Hi! welcome to our video on medications
for allergic rhinitis and cough.
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.
-itis means inflammation.
It's an allergic response and you
end up with that runny nose.
So it's an inflammatory response to allergens
that involves your upper respiratory tract.
Now this can be just short terms
-seasonal, or they can last all year long,
that's called perennial.
So you have symptoms that
include swollen sinuses,
itchy/watery eyes, stuffy or runny
nose and an itchy sore throat.
We have 3 groups of medications that we use
predominantly to treat allergic rhinitis.
Antihistamines, you can go
take them orally or intranasally.
Intranasal glucocorticoids or
Now I have a question for you.
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.
Well I'm not gonna tell you the
answer to that question yet.
Stay tuned and I'll tell you which
one of those groups of medication
contains that over the counter medication.
Okay, so first up.
We're gonna look up antihistamines.
Now, they get their name because they can act
to the histamine receptors in your body.
Now, histamine wreaks
havoc in your body.
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.
So we have first generation -
Now those are the ones
that make you real sleepy.
You may know it by
the name of Benadryl.
But first generation antihistamines,
they have this central acting thing
where they make you real sleepy
which is actually helpful.
Sometimes people use that
as a sleep aid at night.
But if you have to work or go
to school, that's not so good.
Second generations are non-sedating.
So you can take something
like fexofenadine, loratadine
and use those drugs to do
the same type of thing.
They'll block that histamine response
but they won't make you sleepy.
Now you can take intranasal antihistamines
that sometimes this can be really effective.
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.
You're gonna have fewer
systemic side effects
and you're gonna have some
really good and quick results.
So we've got a name there for you
for an intranasal antihistamine.
So when we're looking at this first group
of medications, what we want to do
is get the drug unto those
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.
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.
Remember that's the important concept when
we're using antagonist or antihistamines.
The drug fits on those special
receptors and will block
the nastiness that normally
happens in your body.
Now even more effective for treating allergic
rhinitis are intranasal glucocorticoids.
The antihistamines just block that histamine
receptor but the intranasal glucocorticoids
really suppress that inflammatory
response on a much bigger level.
So the first generation group,
you see them listed there,
beclomethasone and the other two medications,
they have more systemic effects.
Remember, anytime a drug
is labeled as a first generation,
those were the earliest
ones that we discovered.
Second generation means we figured
these drugs out a little bit later
and are usually better
and more effective.
No difference with the second generation
of intranasal glucocorticoids
because they also have
less systemic effects.
So if you can, the second generation
is usually a better option for you.
Now, the route matters when we talked about
that in our introduction to pharmacology.
The route and the dose as a drug is
administered really impacts the treatment plan.
Intranasal administration of these
corticosteroids or these glucocorticoids
is the most effective to
treat allergic rhinitis.
So they're gonna be more
effective than antihistamines.
Now the third group is
I wanna break that word down for
you before we start moving on.
Sympathomimetic means it mimics
the sympathetic nervous system.
So a sympathetic nervous system
response is when my body realizes,
woah! we are gonna have to
kick in into high gear.
We've gotta do something
really, really fast.
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.
Have you ever had a stuffy nose and
you, and you talk like this.
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.
That is so frustrating.
Well see, the problem is not
'cause your nose is all full of mucus.
The problem is those
membranes are all swollen.
So what you need to do is
to shrink the membranes.
An antihistamine is not gonna be as
effective at shrinking those membranes.
But if I give a
hey! that's gonna mimic the
sympathetic nervous system.
That's gonna cause the blood vessels to
restrict and get really tight and small.
Those membranes are
gonna become less.
They're gonna have that constriction,
they're is gonna get them to be opened up.
So they're gonna become less
swollen and far more open.
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.
Now let's talk about this
It can be given either
oral or a nasal spray.
The first medication up there that we've listed
for you also can be given nasal or oral.
So I want you to underline the
drug names of both of these.
Both of these two drug names that are
used as sympathomimetic decongestants.
Make sure that you have
big V listed up by these.
We know, remember that it
Now it hits those alpha-1 receptors.
They're part of the
sympathomimetic nervous system
and we'll talk more about those
specifically in other videos.
But what you can hit right now is that anytime
a drug mimics my sympathetic nervous system,
it's gonna cause vasoconstriction.
And it is because these drugs
activate those alpha-1 receptors.
That's what their job is, cause vasoconstriction,
swollen membranes become less swollen,
air passages become more open.
That's why you need to use them in
caution with cardiovascular patients.
Patients who already have problems with high
blood pressure or coronary artery disease,
they don't need any more
vasoconstriction than they already have.
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.
Now if I take an oral medication, I'm
gonna have more systemic effects.
Putting a cardiovascular patient
at even more risk.
If you take a nose spray, theoretically,
you're gonna have less systemic effects
because you directly deliver
it right to your nose.
But it's still not a good idea for
patient with a cardiovascular history
to receive a sympathomimetic
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.
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.
So i love it that you've got a
big heart there on the slide
but I want you to really
underscore that point.
Because that can cause significant
problems for your patients.
So because they're sympathomimetics,
they shrink that swollen membranes
and you have that much
easier way to breathe.
But it has a potential
for some abuse.
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.
We've gotta find some different
kind of solution for you
rather than being on a
sympathomimetic for a long term.
So here it is,
here's theanswer to your question.
Pseudoephedrine is the
ingredient in crystal meth.
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.
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.
Now for using an intranasal spray for a
sympathomimetic, you only wanna use it for a few days.
That's another real key point.
So you wanna know that it
I don't want to use it in patients with heart
disease and I'm gonna wean that slowly.
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.
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.
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.
Otherwise, if you just stop it abruptly,
then that would just rebound congestion
that is worse than
your original problem.
So that's a good note.
Write yourself a question in the margin.
Why do we wean intranasal
So why are we weaning this instead of what
happens if they're abruptly discontinued?