Introduction

The skill of nurse practitioner to timely and successfully detect and diagnose a particular disease or condition is one of the most critical requirements in medical practice. Obtaining such a skill may depend upon various factors, such as education, individual professional learning, evidence practice, etc. However, a skillful nurse should be able to provide the highest level of care for a patient and assure his/her recovery by the means of administration of a proper treatment. The current paper presents the imaginary case of being a nurse practitioner at a local clinic, who faced a case of having a patient with influenza A. The patient is a 36-year-old male, who has flu-like symptoms and asks to prescribe him an antibacterial drug. He claims that he is most likely to have flu because he missed a flu shot. Moreover, the performed medical examination approves the contraction of influenza A. The paper explores the aspects of administering a relevant medicine and treatment for the patient, such as antitussive drugs and pseudoephedrine. The correct description of the features of the described drugs enhances the understanding of the aspects of their administration, as well as other critical effects. Every nurse is required to obtain the knowledge in order to be able to propose correct medical interventions in the cases with patients with similar condition.

What are the Antitussive Drugs Administered For?

Antitussive drugs are administered for treating cough. Specialists advise administering antitussives in patients, who have mild and persistent cough (Arcangelo & Peterson, 2006). The potency of the administered drug depends on the severity of coughing. Thus, patients with severe cough may require medications with codeine or similar agents. Coughing is defined as the forceful expulsion of air from ones lungs, and may be productive and non-productive (Ford & Roach, 2010). Productive coughing leads to the expel of secretions from the respiratory tract, whereas nonproductive coughing is dry. Many antitussives may be administered with antihistamines or expectorants, in order to combine the relieving effect towards the existing symptoms.

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Which Antitussive Agent will You Prescribe?

Administration of a specific drug depends on the condition of the patient, the potency of symptoms and the other factors, such as drug-to-drug and drug-to-food reaction. Scholars claim that most antitussives depress the cough center that is located in the medulla, which is why they are called centrally-acting (Ford & Roach, 2010). At the same time, there are drugs, which act peripherally by anesthetizing stretch receptors of the respiratory system, decreasing the cough. This category of agents is called peripherally-acting. The analysis of the patients condition and the available medications led to the conclusion that he should be administered diphenhydramine.

What are the Dosage Ranges, Action, Use, Pharmacokinetics, Patient Teaching and Other Aspects?

Trade Names

The trade names of substance are AllerMax, Hydramine Cough, Tusstat, and Silphen Cough.

Dosage Ranges

25 mg q 4 hours orally (Ford & Roach, 2010).

Not to exceed a total dose of 150 mg/day.

Action

Produces marked sedation because of antimuscaric activity.

Use

Symptomatic relief of cough caused by colds, allergy, or bronchial irritation (Ford & Roach, 2010).

Pharmacokinetics

Diphenhydramine competes with free histamine for binding at HA-receptor sites (Diphenhydramine, n. d.).

Antagonizes most of the pharmacological effects of histamine.

Pharmacodynamics

Diphenhydramine antagonizes the effects of histamine on HA-receptors in the gastrointestinal tract, uterus, large blood vessels, and bronchial muscle (Diphenhydramine, n. d.).

The drug is quickly and practically completely metabolized. After the oral administration, it undergoes metabolism in the liver. As a consequence, it is metabolized to diphenylmethoxyacetic acid. The drug also undergoes dealkylation to form the N-demethyl and N, N-didemethyl derivatives (Diphenhydramine, n. d.).

Competitively inhibits the histamine-1 (H1) receptor. As a result, it alleviates the symptoms caused by endogenous histamine on bronchial, capillary and gastrointestinal smooth muscles. This prevents histamine-induced bronchoconstriction, vasodilation, increased capillary permeability, and GI smooth muscle spasms (Diphenhydramine, n. d.).

Drug-to-drug Interactions

Causes problems when administering with other medications containing diphenhydramine.

Requires severe restriction of alcohol consumption.

Sedatives and tranquilizers aggravate the produced effect of sleeplessness.

Interacts with allergy medications.

Interacts with anxiety medications.

Interacts with antidepressants.

Drug to Herbal or Food Interactions

Alcohol usage aggravates the state of drowsiness and dizziness.

Sedative herbs increase the sedative effect.

Contraindications

Increased eye pressure.

Glaucoma.

High blood pressure.

Peptic ulcer.

Blockage of urinary bladder.

Enlarged prostate.

Adverse Effects

Drowsiness, dizziness, gastrointestinal upset.

Impairment of motor skills.

Sedation and possible depression.

Mental confusion, occasional swallowing difficulties.

Delirium in elderly patients (Benadryl side effects in detail, n. d.).

Hypotension and palpitations.

Blurred vision.

Urinary retention.

Guidelines for Administration

Usually administered orally.

There is a possibility for intravenous or intramuscular admission.

Patient Teaching

The patient should stop taking the drug in case ones condition is severely deteriorated by one of the adverse effects enlisted above.

It is advised to avoid alcohol consumption.

The patient should not operate any vehicles or mechanisms after the drugs administration.

The drug should not be combined with sedatives or tranquilizers.

It is advised to monitor the blood pressure level before and after administering the drug, in order to trace its impact on this characteristic.

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The Case of Prescribing Pseudoephedrine

The discussed case admits that pseudoephedrine may also be prescribed for the patient, which requires the discussion of its characteristics.

Trade Names

A Cold, Alcold, Arinac, Benylin, Cepcold, Sudafed.

Dosage Ranges

From 30 to 60 mg orally with a break of 4 - 6 hours.

120 mg orally every 12 hours.

Maximum daily dose is 240 mg in one day.

Action

The substance has an indirect action on the adrenergic receptors.

Produces vasoconstriction and causes the release of norepinephrine vesicles in presynaptic neurons (Decongestants, n. d.).

Relaxes bronchial muscle.

Use

Used for the treatment of nasal and sinus congestion, and rhinitis.

Optional treatment of allergic rhinitis, sinusitis and otitis.

Pharmacokinetics

Absorbed by gastrointestinal tract. The substance is characterized by 96.5% +/- 1.5 volume of distribution, associated with hepatic metabolism (Pseudoephedrine (HCl), n. d.). The excretion is renal along with the half life in plasma of about 8 hours.

Pharmacodynamics

The substance has both direct and indirect sympathomimetic activity and, if efficient, in terms of the effect on the respiratory tract.

It is characterized as a stereoisomer of ephedrine with a similar simulative action.

Unlike ephedrine, it has fewer effects on central nervous system and less pressor activity.

Causes vasoconstriction and leads to the distribution of local blood flow, reducing oedema in the nasal mucosa. As a consequence, it improves ventilation and drainage.

 

Drug-to-drug Interactions

Administering with antidepressants may lead to a drastic increase in blood pressure or hypertensive crisis.

Similar increase in blood pressure is expected with admission together with decongestants, and psychostimulants resembling amphetamine.

Beta blockers may cause an increase in blood pressure.

Elimination of the active substance is caused by urinary acidifiers and alkalinisers.

 

Drug to Herbal or Food Interactions

Coffee and other caffeine that contains substances may increase the blood pressure and heart beat ratio when administered with pseudoephedrine.

Alcohol consumption increases dizziness, confusion and causes difficulties in the concentration, when consumed with medicine.

Contraindications

Patients with hypertension and coronary heart diseases should avoid taking the medicine.

Patients with bad reactions, increased blood pressure, severe heart disease should not be administered the medicine.

Patients with liver or kidney problems, intolerance to some sugars, glaucoma, and prostate problems should consult a physician and avoid manual treatment (Sudafed, n. d.).

Adverse Effects

Fast uneven heartbeat.

Dizziness or anxiety.

Easy bleeding, general weakness, chill, flu symptoms.

Dangerously high blood pressure, which causes severe headache, blurred vision, ringing in the ears, chest pain, and seizure (Pseudoephedrine uses, dosage & side effects, n. d.).

Loss of appetite.

Warmth or redness under the skin.

Sleep problems.

Guidelines for Administration

Usually administered orally.

There are specific forms of drugs with pseudoephedrine for intravenous or intramuscular injections.

Patient Teaching

The patient has to administer pseudoephedrine carefully, paying specific attention to ones condition and the consumed drugs or substances. The alcohol, psychostimulants and caffeine consumption is prohibited. Moreover, the patient has to monitor his/her blood pressure, in order to prevent hypertension. Similarly, in case the patient experiences increased heartbeat, chest pain and easy bleeding, one should stop administering the drug and immediately consult a physician.

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Conclusion

Summarizing the presented ideas, the paper concludes that the patient of the proposed case would benefit from the administration of diphenhydramine and pseudoephedrine. The cause for administering the described drugs is their considerable antitussive and drainage improvement effect. Additionally, it is relevant to administer these drugs because they allow treating the conditions, which patients with influenza go through. For instance, they allow preventing running nose, increased temperature and other similar conditions. At the same time, administering the medicines should be followed by teaching the patient about its proper intake and possible side effects. Thus, in case of the exposed adverse effects, it is required to stop taking the medicine and consult a physician for further instructions. Similarly, the patient has to avoid alcohol consumption and operating machinery because of the effects of dizziness and drowsiness. As a consequence, the adequate administration of the prescribed drugs and the maintenance of rules of their admission would lead to a patients quick recovery.

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