Learning Outcomes
By the end of this section, you should be able to:
- 39.3.1 Identify the characteristics of antihistamines, decongestants, and cerumenolytic drugs used to treat ear disorders.
- 39.3.2 Explain the indications, actions, adverse reactions, and interactions of antihistamines, decongestants, and cerumenolytic drugs used to treat ear disorders.
- 39.3.3 Describe nursing implications of antihistamines, decongestants, and cerumenolytic drugs used to treat ear disorders.
- 39.3.4 Explain the client education related to antihistamines, decongestants, and cerumenolytic drugs used to treat ear disorders.
Antihistamines
Antihistamines decrease congestion of mucous membranes, which might decrease corresponding obstruction of tubes within the ear. Antihistamines are used primarily to treat allergies and manage symptoms related to upper respiratory infections. Selected first-generation antihistamines are included here. Please refer to Upper Respiratory Disorder Drugs for a more detailed review of antihistamine medications.
Table 39.6 lists common antihistamines for ear disorders and typical routes and dosing for adult and pediatric clients.
| Drug | Routes and Dosage Ranges |
|---|---|
| Chlorpheniramine maleate (Chlor-Trimeton) |
Adults and children ≥12 years: 4 mg tablet orally every 4–6 hours as needed. Maximum dose: 6 tablets/day. Children 6–12 years: ½ of a 4 mg tablet every 4–6 hours. Maximum dose: 3 tablets/day. Children <6 years: Do not use. |
| Cetirizine hydrochloride (Zyrtec) |
Adults and children >6 years: 10 mg once daily; do not take more than 10 mg in 24 hours. A 5 mg product may be appropriate for less severe symptoms. |
| Diphenhydramine (Benadryl) |
Adults and children >12 years: 25–50 mg orally every 4–6 hours as needed. Maximum of 6 doses in 24 hours. Children 6–12 years: 25 mg orally every 6 hours as needed not to exceed 4 doses in 24 hours. Children <6 years: Do not use. |
| Loratadine (Claritin) |
Adults and children >6 years: 10 mg once daily; do not take more than 10 mg in 24 hours. |
Adverse Effects and Contraindications
The use of antihistamines in clients with hypertension can further increase blood pressure. Clients at risk for cardiac dysrhythmia, such as a prolonged QT interval on an electrocardiogram, should communicate with their provider before taking a first-generation antihistamine like diphenhydramine due to potential proarrhythmic effects (Williamson, 2022). Since antihistamines have a drying effect, clients with glaucoma and urinary retention should avoid taking an antihistamine. Antihistamines exacerbate the sedating effects of tranquilizers and alcohol, which can lead to respiratory depression and injuries from falls. Due to antihistamines’ blocking effects on acetylcholine, they can also cause constipation.
Table 39.7 is a drug prototype table for first-generation antihistamines featuring diphenhydramine. It lists drug class, mechanism of action, adult and pediatric dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.
| Drug Class Antihistamine Mechanism of Action Stops chemicals in the immune system that trigger allergy-related symptoms |
Drug Dosage Adults and children >12 years: 25–50 mg orally every 4–6 hours as needed. Maximum of 6 doses in 24 hours. Children 6–12 years: 25 mg orally every 6 hours as needed not to exceed 4 doses in 24 hours. Children <6 years: Do not use. |
| Indications For the treatment of symptoms associated with the common cold or allergic rhinitis including sneezing, rhinorrhea, itching of the nose or throat, and itchy, watery eyes Therapeutic Effects Temporary relief of rhinitis, sneezing, itchy eyes, nose, or throat due to upper respiratory inflammation |
Drug Interactions Sedatives and tranquilizers with sedative effects Alcohol Food Interactions No significant interactions |
| Adverse Effects Drowsiness Dry mouth Dizziness Headache Constipation |
Contraindications Hypertension Cardiovascular arrhythmia History of glaucoma Urinary retention Caution: Operating a motor vehicle or machinery |
Nursing Implications
The nurse should do the following for clients who are taking antihistamines:
- Monitor the client for potential side effects including drowsiness or oversedation.
- Educate the client to refrain from driving or operating machinery while taking these medications because they can cause drowsiness and impair cognitive function.
- Educate the client to guard against potential constipation by increasing fiber and fluid intake.
- Provide client teaching regarding the drug and when to call the health care provider. See below for client teaching guidelines.
Client Teaching Guidelines
The client taking an antihistamine should:
- Be aware that antihistamines can cause drowsiness.
- Keep fluids or hard candy on hand to manage symptoms of dry mouth.
- Maintain adequate fiber and fluid intake to reduce likelihood of experiencing constipation.
The client taking an antihistamine should not:
- Drive or operate machinery when feeling drowsy.
Decongestants
Decongestants are medications that shrink swollen blood vessels and tissues in the nose to reduce nasal congestion, which can facilitate drainage to relieve ear congestion. They can be used to manage symptoms of an upper respiratory illness or prophylactically when flying to decrease discomfort associated with changes in air pressure. These medications should be used with caution in clients with a history of heart disease, thyroid disorder, diabetes, or hypertension. Alternatives include using saline nasal spray, room humidification, or being in a room with a hot shower running that creates a steamy environment. (For more detailed information on decongestants, please see Upper Respiratory Disorder Drugs.)
Adverse Effects and Contraindications
Decongestants should be avoided in clients who have a history of hypertension or heart disease because these medications can raise blood pressure and stimulate the heart. They can increase intraocular pressure in clients who have glaucoma; particularly among clients with benign prostatic hypertrophy, decongestants can inhibit the ability to void.
Table 39.8 is a drug prototype table for decongestants featuring pseudoephedrine (Sudafed). It lists drug class, mechanism of action, adult and pediatric dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.
| Drug Class Nasal decongestant Mechanism of Action Indirectly stimulates alpha-adrenergic receptors, causing vasoconstriction |
Drug Dosage Regular-release tablets or liquid-filled capsules: Adults and children ≥12 years: 60 mg orally every 4–6 hours; maximum dose: 240 mg daily. Children 6–11 years: 30 mg orally every 4–6 hours; maximum dose: 120 mg daily. 12-hour extended-release tablets: Adults: 120 mg orally (1 tablet) every 12 hours; maximum dose: 240 mg daily. 24-hour extended-release tablets: Adults: 240 mg orally every 24 hours; maximum dose: 240 mg daily. Oral solution containing 15 mg or 30 mg pseudoephedrine per 5 mL: Adults: 60 mg orally every 4–6 hours; maximum dose: 240 mg daily. |
| Indications For temporary relief of sinus congestion and pressure For temporary relief of nasal congestion due to a cold or other upper respiratory allergies Therapeutic Effects Eases discomfort and allergy symptoms |
Drug Interactions Monoamine oxidase inhibitors (MAOIs) Food Interactions No significant interactions |
| Adverse Effects Insomnia Anxiety Elevated blood pressure Elevated glucose Increased intraocular pressure Worsening glaucoma |
Contraindications Heart disease Hypertension Thyroid disease Diabetes Urinary retention due to enlarged prostate gland |
Nursing Implications
The nurse should do the following for clients who are taking decongestants:
- Monitor the client’s blood pressure, especially if they have a history of hypertension, and report elevated readings to the provider.
- Monitor the client’s blood glucose levels if the client has diabetes and report elevated readings to the provider.
- Be aware that decongestants can raise intraocular pressure. This can be especially concerning for clients with glaucoma. Assess the client for any visual changes, eye pain or irritation, or headache. Report any findings to the provider.
- Provide client teaching regarding the drug and when to call the health care provider. See below for client teaching guidelines.
Client Teaching Guidelines
The client taking a decongestant should:
- Talk to their health care provider before starting a decongestant, especially if underlying health conditions exist.
- Check their blood pressure while taking decongestants if they have prehypertension/hypertension.
- Monitor their blood glucose levels while taking decongestants if they have prediabetes/diabetes.
- If they have glaucoma, check with their ophthalmologist about decongestant use and report any visual changes, eye pain, or headache.
- Take decongestants for the shortest amount of time possible and do not take multiple decongestants from different decongestant classes.
- Clients taking monoamine oxidase inhibitors (MAOI) and decongestants can experience hypertensive crisis (Edinoff et al., 2022).
Otic Cerumenolytics
Typically, the body naturally expels earwax; however, sometimes a buildup occurs requiring the administration of medication to facilitate its removal. A commonly prescribed cerumenolytic is carbamide peroxide (Debrox). The drops work by releasing oxygen to soften and encourage spontaneous extrusion of cerumen. They also have a weak antibacterial effect.
Table 39.9 is a drug prototype table for otic cerumenolytics featuring carbamide peroxide. It lists drug class, mechanism of action, adult and pediatric dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.
| Drug Class Otic cerumenolytic Mechanism of Action Contains peroxide, which creates foaming that softens and breaks apart the wax |
Drug Dosage Adults and children ≥12 years: 5–10 drops of the 6.5% solution in ear twice daily for up to 4 days. |
| Indications To soften and encourage spontaneous extrusion of cerumen Therapeutic Effects Facilitates ear wax removal |
Drug Interactions No significant interactions Food Interactions No significant interactions |
| Adverse Effects Ear discomfort Transient loss of hearing Dizziness Local irritation |
Contraindications Ear infection Ear pain Ear rash Recent ear surgery Eardrum dysfunction |
Nursing Implications
The nurse should do the following for clients who are taking an otic cerumenolytic:
- Educate clients about the benefits of ear wax and how the ear is a self-cleaning organ.
- Examine the client’s ears before treatment for any evidence of drainage or other symptoms that would prevent safe administration. Consult with the provider if concerning finding are present.
- Examine the client’s ears after treatment using an otoscope to determine effectiveness of treatment. If no results are obtained, notify the provider for further evaluation.
- After administering the medication, any remaining wax can be removed by gentle irrigation with warm water.
- Provide client teaching regarding the drug and when to call the health care provider. See below for client teaching guidelines.
Client Teaching Guidelines
The client taking an otic cerumenolytic should:
- Use in consultation with their provider.
- Pull the pinna in an upward fashion to instill drops.
- Remain in a lying position for 5 minutes after instillation.
- Report ear discomfort, dizziness, or local discomfort.
The client taking an otic cerumenolytic should not:
- Instill cerumenolytic drops after recent ear surgery or if there is eardrum dysfunction.