The first-generation antihistamine that can be given IV for acute allergic reactions and is the active ingredient in many nighttime sleep aids is diphenhydramine.
Missing Word
diphenhydramine
Diphenhydramine is the prototype first-generation antihistamine. It crosses into the brain, which explains both its use as a sleep aid and its marked drowsiness.
Category: First-Generation Antihistamines
Question 2
First-generation antihistamines make poor long-term sleep aids because tolerance to their sedating effect develops after only a few nights of use.
Missing Word
tolerance
Tolerance is a reduced response to a drug after repeated use. It builds quickly to the sedation of first-generation antihistamines, so a nightly sleep aid loses its effect while the anticholinergic adverse effects remain.
Category: First-Generation Antihistamines
Question 3
The second-generation antihistamine that should be taken with water because grapefruit, orange and apple juice reduce its absorption is fexofenadine.
Missing Word
fexofenadine
Fruit juices lower fexofenadine absorption and blunt its effect, so it is taken with water. It is used for seasonal allergies and chronic hives.
Category: Second-Generation Antihistamines
Question 4
Desloratadine, a second-generation antihistamine, is the active metabolite that the body forms when it breaks down loratadine.
Missing Word
metabolite
A metabolite is a substance produced when the body breaks a drug down. Desloratadine is the active product of loratadine metabolism and is marketed as its own drug for allergies and hives.
Category: Second-Generation Antihistamines
Question 5
The over-the-counter expectorant that loosens mucus by increasing respiratory tract fluid, and that is meant for a productive cough rather than a dry one, is guaifenesin.
Missing Word
guaifenesin
Guaifenesin is the standard over-the-counter expectorant. It thins secretions so they are easier to cough up and does not suppress the cough, so it suits a cough that brings up mucus; clients drink extra fluids to help it work.
Category: Expectorants
Question 6
A runny nose, one of the allergy symptoms that second-generation antihistamines such as levocetirizine relieve, is known medically as rhinorrhea.
Missing Word
rhinorrhea
Rhinorrhea is the medical term for a runny nose. In allergic rhinitis, histamine increases nasal secretions, and blocking H1 receptors reduces the drainage.
Category: Second-Generation Antihistamines
Question 7
When using a nasal decongestant spray, the client aims the tip toward the outer wall of the nostril, away from the septum.
Missing Word
septum
The septum is the wall that divides the two nasal passages. Aiming away from it spreads the drug over the swollen tissue and avoids irritating the septum.
Category: Decongestants
Question 8
Codeine suppresses coughing by acting on the cough center in the part of the brainstem called the medulla.
Missing Word
medulla
The medulla holds the cough center. Opioid antitussives such as codeine act there, which is also why they can depress breathing.
Category: Opioid Antitussives
Question 9
The nonopioid antitussive that comes as a capsule and works by numbing stretch receptors in the airways and lungs is benzonatate.
Missing Word
benzonatate
Benzonatate is chemically related to local anesthetics and reduces the cough reflex at its source in the airways. Because of that numbing action, the capsule is swallowed whole.
Category: Nonopioid Antitussives
Question 10
The nonopioid cough suppressant found in many over-the-counter syrups that can cause serotonin syndrome when combined with an SSRI is dextromethorphan.
Missing Word
dextromethorphan
Dextromethorphan acts on the cough center and has serotonergic activity. Combining it with SSRIs or other serotonergic drugs can cause serotonin syndrome, and it must not be taken with MAOIs.
Category: Nonopioid Antitussives
Question 11
The mucolytic that can be instilled directly into a tracheostomy for routine care and is also given before bronchial studies is acetylcysteine.
Missing Word
acetylcysteine
Acetylcysteine breaks the bonds that hold mucus together, thinning secretions so they can be suctioned or coughed out. It is also used for pneumonia, bronchitis and cystic fibrosis.
Category: Mucolytics
Question 12
A client who has used oxymetazoline spray far longer than directed reports that the stuffiness comes back worse each time a dose wears off, a problem called rebound congestion.
Missing Word
rebound
Rebound congestion develops when a topical decongestant is overused: the nasal mucosa becomes inflamed and swells again as each dose wears off, which tempts the client to spray more often. The nurse teaches short-term use only and stopping the spray under provider guidance.
Category: Decongestants
Question 13
Pseudoephedrine labeling tells clients with disease of the thyroid, the gland in the neck that regulates metabolism, to ask a provider before use.
Missing Word
thyroid
Pseudoephedrine stimulates adrenergic receptors, and in a client with an overactive thyroid this can add to a fast heart rate, nervousness and high blood pressure. The label also lists heart disease, high blood pressure, diabetes and trouble urinating from an enlarged prostate.
Category: Decongestants
Question 14
Dornase alfa thins the sputum of cystic fibrosis by breaking down the DNA released from dead white blood cells.
Missing Word
DNA
Infected cystic fibrosis sputum is thick with DNA from broken-down neutrophils. Dornase alfa is an enzyme that cuts this DNA, making the mucus thinner and easier to clear.
Category: Mucolytics
Question 15
During an allergic response, histamine is released from mast cells in the tissues and from circulating white blood cells called basophils.
Missing Word
basophils
Basophils are white blood cells that store histamine, as tissue mast cells do. When an allergen activates them, the released histamine produces the sneezing, itching and swelling that antihistamines block.
Category: Antihistamine Use