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Antihistamines and Decongestants

NCLEX Review Guide: Eye and Ear Medications, Antihistamines and Decongestants

Eye Medications

Mydriatics and Cycloplegics

  • Atropine, Cyclopentolate, Tropicamide - dilate pupils and paralyze accommodation for eye exams and surgery
  • Never use in patients with narrow-angle glaucoma - can precipitate acute glaucoma attack
  • Effects last 1-3 hours (tropicamide) to several days (atropine)

Miotics (Glaucoma Medications)

  • Pilocarpine - constricts pupils and increases aqueous humor outflow to reduce intraocular pressure
  • Administered every 6-8 hours as directed for chronic glaucoma management
  • Side effects include headache, brow ache, and decreased night vision

Memory Aid: Eye Drop Administration

"Down and Out" - Pull lower eyelid down and look up, instill drops in conjunctival sac, not directly on cornea

Key Points

  • Always check for allergies before administering eye medications
  • Wait 5 minutes between different eye medications to prevent washout
  • Apply gentle pressure to nasolacrimal duct for 1-2 minutes after instillation

Ear Medications

Otic Preparations

  • Cerumenolytics (mineral oil, docusate) - soften earwax for easier removal
  • Antibiotic drops (ciprofloxacin, ofloxacin) - treat bacterial otitis externa
  • Never use ototoxic medications if tympanic membrane is perforated
  1. Warm medication to room temperature to prevent dizziness
  2. Adults: Pull pinna up and back; Children <3: Pull pinna down and back
  3. Instill prescribed drops and have patient remain on side for 5 minutes
  4. Insert cotton ball loosely if ordered

Key Points

  • Always assess for tympanic membrane integrity before otic medication administration
  • Room temperature medications prevent vestibular stimulation and dizziness

Antihistamines

First Generation (Sedating)

  • Diphenhydramine (Benadryl), Chlorpheniramine - cross blood-brain barrier causing significant sedation
  • Anticholinergic effects include dry mouth, constipation, urinary retention, and blurred vision
  • Contraindicated in narrow-angle glaucoma, BPH, and severe asthma

Second Generation (Non-sedating)

  • Loratadine (Claritin), Cetirizine (Zyrtec), Fexofenadine (Allegra) - minimal CNS penetration
  • Preferred for long-term allergy management due to reduced sedation and anticholinergic effects
  • Cetirizine may cause mild sedation compared to other second-generation agents

First vs Second Generation Antihistamines

First GenerationSecond Generation
Highly sedatingMinimal sedation
Strong anticholinergic effectsMinimal anticholinergic effects
Short duration (4-6 hours)Long duration (12-24 hours)
Multiple daily dosesOnce daily dosing

Key Points

  • First-generation antihistamines increase fall risk in elderly patients
  • Avoid alcohol and other CNS depressants with sedating antihistamines
  • Take with food to reduce GI upset

Decongestants

Oral Decongestants

  • Pseudoephedrine, Phenylephrine - alpha-adrenergic agonists that constrict nasal blood vessels
  • Contraindicated in severe hypertension, coronary artery disease, and hyperthyroidism
  • Can cause insomnia, nervousness, increased blood pressure, and palpitations

Nasal Decongestants

  • Oxymetazoline (Afrin), Phenylephrine nasal spray - provide rapid relief of nasal congestion
  • Limit use to 3 days maximum to prevent rebound congestion
  • Rebound congestion occurs when nasal passages become dependent on medication

Memory Aid: Decongestant Precautions

"3-Day Rule" - Nasal decongestants for 3 days max to avoid rebound congestion

"Heart Check" - Always assess cardiovascular status before oral decongestants

Clinical Scenario

A 65-year-old patient with hypertension asks about using pseudoephedrine for cold symptoms. What is the priority nursing consideration?

Answer: Assess blood pressure and cardiac status. Pseudoephedrine can increase BP and heart rate, potentially dangerous in hypertensive patients. Recommend alternative treatments or consult provider.

Key Points

  • Monitor blood pressure in patients taking oral decongestants
  • Educate patients about 3-day limit for nasal decongestants
  • Pseudoephedrine requires ID for purchase due to methamphetamine production concerns

Commonly Confused Points

Mydriatics vs Miotics

MydriaticsMiotics
Dilate pupilsConstrict pupils
Used for eye examsUsed for glaucoma
Contraindicated in narrow-angle glaucomaTherapeutic for glaucoma
Examples: Atropine, TropicamideExamples: Pilocarpine

Common Pitfalls

  • Don't confuse ear drop administration technique between adults and children
  • Remember that first-generation antihistamines have more side effects than second-generation
  • Never exceed 3-day limit for nasal decongestants

Study Tips and Memory Aids

Acronyms and Memory Devices

  • EYE DROP STEPS: "Wash, Warm, Wait, Wipe" - Wash hands, warm to room temp, wait 5 min between drops, wipe excess
  • ANTIHISTAMINE GENERATIONS: "First = Fatigue" (sedating), "Second = Safe" (non-sedating)
  • DECONGESTANT CAUTIONS: "Heart, Hypertension, Hyperthyroid" - main contraindications

Quick Check Questions

  • ☐ Can you explain the difference between mydriatics and miotics?
  • ☐ Do you know the proper ear drop administration technique for adults vs children?
  • ☐ Can you list three contraindications for first-generation antihistamines?
  • ☐ Do you understand why nasal decongestants should be limited to 3 days?

You're building the knowledge foundation that will make you an exceptional nurse! Every medication you master brings you closer to providing safe, effective patient care. Keep studying - your future patients are counting on your expertise! 🌟

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