Decongestants systemic

Topical and systemic decongestants are sympathomimetic agents that act on adrenergic receptors in the nasal mucosa to produce vasoconstriction, shrink swollen mucosa, and improve ventilation. Decongestants work well in combination with antihistamines when nasal congestion is part of the clinical picture. 

Manage rebound congestion by stopping ephedrine one nostril at a time, substitute systemic decongestant and/or nasal steroid... 

Systemic decongestants Provide longer-lasting relief... 

Systemic decongestants or nasal decongestants for the reduction of the congestion that accompanies sinusitis... 

Three types of decongestants are nasal decongestants, systemic decongestants, and intranasal glucocorticoids. 

Systemic decongestants constrict the swollen mucosa and dilated blood vessels of the nasal passages, and improve air circulation and mucus drainage. 

They can be used by patients for whom systemic decongestants are contraindicated, but should be avoided by patients taking monoamine oxidase inhibitors. 

Proven therapeutic modalities include avoidance of allergens and pharmacologic management with antihistamines, topical and systemic decongestants, topical steroids, cromolyn sodium, and immunotherapy. 

I Systemic Decongestants. Oral decongestants are not as effective on an immediate basis as the topical agents, bnt their effects sometimes last longer and they cause less local irritation. 

There are three types of decongestants. These are nasal decongestants that provide quick relief to the patient systemic decongestants that provide a longer lasting relief from congestion and intranasal glucocorticoids that are used to treat seasonal and perennial rhinitis. 

Many alkaloids have pronounced biological properties, and a substantial number of the pharmaceutical agents used today are derived from naturally occurring amines. As a few examples, morphine, an analgesic agent, is obtained from the opium poppy Papaver somnifemm. Cocaine, both an anesthetic and a central nervous system stimulant, is obtained front the coca bush Erythroxylon coca, endemic to upland rain forest areas of Colombia, Ecuador, Peru, Bolivia, and western Brazil. Reserpine, a tranquilizer and antihypertensive, comes from powdered roots of the semitropical plant Rauwolfia serpentina. Ephedrine, a bronchodilator and decongestant, is obtained front the Chinese plant Ephedra sinica. 

When used topically in prescribed doses, there are usually minimal systemic effects in most individuals. On occasion, nasal burning, stinging, and dryness may be seen. When the topical form is used frequently or if the liquid is swallowed, the same adverse reactions seen with the oral decongestants may occur. 

SUM MARY DRUG TABLE SYSTEM 1C AND TOPICAL NASAL DECONGESTANTS... 

Patients older than 60 years are at greater risk for experiencing adverse reactions to the decongestants. Overdosage may cause hallucinations convulsion, and central nervous system depresaon. 

Unit V has three chapters concerning drugs that affect the respiratory system. The first chapter in this unit discusses antihistamines and decongestants, the second chapter in the unit covers bronchodilators and antiasthma drugs, and the last chapter of the unit deals with antitussives, mucolytics, and expectorants. 

Antihistamines and intranasal corticosteroids are considered first-line therapy for allergic rhinitis, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options. 

Pharmacotherapy has an important role in managing AR symptoms (Table 59-2). Intranasal corticosteroids, systemic and topical antihistamines and decongestants, mast cell stabilizers, and immunotherapy all are beneficial in treating symptoms of AR.9 Antihistamines and intranasal corticosteroids are considered first-line therapy for AR, whereas decongestants, mast cell stabilizers, leukotriene modifiers, and systemic corticosteroids are secondary treatment options10-12 (Fig. 59-2). Whenever exposure to allergens can be predicted (e.g., SAR or visiting homes with a pet), medications should be used pro-phylactically to maximize effectiveness.11... 

Decongestants such as OTC pseudoephedrine are sympathomimetic agents that constrict capacitance vessels in the nasal turbinates.17 Decongestants effectively reduce nasal congestion and to some extent rhinorrhea associated with AR.8,12 The recommended dose of pseudoephedrine is 30 to 60 mg every 4 to 6 hours for a maximum daily dose of 240 mg.15 Systemic adverse effects such as irritability, dizziness, headache, tremor, tachycardia, and insomnia can occur. Additionally, use is associated with increased blood pressure and intraocular pressure and urinary obstruction.8,12... 

Topical decongestants are applied directly to swollen nasal mucosa via drops or sprays (Table 79-3). They result in little or no systemic absorption. 

Rhinocort Aqua and Nasonex are preparations containing topical nasal corticosteroids (budesonide and mometasone furoate respectively). Otrivine contains a nasal decongestant (xylometazoline) and Sudafed is a systemic preparation containing a nasal decongestant (phenylephrine). Molcer is a preparation for ear-wax removal and which contains docusate sodium. Emadine contains an antihistamine (emedastine) and is presented as eye drops. 

Phenylephrine is a nasal decongestant that mimics the sympathetic system, thereby increasing the heart rate and blood pressure. It may aggravate conditions such as diabetes, hypertension and glaucoma. Patients with hypertension, ischaemic heart disease, hyperthyroidism, diabetes and glaucoma are therefore given topical nasal sympathomimetics rather than systemic sympathomimetics. Both topical and systemic sympathomimetics are contraindicated in patients taking monoamine oxidase inhibitors, because concurrent administration of the two products may lead to a hypertensive crisis. 

Triprolidine is an antihistamine. Phenylpropranolamine, pseudoephedrine, phenylephrine and oxymetazoline are nasal decongestants. Nasal decongestants administered systemically are often available in combination with an antihistamine. 

Vasoconstriction. Local application of a-sympathomimetics can be employed in infiltration anesthesia (p. 204) or for nasal decongestion (naphazoline, tetra-hydrozoline, xylometazoline pp. 90, 324). Systemically administered epinephrine is important in the treatment of anaphylactic shock for combating hypotension. 

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