McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 5 4 Drugs acting on the upper respiratory tract

TABLE 54.2

DRUGS IN FOCUS Decongestants

Drug name

Dosage/route

Usual indications

Topical nasal decongestants ephedrine

Instill solution in each nostril q 4 hours, do not use for children <6 years unless advised by doctor Adult and paediatric (>6 years): two to three sprays or drops in each nostril b.d. Paediatric (2–6 years): two to three drops of 0.125% solution in each nostril q 4 hours as needed Adult and paediatric (>6 years): one to two sprays in each nostril q 3–4 hours Paediatric (2–6 years): two to three drops of 0.125% solution in each nostril q 4 hours as needed Adult and paediatric (over 10 years): one spray into each nostril 2–3 times daily Adult: 60 mg PO q 4–6 hours Paediatric: 6–12 years: 30 mg PO q 4–6 hours 2–5 years: 15 mg PO q 4–6 hours 1–2 years: 0.02 mL/kg PO q 4–6 hours 3–12 months: three drops/kg PO q 4–6 hours Adult: one to two inhalations in each nostril b.d. Paediatric (6–11 years): one inhalation in each nostril b.d. Adult and paediatric (>6 years): two sprays in each nostril morning and evening or four sprays in each nostril in the morning

Relieves discomfort of nasal congestion associated with the common cold, sinusitis, allergic rhinitis; relieves pressure of otitis media Relieves discomfort of nasal congestion associated with the common cold, sinusitis, allergic rhinitis

oxymetazoline (Dimetapp, Drixine)

phenylephrine (Nyal)

Relieves discomfort of nasal congestion associated with the common cold, sinusitis, allergic rhinitis

xylometazoline (FLO Xylo-POS)

Relieves discomfort of nasal congestion associated with the common cold, sinusitis, allergic rhinitis; relieves pressure of otitis media Decreases nasal congestion associated with the common cold, allergic rhinitis; relief of pain and congestion of otitis media Treatment of seasonal allergic rhinitis in people who are not obtaining a response with other decongestants or preparations; relieves inflammation following removal of nasal polyps Treatment of seasonal allergic rhinitis in people who are not obtaining a response with other decongestants or preparations; relieves inflammation following removal of nasal polyps Treatment of seasonal allergic rhinitis in people who are not obtaining a response with other decongestants or preparations; relieves inflammation following removal of nasal polyps Treatment of seasonal allergic rhinitis in people who are not obtaining a response with other decongestants or preparations; relieves inflammation following removal of nasal polyps

Oral decongestant

pseudoephedrine (Codral, Demazin,

Logicin, Sudafed)

Topical steroid nasal decongestants beclomethasone (Beconase)

budesonide (Pulmicort)

fluticasone (Avamys, Flixonase)

Adult and paediatric (4–11 years): two sprays in each nostril daily

triamcinolone (Telnase)

Adult: two sprays in each nostril every day

indicate lesions or erosion of the mucous membranes. Use for longer than 3 to 5 days can lead to rebound con- gestion. (Rebound congestion occurs when the nasal passages become congested as the drug effect wears off. As a result, people tend to use more drug to decrease the congestion, thus initiating a vicious cycle of congestion– drug–congestion, which leads to abuse of the decongest- ant.) Sympathomimetic effects (e.g. increased pulse and

blood pressure; urinary retention) should be monitored because some systemic absorption may occur, although these effects are less likely with topical administration than with other routes. Clinically important drug–drug interactions The use of topical nasal decongestants is contraindi- cated with concurrent use of cyclopropane or halothane