergic- Dry mouth, nose, throat, thickening of bronchial secretions.

Antihistamines .CONTINUED
Drug Interactions
Additive or cumulative Effect May block or reverse the effects of another drug. May mask the toxic signs and symptoms of another drug.

Nursing Implications

May have opposite effect on children (instead of drowsiness, may cause excitability) Discontinue four days before allergy skin testing. Sedationdont drive or operate heavy machinery. Dont mix with other CNS Depressants (alcohol) Give most IM antihistamines Z-track.

Glucocorticoids (Corticosteroids)
Drugs
Cortison (cortone) Dexamethasone (Decadron) Prednisone (Deltasone)

Action

Suppresses hypersensitivity and immune responses by preventing cell mediated immune reactions(process is not entirely understood). Affect CHO and Protein metabolism

Distribution

Enters all tissues and compartments, including the CSF.

Primarily as anti-inflammatory and immunosuspressant agents.

Clinical Use

They cause a rapid reduction in symptoms but do not affect disease progression. Replacement therapy in adrenal insufficiency

Relieve hypersensitivy reactions

Reduce or prevent the cerebral edema Hypercalcemia (Vitamin D intoxication)

Glucocorticoids .CONTINUED
Pharmacologic doses of cortisol depress the activity of both adrenal cortical cells and ACTH secreting anterior pituitary cells Inhibits inflammatory response

Adverse Effects

Increases sodium and water retention Redistribution of fat stores Stimulates glucose synthesis Central Nervous system effects Causes protein catabolism GI Disturbances

PO with meals.

Route

Can also be given IM, IV, nhalant, Intraarticular, topical. 2/3 dose usually given in AM and 1/3 dose usually given in PM

Contraindications

Use cautiously in patients with peptic ulcer disease, hypertension, infection.

Glucocorticoids CONTINUTED, MORE

Nursing Implications
Do not take aspirin concomittantly (or alcohol, caffeineCauses GI upsets) Check stool for occult blood Check for coffee ground. N-G drainage or emesis. Observe closely for anaphylactice reaction Monitor glucose, weight gain, BP, CBC, electrolytes, increased ocular pressure.

Encourage patients on long term corticosteroid therapy to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates. Cause immunosuppression and may mask symptoms of infection, instruct patient to avoid people with known contagious illness, report possible infections, and consult physician before receiving vaccinations. Discuss possible effects on body image Advice patient to carry medical information ID and not to stop taking abruptly. Monitor closely for S&S of infection. Observe and report emotional changes

Patient Education

If topical, monitor ecchymoses or increased skin fragility.

Mineralcorticoids (Corticosteroids)
Drugs Action Clinical Use Adverse Effects
Aldosterone Fludrocortisone (Florinef)

Affect fluid and electrolyte balance by acting on the distal renal tubule to enhance sodium reabsoprtion and potassium and hydrogen secretion. Regulate Electrolyte and water balance.

Adrenal insufficiency replacement therapy

Edema, hypertension, congestive heart failure, hypernatremia, hypokalemia, hypocalcemia.

Mineralcorticoids .CONTINUED
Contraindications
Hypertension Heart disease

Use cautiously with patients on diuretics.

Nursing Implications

Eat foods high in K. Monitor K levels, BP, report weight gain, edema. Inject IM Mineralcorticoids in dosogluteal site. Never in arm.

Immunosuppressants
Drugs Clinical Use Action Adverse Effects Nursing Implications
Cyclosporine

To prevent rejection in patients who undergo organ tansplantation. Interferes with cellular metabolism and alters antibody formation (specific action is unclear). Fever, chills, leukopenia (decreased WBC), thrombocytopenia (decreased platelets) Increased risk of bleeding and alopecia (hair loss) Nephrotoxicity (most serious and adverse effect!!!) Monitor for infection Monitor Labwork Be aware that many times, the first dose is given along with corticosteroids and antihistamines to decrease the chance of hypersensitivity reaction. No immunizations until imunosuppressant therapy is D/c,

Anti-Gout
Drugs Action Drug Interactions Adverse Effects Nursing Implications
Probenecid (Benemid) Allopurional (Zyloprim) Colchicine Increased excretion of uric acid in the urine, thus preventing deposits in joints. Probenecid has NO ANTI INFLAMMATORY ACTION.

Increases blood levels of penicillin

Gi Upset

Take with meals or antacids to decrease GI upset

Drink plenty of fluids to prevent renal calculi

Eat a high vegetable diet to alkalinize the urine

Gold Salts
Drugs Clinical Use Action
Adverse Effects
Auranofin (Ridaura) Treatment of Rheumatoid arthritis Blocks the inflammatory disease process (exact mechanism is unclear)

Dirrhea (most common). May also cause dermatiis, thromocytopenia, leukopenia, and stomatitis (mouth ulcers). Leaves a metallic taste in mouth.

Nursing Implications

May Use topical corticosteroids or antihistamines to decrease dermal reactions Monitor platelets Be aware that oral gold salts talk 2-4 months to be effective Explain that rinsing mouth with 1 tsp salt in 8 oz water can help mild mouth ulcers.