‫بسم هللا الرحمن الرحيم‬

BACHELOR OF SCINCE IN NURSING

2nd YEAR

PHAMACOLOGY

MADAAM WANU
1
 GROUP 3
MEMBER 0F GROUP
MASSOUD MOH’D AMOUR
TAMIM ANTAR SANGAL
JOKHA MOH’D SAID
KHADIJA KHAMIS RAMADHAN
MARYAM MOH’D ABDI

2
 QN
1. THE DRUGS ACTING ON THE
RESPIRATORY SYSTEM
a. ARTHAMATICS
b. ANTITUSSIVES
c. DECONGESTANTS
d. ANTIHISTAMINE “hi blockers”
THE DRUGS ACTING ON THE
RESPIRATORY SYSTEM
 ASTHMATICS DRUG

• Drugs for treating asthma are divided into two

categories:
(1) Quick-relief medications (which are used to
relief acute asthma) and
(2) Long-term asthma control medications with
(which are used as prophylactic measures)
details below:-
 1. Quick-relief medications
• they are used as needed for rapid, short-term
symptom relief during an asthma attack. Types
of quick-relief medications are:
a. Short-acting beta2 agonists: these inhaled,
quick-relief bronchodilators act within minutes
to rapidly ease symptoms during an asthma
attack. Short-acting beta2 agonists can be
taken using a portable, hand-held inhaler or a
nebulizer.
• Examples are salbutamol and terbutaline.
b. Antimuscarinics: these inhaled antimuscarinics act
quickly to immediately relax the airways, like other
bronchodilators, making it easier to breathe.
• Examples are ipratropium and tiotropium.
c. Systemic corticosteroids:
These systemic corticosteroids (i.e., oral and
intravenous routes) relieve airway inflammation
caused by severe asthma.
However, due to serious side effects when used long
term, the systemic routes are used only on a short-
term basis to treat severe asthma symptoms.
• Examples are prednisone and
methylprednisone.
d. Intravenous xanthines:
These xanthines relax smooth muscle and to
relieve bronchial spasm and are indicated for
severe asthma attack. Example is
aminophylline.
 2. Long-term asthma control
medications:
They work to reduce the amount of
inflammation in the airways and prevent
asthma attacks occurring.
a.Inhaled corticosteroids: they are the most
effective preventers, however, you may need
to use these medications for several days to
weeks before they reach their maximum
benefit.
Examples are fluticasone and budesonide.
b.Long-acting beta2 agonists: these inhaled
medications open the airways. Some research
shows that they may increase the risk of a
severe asthma attack, unless they are used in
combination with an inhaled corticosteroid.
• Examples are salmeterol and formoterol.
c.Leukotriene inhibitors: they act against one of
the inflammatory components of asthma and
provide protection against bronchoconstriction
when taken before exercise or exposure to
allergen or to cold air. Examples of leukotriene
inhibitors include montelukast and zafirlukast.
d.Xanthines: apart from relaxation of bronchial
muscle and relief of bronchial spasm, they can
stimulant effects on respiration and have anti-
inflammatory effects. Example is theophylline.
 SALBUTAMOL

• Salbutamol, also known as albuterol and

marketed as Ventolin among other names, is a
medication that opens up the medium and
large airways in the lungs.
• It is used to treat asthma, exercise-induced
bronchospasm, and chronic obstructive
pulmonary disease (COPD).
• It is usually used by inhaler or nebulizer but is
also available as a pill and intravenous
solution
 USES INDICATION OF SALBUTAMOL

1. Bronchospasm with reversible obstructive

airway diseases
• Salbutamol is indicated for the preventation or
treatment of bronchospasm with reversible
obstructive airway diseases such as
• Bronchial asthama
• Chronic obstructive pulmonary disease (COPD)
which includes chronic bronchitis and
emphysema
2. Exercise-induced bronchospasm
• Salbutamol is used for the prevention of
exercise-induced bronchospasm.

3. Any other situations known to induce

bronchospasm.
 DOSAGE

1. Oral salbutamol:
Adults and Children over 12 years of age:
• Usual starting dosage of salbutamol is 2mg or 4
mg 3 or 4 times a day. A dosage above 4 mg
salbutamol 4 times a day should be used only
when the patient fails to respond adequately. If
a desirable response does not found with 4 mg
salbutamol, it should be cautiously increased
the dosage up to a maximum of 8 mg 4 times a
day as tolerated.
Children 6-12 years of age:
• Usual starting dosage of salbutamol is 2mg 3 or 4
times a day.If a desirable response does not
found with 2mg salbutamol, it should be
cautiously increased the dosage up to a
maximum of 24hrs per day given in 3 or 4 divided
doses.
Children 2-6 years of age:
• Usual dose is 1mg salbutamol tds, or 0.1 mg/kg
body weight/dose, tds or 6hrly.
2.Inhaler formulation
• For the treatment of acute episodes of bronchial
asthma or acute bronchospasm , the usual dose is
one capsule (200 mcg) or two capsules (400 mcg)
inhaled repeated every four to six hours.
• For the treatment of persistent symptoms of
bronchial asthma, one capsule (200 mcg) or two
capsules (400 mcg) inhaled 3 or 4 times daily.
• For the prophylaxis of bronchospasm caused by
exercise, one capsule (for children) or two
capsules (for adults) inhaled 15 minutes before
exercise.
3. Nebulizer solution – 1ml (for children) or 2 ml
(for adult) of salbutamol nebulizer solution
should be diluted with normal saline to final
volume of 2-4 ml is inhaled from a nebulizer
until aerosol generation ceases.
• It may be required repeated in severe acute
attack.
4. Injection form – 5 to 10 ml (each ml contain
50 microgram) of salbutamol injection is used
intramuscularly or intravenously in severe
acute attack. Children are not recommended
for salbutamol injection.
 MODE OF ACTION

• After oral administration, approximately 50%

of salbutamol is absorbed from the intestinal
tract with a slower onset of action, reaching a
peak at about 2 hours after intake. After
inhalation, salbutamol reaches the lungs
directly and acts within 3-5 minutes with a
peak at 15-20 minutes. Overall duration of
action of salbutamol is 4-6 hours.
• It is metabolized in the intestinal tract and in
the liver and is excreted via the urine.
 Mechanism of action:

• Salbutamol stimulates β2 adrenergic receptors

which are predominant receptors in bronchial
smooth muscle of the lung. Stimulation of β2
receptors leads to the activation of enzyme
adenyl cyclase that form cyclic AMP (adenosine-
mono-phosphate) from ATP (adenosine-tri-
phosphate).
• This high level of cyclic AMP relaxes bronchial
smooth muscle and decreases airway resistance
by lowering intracellular ionic calcium
concentrations.
• Salbutamol relaxes the smooth muscles of
airways, from trachea to terminal bronchioles.
• High level of cyclic AMP are also inhibits the
release of bronchoconstrictor mediators such
as histamine, leukotreine from the mast cells
in the airway.
SIDE EFFECTS AND ADVERSE EFFECTS

Feeling a bit shaky

Headache
Rapid heart beat
Flushing
Muscle cramps (uncommon with inhaled
salbutamol).
Irritation or dryness of the mouth and throat
(inhaled salbutamol only).
Hypokalaemia (low blood potassium levels),
and can lead to muscle cramps and weakness,
and in severe cases it can cause death as
patients stop breathing
Restlessness
Diziness
Bronchospasm (inhaled salbutamol only).
 CONTRAINDICATION AND CAUTION

• Salbutamol is contraindicated in persons with

a history of hypersensitivity reaction (urticaria,
angioedema, rash) to salbutamol, or any of its
components.
• Salbutamol is also contraindicated in patients
with pre-existing cardiac tachyarrhythmias
(too fast heart beat, may be regular
or irregular).
 Pharmacokinetics
• It has been found from a number of studies
that upon inhalation of salbutamol, peak
plasma concentration of the drug occurs after
a duration of approximately 3 hours.
• Within 72 hours, the applied dosage is
normally completely excreted, through both
urine and faeces. Analysis of urinary excretion
data indicates that salbutamol has an
excretion half-life of 3.8 hours.
• Salbutamol is metabolised almost exclusively by
the liver, being converted to salbutamol 4'-O-
sulfate. This is then excreted through urination
and defecation.
• After oral inhalation, 80—100% of a dose is
excreted via the kidney, while 10% may be
eliminated in faeces. After oral administration,
75% of a dose is excreted in urine as
metabolites, while others found in faeces.
 DRUG NTERACTION

• The following interactions have been selected

on the basis of their potential significance and
are not necessarily all-inclusive.
• Using this medicine with any of the following
medicines is usually not recommended, but
may be required in some cases.
• If both medicines are prescribed together,
your doctor may change the dose or how
often you use one or both of the medicines.
• Amineptine
• Amitriptyline
• Amitriptylinoxide
• Amoxapine
• Atomoxetine
• Clomipramine
• Desipramine
• Dibenzepin
• Doxepin
 NURSING CONSIDERATION

• Assessment & Drug Effects

• Monitor therapeutic effectiveness which is
indicated by significant subjective improvement
in pulmonary function within 60–90 min after
drug administration.
• Monitor for: S&S of fine tremor in fingers, which
may interfere with precision handwork; CNS
stimulation, particularly in children 2–6 y,
(hyperactivity, excitement, nervousness,
insomnia), tachycardia, GI symptoms. Report
promptly to physician.
• Lab tests: Periodic ABGs, pulmonary functions,
and pulse oximetry.
• Consult physician about giving last albuterol
dose several hours before bedtime, if drug-
induced insomnia is a problem.
Patient & Family Education
• Review directions for correct use of medication
and inhaler (see ADMINISTRATION).
• Avoid contact of inhalation drug with eyes.
• Do not increase number or frequency of
inhalations without advice of physician.
• Notify physician if albuterol fails to provide relief
because this can signify worsening of pulmonary
function and a reevaluation of condition/therapy
may be indicated.
• Note: Albuterol can cause dizziness or vertigo;
take necessary precautions.
• Do not use OTC drugs without physician
approval. Many medications (e.g., cold
remedies) contain drugs that may intensify
albuterol action.
• Do not breast feed while taking this drug
without consulting physician.
 ANTITUSSIVES

• Antitussives or cough suppressants are drugs that

suppress coughing, possibly by reducing the activity
of the cough center in the brain
Examples of antitussives drugs are
 Pentoxyverine
 Codeine,
 pholcodine,
 dextromethorphan
 noscapine.
 Butamirate
 Pentoxyverine

• Pentoxyverine or carbetapentane is
an antitussive (cough suppressant) commonly used
for cough associated with illnesses like common
cold.
• It is sold over-the-counter in the United States
as Solotuss, or in combination with other
medications, especially decongestants. One such
product is Certuss, a combination of guaifenesin and
pentoxyverine.[2]
• The drug is available in the form of
drops, suspensions and suppositories
 USES INDICATUION

• The drug is used for the treatment of dry

cough associated with conditions such as
common cold, bronchitis or sinusitis.
Like codeine and other antitussives, it relieves
the symptom, but does not heal the illness.
 DOSAGE
Usual Adult Dose for Cough
• Carbetapentane 30mg/5 ml oral suspension,
extended release:
5 to 10ml orally every 12hours.
• Usual Pediatric Dose for Cough
• Carbetapentane 30mg/5ml oral suspension,
extended release.
2 to 5 years: 1.25ml to 2.5ml orally every 12 hours.
6 to 11 years: 2.5 mL to 5ml orally every 12 hours.
12 years or older: 5ml to 10ml orally every 12 hours.
 MODE OF ACTION
• Pentoxyverine suppresses the cough reflex in the
central nervous system,[1] but the exact
mechanism of action is not known with certainty.
The drug acts as an antagonist at muscarinic
receptors[3] (subtype M1) and as an agonist at
sigma receptors.
• Its anticholinergic properties can theoretically
relax the pulmonary alveoli and reduce phlegm
production.
• Spasmolytic and local anaesthetic properties
have also been described.The clinical relevance of
these mechanisms is uncertain.
SIDE EEFECTS AND ADVERSE EFFECTS

Common side effects may include:

constipation, diarrhea;
nausea, vomiting, upset stomach, loss of
appetite;
weakness, mild dizziness or drowsiness;
anxiety, feeling nervous or excited; or
sleep problems (insomnia).
 Contraindications and cautions

• Pentoxyverine is contraindicated in persons with

bronchial asthma or other kinds of respiratory
insufficiency (breathing difficulties), as well as angle-
closure glaucoma.
• No data are available for the use of pentoxyverine
during pregnancy, lactation, or children under two
years of age, wherefore the drug must not be used
under these circumstances
• Antitussive drugs are not useful in patients with
extensive phlegm production because they prevent
coughing up the phlegm.
 Pharmacokinetics

• The substance is absorbed quickly from the

gut and reaches its maximum plasma
concentration (Cmax) after about two hours. If
applied rectally, Cmax is reached after four
hours. The bioavailability of the suppositories,
measured as area under the curve (AUC), is
about twofold that of oral formulations, due
to a first pass effect of over 50%.
• By far the most important metabolisation
reaction is ester hydrolysis, which accounts for
26.3% of the total clearance through the
kidneys. Only 0.37% are cleared in form of the
original substance.
• The plasma half life is 2.3 hours for oral
formulations and three to 3.5 hours for
suppositories.[9] Pentoxyverine is also
excreted into the breast milk.
 Drug interaction

• No interactions have been described at usual doses. It

is possible that pentoxyverine can increase the
potency of sedative drugs like benzodiazepines,
some anticonvulsants and antidepressants, and
alcohol.
• Likewise, some consumer informations warn patients
from taking the drug in combination with or up to two
weeks after monoamine oxidase inhibitors, which are
known to cause potentially fatal reactions in
combination with the (chemically only distantly
related) antitussive dextromethorphan
 Nursing Considerations:

• Inform patients that because linoleic and

gammalinolenic are polyunsaturated fatty acids,
they are subject to oxidation and should be
stored properly and can be checked by smelling
or tasting for bitterness.
• Caution patients when taking phenothiazine
drugs, they can reduce seizure threshold, could
cause increase risk of temporal lobe epilepsy.
• Caution parents to use this herb for a
hyperactive child only under supervision of a
health care provider.
• A 3 month treatment may be needed to
achieve clinical response.
 DECONGESTANTS
• A decongestant (or nasal decongestant) is a type of
pharmaceutical drug that is used to relieve nasal
congestion in the upper respiratory tract.
• Decongestant nasal sprays and eye drops often
contain oxymetazoline and are used for topical
decongestion. Pseudoephedrine acts indirectly on
the adrenergic receptor system, whereas
phenylephrine and oxymetazoline are direct
agonists. The effects are not limited to the nose,
and these medicines may cause hypertension (high
blood pressure) through vasoconstriction
 Common decongestants include:

 Ephedrine
 Levomethamphetamine
 Naphazoline
 Oxymetazoline
 Phenylephrine
 Phenylpropanolamine
 Propylhexedrine
 Pseudoephedrine
 EPHEDRINE:

• Ephedrine is used for temporary relief of

shortness of breath, chest tightness, and
wheezing due to bronchial asthma.
• Ephedrine is a decongestant and
bronchodilator. It works by reducing swelling
and constricting blood vessels in the nasal
passages and widening the lung airways,
allowing you to breathe more easily.
• Ephedrine also interacts with muscle cells,
increasing heat expenditure in them as well as
fat cells.
• It can also prevent the breakdown of muscle
tissue to a small degree.
 Uses indication

• Ephedrine is primarily indicated in conditions

like Bronchial asthma, Diabetic neuropathic
edema, Hypotension, Narcolepsy, Nasal
congestion, Nocturnal enuresis, Reduction of
neutropenia-related risk of
infection, Reversible airways obstruction, and
can also be given in adjunctive therapy as an
alternative drug of choice in CNS
stimulation, Myasthenia gravis, Stokes-adams
attack.
 DOSAGE
Dose Single Dose Frequency Route Instructions

Adult Dosage
25 to 50 mg 38 (37.5) As IM,SC
recommended.
25 to 50 mg 38 (37.5) As IM,SC,Slow IV
recommended.
5 to 25 mg 15 (15) As IV Repeated 5 to
recommended. 10 minutes
0.5 to 1 % 0.75 (0.75) As Nasal drops for the
recommended. treatment of
nasal
congestion.
25 to 50 mg 38 (37.5) 4 hourly PO
Paedriatic Dosage (20kg)
0.5 to 1 % 0.75 (0.75) As Nasal As
recommen Required
ded.
1.5 mg/kg 1.5 (1.5) 8 hourly Oral -
Neonatal Dosage (3kg)
0.5 to 1 % 0.75 (0.75) As Nasal As
recommen required
ded.
0.93 mg/kg 0.93 (0.93) 8 hourly Oral
 MODE OF ACTION

Mechanism of action
• Ephedrine, a sympathomimetic amine, acts on
part of the sympathetic nervous system (SNS).
• The principal mechanism of action relies on its
indirect stimulation of the adrenergic
receptor system by increasing the activity
of norepinephrine at the postsynaptic α and β
receptors.
• Its peripheral actions, which it owes in part to the
release of norepinephrine, simulate responses
that are obtained when adrenergic nerves are
stimulated. These include an increase in blood
pressure, stimulation of heart muscle,
constriction of arterioles, relaxation of
the smooth muscle of
the bronchi and gastrointestinal tract,
and dilation of the pupils. In the bladder,
relaxation of the detrusor muscle is not
prominent, but the tone of the trigone
and vesicle sphincter is increased.
 Side effects and adverse effects

• Common side effects of Ephedrine usually

occur with larger doses and include:
nervousness,
anxiety,
dizziness,
spinning sensation (vertigo),
headache,
nausea,
loss of appetite,
trouble sleeping (insomnia),
fast heart rate,
palpitations,
sweating,
vomiting,
weight loss, and
difficult or painful urination.
 Contrandication and cautions

• Contraindications for the use of ephedrine

include: closed-angle
glaucoma, phaeochromocytoma, asymmetric
septal hypertrophy (idiopathic hypertrophic
subaortic stenosis), concomitant or recent
(previous 14 days) monoamine oxidase
inhibitor (MAOI) therapy,
• general anaesthesia with halogenated
hydrocarbons (particularly halothane),
tachyarrhythmias or ventricular fibrillation, or
hypersensitivity to ephedrine or other
stimulants.
• Ephedrine should not be used at any time
during pregnancy unless specifically indicated
by a qualified physician and only when other
options are unavailable
 Pharmacokinetics
• Absorption: Rapidly and completely absorbed
after oral, S.C., or I.M. administration.
Distribution: Widely distributed throughout
the body.
Metabolism: Slowly metabolized in the liver
by oxidative deamination, demethylation,
aromatic hydroxylation, and conjugation.
Excretion: Dose is mostly excreted unchanged
in urine; rate of excretion depends on urine
pH.
 Drug interaction

• Drug-drug. Acetazolamide: May increase serum

ephedrine levels. Monitor patient for toxicity.
Alpha blockers: Causes unopposed beta-
adrenergic effects, resulting in
hypotension. Avoid use together.
• Antihypertensives: Decreases antihypertensive
effects. Monitor blood pressure.
Atropine: Blocks reflex bradycardia and
enhances pressor effects. Monitor patient
carefully.
• Beta blockers: Causes unopposed alpha-
adrenergic effects, resulting in
hypertension. Monitor blood pressure.
Cardiac glycosides, general anesthetics
(especially cyclopropane, halothane): May
sensitize myocardium to effects of ephedrine,
causing arrhythmias. Monitor patient closely.
• Diuretics, methyldopa, reserpine: Decrease
pressor effects of ephedrine. Monitor patient
carefully.
• Diuretics, methyldopa, reserpine: Decrease
pressor effects of ephedrine. Monitor patient
carefully.
• Sympathomimetics: Increases effects and
toxicity. Avoid use together.
Theophylline: Causes more adverse reactions
than either drug when used alone. Use
together cautiously.
 Nursing Consideration

• Assessment & Drug Effects

• Supervise continuously patients receiving
ephedrine IV. Take baseline BP and other vital
signs. Check BP repeatedly during first 5 min,
then q3–5min until stabilized.
• Monitor I&O ratio and pattern, especially in
older male patients. Encourage patient to void
before taking medication (see ADVERSE
EFFECTS).
• Monitor for systemic effects of nose drops
that can occur because of excessive dosage
from rapid absorption of drug solution
through nasal mucosa.
• This is most likely to occur in older adults.
• Patient & Family Education
• Note: Ephedrine is a commonly abused drug.
Learn adverse effects and dangers; take
medication ONLY as prescribed.
• Do not take OTC medications for coughs, colds,
allergies, or asthma unless approved by
physician. Ephedrine is a common ingredient in
these preparations.
• Do not breast feed while taking this drug without
consulting physician.
 ANTHISTAMINE “hi blocker”
• An antihistamine is a type of pharmaceutical
drug that opposes the activity of histamine
receptors in the body .Antihistamines are
subclassified according to the histamine
receptor that they act upon: the two largest
classes of antihistamines are
H1-antihistamines and
H2-antihistamines.
• Antihistamines that target the histamine H1-
receptor are used to treat allergic reactions in
the nose (e.g., itching, runny nose, and
sneezing) as well as for insomnia.
• They are sometimes also used to treat motion
sickness or vertigo caused by problems with
the inner ear.
• Antihistamines that target the histamine H2-
receptor are used to treat gastric acid
conditions (e.g., peptic ulcers and acid reflux).
H1-antihistamines work by binding to
histamine H1 receptors in mast cells, smooth
muscle, and endothelium in the body as well
as in the tuberomammillary nucleus in the
brain;
• H2-antihistamines bind to histamine H2
receptors in the upper gastrointestinal tract,
primarily in the stomach.
 Examples of H1 anti histamines

• Acrivastine
• Azelastine
• Bilastine
• Bromodiphenhydramine
• Brompheniramine
• Buclizine
• Carbinoxamine
• Chlorodiphenhydramine
• Chlorphenamine
• Chlorpromazine (antipsychotic)
• Clemastine
Examples of H2-antihistamines
• Cimetidine
• Famotidine
• Lafutidine
• Nizatidine
 CHLORPHENAMINE

Generic and proprietary names

• Chlorphenamine.
• Piriton.
USES INDICATION OF Chlorphenamine

• Relieving symptoms of sinus congestion, sinus

pressure, runny nose, watery eyes, itching of
the nose and throat, and sneezing due to
upper respiratory infections (eg, colds),
allergies, and hay fever. It may also be used for
other conditions as determined by your
doctor.
• Chlorpheniramine is an antihistamine. It works
by blocking the action of histamine, which
helps reduce symptoms such as watery eyes
and sneezing.
 DOSAGE OF CHLORPHENAMNE
• Adults: 4mg (1 tablet or 10 ml liquid
medicine) every 4-6 hours. Do not take more
than six doses (24mg) a day if you are under
65 years of age, or more than a total of three
doses (12 mg) a day if you are over 65 years.
• Children aged 6-12 years: 2 mg (5 ml liquid
medicine) every 4-6 hours. Do not take more
than a total of six doses (12 mg) per day.
• Children aged 2-6 years: 1mg (2.5 ml liquid
medicine) every 4-6 hours. Do not take more
than a total of six doses (6 mg) a day.
• Children 1-2 years: 1mg (2.5 ml liquid
medicine) twice daily, preferably morning and
evening.
 Mechanism of Action

• Chlorpheniramine binds to the histamine H1

receptor. This blocks the action of endogenous
histamine, which subsequently leads to
temporary relief of the negative symptoms
brought on by histamine.
• Competes with histamine for H1 receptor sites
and reduces allergic response by blocking
histamine.
 Side effects and adverse effects

Common side-effects
Drowsness.
Headache.
Psychomotor impairment.
Urinary retention.
Dry mouth.
Blurred vision.
Gastrointestinal problems.
• Other side-effects
- Injection may cause transient hypotension or
central nervous system (CNS) stimulation and
may be irritant.
Palpitations/arrythmias.
Hypotension.
Hypersensitivity reactions.
Extra pyramidal effects.
Dizziness and confusion.
Sleep disturbances.
Blood disorders.
Liver dysfunction.
 Contraindications and caution

• Hypersensitivity to chlorpheniramine maleate

or any component of the formulation; narrow-
angle glaucoma; bladder neck obstruction;
symptomatic prostate hypertrophy; during
acute asthmatic attacks; stenosing peptic
ulcer; pyloroduodenal obstruction.
• Avoid use in premature and term newborns
due to possible association with SIDS.
 Pharmacokinetics

• Chlorphenamine is an H1-receptor antagonist

which competetively blocks H1-receptor sites
on tissues.
Duration
4-6 hours
Absorption
Absorbed relatively slowly from the GI tract
(oral); peak plasma concentrations after 2.5-6
hours.
• Distribution
Widely distributed; CNS. Protein-binding: 70%.
Metabolism
Extensive; converted to desmethyl- and
didesmethylchlorphenamine.
Excretion
Via urine (as unchanged drug and
metabolites).
 Drug interaction

• - Sedation increased by alcohol.

• - Increased CNS depression with barbiturates,
opiates, hypnotics and tricyclics.
• - Monoamine oxidase inhibitors may increase
side-effects.
• - Increased anticholinergic action with
atropine, quinidine, phenothiazine and
haloperidol.
 Nursing considerations
• Patients vary in their response to sedating
antihistamines and there is little evidence that one
is superior to another.
• Children and older people may be more susceptible
to side-effects.
• Evaluate therapeutic response.
• Nurses should refer to manufacturer's summary of
product characteristics and to appropriate local
guidelines
•
 REFFERENCES

• http://drugs.webmd.boots.com/drugs/drug-
412-.aspx?drugid=412&drugname=
• http://www.ch.ic.ac.uk/local/projects/moha
taren/Files/pharma.htm
• https://en.wikipedia.org/wiki/Pentoxyverine
• http://salbutamol.org/dosage-of-
salbutamol/
• https://www.nursingtimes.net/chlorphenamine
/203724.article
• http://www.drugsupdate.com/generic/view/36
3/Chlorphenamine
• https://www.drugs.com/dosage/ephedrine.htm
l
• http://www.rxlist.com/ephedrine-side-effects-
drug-center.htm
• http://www.druginfosys.com/drug.aspx?drugco
de=278&type=1